Age-Friendly Design and Optimization of Digital Health Technologies for Medication Adherence in Older Adults With Chronic Diseases: Scoping Review
Journal of Medical Internet Research ·
Background: Medication nonadherence represents a persistent clinical challenge among older adults with chronic diseases, complicating long-term disease management and prognosis. Digital health technologies (DHTs) deliver promising opportunities for remote, out-of-hospital medication management; nevertheless, age-related cognitive-physiological decline and insufficient digital literacy widen the digital divide, creating barriers to real-world uptake and sustained use of DHTs. Existing systematic reviews mainly synthesize intervention effect sizes, but few unpack multilevel drivers of mixed outcomes or generate actionable age-friendly design guidance that is empirically grounded and tailored to older adult needs. Objective: This scoping review aimed to identify and characterize DHT interventions designed to improve medication adherence in older adults with chronic diseases, examine the range of factors influencing their use, and derive age-friendly design principles from the available literature. Methods: Following the scoping review framework by Arksey and O’Malley and the PRISMA-ScR reporting standards, we searched 7 databases from January 1, 2013, to August 2026. An updated search was performed on September 2, 2026, to ensure the currency of the studies. Eligible sources included quantitative, qualitative, and mixed methods original studies as well as secondary reviews published in English or Chinese. Two independent reviewers performed screening, data extraction, and thematic synthesis guided by social cognitive theory and person-environment fit theory. Results: A total of 60 studies were included, of which 46 (76.7%) were published between 2022 and August 2026, indicating rapidly growing research interest. Study mapping revealed a skewed distribution across the medication journey, with most investigations concentrated on the daily routine phase, while prescription, pickup, storage, and refill remained severely understudied. We synthesized a 4-level model comprising individual, technical, social-environmental, and intervention program factors influencing DHT performance. Major study gaps were identified: only 1 study specifically recruited older adults living alone, only 1 study used validated standardized usability metrics, and no included study assessed bidirectional electronic health record interoperability. Based on barriers reported by older users, we derived a 5-dimension age-friendly design framework encompassing perceptibility, comprehensibility, operability, emotional warmth, and security-interoperability. Conclusions: Moving beyond prior reviews focused predominantly on intervention efficacy, this scoping review presents a theory-informed 4-level influencing-factor model and an empirically derived age-friendly design framework to guide future development and implementation. For clinical practice, nurses and other health care professionals should conduct preimplementation baseline assessments of older adults’ cognitive function, digital literacy, and social support and tailor DHT recommendations accordingly. For future research, investigators should prioritize socially vulnerable subgroups, including those living alone and those in resource-limited settings, standardize usability reporting using validated instruments, and actively integrate clinical system interoperability to enable closed-loop care. Closing intra–age-group digital health inequities requires interdisciplinary collaboration across nursing, medicine, pharmacy, and health informatics, ensuring that DHTs become tools of empowerment rather than sources of exclusion. Trial Registration: OSF Registries osf.io/za6f2; https://osf.io/za6f2/
Background: Medication nonadherence represents a persistent clinical challenge among older adults with chronic diseases, complicating long-term disease management and prognosis. Digital health technologies (DHTs) deliver promising opportunities for remote, out-of-hospital medication management; nevertheless, age-related cognitive-physiological decline and insufficient digital literacy widen the digital divide, creating barriers to real-world uptake and sustained use of DHTs. Existing systematic reviews mainly synthesize intervention effect sizes, but few unpack multilevel drivers of mixed outcomes or generate actionable age-friendly design guidance that is empirically grounded and tailored to older adult needs. Objective: This scoping review aimed to identify and characterize DHT interventions designed to improve medication adherence in older adults with chronic diseases, examine the range of factors influencing their use, and derive age-friendly design principles from the available literature. Methods: Following the scoping review framework by Arksey and O’Malley and the PRISMA-ScR reporting standards, we searched 7 databases from January 1, 2013, to August 2026. An updated search was performed on September 2, 2026, to ensure the currency of the studies. Eligible sources included quantitative, qualitative, and mixed methods original studies as well as secondary reviews published in English or Chinese. Two independent reviewers performed screening, data extraction, and thematic synthesis guided by social cognitive theory and person-environment fit theory. Results: A total of 60 studies were included, of which 46 (76.7%) were published between 2022 and August 2026, indicating rapidly growing research interest. Study mapping revealed a skewed distribution across the medication journey, with most investigations concentrated on the daily routine phase, while prescription, pickup, storage, and refill remained severely understudied. We synthesized a 4-level model comprising individual, technical, social-environmental, and intervention program factors influencing DHT performance. Major study gaps were identified: only 1 study specifically recruited older adults living alone, only 1 study used validated standardized usability metrics, and no included study assessed bidirectional electronic health record interoperability. Based on barriers reported by older users, we derived a 5-dimension age-friendly design framework encompassing perceptibility, comprehensibility, operability, emotional warmth, and security-interoperability. Conclusions: Moving beyond prior reviews focused predominantly on intervention efficacy, this scoping review presents a theory-informed 4-level influencing-factor model and an empirically derived age-friendly design framework to guide future development and implementation. For clinical practice, nurses and other health care professionals should conduct preimplementation baseline assessments of older adults’ cognitive function, digital literacy, and social support and tailor DHT recommendations accordingly. For future research, investigators should prioritize socially vulnerable subgroups, including those living alone and those in resource-limited settings, standardize usability reporting using validated instruments, and actively integrate clinical system interoperability to enable closed-loop care. Closing intra–age-group digital health inequities requires interdisciplinary collaboration across nursing, medicine, pharmacy, and health informatics, ensuring that DHTs become tools of empowerment rather than sources of exclusion. Trial Registration: OSF Registries osf.io/za6f2; https://osf.io/za6f2/