Abstract As digital healthcare systems expand globally, older adults face systemic exclusion through ageist practices embedded in technology design, clinical workflows, and sociocultural norms. Addressing these challenges for older adults is a crucial responsibility for gerontological social workers. This qualitative study investigates how digital healthcare systems in Chinese hospitals sustain ageism through interviews with 21 older patients and 13 healthcare staff, alongside participatory observations at a major public hospital. Findings reveal ageism’s multi-level dynamics: individual-level internalized stereotypes and physical barriers, interpersonal proxy assistance from families/staff that erode autonomy, technological hostile design, institutional policies prioritizing efficiency over accessibility, and filial piety cultural norms paradoxically reinforcing dependency. Older adults were relegated to ‘digital refugees’, reliant on fragmented support rather than integrated into inclusive systems. Social workers, though critical advocates, faced institutional constraints prioritizing performative compliance over equity. The study underscores the interplay of Confucian values, techno-optimism, and structural neglect in perpetuating digital ageism. It challenges assumptions that familial support or assistive technologies inherently empower older adults, revealing how ageist biases are codified into institutional practices. Implications for social work include incorporating anti-digital ageism into curricula, advocating for participatory design, reforming policy to mandate accessibility standards, and fostering community-hospital partnerships to bridge digital divides.
Zhang et al. (Fri,) studied this question.