A research letter published in the Journal of the American Medical Association has found that digital health technology is not effectively reaching senior citizens and the low usage rates for digital health, despite high ownership rates for mobile phones & computers.

A core promise of digital health is to aid in management of chronic medical conditions. Apps for high blood pressure, connected glucometers for diabetes, and smart inhalers for asthma & COPD all make the pitch that they can help improve day to day management of these conditions which will ultimately improve outcomes.

In this study, researchers from Brigham & Women’s Hospital looked at data from the National Health and Aging Trends Study (NHATS) which surveys Medicare patients over the age of 65 annually. Part of that survey includes questions on use of technology in general, as well as use of technology for health management. To assess the latter, they ask about use of technology for four tasks in particular: refill prescriptions, contact a clinician, manage insurance, and research health conditions. Here, they looked at data from 2011 and 2014.

As is frequently cited in discussions on digital health, ownership of mobile phones and computers among senior citizens (average age 75) was high – 76% for mobile phones and 64% for computers. We don’t know how many of the mobile phones were smartphones (ie capable of downloading apps, connecting to a device via Bluetooth, etc). Around 40-50% used these devices for email or texting. And tellingly, a much smaller number used them for more advanced tasks like mobile banking or shopping (10-20%).

When it came to digital health, only 25% of senior citizens used digital health in any of the four tasks surveyed. Between 2011 and 2014, there was a marginal increase in use from 21%. Among the four tasks, using technology to search for health information was the most common – about 18% of respondents.

These are important findings given the pitch that many digital health products make when it comes to managing chronic disease and given that these conditions are most prevalent among senior citizens. The best health app or device is going to be pretty ineffective on a population level if only a quarter of a key demographic can be reached as a potential user.

It also highlights the importance of leveraging digital health tools beyond slick health apps and connected health devices. For example, text messaging to promote healthy behavior change has shown promise in numerous studies. In the NHATS data, while about half of respondents used their mobile devices for texting – that’s definitely an improvement over the ~25% that seem to be using apps or mobile internet.

Overall, this study really highlights a critical but often overlooked step when it comes to development of digital health technology – knowing and understanding the needs of the intended user.

Levine et al. Trends in Seniors’ Use of Digital Health Technology in the United States, 2011-2014. JAMA. 2016;316(5):538-540. Full Text