
Online services in social and health care: “Talk about the digital leap have been a disservice to older people”
Statistics tell a clear story about the rapid digitalization of social and health care services.
A report by the Finnish Institute for Health and Welfare (THL) states that in 2020 a third of all out-patient contacts took place remotely. Remote appointments increased in all age groups, while the use of digital services increased most modestly among people over 84.
In Finland, the three most frequently used online services related to health care are online booking of appointments, checking lab and test results from the Kanta service, and renewing electronic prescriptions.
Considerably fewer people participate in online appointments with doctors or nurses.
The prioritizing of digital services is also driving social and health care services online, while partly ignoring the various needs of older users.
“Only about half of those in the 75–89 age group use the Internet. Directing people to remote and online services calls for a keen and sensitive eye to ensure that nobody drops outside the service system,” says Professor Sakari Taipale, whose team broadly studies the adoption of digital technologies among older people.
The team belongs to the Centre of Excellence in Research on Ageing and Care at the Ģֱ.

The use of digital services falls off at age 80
In daily life, how people use digital services is individual and influenced by many factors. A significant share of older people benefit from electronic services, and many also want to use these.
One boundary marker is located around the age of 60. At this age, the usage of online services starts to decline at the population level. One reason for this is that along with their retirement, many people lose access to the extensive electronic services of occupational health care.
“Those people who continue to use digital services as before up to the age of 75–80 are those who find their digital skills to be good and have also used such services a lot,” Taipale says. .
A significant change, however, occurs at the age of 80, with the use of digital services falling, even among those with good digital skills.
This happens not only in Finland but in other countries as well.
“It is often thought that by educating people, skills and the rate of use could be maintained. However, people clearly start using electronic services less, even those who consider their skills good and use digital services a lot.”
Taipale says that the baby-boomer cohort is now coming to the stage where not everybody can use electronic services like before. These baby-boomers, who include those born between 1945 and 1950, are now approaching the age of 80.

At present, the use of digital devices among the oldest age cohorts is still an unknown area even for researchers. None of the current surveys collects data about the usage of electronic services among people older than 90.
What we do know is that digital services cannot solve the need for care pertaining to old age.
“People are nowadays staying healthier longer and their digital skills are improving, which means we have older and older users of digital services,” Taipale says. “It is noteworthy, however, that the years at the end of our lives when we are dependent on care and aid have not changed much in terms of number. The need for help does not decrease as such but occurs later in life. This will also show up in the usage of digital services.”
Digital consumption is individual: usage should be investigated more thoroughly
People’s self-conception of their own digital skills declines along with age. When citizens’ conceptions about their digital skills were surveyed in EU Member States, more than 80 percent of respondents within the age range 40–54 considered themselves skilful users of digital services. In the group of people over 65, only about 40 percent were of this opinion.
While good digital skills help maintain the usage of digital services in old age, in daily life the usage is highly individual, Taipale says.
He draws on the notion of digital repertoire – there are many reasons and ways to use or not to use digital services or applications in everyday life.
Personal history influences usage, Taipale suggests, while proposing a number of questions that need to be asked when exploring older people’s usage of technology: Does a person use online services alone? Does a person use some services alone? Does the person have any friends helping them? Are the services used together? Is there any user support available?
Gaps remain, however, that prevent the use of digital services altogether or at least impede their introduction.
“We already know fairly well the gaps that distinguish users and non-users, digitally skilled and less skilled, and those who benefit from digitalization and those who do not,” Taipale says.
In Taipale’s opinion, there’s a basis for more thoroughly exploring the digital competences of older people. It would also be useful when designing online services for social and health care.
“It would be possible to proceed in the same way as in assessing the need for care services. It has to be charted which services older people can actually use independently, which with little guidance, and which with more extensive assistance. In daily life, there are many factors affecting usage, and when people grow older, their needs for digital services also change.”
Skills do not progress in sudden leaps: no need to feel embarrassed
Research knowledge on how older people use smartphones or mobile applications also helps predict how they might use digital services for social and health care in the future, Taipale says.
International research shows that when it comes to using mobile applications, older people advance by small steps instead of any great leaps.

Taipale says the users can be divided into three groups:
“The first group includes those who use a phone only for calls and messages. The second group also often uses a phone with apps related to photos and time management. In the third group, the users also browse the Internet, for example, and download new apps to their phones,”.
A user’s skills and ways of use seldom jump to a new level all at once. Transitions are slow and gradual.
Digital skills are also often compared to the competences of younger people.
“Talk about the digital leap may have been a disservice to older people,” Taipale says.
“There is need for a cultural change so that people would understand that everybody needs help with some issues. Now people feel a bit ashamed to ask for help from their friends or relatives in digital issues.”
According to him, Finnish society lacks natural places and encounters where older people could learn digital skills from each other. Peer learning would be effective, however.
“People should remain active, especially after retirement. Otherwise there is a risk of exclusion from learning opportunities as well. Daily learning is going on all the time if there is interest and a willingness to experiment.”
Taipale says that in digital issues the need for help often occurs already much earlier than in other everyday matters.
Alternatives to digital services must be presented more clearly
A typical feature of social and health care services is that they are used occasionally. People usually have their prescriptions renewed or check their lab results infrequently. A user may have to learn again each time how to use the service.
Taipale says that public authorities are obligated to provide adequate online services as well as guidance and support for their use.
Similarly, an alternative to digital services must be available and informed about clearly.
But can the phone numbers or instructions be found when needed?
“Digital services are regarded as a primary option, which means there is a risk that other options get hidden,” Taipale points out. “It should not be like this. We should avoid stigmatising the user for being incapable. Phone numbers must be easy to find.”
Taipale wishes online service providers would not revise the necessary services too often or radically alter their appearance. If a rarely used service looks different each time, it prevents a smooth user experience.
When improving usability, the wishes of users should be better taken into account, as should the ways things are used.
Assisted online activity should be improved
Other changes to online service practices would be urgently needed, such as when older people need assistance with conducting their affairs online.
“We know from practice that many older people use electronic services together with somebody,” Taipale suggests.
“However, the services are designed to be used independently or fully on behalf of another person. Assisted online activity is not properly recognized. In this respect, legislation could specify that assisted online activity could take place safely also when another person’s help is needed for electronic identification or with other technical challenges.”
Taipale also gives a few hints related to everyday life: discuss in time with others close to you about how online services will be used when an older person can no longer do it independently. Ask who will do it on their behalf and what kind of authorizations or parallel user credentials are needed.
