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Poor health contributing to digital divide among older Singaporeans

September 15, 2020

Increasingly, everyday activities and services are shifting online, making the ability to use the internet an essential skill. The current COVID-19 pandemic has further highlighted the importance of digital connectivity, especially for older and vulnerable adults, for their continued contact with family and friends. Digital Ambassadors, a Singapore Government initiative to ensure all Singaporeans have access to the fundamental digital tools, helps older adults learn how to use technological tools.

Analysing data from almost 4,000 older Singaporeans who took part in a national survey conducted by Duke-NUS' Centre for Ageing Research & Education (CARE) in 2016-2017, the team found that one in 15 respondents had difficulties using the internet because of poor health. And 57 per cent did not use the internet because of other reasons.

"Our findings suggest that health-related difficulties are relevant in understanding the digital divide between the young and the old. Concurrent with optimising the health of older persons, policymakers should consider supporting research and development into assistive technology and design aimed at helping older internet users overcome health-related difficulty in internet use," said Assistant Professor Rahul Malhotra, Head of Research of Duke-NUS' CARE. Asst Prof Malhotra is also a faculty at the Duke-NUS' Health Services and Systems Research Programme.

The study, which was published in The Gerontologist, found that those who were male, were less educated, and those who had limitations in instrumental activities of daily living such as using the phone and doing housework, were more likely to face challenges in using internet due to poor health. The team also found that those of higher age, females, with less education, and residing in low-income housing were more likely to not use the internet for non-health-related reasons.

"In this study, we were not able to identify the specific obstacles faced by those not using the internet for non-health-related reasons. But hurdles such as the lack of digital literacy and the cost of devices and internet service provision likely play a role," said Asst Prof Malhotra.

A particularly concerning finding of the study, relevant in the current time when safe distancing is a new norm for preventing the spread of COVID-19 infections, was that health-related difficulties in internet use created additional barriers to online communication between older adults and their family and friends, and poor social connections and support. Cumulatively, this resulted in a lower quality of life for older adults.

"Health-related difficulties in using the internet matter, because it means that teaching digital skills and offering cheap internet access to seniors may not fully address the digital divide. Online communication tools are thought to benefit seniors with physical limitations, since it does not require travel. Unfortunately for some seniors, health issues stand in the way of even their internet use. Providing social support to these older adults through non-digital means thus remains key, even as we work towards identifying and minimising health-related difficulties in internet use," said Assistant Professor Shannon Ang, from Sociology, NTU Singapore.

"Singapore is addressing ageing as a prioritised national agenda by studying trends and implications, and recommending solutions. This collaborative study on the ability of the elderly to use the internet shows that it is imperative to help older adults who rely on the internet to stay socially connected, which will aid in their ability to maintain a high overall quality of life as they age," said Professor Patrick Casey, Senior Vice-Dean for Research at Duke-NUS.

In future work, the research team plans to gain a deeper understanding of the specific health problems that directly lead to difficulty in internet use among older adults. These may include poor vision and loss of fine motor skills.

The data is from the Transitions in Health, Employment, Social engagement and Inter-Generational transfers in Singapore Study, Wave 1 (THE SIGNS Study-I), a large population-based survey of older Singaporeans conducted in 2016-2017, by Duke-NUS' CARE with support from the Ministry of Health, Singapore.
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Duke-NUS Medical School

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