Digital Divide Leaves Millions of Older Adults in Türkiye Struggling to Reach Healthcare

As health systems around the world move appointments, prescriptions, and medical records onto screens, a new population-based study from Türkiye offers a stark warning about who gets left behind. Researchers analyzing survey data from more than 11,600 adults aged 65 and older, representing roughly 8.6 million older people nationwide, found that health-oriented digital access remains strikingly limited among the country’s elderly population. Only about 14 percent reported using mobile health applications, and a similar share used e-government services, the online portals through which many public services, including health-related transactions, are now handled. At the same time, half of all older adults surveyed said they had difficulty obtaining medical appointments, the single most common barrier to care they reported. The study, published in BMC Public Health, links these two phenomena: older adults with greater digital access reported significantly fewer difficulties reaching healthcare services.

The research team, led by Hande İleri of the University of Health Sciences Turkey, Izmir Faculty of Medicine, together with Muhammed Mustafa Uzan and Yasemin Kılıç Öztürk, drew on the 2023 Türkiye Older Persons Profile Survey, a nationally representative dataset collected by the Turkish Statistical Institute. Because the analysis used anonymized secondary microdata obtained through official permission procedures, the study did not require separate ethics committee approval, and consent was handled as part of the original survey protocols. What makes the study methodologically notable is its scale and its weighting approach: rather than a convenience sample of clinic patients, it captures the older population of an entire country, with survey weights applied so the results reflect the true demographic composition of Türkiye’s aging citizens.

To measure digital engagement with health systems, the researchers constructed a composite score built from four components: mobile internet use, general internet browsing, use of mobile health applications, and use of e-government services. This composite approach matters because digital access is not a single on-or-off switch. An older adult might own a smartphone but never open a health app; another might browse the web fluently yet be stymied by the authentication steps of a government portal. By combining these indicators, the score captures a spectrum of practical, health-relevant digital capability rather than mere device ownership. On the other side of the analysis, healthcare access difficulty was measured with a composite score based on seven distinct reported problems in accessing or using healthcare services, ranging from the struggle to secure appointments to broader obstacles in navigating the system.

The statistical engine of the study was a set of survey-weighted general linear models, a technique appropriate for complex survey data because it incorporates the sampling weights of individual respondents, ensuring that underrepresented groups exert their correct influence on the estimates. After full adjustment for sociodemographic and health-related factors, the association held firm: each increment in the health-oriented digital access score was associated with a lower healthcare access difficulty score, with a coefficient of -0.045 and a 95 percent confidence interval spanning -0.066 to -0.024, and a p-value below 0.001. In plain terms, even after accounting for income, education, health status, and other confounders, older adults who were more digitally connected reported systematically fewer barriers to care.

Correlation, of course, is not causation, and the authors are careful to frame their findings as an association from cross-sectional data. It is possible that older adults who face fewer healthcare obstacles are also more likely to engage with digital tools, rather than the reverse. Yet the biological and social plausibility of the digital pathway is compelling. When appointment booking migrates to apps, when prescription renewals require portal logins, and when health information is distributed through websites, the person without those tools faces a compounding series of friction points. The finding that difficulty obtaining appointments affected fully half of the older population suggests that the scheduling bottleneck, increasingly digitized in many health systems, sits at the heart of the access problem.

The demographic backdrop amplifies the stakes. The proportion of older adults is rising worldwide, and Türkiye is squarely within this global transition. Healthy aging frameworks, including those promoted by international health bodies, emphasize timely access to healthcare as a pillar of wellbeing in later life. If the infrastructure of access is quietly shifting online while a large share of the elderly population remains offline, the digital divide ceases to be a technology story and becomes a health equity story. The Turkish data make this concrete: roughly one in seven older adults used mobile health applications, meaning that the vast majority, more than 85 percent, did not, even as digital channels became more common at many stages of healthcare access.

The study’s authors argue that digital inclusion should be treated as an integral component of broader efforts to promote equitable healthcare access for older adults, not as a separate technology policy. That framing has practical implications. Digital literacy programs targeted at seniors, simplified authentication for e-government health services, and hybrid systems that preserve telephone and in-person booking channels could all narrow the gap. The composite score developed in the study also offers a template for other countries: by measuring mobile internet use, browsing, health app adoption, and e-government engagement together, health ministries can track whether their digital transformation is actually reaching the populations that need care most.

Türkiye’s situation resonates far beyond its borders. Many health systems, from Europe to East Asia, have accelerated digitization in the wake of the COVID-19 pandemic, moving vaccination records, telemedicine, and appointment systems onto smartphones. Older adults everywhere show lower rates of adoption of these tools, and the Turkish study provides one of the clearest population-based quantifications of how that gap maps onto real difficulties in obtaining care. The finding that e-government use, often the gateway to subsidized or state-coordinated health services, stood at just 14.5 percent among older Turks illustrates how quickly administrative modernization can outpace the populations it is meant to serve.

There are also technical lessons in how the study was conducted. Using the individuals sampling weight in the general linear models guards against the distortion that arises when survey designs oversample certain groups, and the composite scoring strategy avoids the fragility of single-item measures, which can conflate, say, owning a tablet with being able to complete a telemedicine consultation. The seven-item healthcare access difficulty score similarly acknowledges that barriers to care are multidimensional, encompassing cost, transport, information, and scheduling. Together, these methodological choices lend weight to the central conclusion that the digital access association is not an artifact of a poorly specified model.

The study received no specific grant funding from public, commercial, or not-for-profit agencies, and the authors declare no competing interests. Published open access under a Creative Commons license, the research invites replication in other national contexts, and its message is likely to travel well: as health systems digitize, they must carry their oldest users with them, or the promise of technology-enabled care will harden into a new form of exclusion. With 8.6 million older adults represented in a single national dataset, and half of them struggling simply to book an appointment, the numbers from Türkiye read as a quantified call to action for every aging society watching its healthcare front door move onto a screen.

Subject of Research: The association between health-oriented digital access and healthcare access difficulties among older adults in Türkiye

Article Title: Health-oriented digital access and healthcare access difficulties among older adults in Türkiye: a population-based cross-sectional study

Article References: Health-oriented digital access and healthcare access difficulties among older adults in Türkiye: a population-based cross-sectional study. (n.d.). https://doi.org/10.1186/s12889-026-29258-0

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29258-0

Keywords: digital health, older adults, healthcare access, Türkiye, e-government, mobile health applications, health equity, aging, digital divide, BMC Public Health, cross-sectional study, health services accessibility