This study examined not only the relationships among Internet use and health needs, psychological capital, and social capital, but also the relationships among different types of Internet use and these variables among a nationally representative sample of community-dwelling older adults aged 65 and older in the United States. Although some previous studies have examined the characteristics of older health information technology users [8
], this study is one of the first to examine the characteristics of older adults who engage in other types of Internet use activities. The 51% prevalence of Internet use among older adults in 2011 (compared to 58% in the 2012 Pew Internet use survey) lags far behind that of younger adults, including those in the 50 to 64 age group. Nevertheless, older Internet users engaged in diverse types of Internet activities: almost 86% of the users sent emails/text messages, 51% shopped, paid bills, and/or did banking, and 45% conducted health-related tasks on the Internet. Just 9% of the users used the Internet only for sending emails/text messages.
The findings show that demographic and socioeconomic status variables were significant predictors of Internet use versus nonuse. As previous studies demonstrated [14
], black and Hispanic individuals are less likely to use the Internet, and one of the strongest determinants of older adults’ Internet use is their education level. Compared to college graduates, high school graduates were 80% less likely to use the Internet, and those with less than a high school education were 90% less likely to use the Internet. As expected, having a diagnosis of dementia or Alzheimer’s disease significantly lowered the odds of Internet use, but the number of chronic medical conditions (excluding dementia or Alzheimer’s disease) and ADL/IADL impairments were not significant factors. With regard to psychological capital, H1 was supported because both depressive symptoms and anxiety symptoms were associated with a lower likelihood of Internet use, and H2 was not supported because self-efficacy was not related to Internet use. With regard to social capital, the findings support H3 because having both a living child and having a living sibling significantly increased the odds of Internet use. H4 was largely supported because all social integration/tie indicators, except the informal caregiving variable, were significantly associated with Internet use. However, unlike other social capital variables, religious service attendance decreased the odds of Internet use. In general, those who attended religious services were more likely to be women (whose Internet use did not differ from that of men) and non-Hispanic black, Hispanic, and those of other ethnic groups (who are less likely to use the Internet), but attenders also had characteristics associated with higher levels of Internet use, specifically higher levels of education and social capital (eg, more interactions with family and friends, more volunteering, and more participation in clubs, classes, and other organized activities).
The findings also show that different types of Internet users share some similar characteristics, but have different characteristics as well. Having a higher number of medical conditions (implying more health care needs) and engaging in formal volunteering increased the odds of Internet use for health-related tasks, thus supporting H5. Also, H6 and H7 regarding psychological and social capital factors associated with Internet use for various purposes were also partially supported. Anxiety symptoms decreased the odds of Internet use for health-related tasks and increased the odds of email/texting only. Engagement in volunteer work was associated with increased odds of Internet use for health-related tasks, but decreased odds of using the Internet for email/texting only. Religious service attendance was associated with decreased odds of Internet use for shopping/banking tasks. Sociodemographic correlates of using the Internet only for email/texting were the older age groups (80-84 and ≥85 years), a black or other racial/ethnic background, a high school education or less, and lower income. These findings show that older adults who used the Internet for email/texting purposes only were the most socially and economically disadvantaged group of the Internet users.
As discussed, Internet technology can offer multiple benefits and conveniences for older adults dealing with physical and functional decline and social isolation in later life. Owing to advances in Internet and other mobile technology, individuals now can access more information about their health than ever before [19
]. The Internet also has the potential to help older adults with disabilities carry out health care-related and other activities with greater ease (eg, without having to rely on others for transportation). This study confirms the findings of previous studies that older adults who are older and socioeconomically disadvantaged are significantly less likely to use the Internet, including accessing health-related information. Given the pervasive Internet technology use among young and middle-aged people, Internet use among future generations of older adults will be common; however, the current generation of older adults who use the Internet, especially those in the older group (≥80 years), learned to use the Internet in late life [6
]. A previous study found that nonusers were most likely to cite financial reasons for their lack of computer use, specifically the cost of computer equipment and Internet access [19
]. The present study suggests that a large proportion of the oldest age group does not use computers/Internet for a variety of reasons, such as lack of financial resources or of social support to do so. Given the decreasing cost of computers/tablets, public or private not-for-profit programs are needed to provide inexpensive devices (eg, netbooks, Chromebooks) and Internet subscriptions for low-income older adults.
Along with sociodemographic variables, this study also found that most social capital variables were significantly correlated with Internet use, as hypothesized. This confirmation of the importance of social integration/ties and social support in facilitating older adults’ learning and adoption of Internet technology also suggests a synergistic relationship: by teaching those with less social capital to use computers and the Internet, their social capital may increase because computer/Internet use can increase their ties to others (relatives, support groups, hobby groups, etc).
The study has a few limitations. First, the NHATS presently offers only a cross-sectional dataset (longitudinal data will be provided in the future); thus, only correlational, not causal, relationships could be deduced. Second, measures of psychological capital used in NHATS—depression, anxiety, and self-efficacy—were abbreviated, not full, scales. The shortened scales may not have adequately captured the complex nature of psychological capital. Moreover, the self-efficacy and anxiety scales were not specific to computer/Internet use. Third, although NHATS provides the most recent data on technology use among a nationally representative sample of US older adults, it did not include a full array of Internet activities in which these older adults may have engaged. Such data would have provided a more valuable description of older adults’ Internet activity. Finally, NHATS did not distinguish email from texting. The distinction may have provided a clearer picture of either activity.
Despite these limitations, this study’s results have significant implications for future research and computer/Internet technology training for older adults. First, research should reexamine the role of psychological capital, especially self-efficacy and anxiety symptoms, using scales that specifically measure psychological capital pertaining to computer/Internet use and using longitudinal data. Second, research should identify characteristics of religious service attenders that may be associated with lower odds of their Internet use, since church settings may provide venues for overcoming barriers to Internet use, teaching computer/Internet skills, and encouraging computer/Internet use. Third, computer/Internet training for older adults needs to consider the significant role other social support networks can play as well. Children, other family members, and friends may rally around older adults who have anxiety about learning Internet technology. A related benefit is that younger people may feel a sense of accomplishment from teaching older adults how to use the Internet or other technology. Intergenerational connections can be established by expanding or developing programs in which high school and college students volunteer at senior programs, assisted living facilities, or in the homes of homebound older adults to teach computer and Internet operational skills, including how to use the Internet for fun and relaxation as well as obtaining health information, making appointments, banking, and other tasks. Fourth, computer/Internet technology training for older adults needs to focus on the older age group of older adults, racial/ethnic minority older adults, older adults with low levels of education and low income, those not married and living alone, and those with low levels of social integration and social support. Older adults with these characteristics can potentially benefit the most from what Internet technology can offer.
Health care sectors are adopting increasing numbers of telehealth and telemental health interventions for older adults [39
]. With accumulating evidence of their potential to improve access to health and mental health services among geographically and socially isolated older adults and other underserved groups, Internet- and mobile-based health and mental health care service delivery is expected to become a widespread reality in the near future [42
]. Older adults must be prepared for the changing health care delivery and eHealth services by improving their access to and training for Internet technology. Previous studies have found that older adults with socioeconomic disadvantages were able to learn computer and Internet use to seek health information in collaborative training sessions, and that the participants in training sessions showed a reduction in computer anxiety and increase in computer self-efficacy in retrieving and evaluating online health information [6
]. Unfortunately, the current study shows that the digital divide is still very real, and that poorly educated, socially isolated, racial/ethnic minority older adults are still not riding the Internet technology wave.