Technological Inequality and Social Exclusion of Older People during the COVID-19 Pandemic

in The International Journal of Social Quality
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Anna Tsetoura Lawyer, Hellenic Open University, Athens, Greece tsetoura.anna@ac.eap.gr

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Abstract

The digital transformation of contemporary societies may already have been seen by older people as an obstacle; during the pandemic, however, great emphasis was given to technology. The purpose of this article is to illustrate the phenomenon of social exclusion of older people, linked to their vulnerability and the “COVID circumstances” and shaped by the various measures imposed by different countries to limit physical contact, which led to technological inequality. The findings emphasize the isolation of the elderly and their non-use or insufficient use of health services and long-term care services. Further implications relate to socioeconomic costs arising from the inefficient treatment of their needs regarding their physical and “technological” vulnerability. The article concludes with considerations of the importance of distinct—both individually and collectively oriented—approaches to create better social conditions that will enhance technological equality for the elderly.

Older people frequently face societal exclusion in their everyday lives. This phenomenon was acknowledged long before the recent pandemic. However, given that older people face “technological disadvantage” and that technology has become more dominant than ever since the COVID crisis, the social exclusion of older people has increased. The COVID-19 pandemic has imposed societal isolation on everyone (Cordeiro Carvalho et al. 2021). However, technology provides the possibility of staying connected with other people and society. Technology as discussed here includes devices like computers, cell phones, iPads and other tablets, and any forms of software, weblinks, or websites (Sen et al. 2022). Internet access provides a means of shopping online, engaging in physical exercise programs, and taking part in medical teleconsultations, classes, and countless other activities without leaving home (Seifert et al. 2020).

However, empirical studies reveal a digital gap between younger and older adults (Hunsaker and Hargittai 2018). Many older people encounter difficulties when dealing with new communication tools (Rivinen 2020) and are averse to using or learning about them; this is referred to as “technophobia” (Nimrod 2018). Older and more physically frail adults are not online and have to cope with a double burden of digital and social exclusion. This vulnerability can negatively impact their access to digital services and content, such as health information, digital communication, societal networks, and online shopping (Seifert et al. 2020).

The digital era has transformed and continues to transform society rapidly, influencing our access to information, employment, working conditions, health and care services, and interpersonal connections, and in turn the conditions for good health (Davies et al. 2021). However, alongside advancements in digital innovation, digital exclusion is increasingly being recognized as an important factor potentially contributing to both health and societal inequalities (Marmot 2020). This is extremely relevant in the case of the limitations of the COVID-19 pandemic: either restrictive measures introduced by governments across countries, with digital services replacing physical contact, or personal efforts to limit physical contact. However, there are no extensive studies examining the socioeconomic impact of the pandemic on older people. Most existing studies examine the exclusion of the elderly and their falling behind technological developments before the recent pandemic, highlighting the necessity for further research.

Methodology and Conceptual Perspective

This article presents descriptive, qualitative research based on data from international literature. The main research question is: “How is the lack of technological skills among the elderly interrelated with their social exclusion during COVID-19?” I will correlate preexisting data with the circumstances of COVID-19 and examine the degree of digital transformation of societies, which is accelerating due to the pandemic, in order to understand the extent of older people's social exclusion, while taking into account their digital reluctance.

“Social” exclusion and “social” isolation, as well as the “societal processes” involved, are core concepts in this study. These concepts therefore deserve attention as components of the theoretical perspective that underpins its reasoning, interpretations, and conclusions. Social quality theory (SQT) provides a heuristic conceptual formwork for the article. The adjective “social” in this perspective refers to the noun “the social.” The latter refers to a fundamental aspect of human life: “the outcome of the (reciprocal) interactions between processes of self-realization of people and processes resulting [in] the formation of collective identities” (van der Maesen and Walker 2012: 46). This fundamental (ontological) notion implies that human beings are viewed and need to be approached as basically “social beings.” The “social quality” of the lives of the elderly, from this perspective, is based on the quality of the “social” processes they are involved in. This, for instance, implies that enabling older people to use digital media and preventing social exclusion cannot be achieved through approaches that address just individual older people. Helping older people to realize themselves, from this perspective, should always involve the communities and institutions of which they are part and on which they are dependent. In reading and interpreting the argument of this article, this substantiation of “social” must be kept in mind. We also deploy the conditional factors of social quality (socioeconomic security, social inclusion, social cohesion, and social empowerment) (van der Maesen 2020). These express the conditions in the societal environment that facilitate (or hamper) the self-realization of older people. We conversely use social exclusion as the negative pole, and social isolation as the ultimate personal consequence of living conditions that fail to enhance social inclusion.

The concept of “social quality,” according to SQT, is defined as: “The extent to which people are able to participate in soci(et)al relationships under conditions which enhance their well-being” (Beck et al. 2012: 68). In a theoretical sense, this has been elaborated in a study on how to connect the natural sciences and human sciences (an aim of SQT) (Westbroek et al. 2020). In a more practical sense, “social quality” is central to the double issue of this journal about the societal impact of COVID-19 (Nijhuis and van der Maesen 2021). The present article concerns an aspect of this societal impact. Finally, for the purpose of this research, I use the following definitions of the European Commission for the terms that appear in the figures: “online availability” indicates whether a service is online, ranging from offline (0 percent) to only information online (50 percent) and fully online (100 percent) (EC 2020b). “Penetration” refers to internet use: submitting official forms to public authorities (ibid.). “Digitization” is defined as: On-track of: User Centric Government, Transparent Government, Citizen and Business, Mobility and key enablers (ibid.).

User Centricity – indicates to what extent (information about) a service is provided online and how this is perceived. Transparency – indicates to what extent governments are transparent regarding: i) their own responsibilities and performance, ii) the process of service delivery and iii) personal data involved. Cross-Border Mobility indicates to what extent EU citizens and businesses can use online services in another country. Key Enablers – indicates the extent to which five technical pre-conditions are available online. There are: Identification (eID), Electronic documents (eDocuments), Authoritative Sources, and Digital Post. Digital Post refers to the possibility that governments communicate electronically-only with citizens or entrepreneurs through e.g. personal mailboxes or other digital mail solutions (EC 2019). “ICT usage” is defined as the use of the internet for the variety of activities performed by citizens already online; such activities include online consumption of content, modern communication activities, and online shopping and banking (EC 2020b, with reference to the definition in Eurostat's ICT Householder Survey). By “digital skills” I mean the skills needed to take advantage of the possibilities offered by a digital society; such skills range from basic user skills that enable individuals to interact online and consume digital goods and services to advanced skills that empower the workforce to take advantage of technology for enhanced productivity and economic growth (ibid., with reference to Eurostat's ICT Households Survey, Labour Force Survey, and education statistics). Overall, as noted recently, digital skills refer to five areas: information and data literacy skills, communication and collaboration skills, digital content-creation skills, safety skills, and problem-solving skills (Eurostat 2022c).

Aging and the Emerging Technological Vulnerability Expedited by COVID-19

Despite the unexpected nature of the crisis and the greater vulnerability associated with age, inequality in digital technology between age groups may lead to low use or poor exploitation of services that promote the well-being of older individuals, exacerbating existing inequality (Souter 2020). Consequently, research in gerontology has posed the question of why older adults use or do not use the internet (Schulz et al. 2015). Early on, studies highlighted the relevance of psychological factors, claiming that older adults are less likely to use the internet because they demonstrate a higher prevalence of computer anxiety (Cattaneo et al. 2016; Neves et al. 2013; Lee et al. 2011; Charness and Boot 2009), frustration with user interfaces (Damodaran et al. 2013), negative attitudes toward technology (Kamin et al. 2017), and concerns about security issues on the internet, mainly regarding personal information (Lee et al. 2011; Gatto and Tak 2008). Second, research has highlighted that older adults face health-related barriers when accessing digital technologies, arguing that access to the internet is more challenging for those with, for example, poor eyesight, shaky hands, or (mild) cognitive impairment (Damodaran et al. 2013; Lelkes 2013; Cresci et al. 2010; Charness and Boot 2009). Third, research has identified multiple socioeconomic factors, mainly education and income, as predictors of older adults’ internet use (Gallistl et al. 2020). Low education and income (Lelkes 2013; Neves and Amaro 2012; Cresci et al. 2010; Charness and Boot 2009), which impede and complicate access to devices, have been identified as main determinants of internet use in later life (Bakaev et al. 2008), and some studies even suggest that it is not age itself, but rather a combination of experience and level of education that determines a person's level of computer anxiety in later life (Fernández-Ardèvol and Ivan 2015).

Further, various studies emphasize the existing unequal access to the internet for older adults (Keya et al. 2022). Measurement and estimates of technology access by older adults will help address the problem of isolation, especially in meeting the needs of the economically disadvantaged communities that remain unidentified (ibid.). For example, the use of technologies like mobile health has increased around the world due to COVID-19, but with that growth comes the possibility of a digital divide (Goto et al. 2021). Technology is expensive for those living on fixed incomes who do not have the cash to purchase or use new devices, and besides cost, there are concerns in this population regarding the ability to utilize technology efficiently, especially for those with comorbidities and disabilities of body physiology, such as reduced motor skills and eye and hand coordination (Keya et al. 2022). These are issues that have not been resolved.

Online contact is generally not considered by older people to be a good replacement for face-to-face contact (Liddle et al. 2021). Lonely people may also be less likely to seek out contact, online or in person (van Breen et al. 2020; Lim et al. 2016). Furthermore, there is mixed evidence as to whether online behavior is caused by or causes loneliness (Boursier et al. 2020; Lim et al. 2020). This means that digital loneliness interventions could potentially introduce risks to well-being (Stuart et al. 2022). Gardiner et al. (2018) note that many loneliness interventions have been implemented atheoretically (without deriving from or testing formal hypotheses) and as a result have had mixed success and could even cause detriments to well-being (Stuart et al. 2022).

In particular, in EU countries, we can observe a great extent of digitization, as shown in Table 1. At the same time, we observe a non-equivalent extent of digital skills, with an emphasis on age. As a matter of fact, not only older but also younger people (group of reference 35–74 years in the second column of Table 1 shows that even very young people in the working age e.g. 35-50) lack ICT education.

Table 1.

Comparative table—digitization and digital skills

EU Countries Individuals aged 16–74 with basic or above-basic digital skills (from 2021 onwards) Share of employed people with ICT education aged 35–74 years

(2021)
egovernment (online availability, 2020) Digitization (performance, 2020) Penetration (performance, 2020) Digital skills (user characteristics, 2020) ICT usage (user characteristics, 2020)
Austria 63% 39.5% 97% 87% 62% 57% 54%
Belgium 54% 29.0% 88% 73% 48% 50% 61%
Bulgaria 31% 35.3% 79% 54% 43% 34% 37%
Croatia 63% 17.8% 73% 53% 52% 49% 55%
Cyprus 50% 28.1% 79% 61% 44% 36% 54%
Czechia 60% 23.1% 82% 64% 44% 49% 54%
Denmark 69% 35.2% 99% 84% 89% 61% 75%
Estonia 56% 26.9% 98% 92% 85% 67% 65%
Finland 79% 50.5% 96% 83% 90% 78% 76%
France 62% 28.5% 93% 73% 69% 47% 53%
Germany 49% 37.1% 90% 68% 46% 56% 62%
Greece 52% 36.1% 84% 53% 30% 35% 46%
Hungary 49% 30.1% 87% 63% 46% 42% 56%
Ireland 70% 38.7% 88% 65% 69% 56% 62%
Italy 46% 23.9% 92% 71% 25% 32% 44%
Latvia 51% 28.4% 96% 87% 72% 35% 54%
Lithuania 49% 28.8% 96% 83% 67% 44% 57%
Luxembourg 64% 45.2% 90% 79% 56% 58% 59%
Malta 61% 23.4% 100% 97% 49% 62% 66%
Netherlands 79% 32.4% 90% 78% 83% 64% 75%
Poland 43% 29.2% 87% 59% 45% 37% 50%
Portugal 55% 22.3% 99% 82% 53% 38% 48%
Romania 28% 21.2% 70% 43% 66% 33% 36%
Slovakia 55% 17.6% 85% 61% 44% 46% 53%
Slovenia 50% 28.4% 91% 72% 49% 48% 52%
Spain 64% 40.5% 96% 78% 71% 48% 61%
Sweden 67% 39.7% 92% 77% 87% 72% 76%

Source: created by the author, combining data from surveys by Eurostat and the European Commission (Eurostat 2022a, b, and c; EC 2020b).

The abovementioned findings are supported by additional data. A population-wide survey across seventeen European countries revealed that 51 percent of people aged ≥50 do not use the internet (König et al. 2018). In 2020, a survey in the United Kingdom revealed that 10,500,000 people (16 percent of the adult population) cannot perform basic activities with digital devices, such as turning on a device, connecting to Wi-Fi, or opening an app by themselves (Lloyds Bank 2020). Data from the Digital Economy and Society Index of the European Commission suggests that while the level of digital skills has continued to increase across many countries in recent years, progress among different population groups is highly variable (EC 2020a). In 2019, 82 percent of young people (aged 16–24) and 85 percent of those with high formal education had at least basic digital skills, compared to only 35 percent of people aged 55–74 (ibid.).

Social Isolation and COVID-19

Social isolation (SI) is one of the most disruptive transformations facing the aging population in recent history (Datta et al. 2019). It implies the absence of human contact or meaningful interpersonal and societal relations, something that adversely impacts the social quality of the lives of older adults, significantly reducing their emotional and physical health (Ahn and Shin 2013). For older adults, societal well-being involves certain external and internal criteria, such as an observable presence of connections or exchanges and satisfaction with their quality (Hudson and Doogan 2019). In geriatric health research, preventing SI is an overarching issue (Kruse et al. 2020), especially given the surge in seniors living alone (Keya et al. 2022). Thomas Cudjoe et al. (2020) found that 7.7 million older adults in the US are socially isolated and 1.3 million are on the threshold of the effects of SI, which accounts for those who are severely isolated. The COVID-19 pandemic is worsening loneliness for many older people through the challenges it poses to their engagement with their lifeworlds (Stuart et al. 2022).

In particular, loneliness is the distressing feeling experienced during perceived social isolation, akin to thirst or hunger pangs (Hawkley and Cacioppo 2010). While social isolation is by itself associated with poorer health outcomes, the psychological experience of loneliness makes an additional, unique contribution to illness and mortality, comparable to that of smoking and greater than that of obesity (Holt-Lunstad et al. 2015). More recent longitudinal evidence suggests that COVID-related restrictions among older adults do indeed predict loneliness and negative mental health effects in the longer term (Mayerl et al. 2021).

However, much loneliness research has been cross-sectional, short-term, or atheoretical (Lim et al. 2020), meaning that the causes and effects of loneliness occasioned by epidemics or pandemics remain unclear, while there are concerns that studies have underrepresented the oldest old, those not experiencing good health, and those not independently using the internet (Dahlberg 2021). For many older people, mitigating loneliness is already challenged by the often-irreplaceable nature of lost contacts with others in later stages of life (e.g., the death of a spouse), the feeling of being trapped at home alone if chronically ill (Bennet and Victor 2012), and the effects of being left behind by digital technology (Coelho and Duarte 2016). Combined with COVID-19 restrictions limiting older people's ability to engage in typical social activities, visit locations that alleviate loneliness (Schellekens and Lee 2020), or access social services (Giebel et al. 2021), many established coping strategies are untenable. Digital technology has been offered as a potential aid; however, many popular digital tools have not been designed to address the needs of older adults during times of limited contact, since older adults face unique barriers when accessing and using technologies (Stuart et al. 2022).

The results of relevant research indicate that younger people are frequently at an advantage: younger heavy users of technology are more likely to have higher levels of societal potentialities than older heavy users (Neves et al. 2018). Data shows that a twenty-year-old is 29 percent less likely to have a high level of societal potentialities if they are a non-user, whereas a seventy-year-old is 70 percent less likely to have a high level of societal potentialities if they are a non-user (ibid.).

The Economic Dimension of Exclusion in the Age of Internet Users (E-Shops and E-Commerce)

The internet has contributed to the expansion of e-commerce, as personalized online purchases have increased considerably in the past decades. Out of all sales worldwide, e-commerce sales account for 18 percent (Dias et al. 2022). China was the world leader in e-commerce sales in 2020, and the highest percentage growth was observed in Argentina. Brazil and Mexico were the Latin American leaders in 2020, with 31 percent and 28 percent of e-commerce sales in Latin America, respectively; USD 112.4 billion was spent in the online market in Brazil, followed by Mexico (USD 31.5 billion) and Colombia (USD 14.5 billion) (Statista 2022).

While the first level of the digital divide—inequalities in access to the internet—has been significantly reduced across Europe in the last decade, the second and third levels of the age-related digital divide—inequalities in competence and performance—are still prevalent (Negreiro 2015) and are much harder to solve with political interventions. Digital inclusion, which comprises access, skills, attitudes, and different levels of engagement with the internet (Helsper 2012), is thus still unequally distributed across age groups (Gallistl et al. 2020).

In 2020, 44 percent of large enterprises conducted e-sales, corresponding to an e-sales value of 27 percent of total turnover in this size class. Among medium-sized enterprises, 29 percent made e-sales, generating 15 percent of total turnover in this size class; by contrast, 20 percent of small enterprises engaged in e-sales, generating only 8 percent of the turnover of such enterprises. E-sales can be carried out via websites or apps (web sales) or in an automated way via EDI (electronic data interchange)–type messages. In 2020, among EU countries, the percentage of enterprises making e-sales ranged from 12 percent in Bulgaria and Luxembourg to 40 percent in Ireland, followed by Denmark (38 percent) and Lithuania and Sweden (both 36 percent). Web sales were the dominant mode of conducting e-sales in all EU member states in 2020. The percentage of enterprises receiving electronic orders over websites or apps only ranged from 32 percent in Lithuania to 9 percent in Luxembourg. Enterprises consider it important to be visible on the internet. Consequently, websites or apps are increasingly offered by enterprises for various purposes. In particular, websites or apps allow customers to purchase by placing their orders electronically. Considering the breakdown of economic activity in 2020, almost all enterprises conducting e-sales in the accommodation sector received orders via websites or apps (99 percent), while 6 percent had e-sales via EDI-type messages.

Table 2 shows internet users worldwide for 2019. For example, India ranks second in the world, with 560 million internet users. It would be interesting to know the age of these internet users, but extensive relevant studies do not exist. However, according to a relevant study, 73 percent of Indian online shoppers are aged below 35, indicating the popularity and usage patterns of online shopping among the youth (Agarwal et al. 2021). In parallel, it should be taken into consideration that Asia appears (see Table 3) to have the largest distribution of internet users in the world. Thus, whether the abovementioned study regarding India is indicative is critical. In any event, despite the extent of e-markets, the older population group seems not to take part in these digital transactions, staying outside the e-market and related economic activities. In other words, older people as consumers lag behind the digital transformation of commerce, and this might have a long-term negative influence on the economy.

Table 2.

Twenty countries with the highest numbers of internet users. There were 3,213,351,128 internet users in the top twenty countries on 30 June 2019.

Countries Internet users

(millions of users)
 1. China

 2. India

 3. United States

 4. Indonesia

 5. Brazil

 6. Nigeria

 7. Japan

 8. Russia

 9. Bangladesh

10. Mexico

11. Germany

12. Philippines

13. Turkey

14. Vietnam

15. United Kingdom

16. Iran

17. France

18. Thailand

19. Italy

20. Egypt
854

560

292

171

149

123

118

116

 96

 88

 79

 79

 69

 68

 63

 62

 60

 57

 54

 49

Source: Internet World Stats, www.internetworldstats.com/top20.htm (accessed 26 January 2023.) © 2019 Miniwatts Marketing Group.

Table 3.

World population and internet users.

World regions Population

(2022, est.)
Population

(% of world)
Internet users

(Dec. 2021)
Penetration rate (% of pop.) Growth

(2000–2022)
Internet users (world distribution %)
Asia 4,350,826,899 54.8% 2,790,150,527 64.1% 2,341% 53.1%
Africa 1,394,588,547 17.6% 601,327,461 43.1% 13,220% 11.5%
Europe 841,319,704 10.6% 743,602,636 88.4% 608% 14.2%
Latin America/Caribbean 663,520,324 8.4% 533,171,730 80.4% 2,851% 10.1%
North America 372,555,585 4.7% 347,916,694 93.4% 222% 6.6%
Middle East 268,302,801 3.4% 205,019,130 76.4% 6,141% 3.9%
Oceania/Australia 43,602,955 0.5% 30,549,185 70.1% 301% 0.6%
World total 7,934,716,815 100.0% 5,251,737,363 66.2% 1,355% 100.0%

Source: Internet World Stats, www.internetworldstats.com (accessed 26 January 2023). © 2022 Miniwatts Marketing Group.

E-Health and Non-Use or Insufficient Use of Health Services during the COVID-19 Pandemic

Digital technologies have transformed methods of healthcare delivery and have been embraced within the health, social, and public response to the COVID-19 pandemic. However, this has directed attention to digital inequalities, as people who are most in need of support (in particular, older people and those experiencing social deprivation) are often least likely to engage with digital platforms (Davies et al. 2021). The response to the COVID-19 pandemic represents a sustained shift toward the adoption of digital approaches to working and engaging with populations, one that will continue beyond the pandemic.

An emerging area at the intersection of informatics, healthcare, and business is electronic health (e-health) (Eysenbach 2001), which encompasses the mediation and interaction between healthcare and the individual via information and communication technology (ICT) (EC 2016). Although the extent of the implementation and application of e-health systems varies, the overall goal is the same: using ICT to provide better care more efficiently at a lower cost (EC 2012). Although the growing role of digital media in health communications has been well documented, scant empirical data is available on how older adults use digital media for learning purposes and to keep abreast of ongoing health crises (Neely et al. 2021). Even in high-income countries, marked inequalities in internet access are evident (Davies et al. 2021).

The digital inverse care law (McAuley 2014; Eysenbach 2000) reflects the direct impact of digital exclusion on health, for example in reducing an individual's access to timely and reliable health information, services, and support (e.g., from professionals or peer support groups) delivered on digital platforms (Davies et al. 2021). A focus on digitally delivered health systems without due consideration of digital exclusion will not be able to prevent “intervention generated inequalities” from reinforcing the underlying inequalities in health (Ramsetty and Adams 2020; Arroll et al. 2020). In a nationwide representative study of engagement with digital technology for health purposes in Wales, the use of digital technology was lower among groups of people who were likely to have greater health needs, including older people, those living in less affluent areas, those with poorer underlying health, and those reporting health-harming behaviors (e.g., smoking, drinking, and physical inactivity) (Davies et al. 2019). This has also been highlighted within the context of COVID-19, a period in which having an internet presence is crucial to rapidly accessing not only health information, but also digital health consultations and health-monitoring apps. Furthermore, people who are at the highest risk of poor health outcomes are also those most likely to be digitally excluded, including older people and those living in more deprived areas (Caul 2020).

Digital exclusion is concurrent with Dahlgren and Whitehead's (2006) definition of a societal determinant of health, as a societal and economic factor with the potential to increase or decrease social inequities in health (Davies et al. 2021). Recognition of digital exclusion as a social determinant of health by governments and systems would increase the visibility of the issue, highlight the need for routine measurement, report spotlight variations across population groups, and focus action on the factors contributing to digital exclusion across policy, health, and social systems (ibid.).

In response to the COVID-19 pandemic, digital contact-tracing apps were rapidly implemented in several countries (Zastrow 2020). Let us take for example the United Kingdom. Engagement with the app is dependent on the individual owning a smartphone, having the skills to understand and download the app, and keeping their phone switched on, with Bluetooth enabled (Davies et al. 2021). However, 6,500,000 adults in the United Kingdom cannot turn on a device, and 5,900,000 adults cannot open an app (Lloyds Bank 2020). A survey carried out by IPSOS Mori for the Health Foundation (2020) revealed a clear digital divide by age, occupation, and educational level in public readiness to download the NHS COVID-19 app (Davies et al. 2021).

Most obviously, the strain placed on health services means that the availability of professional supporters and their ability to provide quality care has been markedly reduced (Hanna et al. 2021). Likewise, the ability of families and friends to maintain regular face-to-face contact has been diminished, especially in relation to cross-generational contact with non-cohabiting older relatives; the legacy of this reduced contact on loneliness is as yet unclear (Dahlberg 2021), but it may have fractured relationships and resulted in fears and cognitions of chronic loneliness (Harkin et al. 2022). Recognizing that some individuals will never cross the divide, patients have also emphasized the importance of continued support of low-tech communication methods and healthcare delivery to prevent a widening of the digital divide (Alcocer Alkureishi et al. 2021). Furthermore, patients viewed technology access and literacy as drivers of the societal determinants of health, profoundly influencing how such determinants function to worsen or improve health disparities (ibid.).

The percentages of adults who used digital information technologies (computers, smartphones, internet, email, and apps), had obtained health information and advice from an internet-based resource in 2018, and who were interested in using internet-based and m-health (mobile health or e-health) modalities for obtaining health information and advice declined with age (Gordon et al. 2019). Healthcare providers and organizations serving middle-aged and older adults with chronic health conditions should not assume that patients, especially those who are older and less educated, want to engage with internet-based or m-health resources (ibid.). As part of patient-centered care, it is important for providers to ascertain their patients’ use of digital information technologies, their preferences for obtaining health information, and their education rather than routinely referring them to internet-based resources. Another study found low rates of technology adoption, as well as poor digital, health, and e-health literacy, among its sample, with limited experience of and exposure to technology and low confidence contributing to this phenomenon (Arroll et al. 2022). Strong support from family and local primary healthcare providers is a potential enabler for using technology to bridge inequities in healthcare in the future, coupled with the adoption of simple technology that can overcome the barriers of poor literacy and the physical aspects of aging (ibid.). Another study (Keeling et al. 2019) included people with a range of acute and chronic health conditions. While health status will likely impact on Digital Unengagement/Digital Engagement (DU/DE) with online health services, the results (Tables II and IV of the study) indicate that within the DU and DE groups, those with acute and chronic conditions largely share the same drivers. Yet engagement with online health services is likely to be complex in situations where people have severe conditions (ibid.).

The Role of Long-Term Care Overturned in “COVID Circumstances”

Older adults are experiencing increased stress and mental health challenges due to their increased vulnerability to COVID-19 and the strict isolation requirements that have been imposed during the crisis. Recreation and stimulation programs in residential-living and long-term care homes have also been temporarily discontinued, further increasing isolation and loneliness (Chu et al. 2020; Steinman et al. 2020). The isolation may be worse for older individuals living alone, because caregivers cannot visit and many home-care services and community programs for older adults and their caregivers, such as adult day programs, have been suspended, leading to a loss of support (Flint et al. 2020). Many older adults have been placed in positions where they have less autonomy in decision-making regarding their own care and independence (Rylett et al. 2020). This has led to a sense of loss of self-determination and “mattering” (Flett and Heisel 2020); that is, they have lost the sense of being valued or having a voice. Enabling older adults to make or participate in making decisions about their own well-being is predictive of protecting both their mental and physical health. This is crucial to decisions about the care and provision of medical resources to the frail and elderly who have contracted COVID-19 (Hubbard et al. 2020).

Ageism—a discriminatory attitude toward people of advanced age—may have contributed to detrimental effects to the health and longevity of older adults with COVID-19 (Fraser et al. 2020). Older adults live in many different residential settings with varying levels of support. The health and societal crises resulting from COVID-19 have placed a spotlight on issues that have existed for years in the care delivery system for older adults (Rylett et al. 2020). For example, in Canada, although the pandemic has affected older adults across the country, regardless of their living arrangements, no part of this system has been impacted more profoundly than long-term care (LTC) homes. In Canada, 80 percent of deaths due to COVID-19 occurred in LTC homes, the highest percentage of any reporting country worldwide (ibid.). However, only about 7 percent of older adults in Canada reside in LTC homes, with most older adults living in the community and requiring support from home and community care services or family members to allow them to function relatively independently. Quarantine and physical distancing have seriously impacted the ability of these support systems to provide essential care and resources to older adults living independently, leaving them alone, increasingly vulnerable, and unable to obtain their basic needs for survival. Moreover, many older adults have one or more medical conditions, requiring access to healthcare services and treatments that may be interrupted or inaccessible during the pandemic (ibid.).

Concluding Remarks

While aging is understood as an imminent crisis that, among other things, must be “solved” by technology, the non-use of digital technologies threatens to amplify the crisis. A critical perspective on internet use in later life thus must question this problematization and ask when, how, and for whom non-use might be problematic. This perspective calls for interventions that “fit in with the lives of older people” (Neven and Peine 2017) rather than the logics of the aging-and-innovation discourse (Gallistl et al. 2020). Existing studies (Keya et al. 2022; Stuart et al. 2022) suggest digital interventions in order to deal with a lack of digital skills. Is this possible, sufficient, or equitable?

From this article's theoretical perspective, older people are “social beings” who are strongly part of and dependent on their interactions with communities and facilitating institutions in their societal environment. This means that we have to think about what kind of societies we want. The crucial question, in fact, is whether society will be adjustable to the societal needs of vulnerable groups such as older people, or whether people are obliged to be adjustable. Innovation today is nearly the same as digitalization; when we get older, something else may be more innovative. While increasing numbers of older people are a valuable societal resource, they are often viewed as a drain on resources (Cuddy et al. 2005). However, the socioeconomic and financial dimensions (within the social quality framework) should be at the service of human values, values that the world ought (and in particular, the EU claims to) pursue (van der Maesen 2020). The four conditional (objective) factors of social quality—socioeconomic security, social cohesion, social inclusion, and social empowerment—are part of the pathway to the inevitable transformation of the socioeconomic dimension. This can be seen, for example, in the societal impact of the current COVID-19 pandemic (Nijhuis and van der Maesen 2021).

What are the contemporary societal patterns that underpin the disadvantaged position of older people in our evolving digital world? In Europe, the dominance of the socioeconomic and financial aspects of life over the sociocultural and welfare-based and the socioenvironmental and ecological aspects was proclaimed long ago and has risen to being a fundamental axis of the EU. This is in fact the core assumption of the neoliberal doctrine (Westbroek et al. 2020). In European countries economic goals tend to supplant other values (Tsetoura 2015). This is now being furthered by the EU's goals pertaining to digital economy in the context of the European Pillar of Social Rights Action Plan (Tsetoura 2022). Various legal, ethical, and societal issues arise concerning whether or not someone can or should have the right to choose regarding the use of new technologies. The abovementioned issues are neglected in the face of the rise of the digital economy, without examining whether citizens, whatever their age, can actually follow up the technological developments. In contemporary times neoliberal economic principles are leading ahead in an automatic process, while the people, the actual human factor of the societies, are left behind. One expression of this pattern is that people who do not have digital skills (or opt not to have them) are considered “non-useful” for the current economic system. Society is identified with the economic realm and those not able to contribute to capital accumulation are not considered to contribute to society. As is argued in Working Paper 17 on social quality, those who argue for further exploration of the social quality of the daily circumstances under which people live in society are more concerned with people's standing in societal life (IASQ 2019).

Interestingly, this article has found that while the elderly are the most vulnerable group with regard to the insertion of technology in our everyday lives, they are not alone, since even much younger and more “economically active” groups do not have the digital skills that are considered basic. Societies are going digital to serve the socioeconomic and financial goals of contemporary money circulation, and at the same time large parts of the population are excluded. The degree and the consequences of this exclusion will probably become more profound and evident in the near future. Government policies seem to put financial interests first while individuals like the elderly are unable to have their voices heard, especially during the difficult times of the pandemic, in which collective configurations at community or even neighborhood levels have been prevented.

The trend seems to be one of over-digitalization, while the possibilities for supportive physical human resources are neglected or even eliminated. The aim, though, should not be to abolish or limit “the digital,” but instead to not abolish the “nondigital.” Future concerns could also include how dangerous it is, especially in health and social services, to be completely dependent on “the digital.” This should certainly take into account additional challenges such as cyber-crime and the protection of personal data, or objective technical obstacles such as interruptions of internet connections. If digital exclusion prevents the most vulnerable people from participating in digital technologies, then many collective societal benefits are not equitable (Davies et al. 2021). This highlights the importance of digital innovation being accompanied by nondigital approaches. Interpersonal processes and being part of communities (like neighborhoods) are essential needs and opportunities for people who cannot or choose not to engage with digital solutions. Not much is known about the effectivity of adequate and possible approaches. We therefore need to evaluate the outcomes of such individual and collective approaches across population groups (Ada Lovelace Institute 2020).

Note

The core of this article was originally presented at the international Ioannina Meeting on Applied Economics and Finance (IMAEF 2022) held in Kefalonia, Greece, 20–24 June 2022.

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Contributor Notes

Anna Tsetoura is a lawyer and a member of the Hellenic Open University Associate Teaching Staff, with a PhD from the Aristotle University of Thessaloniki, Greece, Advanced Master of Laws In European Social Security-KU Leuven (Belgium), Law diploma Aristotle University of Thrace Greece. She has also conducted postdoctoral research at Democritus University of Thrace, Greece. She has taught at Greek universities and at the National School of Judges on European social security law, social insurance and social institutions, retirement and pension systems, healthcare, civil society, social policy, and the financing of social security systems. She has also participated in national and European research programs on improving social protection and has taught social security courses. Email: tsetoura.anna@ac.eap.gr

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