With the growth of the economy and improvements to medical services in China, the average life expectancy has increased. China is becoming an aging society at the fastest pace in history. In 2018, there were 166.58 million people in the country aged 65 or older . People above the age of 65 are projected to represent 26% of China’s population, and those aged 80 and older are expected to represent 5%, by 2050 according to a report by the World Bank . There are thus a large number of empty nesters in China. Elderly people living alone account for nearly 10% of the total, and those living with only spouses account for 41.9% according to the China Family Development Report in 2015 . The traditional family-based model of support for the aged has thus significantly deteriorated.
In light of the rapidly aging population, the demand for care and health services for the elderly is growing. Against the backdrop of limited capacity and weakening of family-based care, developing digital health technologies has emerged as a solution to this problem. Policies advocating digital health technologies have been introduced in the last several years. In 2015, the Chinese government set itself the goal of “promoting the development of the digital health technologies’ industry.”  To promote the use of Internet for care for the elderly, it is important to improve their access to the Internet.
A number of older people have kept abreast of technological developments in recent years. A study in Spain showed that older adults were interested in learning and acquiring Information and Communication Technologies’ skills . Xie found that elderly people had good knowledge of the Internet, especially because of its convenience and usefulness .
By the end of 2018, 98.6% of Internet users accessed it using mobile phones in China. A total of 48 and 35.9% used desktop and laptop computers to access the Internet, respectively, whereas 31.1% used TVs. The Internet penetration rate in China was 57.7%, and that in Heilongjiang Province was 52%. It ranked 18th of the country’s 31 provinces. However, many elderly believe that they are excluded from the online environment. By December 2017, Internet users aged 60 and older accounted for 5.2% of all Internet users and only 16.7% of the total population of the elderly . The barriers they face to using the Internet included cost, inappropriate design, physical and mental limitations, mistrust, and a lack of time [8, 9]. For most elderly people in China, the Internet is a novelty that appeared when they entered middle or old age. It is thus challenging for them learn to use it .
Most studies in the area have focused on the impact of Internet use by the elderly as well as factors influencing it.
The demand among the elderly for the use of the Internet is relatively simple. Most of them use it for entertainment (such as listening to the music and watching videos), accessing information (such as news, stock market information, and health-related information), and communicating with others (such as use WeChat or Facebook) [11, 12]. Compared with other age groups, the elderly are primarily interested in the Internet for health reasons . They are more likely to search for health information online . Most elderly people learn how to use the Internet through their children or other young people, while a minority learns by itself.11 Regarding the frequency of Internet use, a study found that 47.4% of older adults in the U.S. spend more than 7 h per week on the Internet, and only 7.1% reported spending no time on it . Wei’s study showed that the elderly in China who use the Internet every day of the week accounted for 48.5% of the total elderly population .
The influence of the Internet on the lives of the elderly as well as their physical and psychological health has attracted the attention of many scholars. Elderly people with health problems are especially likely to benefit from using the Internet because it allows them to carry out an increasingly diverse array of tasks . A study has shown when the elderly have access to larger social networks, the risk of such diseases as hypertension significantly decreases . The Internet can also serve them as a powerful tool for communication to meet their need for interpersonal and social interactions . Higher levels of Internet use are significant predictors of higher levels of social support, reduced loneliness, better life satisfaction, and psychological well-being among the elderly . Some researchers reported that older adults who successfully created and shared content online enhanced their social connections and reduced social isolation. Ding claimed that new media can be an important channel to promote and enhance the social adaptation of the elderly . However, the impact of the Internet on different populations is different, and there are some drawbacks to Internet use. A survey of the online activities of 4113 American adults found that social isolation deepened with increasing activities online . A study on teenagers found that Internet use may render them unable to distinguish between the Internet and reality, and make them more susceptible to cyberbullying . The adverse effects of using the Internet on the elderly are more clearly manifested in their physical health. For example, sitting for a long time affects their blood circulation, leads to cardiovascular diseases, and causes cervical pain, joint pain, tinnitus, and dizziness .
Many studies have found that certain socioeconomic and demographic factors, including age, sex, education, income status, health literacy, and urban and rural conditions, are associated Internet use by the elderly [25,26,27]. Older adults who are male, younger, live in urban areas, and have higher income, education, and health literacy have a higher probability of Internet use [28, 29].
Some physical and functional health problems can pose barriers to Internet use . The elderly often suffer from reduced vision and physical disabilities that make it more difficult for them to use the Internet . They tend to have poor memory as well, and thus are slower at learning new procedures for the Internet .
Some studies have found that psychological factors, such as loneliness, personality, and perspectives on life, affect Internet use. Using the Internet is an efficient way to promote friendships and social interaction, and to avoid negative feelings related to loneliness . In addition, Peng found that elderly people who are optimistic are more likely to use the Internet, as are those who think that they have the right to control their own lives . Erikson and Johnson found that Internet use and self-sufficiency are significantly related, where such elderly people were more likely to use the Internet .
Social factors are also important aspects of Internet use by the elderly. Studies have suggested that elderly people with good social support have higher motivation to learn the Internet and tend to do so. Care and support by family, and their encouragement can significantly increase Internet use among the elderly . Participation in activities with family and friends is also likely to increase the need and perceived usefulness of Internet connectivity to maintain social integration and ties .
This study describes the current state of Internet use among the elderly, the demand for digital health technologies, and factors affecting their online behavior. The results are important for improving Internet use among the elderly. On the one hand, they can provide a fundamental theory for the development of the service industry for the elderly, and on the other, they can yield valuable suggestions for meeting their needs, improving their quality of life, and enabling them to benefit from the Internet.