This was not Lindy Lam’s first time forgetting her login password of the eHealth application. After her repeated attempts to log in all failed, this 67-year-old lady began searching for a way to reset her password helplessly once again.

“I have to ask others for help,” said Lam.

Lam downloaded eHealth as required to log her vaccination records during the pandemic. However, these complicated smartphone applications seemed to overwhelm Lam from the very start.

Some other apps allow fingerprint login, but it is also useless, Lam added. She can never get it to open no matter how many times she presses her finger to the screen, because the elderly’s fingers are always dry and even chapped. When doing heavy housework, Lam’s hands would often get soaked in water for a long time, which also greatly affects the fingerprint recognition.

She considered switching to face recognition login as well but was similarly hampered by the intricate setting steps involved.

“I just can’t log in,” she sighed.

Lam is among the many elderly people in Hong Kong who are facing difficulties in using smartphones, especially for these digital health apps. Among the 104 respondents with an average age of 80, the Generations Connect Project conducted by the University of Hong Kong found that despite the fact that nearly 90% of the elderly respondents owned smartphones, 69% of them were noted to have inadequate e-health literacy.

Digitalised life in post-pandemic era

Since the three-year pandemic, Hong Kong has been experiencing “digital transformation”, with online shopping, food delivery and e-payment becoming integrated into peoples’ daily life, said LegCo.

A significant increase in smartphone ownership has also been observed among individuals aged 60 and above, with a nearly 20% rise compared to the pre-pandemic level.

However, in this new normal of digitalisation, whether the elderly are able to effectively use smartphones for daily life has emerged as a pressing concern.

Lam shared a frustrating experience when a bus route changed without her knowledge.

“I boarded the bus as usual, but then found it wasn’t stopping at my destination station.”

Later, she learned all this information was available on bus or map apps.

“Without using these apps, we elderly people become really limited in where we can go; we have to rely on asking others for directions.”

To help her peers avoid similar situations, Lam has taken matters into her own hands: “I compiled the routes of all the commonly visited places like the housing department and community centers to share with my friends.”

Yet, unlike transportation or food delivery, where alternatives exist and workarounds can be created, healthcare is an essential aspect of elderly life that cannot be easily substituted.

The digitalization of health services, from appointment bookings to medical records, has made digital health literacy a crucial skill for the elderly to maintain their well-being and independence in this smartphone-centric society.

Gap of digital health literacy

During the Covid, many public venues require people to scan QR codes and present their vaccination records for entering.

“People have downloaded those Covid apps for me such as eHealth, but I’ve never figured out how to use them,” said 85-year-old Ho Luen, who had to fill out a handwritten form with the help of others to enter public places.

Although Ho said she used her mobile phone everyday for contacting family and reading news from time to time, she did not understand how to handle the functions in these apps.

“There are too many buttons, making me dizzy,” she said.

According to the Needs of Grassroots Elderly Population Report 2023, 54.4% of people over 60 face the overall difficulty in smartphone usage, and nearly 60% of them find it hard to use Covid related apps specifically.

This kind of situation has continued post-pandemic.

While many functions developed on healthcare apps, like online medical reports and digital prescriptions, benefit most people, Lee Kam-ling found them troublesome.

“I don’t understand some user interfaces on these applications because they are in English, and also the text is too small to read,” said the 72-year-old, who often mixed up current and previous medication instruction records.

“It is still better for me to write down how to take the medication on paper rather than rely on these apps,” she said.

For Lee, the most essential aspect of using these digital health apps lies in their online outpatient appointment function.

She usually makes the appointments by making phone calls, but the lines are often busy without answers.

“It’s so inconvenient, even for simply making an appointment,” Lee said.

Population aging coupled with advancements in medical care has led to increasing lifespans among citizens, resulting in a rising prevalence of chronic diseases, thereby escalating the demand for public healthcare services. Source: HK01.

According to the Hospital Authority’s records from last Saturday, the longest waiting time in the Accident and Emergency (A&E) department exceeded eight hours, while the average waiting time was approximately four hours.

Without using the mobile apps for reservation, people may find themselves compelled to wait for more than eight hours outside the emergency room to keep track on the calling status.

“Other people often tell me to try the online booking function in mobile applications, saying it’s very convenient. But it seems too complex with many options, and I don’t know how to use it,” said Lee.

Zhang Baoyi, previously the director of the Institute of Sociology at the Tianjin Academy of Social Sciences, said that for a long time, older people have been accustomed to shopping with cash, queuing for medical appointments, and buying tickets at counters. However, after the pandemic, many of these services moved online, leading the elderly to fall behind the pace of social change.

As Lam pointed out, the current situation for most elderly people is that they need to download and learn too many healthcare apps with various functions, which is too demanding for them. For example, vaccination records are in eHealth, whereas follow-up medical reports are in HA Go; there is also an app called Senior Citizen Card (長者咭) for accessing various elderly benefits.

“Some of the apps would even pop up ads telling me my blood pressure was really high to draw eyes, which really frightened me as I thought my blood pressure had actually increased so much,” said Lam, who now seems to feel resistant to installing these apps.

As a result, many elderly people like Lam not only lack the skills to handle such apps properly, but they are also discouraged from learning to use them.

A questionnaire survey conducted in the study by Kim and colleagues reflected this issue, assessing the usage of digital health technology among elderly individuals in Hong Kong.

On average, the elderly respondents showed a negative attitude towards the use of digital health technology (Mean: 3.68) and expressed reluctance to continue using it in the future (Mean: 3.58). Also, they generally did not perform good eHealth literacy (Mean: 3.42).

For those elderly with less digital health literacy, they are more likely to have a poorer mental health conditions and a greater sense of loneliness, found by the Generations Connect Project.

An issue to be solved in ageing society

According to Census and Statistics Department, the proportion of elderly population aged 60 and above increased from 14.8% in 2000 to 29.8% in 2022.

Amid the ageing population and digital transformation, Hong Kong government has launched new rounds of the Information and Communications Technology (ICT) Outreach and Training Programme, offering free digital training courses in the community for the elderly. The courses cover topics such as mobile payment, government mobile applications, and smart healthcare.

Elderly people attend cognitive training with tablets in the ICT Outreach Programme. Source: GovHK.

Sunny Tan, a member of the Legislative Council, suggested that these digital support programmes for the elderly need to be further optimized. Moreover, Hong Kong’s IT industry should also be encouraged and funded to develop applications tailored to the needs of the elderly.

“Currently, one-fifth of the local population in Hong Kong is ageing, and in the future, we can expect one in every four individuals to be an elderly person. In this digital era, one of the most important tasks is to educate the elderly on using smartphones to improve their health,” said Chris Sun Yuk-han, the labour and welfare secretary.