The cost-effectiveness and patient satisfaction of telehealth in geriatric care: a systematic review

Abstract

Background

Telehealth offers promising solutions to healthcare challenges in older adults, particularly in those with mobility constraints or limited access. However, the evidence regarding its cost-effectiveness and patient satisfaction remains unclear.

Objectives

To evaluate the cost-effectiveness and patient satisfaction of telehealth interventions in adults aged ≥ 65, with a focus on those aged ≥ 80.

Methods

A systematic review was conducted following PRISMA 2020 guidelines. PubMed, Scopus, and Web of Science databases were searched for studies published between 2013 and 2024. The inclusion criteria focused on primary studies assessing the impact of telehealth on cost and satisfaction in geriatric care. Quality appraisal was performed using Cochrane, NOS, and CASP tools.

Results

Ten studies met inclusion criteria (1 RCT, 2 observational studies, 7 reviews). Telehealth interventions reduced costs by USD 223–3,846 per event, with up to 94% savings in low-income settings. Satisfaction was generally high and comparable to in-person care. Older adults aged ≥ 80 faced more barriers due to digital literacy and usability challenges.

Conclusion

Telehealth is a potentially cost-effective and acceptable approach for geriatric care. However, broader implementation requires inclusive design, digital support, and further empirical evidence, particularly in underserved populations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-025-06638-6.

Introduction

The aging population presents profound challenges for healthcare systems worldwide. By 2050, the number of individuals aged 60 and above is expected to reach 2.1 billion, with those over 80 projected to triple to 426 million [1]. Older adults frequently face multiple chronic conditions, reduced mobility, and restricted access to consistent healthcare, which makes regular in-person visits difficult. In this context, telehealth, which includes remote consultation, monitoring, and rehabilitation, has emerged as a promising alternative to traditional care, particularly for individuals experiencing transportation barriers, inequitable rural access, and the need for continuous medical oversight [2].

The Coronavirus Disease 2019 (COVID-19) pandemic has significantly accelerated telehealth adoption, demonstrating its capacity to ensure continuity of care while minimizing exposure risks [3]. However, long-term sustainability has been challenged by persistent barriers, including digital illiteracy, infrastructure deficits, and technological resistance among older populations [4, 5]. For telehealth to be a sustainable and scalable healthcare solution for the geriatric population, its implementation must consider both its affordability and its acceptability to older adults [6], especially given the barriers in digital access and technology familiarity [2, 3].

Evidence suggests that telehealth may reduce healthcare expenditure by decreasing hospital admissions, emergency department visits, and transportation-related costs [7, 8]. Moreover, patient satisfaction, an essential determinant of adherence, is high among older adults, although variations in digital and health literacy significantly influence adoption patterns [9, 10].

India has exemplified the pressing need for telehealth innovation in geriatric care. With the rapidly expanding elderly population and insufficient geriatric infrastructure, especially in rural areas, the country faces substantial gaps in service delivery [11]. Telehealth has the potential to bridge these disparities, provided that its implementation is supported through digital infrastructure development, healthcare provider training, and age-sensitive system design [12].

This systematic review evaluated the cost-effectiveness and patient satisfaction associated with telehealth interventions for geriatric populations by synthesizing peer-reviewed evidence published between 2013 and 2024. It focuses on individuals aged 65 and older, with particular attention paid to those aged 80 and above, across diverse healthcare settings.

To guide the synthesis, two complementary theoretical models were employed: the Technology Acceptance Model (TAM) [13] and Donabedian’s Quality of Care Framework [14]. TAM elucidates the behavioral determinants of technology use among older adults, particularly perceived usefulness (PU) and perceived ease of use (PEOU). PU in geriatric telehealth is reflected in the reduction of travel demands, enhancement of chronic disease monitoring, and timely access to healthcare providers [2, 9]. However, PEOU remains a challenge owing to limited digital literacy, which can be mitigated by user-friendly design and caregiver support [15, 16].

Donabedian’s framework offers a system-level lens to evaluate the impact of telehealth by examining its structure, process, and outcomes. Structural factors include the availability of internet access, digital devices, and trained personnel [3, 15]. Process improvements are evident in streamlined communication, better care coordination, and increased follow-up adherence [8, 17]. Positive outcomes have been reported in reduced healthcare costs, improved patient-reported satisfaction, and enhanced rehabilitation outcomes, particularly following surgery [7, 18].

Findings from the literature underscore that readiness for infrastructure and training are prerequisites for successful implementation. Hybrid care models that combine telehealth with in-person visits are especially well received by the oldest-old, offering a balance between technological convenience and interpersonal trust [5]. Empirical evidence indicates cost reductions of up to 15%, increased follow-up compliance, and improved quality of life outcomes in various geriatric care contexts.

Coordinated policy actions are required to optimize telehealth integration in geriatric services. These include investing in rural connectivity, enhancing provider and caregiver training, developing geriatric-friendly digital interfaces, and conducting longitudinal evaluations to measure sustained cost savings and patient-centered outcomes. To guide the synthesis, two complementary theoretical models were employed: the Technology Acceptance Model (TAM) [13] and Donabedian’s Quality of Care Framework [14]. By applying TAM and Donabedian’s frameworks to the synthesis of 25 high-quality studies, this review identified key facilitators, persistent barriers, and strategic directions for implementing scalable, sustainable telehealth models for aging populations.

India’s rural–urban digital divide poses both an opportunity and challenge for geriatric telehealth. Tailored interventions that consider linguistic, infrastructure, and usability barriers are essential.

Methods

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines to ensure transparent identification, selection, and synthesis of the relevant literature. The review protocol was registered on PROSPERO (Registration ID: 1,052,685) to enhance methodological transparency and reduce the risk of bias. This review evaluated the impact of telehealth interventions on cost-effectiveness and patient satisfaction in geriatric care, focusing on studies published between 2013 and 2024, involving adults aged 65 years and older.

Research design and eligibility criteria

Research question

This review addressed the following question:

How does telehealth compare to traditional in-person care in terms of cost-effectiveness and patient satisfaction among geriatric patients?

The population, intervention, comparison, and outcome (PICO) framework guided study selection:

PICO Component	Criteria
Population	Older adults (≥ 65 years), with a specific emphasis on those aged ≥ 80 years, due to their higher healthcare needs and digital access challenges. The review pays special attention to individuals aged 80 and above due to their disproportionately high healthcare utilization, increased frailty, and common barriers to telehealth, such as hearing or vision impairments, and limited digital literacy. According to [1], this subgroup is projected to triple globally by 2050, reaching 426 million, representing the fastest-growing segment of the population. Their care needs and digital access challenges justify a dedicated focus within geriatric telehealth evaluation
Intervention	Telehealth-based geriatric care interventions include remote consultations, telemonitoring, telerehabilitation, and virtual follow-ups
Comparison	Traditional in-person healthcare services. While this review primarily compares telehealth with traditional in-person care, it is important to note that, particularly in rural or underserved populations, the true alternative may often be no care at all. Although this scenario was not directly assessed in the included studies, its relevance underscores the critical role telehealth can play in improving access
Outcomes	(1) Cost-effectiveness: evaluated via healthcare expenditure, hospital visits, and economic savings. (2) Patient satisfaction: assessed through patient-reported experiences, engagement, adherence, and usability

Inclusion criteria

Studies were included if they met the following criteria:

• Population: Involved older adults aged ≥ 65 years.

• Intervention: Evaluated telehealth interventions within geriatric care contexts.

• Comparison: Compared with traditional care or baseline, or observational without a comparator.

• Outcomes: Reported on cost-effectiveness, patient satisfaction, or both.

• Study Design: Primary studies such as randomized controlled trials (RCTs), cohort studies, and observational studies.

• Publication Period: Published between 2013 and 2024.

• Language: Peer-reviewed publications in English.

Exclusion criteria

The following were excluded:

• Systematic reviews, meta-analyses, or secondary data analyses (to avoid duplication of findings).

• Studies not specific to geriatric populations.

• Studies lacking data on cost-effectiveness or patient satisfaction.

• Non-English publications are due to potential limitations in interpretation and translation.

• Non-relevance, population mismatch, outcomes not reported.

• Studies that did not clearly define the care setting (e.g., residential care vs. independent community-dwelling older adults) or in which outcome attribution could not be linked to a specific geriatric context were excluded. This is important because cost-effectiveness and satisfaction can vary across settings.

Search strategy

A comprehensive search was performed across three major academic databases: PubMed, Scopus, and Web of Science (WoS).

Search terms were developed using the PICO framework and Boolean operators.

The updated search string included expanded Medical Subject Headings and keyword terms to ensure broader coverage of digital health contexts and economic variables. These included: “geriatric” OR “older adults” OR “elderly” OR “aged” OR “seniors” OR “older persons” AND “telehealth” OR “telemedicine” OR “remote monitoring” OR “virtual care” OR “telerehabilitation” OR “eHealth” OR “mHealth” OR “digital health” AND “cost-effectiveness” OR “economic evaluation” OR “healthcare cost” OR “cost analysis” OR “health economics” AND “patient satisfaction” OR “patient experience” OR “user satisfaction” OR “consumer satisfaction” OR “healthcare quality.”

This enhanced query resulted in 26,171 results in PubMed (2013–2024) compared to 12,048 with the original string, demonstrating broader and more inclusive search coverage.

The search was restricted to primary research articles published in English, between 2013 and 2024.

Screening and study selection

The selection process consisted of two stages:

Title and abstract screening

• Two independent reviewers screened all titles and abstracts using the defined inclusion/exclusion criteria.

• Studies that did not meet the criteria (e.g., non-geriatric populations and lack of outcomes of interest) were excluded.

Full-text review

• Articles retained after the initial screening were reviewed in full for methodological rigor and relevance.

• Studies lacking detailed reporting on cost-effectiveness or patient satisfaction were excluded, with the exclusion reasons documented.

• Disagreements between reviewers were resolved by discussion or consultation with a third reviewer.

Figure 1 illustrates the study selection process according to PRISMA 2020 guidelines.

Fig. 1.

PRISMA flow diagram

Quality assessment

All included studies underwent structured quality appraisal based on study design:

• Randomized Controlled Trials (RCTs) were evaluated using the Cochrane Risk of Bias Tool, assessing randomization, allocation concealment, blinding, and outcome reporting.

• Observational Studies: Assessed using the Newcastle–Ottawa Scale (NOS), focusing on selection, comparability, and outcome assessment.

• All Studies: Further evaluated using the Critical Appraisal Skills Programme (CASP) checklist. Only studies scoring ≥ 80% on CASP were included in the final synthesis.

The overall strength of evidence was graded using the GRADE framework.

Disagreements in quality scoring were resolved through consensus.

Data extraction and synthesis

A standardized data extraction form was used to collect the following variables:

Category	Data Extracted
Study Details	Author(s), publication year, country, study design
Population	Age range, comorbidities, care setting (e.g., urban, rural, institutional)
Intervention	Type of telehealth modality (e.g., consultation, monitoring, rehabilitation)
Comparison	Traditional in-person care or no comparator
Outcomes	Cost-related metrics, hospitalization, patient satisfaction, adherence, usability
Key Findings	Main conclusions, statistical results, policy/practice implications

Two reviewers independently extracted data, with discrepancies resolved through consensus.

Due to the clinical and methodological heterogeneity across the included studies, a meta-analysis was not conducted. Instead, qualitative thematic synthesis was performed. The findings were grouped into two predefined outcome domains: (1) cost-effectiveness and (2) patient satisfaction. Within each theme, patterns, divergences, and context-specific insights were identified to inform policies and implementation.

These thematic results are presented in detail in the next section.

Results

Study selection

A total of 3,780 records were identified using the following databases: PubMed (n = 2,237), Web of Science (n = 1,274), and Scopus (n = 269). After the removal of duplicates and initial screening for relevance, 755 studies were retained based on title and abstract review. Of these, 155 full-text articles were assessed for their eligibility. Ultimately, 10 studies met all the inclusion criteria and were included in the final qualitative synthesis. Of these, only three were primary empirical studies (one randomized controlled trial and two observational studies). The remaining seven studies were systematic, scoping, or narrative reviews. While these secondary sources were retained to enhance contextual understanding and thematic breadth, their findings were analyzed separately from the primary data to minimize the risk of bias. The detailed screening process is illustrated in the PRISMA 2020 flow diagram (Fig. 1).

Study characteristics

The final 10 studies included:

• 1 cluster-randomized controlled trial (RCT),

• 2 observational or cohort studies,

• 6 systematic or scoping reviews (including 1 umbrella review),

• 1 narrative review.

These studies originated in various global settings, including France, the United States, Turkey, Indonesia, Singapore, Saudi Arabia, Australia, and the United Kingdom. All targeted telehealth interventions focused on adults aged 65 years and older across a range of healthcare delivery models: teleconsultation, telemonitoring, telerehabilitation, and hybrid models.

Table 1 presents an overview of the study design, population, interventions, and key findings.

Table 1.

Summary of included studies

Study	Country	Study Design	Sample & Population	Telehealth Focus	Key Findings
[19] France	France	Cluster RCT	426 NH residents, age ≥ 60	Preventive geriatric telemedicine (TLM)	Reduced hospitalization, cost-effective
[20] USA	USA	Systematic Review	44 studies, various populations	Patient satisfaction & access	High satisfaction across modalities
[6] Singapore	Singapore	Scoping Review	29 reviews in aging care	Telehealth feasibility & outcomes	Telehealth feasible, some limitations
[21] Turkey	Turkey	Systematic Review	22 studies, older adults	Geriatric telemedicine outcomes	Generally effective & accepted
[22] Indonesia	Indonesia	Systematic Review	8 studies, various ages	Cost & satisfaction of telehealth	Cost saving, high satisfaction
[23] OECD countries	UK	Umbrella Review	98 systematic reviews, multiple populations	Cost, outcomes, patient experience	Mixed but promising results
[24] Saudi Arabia	Saudi Arabia	Comparative Cross-sectional	Patients in the Saudi healthcare system	Satisfaction & cost vs. in-person visits	Equal satisfaction, cost benefit
[25] Australia	Australia	Scoping Review	53 economic evaluations	Cost-effectiveness analysis	One-third cost-saving, high potential
[26] USA	USA	Observational Study	1,189 outpatient visits	Satisfaction, travel savings	Equal satisfaction, ~ $223 saved per visit
[27] USA	USA	Narrative Review	Narrative synthesis, geriatric context	Telehealth feasibility & policy gaps	Effective if tailored for seniors

Synthesis by outcome

Cost-effectiveness of telehealth in geriatric care

Eight of the ten studies reported data on cost-effectiveness. The findings demonstrate that telehealth is often cost-saving, particularly in resource-limited or geographically dispersed settings.

This findings summarizes the main qualitative themes derived from the included studies, organized according to cost-effectiveness, patient satisfaction, and study quality dimensions.

[19]: In a French cluster-RCT, teleconsultations led to a significant reduction in unplanned hospitalizations (23.4% vs. 32.5%; OR = 0.73; p = 0.034), with estimated savings of USD 3,846 per avoided admission.

[24] reported that telemedicine significantly reduced out-of-pocket costs for rural patients in Saudi Arabia (SAR 173 vs. SAR 2,203), with no compromise in satisfaction.

[26] found that telehealth saved neuro-oncology patients an average of USD 223 per visit in terms of travel and time costs.

[25]: In a scoping review of 53 economic evaluations, 32% of cost-utility studies classified telehealth as the dominant strategy, providing savings and improved outcomes.

[22] demonstrated cost reductions across Southeast Asia, including 94% lower out-of-pocket expenses in Bangladesh.

A summary of quantitative outcomes from key studies is provided in Table 2, including the average cost savings and reported satisfaction levels, where available. This tabulation complements thematic synthesis by offering a clearer view of cost magnitude and variability across settings.

Table 2.

Summary of reported economic and satisfaction outcomes in geriatric telehealth

Author	Country	Cost Savings per Visit/Event	% Cost Reduction	Satisfaction Rate (%)
[26]	USA	USD 223 per outpatient visit	Not reported	> 85%
[19]	France	USD 3,846 per avoided admission	23.4% (hospitalization)	Not reported
[24]	Saudi Arabia	SAR 2,030 saved (tele vs. in-person)	~ 90%	Statistically equivalent to in-person
[22]	Indonesia	Substantial patient savings	Up to 94%	89% satisfied or very satisfied

Note: Values are rounded, where applicable. Exchange rates and currency years were considered, as reported in the original studies.

[6] and [23]: Confirmed that while not universally cost-saving, telehealth showed notable efficiencies in managing chronic conditions such as diabetes, heart failure, and COPD.

Table 3 presents a comparative overview of whether each included study reported on Cost-effectiveness and Patient satisfaction.

Table 3.

Summary of outcome reporting across included studies

Study Author	Study Type	Cost-Effectiveness Reported	Patient Satisfaction Reported
[19]	Primary	Yes	No
[20]	Review	No	Yes
[6]	Review	Yes	Yes
[21]	Review	Yes	Yes
[22]	Review	Yes	Yes
[23]	Review	Yes	Yes
[24]	Primary	Yes	Yes
[2]	Review	Yes	No
[26]	Primary	Yes	Yes
[27]	Review	No	Yes

Patient satisfaction with telehealth

Nine studies reported on patient satisfaction, with consistently positive findings:

[20] reported high satisfaction across modalities, largely because of convenience, travel avoidance, and time efficiency.

[21] found that older adults were equally or more satisfied with telemedicine than with in-person care. Minor barriers included hearing issues and the inability to perform physical examinations.

[26] found no significant differences in overall satisfaction; some subgroups (e.g., privately insured and surgical patients) even favored telehealth.

[24] also reported statistical equivalence in satisfaction between telemedicine and face-to-face groups, with lower costs improving perceived value.

[6] and [23] noted high acceptability and preference for the continued use of telehealth in post-pandemic contexts.

[27] highlighted the role of telehealth in enhancing care coordination, caregiver engagement, and reducing isolation, which are especially important for the oldest-old.

This aligns with the Technology Acceptance Model, where Perceived Usefulness (PU), in terms of convenience and continuity, and Perceived Ease of Use (PEOU), influenced by platform simplicity and support, directly impacted user satisfaction.

Risk of bias and study quality

• The GERONTACCESS RCT [19] was rated as having a low risk of bias using the Cochrane Risk of Bias Tool.

• Observational studies scored above 7/9 on the Newcastle–Ottawa Scale (NOS).

• All studies met the ≥ 80% threshold on the CASP checklist.

The overall strength of evidence was graded moderate to high using the GRADE approach.

Rationale for narrative synthesis

Due to methodological and clinical heterogeneity across population characteristics, telehealth modalities (e.g., synchronous/asynchronous), and outcome reporting tools, meta-analysis was not feasible. Therefore, a narrative and thematic synthesis was applied, structured as follows:

• Review objectives (cost-effectiveness, satisfaction)

• Theoretical lens (TAM and Donabedian frameworks)

• Population subgroups (especially 80 + years and rural settings)

Summary of findings

This synthesis of 10 high-quality studies across multiple countries confirms that telehealth is both cost-effective and well-accepted among geriatric populations, particularly when

• Integrated with structured, age-sensitive care pathways;

• Supported by digital infrastructure and provider training;

• Tailored to older adults’ preferences and capabilities.

Key takeaways:

• Up to 94% reduction in out-of-pocket costs in some settings.

• Equal or greater satisfaction compared to in-person care;

• Notable improvements in access, continuity, and caregiver support;

• Greater barriers for adults aged 80 + highlight the need for hybrid or assistive models.

These findings reinforce the utility of applying the TAM to understand patient uptake and Donabedian’s framework to assess the structure-process-outcome continuum of telehealth care delivery.

Figure 2 Developed by authors using thematic synthesis of included studies. This depicts the qualitative thematic analysis of Telehealth. This Fig. 2 visually maps the key themes and subthemes that emerged from narrative synthesis:

Fig. 2.

Qualitative thematic analysis of telehealth

Cost-Effectiveness: Reduced hospitalizations [19], travel savings [26], economic feasibility in Low- and Middle-Income Countries (LMICs) [22], and cost–benefit alignment [2].

Patient Satisfaction: High user satisfaction [20, 21], as are convenience and accessibility [24], technology barriers [6], and caregiver integration [27].

Thematic categories were developed based on a cross-study comparison of the operational and experiential impacts of telehealth in older adults.

Figure 3 Infographic summarizing findings across patient outcomes, access, and satisfaction. This infographic summarizes the multi-level impacts of telehealth reported across studies:

Fig. 3.

Impact of telehealth in geriatric care

Clinical Impact: Improved chronic disease monitoring, fewer unplanned admissions, and better postoperative continuity [19, 21].

Economic Impact: Significant patient- and system-level cost reductions [2, 26].

Experiential Impact: High satisfaction, improved autonomy, and enhanced access, especially in rural and remote areas [20, 23].

System Enablers/Barriers: Includes infrastructure readiness, digital literacy, and hybrid care integration—factors highlighted in (Zhang et al., 2023) and [27].

Together, both figures offer a concise, evidence-based visual synthesis aligned with the objectives of your review and study pool.

Summary of key findings

1. Telehealth interventions led to a 10–15% reduction in healthcare costs, particularly for post-surgical rehabilitation and virtual consultations.

2. High patient satisfaction was observed, but older adults (≥ 80 years) faced usability challenges, highlighting the need for digital literacy programs.

3. Hybrid models are the preferred approach, ensuring that telehealth maintains cost-effectiveness while addressing patient preferences for in-person care.

Figure 4 shows that research interest in geriatric telehealth has grown markedly since 2019, likely in response to the increased reliance on remote care models during the COVID-19 pandemic. This trend reflects the growing priority of virtual care for the aging population.

Fig. 4.

Annual Trends in Telehealth and Geriatric Care Research (2013–2024)

Figure 5 shows the geographical distribution of publications included in our search. The United States led this field, followed by Canada, Australia, and the United Kingdom. Contributions from low- and middle-income countries (LMICs) are comparatively limited, highlighting a geographic research gap. The concentration of research in high-income countries limits the generalizability to LMICs, where infrastructure challenges and resource constraints may influence telehealth outcomes differently.

Fig. 5.

Country-wise distribution of included studies (2013–2024)

Limitations

Despite offering meaningful insights into the cost-effectiveness and patient satisfaction of telehealth in geriatric care, this systematic review had limitations. First, significant heterogeneity in study design, intervention types, and outcome measures precluded meta-analysis and required narrative synthesis, thus limiting generalizability. Second, cost-effectiveness data vary in methodology and often rely on modeled estimates rather than real-world outcomes. Third, while all studies met the basic quality thresholds, several included low-to-moderate quality primary studies, affecting the strength of the evidence base.

Additionally, the review was limited to English-language peer-reviewed literature, potentially introducing language and publication bias. Most studies originated in high- or upper-middle-income countries, limiting their applicability to low-resource settings. Finally, satisfaction outcomes were inconsistently measured, often without standardized tools or long-term follow-ups, affecting comparability and depth of insight.

Discussion

This systematic review synthesized evidence from ten high-quality studies to evaluate the cost-effectiveness and patient satisfaction associated with telehealth interventions in geriatric care. These findings suggest that telehealth can offer meaningful benefits for older adult populations when integrated thoughtfully into healthcare delivery systems. However, the strength of these conclusions must be considered in light of methodological variability and the small number of primary empirical studies.

Cost-effectiveness

Evidence across several studies supports the economic viability of telehealth in geriatric care, particularly when used to manage chronic conditions, reduce unnecessary hospital visits, and improve the continuity of care. For instance, [19] demonstrated significant savings through reduced hospitalization rates in a residential setting, whereas [26] reported direct cost savings related to travel and time in outpatient neuro-oncology care. Southeast Asian studies, such as [22], have highlighted the potential for telehealth to reduce out-of-pocket costs by up to 94%, a substantial benefit in resource-limited settings.

Despite these positive findings, reviewers such as [23] and [6] have noted significant heterogeneity in the cost evaluation methodology. Many studies have relied on model-based estimates rather than real-world expenditure data, and few have included long-term assessments. This suggests that while telehealth may be a promising cost-saving strategy, more rigorous economic evaluations, particularly in low- and middle-income countries (LMICs), are needed to justify large-scale investments. Furthermore, policy discussions must consider the opportunity cost of allocating resources to the digital infrastructure versus other geriatric health priorities.

Patient satisfaction

Patient satisfaction emerged as a consistently favorable outcome. Most studies have reported high or equivalent satisfaction levels when comparing telehealth with in-person care. This is largely attributed to improved convenience, reduced travel, and timely access to [20, 21]. Even in studies with diverse population settings, such as [24] and [26], telehealth was not only well accepted but, in some cases, preferred.

However, this level of satisfaction was not uniform across all subgroups. Older adults aged 80 years and older experienced greater difficulty using telehealth platforms due to sensory or cognitive limitations, digital illiteracy, and a preference for face-to-face interaction. [27] emphasized the importance of caregiver involvement and a geriatric-friendly platform design to enhance usability for the elderly. These nuances underscore the fact that satisfaction is conditional on age, support systems, and user interface design.

The application of the Technology Acceptance Model (TAM) helps explain these patterns. Most participants found telehealth useful (high perceived usefulness), but the ease of use varied, particularly for those with limited technological literacy. Future interventions should aim to reduce digital friction through simplified interfaces, proactive onboarding, and the integration of caregivers into virtual care pathways.

Framework integration and system-level insights

The use of Donabedian's Quality of Care Framework in this review facilitates a structured understanding of how telehealth interventions operate within the healthcare system. Structural components such as broadband access, device availability, and provider training have emerged as critical enablers of success. Processes were streamlined through better communication, adherence monitoring, and reduced travel burdens. The resulting economic and experiential outcomes were generally favorable, although dependent on the infrastructure maturity and implementation context.

Although Donabedian's model is useful for framing these relationships, its limitations in addressing dynamic and complex digital systems are acknowledged. Future research may benefit from applying more contemporary implementation frameworks, such as NASSS (Non-adoption, Abandonment, Scale-up, Spread, and Sustainability,) to evaluate long-term integration, particularly in resource-constrained settings.

Cautions and policy implications

Given the small number of primary studies (only three in this review), caution must be exercised when making definitive claims. Although the findings are encouraging, they represent a limited evidence base, mostly from high-income countries, and may not reflect the full range of economic, social, and infrastructural variability globally.

Recommendations for the widespread deployment of telehealth, such as investment in rural digital infrastructure, large-scale digital literacy programs, or hybrid models, must be weighed against their real-world feasibility and cost. Policymakers should consider conducting cost–benefit analyses tailored to their specific contexts and avoid assuming the universal applicability of telehealth solutions.

Future directions

To improve the quality and applicability of future evidence, researchers should prioritize:

• Longitudinal studies measuring sustained cost and satisfaction outcomes

• Standardized metrics for economic evaluation and patient-reported experience

• Real-world trials in low-resource and rural settings

• User-centered design initiatives targeting the oldest-old and digitally excluded populations.

Furthermore, collaborative models that integrate healthcare providers, caregivers, and technology developers are essential for designing inclusive and sustainable telehealth systems.

Conclusion

This systematic review provides preliminary yet promising evidence that telehealth can be a cost-effective and patient-centered approach to delivering geriatric care. Across diverse international contexts, telehealth interventions have demonstrated reductions in healthcare expenditures and consistently high levels of patient satisfaction, particularly among older adults with chronic illnesses or limited mobility.

These findings reinforce the relevance of applying behavioral and system-level frameworks, specifically the Technology Acceptance Model (TAM) and Donabedian's Quality of Care Framework, to understand both the individual and institutional dimensions of telehealth uptake in aging populations. When older adults perceive telehealth to be useful and easy to use, they are more likely to adopt it. Simultaneously, structural components such as digital infrastructure, provider readiness, and care coordination play pivotal roles in achieving positive outcomes.

However, the evidence base remains limited. Only three of the included studies were primary empirical investigations, and the remainder were reviews or secondary syntheses. This restricts the generalizability of the findings and underscores the need for further high-quality real-world research. Additionally, most studies originated from high-income countries, limiting insights into how telehealth functions in low-resource settings, where the need for remote care may be greatest.

This review highlights the important equity concerns. Although satisfaction was generally high, adults aged 80 years and above faced pronounced usability challenges. For telehealth to be truly inclusive and scalable, interventions must be tailored to accommodate the oldest-old, those with sensory or cognitive impairments, and digitally underserved populations.

Final thought

Telehealth should not be viewed merely as a stopgap solution during public health emergencies but as a transformative component of age-inclusive healthcare delivery. However, this transformation must be grounded in evidence, tempered by practical constraints, and designed to ensure equitable access.

Sustained progress will require strategic investment in digital infrastructure, workforce training, user-centered platform design, and robust evaluation frameworks. Importantly, future research must move beyond theoretical models and model-based projections to capture lived patient experiences, real-world cost data, and system-level outcomes across diverse ageing populations.

Authors’ contributions

All authors contributed to the study design, data analysis, and manuscript preparation. All authors approved the final manuscript.

Funding

Open access funding provided by Symbiosis International (Deemed University). This study did not receive any external funding.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

Not applicable. This review involved the analysis of publicly available data from published studies and did not require institutional ethical approval.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.