Health issues stand in the way of even their internet use
As daily life migrates deeper into digital spaces, a study of nearly 4,000 older Singaporeans reveals that for some, the barrier to the internet is not ignorance or indifference, but the body itself — trembling hands, failing eyes, the quiet erosion of physical capacity. Researchers at Duke-NUS found that one in fifteen older adults cannot access the internet due to poor health, a hidden dimension of the digital divide that compounds isolation and diminishes quality of life. The pandemic made this invisible exclusion visible, as the tools of connection became simultaneously more essential and more unreachable for those who needed them most. The finding asks us to reconsider what it means to build an inclusive digital world — not only as a matter of literacy or cost, but as a matter of human embodiment.
- When lockdowns made the internet the primary lifeline to family and healthcare, older adults with physical limitations found themselves cut off from the very tools meant to keep them safe.
- One in fifteen older Singaporeans reported that poor health — vision loss, tremors, arthritis, limited dexterity — made internet use difficult or impossible, a fraction small in statistics but vast in human consequence.
- Beyond health, 57% of non-users faced overlapping barriers: unaffordable devices, absent digital literacy, and a system that assumed everyone could simply learn their way in.
- Isolation deepened measurably — no video calls with grandchildren, no access to health information, no digital substitute for the human contact that physical distancing had taken away.
- Researchers are now pressing policymakers to move beyond digital skills training toward assistive technology, redesigned interfaces, and sustained non-digital social support for those the internet cannot yet reach.
The internet has become the infrastructure of daily life — banking, family connection, healthcare — and the pandemic made that dependence absolute. Yet for a portion of older adults, the digital world remains inaccessible not for lack of will, but because their bodies will not cooperate.
Researchers at Duke-NUS surveyed nearly 4,000 older Singaporeans between 2016 and 2017, probing their digital habits and the obstacles behind them. One in fifteen reported that poor health made internet use difficult or impossible. These were people whose vision had dimmed, whose hands shook with tremors, whose arthritis made a keyboard painful — people who wanted connection but could not reach it. Men with less education, those struggling with basic daily tasks, and people with significant physical limitations faced the highest risk.
Health was only part of the picture. Fifty-seven percent of non-users stayed offline for other reasons — cost, absent digital literacy, simply never having been taught. These burdens fell disproportionately on women, the less educated, and those in low-income housing.
The consequences were not abstract. During the pandemic, older adults without internet access lost a critical lifeline: no video calls with grandchildren, no health updates, no digital bridge across physical distance. Isolation deepened, and quality of life declined measurably.
Lead researcher Rahul Malhotra argued that policymakers had been thinking too narrowly — that digital skills training and subsidized access, while necessary, were not enough. The problem demanded investment in assistive technology and the redesign of devices and interfaces for aging bodies. Sociologist Shannon Ang added a quieter but essential point: some people will always need a phone call, a visit, a hand to hold. The internet supplements human presence; it does not replace it, and for those it cannot reach, the absence cuts deeper.
The research team plans to continue examining specific conditions — vision loss, motor decline, cognitive change — as Singapore works to ensure that the shift toward digital life does not leave behind those whose bodies make that shift hardest.
The internet has become the infrastructure of daily life. Banking, shopping, staying in touch with family—these things happen online now, and the pandemic made that shift absolute. But for some older adults, the digital world remains locked behind a door they cannot open, not because they lack the will or the knowledge, but because their bodies will not cooperate.
Researchers at Duke-NUS in Singapore set out to understand why some older people use the internet and others do not. They surveyed nearly 4,000 older Singaporeans between 2016 and 2017, asking detailed questions about their digital habits and the obstacles they faced. What they found was a pattern that had been largely invisible in the broader conversation about the digital divide: health itself was a barrier.
One in fifteen respondents reported that poor health made it difficult or impossible for them to use the internet. That might sound like a small fraction until you consider what it means. These are people who want to stay connected to their children and grandchildren, who might benefit from online banking or telehealth appointments, but whose vision has dimmed, whose hands shake, whose arthritis makes a keyboard painful. The study, published in The Gerontologist, identified specific groups at higher risk: men with less education, people who struggled with basic daily tasks like using a phone or doing housework, and those living with significant physical limitations.
But the health barrier was only part of the story. Fifty-seven percent of older adults in the survey did not use the internet for reasons unrelated to health. The researchers could not pinpoint exactly what those reasons were, but the likely culprits emerged in the data: the cost of devices and internet service, the absence of digital literacy, the simple fact that no one had taught them. These obstacles fell disproportionately on women, on people with less education, and on those living in low-income housing.
The consequences extended beyond mere inconvenience. During the pandemic, when physical distance became a tool for survival, older adults who could not access the internet lost a critical lifeline to their families. They could not video call grandchildren. They could not receive information about health and safety. They became more isolated, more vulnerable, and their quality of life declined measurably. For some, the health barriers that prevented internet use also prevented them from accessing the very tools that might have compensated for their isolation.
Rahul Malhotra, who led the research, argued that policymakers had been thinking about the problem too narrowly. Teaching digital skills and subsidizing internet access were necessary, he said, but they were not sufficient. "Health-related difficulties are relevant in understanding the digital divide between the young and the old," he wrote. The solution required a parallel effort: investment in assistive technology designed specifically for people with vision problems, tremors, or limited dexterity. It required research into how devices and interfaces could be redesigned to accommodate aging bodies.
Shannon Ang, a sociologist at NTU Singapore who contributed to the study, emphasized that the answer could not be purely digital. "Providing social support to these older adults through non-digital means thus remains key," she said, even as researchers work to minimize health-related barriers to internet use. The insight was both obvious and easily forgotten: some people will always need a phone call, a visit, a hand to hold. The internet is not a replacement for human presence; it is a supplement to it. And for those who cannot access it, the absence cuts deeper.
The research team plans to continue this work, drilling down into the specific health conditions that create the most friction—vision loss, fine motor skill decline, cognitive changes. Singapore, which has made aging a national priority, is positioning itself to address these questions systematically. The goal is not simply to get older people online, but to ensure that the shift toward digital life does not leave behind those whose bodies make that shift harder.
Notable Quotes
Health-related difficulties are relevant in understanding the digital divide between the young and the old. Concurrent with optimizing the health of older persons, policymakers should consider supporting research and development into assistive technology.— Rahul Malhotra, Assistant Professor and Head of Research, Duke-NUS' Centre for Ageing Research & Education
Providing social support to these older adults through non-digital means thus remains key, even as we work towards identifying and minimizing health-related difficulties in internet use.— Shannon Ang, Assistant Professor of Sociology, NTU Singapore
The Hearth Conversation Another angle on the story
Why does health matter more than we thought for internet use?
Because we've been treating the digital divide as a knowledge problem—people just need training and access. But if your hands shake too much to type, or your vision is too poor to read a screen, training doesn't help. You're locked out by your body, not your mind.
So this isn't about older people being resistant to technology?
Not at all. The study found that people wanted to be online. They understood its value. The barrier was physical. A tremor, arthritis, vision loss—these are real obstacles that no amount of motivation overcomes.
What surprised you most in the data?
That fifty-seven percent weren't using the internet for non-health reasons. That's a huge number, and it points to cost, literacy, and access gaps that are separate from health but just as real. We're dealing with multiple divides at once.
During the pandemic, this became urgent, didn't it?
Exactly. Suddenly the internet wasn't optional—it was survival. Older adults who couldn't access it lost contact with family, lost access to health information, became more isolated. The health barriers that prevented them from using the internet also prevented them from using it to cope with isolation.
What's the fix?
There isn't one fix. You need assistive technology designed for aging bodies. You need cheaper devices and service. You need digital literacy programs. But you also need to accept that some people will always need non-digital support—phone calls, visits, human contact. The internet can't replace that.
So policymakers need to think differently?
Yes. They can't just build the digital infrastructure and assume everyone will use it. They have to ask: who's being left behind, and why? And then address those specific barriers, whether they're health, cost, or something else entirely.