Digital access and frailty in older adults: A moderated mediation model of digital literacy and social support.

BACKGROUND: Frailty is common geriatric syndrome associated with disability, hospitalization, and mortality, but could be preventable. Digital access and digital literacy are increasingly relevant to healthy aging, yet pathways linking digital access to frailty risk remain unclear. OBJECTIVES: This study examined whether digital literacy mediates the association between digital access and frailty risk and whether domain-specific social support moderates this indirect association. METHODS: Nationally representative data from 6625 community-dwelling older adults aged ≥65 years were analyzed. Digital access was categorized as no personal device access, device access without home internet connectivity, and connected device access. Digital literacy was assessed using 13 task-based items, and social support was measured as the availability of supporters providing emotional, practical, and financial assistance. Frailty risk was defined as prefrail/frail status based on the FRAIL scale. Covariate-adjusted mediation and moderated mediation analyses were conducted using generalized structural equation modeling, accounting for the complex sampling design. RESULTS: Connected device access was associated with lower frailty risk than no personal device access and device access without home internet connectivity. Digital literacy mediated the associations between digital access and frailty risk. Only practical support significantly moderated the indirect association of connected device access with frailty risk through digital literacy, strengthening the pathway from connected device access to digital literacy. CONCLUSIONS: Digital inclusion strategies should move beyond material access alone and incorporate age-friendly digital skills training and practical support. Nurses can help reduce digital disparities by assessing digital literacy, identifying barriers to digital engagement, and facilitating tailored support.