Determinants of older adults’ adoption and use of smart elderly care services: a qualitative meta-synthesis

Global population aging is placing increasing pressure on healthcare and long-term care systems. Smart elderly care technologies, leveraging the Internet, artificial intelligence, and other digital innovations, have been widely implemented across care settings and offer promising solutions to improve the quality and efficiency of elderly care. However, their effectiveness largely depends on older adults’ experiences, perceptions, and engagement, which are influenced by multiple interrelated factors. This study employed a qualitative meta-synthesis to comprehensively examine the factors influencing older adults’ use of smart elderly care services. A comprehensive search of PubMed, Web of Science, Embase, CINAHL, Cochrane Library, Scopus, CNKI, Wanfang Data, and VIP Database was performed for qualitative studies from inception to August 2025. Two reviewers independently screened studies and appraised methodological quality, and three researchers extracted and coded the qualitative data. The methodological quality of included studies was appraised using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research (2016 version). Using Thomas and Harden’s thematic coding approach, 11 studies were analyzed. Three themes were identified: key facilitators promoting older adults’ acceptance of smart elderly care services; core barriers hindering their utilization; and older adults’ needs and expectations regarding smart elderly care. Older adults’ adoption and sustained use of smart elderly care services were shaped by multiple interacting factors. Perceived usefulness, technological convenience and ease of use, internal needs, and social support functioned as key facilitators, whereas limited digital literacy, inadequate device adaptability, and insufficient external support and resources represented significant barriers. Furthermore, older adults expected smart elderly care services to better address their individualized needs through age-friendly design optimization and expressed a desire for ongoing multidimensional guidance from family members, healthcare professionals, and other support networks during use. Not applicable.