Digital exclusion amongst people aged 65+: prevalence and characteristics from a large, inclusive survey study in Northern England (Preprint)

BACKGROUND Digital exclusion is a super social determinant of health because it can affect many areas of life that influence our health and wellbeing. Older people are more likely to be digitally excluded, but existing estimations of the prevalence of digital exclusion amongst older people are thought to have several limitations. OBJECTIVE To estimate the prevalence of digital exclusion and to describe the internet use and online activities of those aged 65 and over. METHODS A paper-based questionnaire was posted to 5,982 people aged 65+, registered at two GP practices in Yorkshire, UK. Questions covered demographics, factors known or with potential to predict digital exclusion, internet usage, access to devices and connectivity. Participants returned completed questionnaires by post. Additional completions were achieved via follow up telephone calls to non-responders and community group visits. Participants were defined as digitally included if they had independently done any of 22 online tasks and classed as digitally excluded if they had not. Digitally included participants were further categorised as wide or narrow users. Descriptive statistics were produced to describe the digital activities of the sample population. Univariable odds ratios representing the odds of digital exclusion were estimated using logistic regression. RESULTS An excellent response resulted in a representative sample of 3,300 participants aged 65-100. The prevalence of digital exclusion was 16.9%, narrow digital use 29.2% and wide use 52.3%. Nearly 80% of participants had access to a smart device. Multiple characteristics, including older age, Asian ethnicity, living alone, living in a more deprived area, frailty and health problems were associated with increased odds of digital exclusion and narrow use. There was no evidence of an association between gender and digital exclusion. CONCLUSIONS Our findings suggest nearly half of people aged 65+ are digitally excluded or narrow users, who will miss out on some benefits of the digital world. Evidence from this survey can inform how digital engagement is discussed, assessed and supported. Understanding the breadth and detail of older people’s online activities- including those only possible with help from other people- could inform better design and delivery of healthcare and other services. CLINICALTRIAL ISRCTN https://www.isrctn.com/ISRCTN18306736 (registered 23/11/2023)