Demographic statistics indicate that 8.1% of the global population were older adults in 1960, and this number grew to 10% in 2000, with estimates suggesting that 21.4% of the population will be senior citizens in 2050 [1]. A demographic survey in the United States indicated that the elderly population will increase from 13% in 2010 to 19% in 2030 [2]. Internet use is increasingly widespread, although the number of people who do not use the Internet frequently, such as the elderly, is in fact increasing [3]. Despite this, the first nationally representative study in the United States showed that the proportion of seniors (those aged 65 years and older; mean 75, SD 7.4 years) who use any digital health technologies significantly increased from 21% in 2011 to 25% in 2014 [4].

Internet use can bring many benefits, such as increasing the happiness and decreasing the loneliness of older adults in a retirement community [5], encouraging social connections, and accelerating information exchanges among adults older than 50 years in the United States [6]. Studies have shown that the social functions that come from Internet use contribute to the maintenance of relationships for older adults aged 57 to 87 years [7], particularly for older people with limited mobility, because it is a good way for them to come out of solitude and reconnect to the rest of the world [6]. One of the significant aims of active aging is to keep learning in order to adapt to the changes that occur in later life, gain capabilities similar to those of younger people, and remain productive [8], and it is believed that older adults’ involvement in the Internet may achieve this [9-13]. But the Internet is associated with security concerns and learning anxiety (eg, how to handle the operating systems, how to resolve any problems encountered, and the fear that one might break an expensive device) [14,15]. Not every population group benefits from Internet use, and there can even be certain negative impacts. However, many studies in the United States indicate that there are more positive than negative impacts arising from Internet use [16-18].

Many studies have been conducted on why older people may choose to avoid the Internet, such as the webpage design not being suitable for older people and the perception of not being able to learn new things because of insufficient cognitive capability, vision, or motor function [19-27]. The diverse needs of older users should be considered in the design and development of such technology [13]. However, there are still only a handful of studies that aim to understand Internet withdrawal among middle-aged and older adults. A previous study showed that the objective of e-learning was not only to describe something, but also to demonstrate how to do it [28]. Knowles’ adult education theory [29] highlights the importance of self-direction, a reservoir of experience, social roles, and problem-centered orientation in affecting adult learning, and Internet adoption and withdrawal may be affected by these factors. For example, the Internet creates an independent learning opportunity for the self-directed learning of adults, while family or friends can serve as a facilitator. Older learners have a large body of experience to serve as a background for new learning, and they are strongly motivated to learn information that has immediate application [30]. In contrast, if adults feel they are unable to learn, they are more likely to withdraw from Internet use.

Gender differences may also exist in Internet adoption and withdrawal among middle-aged and older adults. Previous studies indicated that website attributes [31], Internet usage patterns [32], and habits [33] are different across genders. More males use the Internet than females [32], and the differences in their visual cues have a great impact on their online choices [34]. Women have also expressed greater levels of anxiety toward computers [35], less self-perceived competence, and lower perceived ease of use with respect to the Internet [36] than men. Moreover, older males seem to perceive the Internet as more useful due to their perceived higher levels of ease of use than females [37]. However, some studies found no differences across genders in these respects [38,39]. It is thus an interesting issue whether there are any gender differences in Internet adoption and withdrawal. If we could underline different characteristics associated with gender, it would encourage the development of genuinely usable information and communications technology products, training, and support approaches, and it could be used as a basis for the design of continuing education materials or for market segmentation of men and women.

In Taiwan, there is little data on older adults’ Internet use, with no nationwide surveys. As a result, there is no solid reference material for Internet adoption and withdrawal among middle-aged and older adults in Taiwan. In addition, because older adults are the fastest growing population in adopting the Internet and computer technology during the past decade [40], depicting factors and reasons associated with Internet adoption and withdrawal may shed light on some aspects of elderly learning theory. Thus, the purposes of this study were (1) to understand the prevalence of Internet adoption and withdrawal among middle-aged and older adults in Taiwan, (2) to examine the factors associated with Internet adoption and withdrawal among middle-aged and older adults in Taiwan, (3) to identify the reasons behind those who had Internet adoption and withdrawal, and (4) investigate if the aforementioned patterns differed by gender.

This study is the first to use nationally representative data for older adults in Taiwan to examine the issues of Internet adoption and withdrawal. The results showed that both the respondents who adopted the Internet and with greater probability of continued use had the characteristics of higher proportion in men, younger and with higher education. In addition, the most important reasons for Internet adoption were associated with “needs,” especially keeping up with the world and job needs. Furthermore, although psychological barriers were the most important factor of Internet withdrawal for both men and women, women were more likely to be affected by health and anthropic factors or accidental barriers in this regard.

A number of factors associated with older adults’ technology adoption have been documented in the literature [41,42], although the reasons behind these factors have rarely been examined. This study found that the main reasons why older adults may choose to use the Internet are associated with needs, especially with regard to keeping up with the world and job-related needs. In addition, if older adults think that using the Internet can increase their employment opportunities (OR 2.0, 95% CI 1.0-3.9, P=.04), access to useful information (OR 0.5, 95% CI 0.3-0.9, P=.01), and recreation and entertainment, then they are less likely to withdraw from using it. These findings echo previous research indicating that older adults who do not use new technology or learn new things may simply not see the need for much of what is being offered [43]. Education or training should be provided to help older adults understand the underlying structures and benefits of new learning opportunities.

Many of the existing studies focused on how deteriorating health conditions can hinder older adults’ use of technology or learning efforts. Recent international studies also indicated that people tend to withdraw from the Internet due to health-related factors (eg, age-related changes in visual acuity, color perception and susceptibility to glare, and hearing problems) and some psychological barriers (eg, computer anxiety, online problems, and privacy issues) [15,16,44-46]. This study used a nationally representative sample and the results echo those of other recent works, showing that psychological barriers play the most important role in Internet withdrawal among middle-aged and older adults in Taiwan, followed by health factors. Moreover, it was surprising to find that most of the middle-aged and older adults in this study’s data felt that “no available time” was the main reason that kept them from not using Internet. This suggests that elderly education should not only focus on health conditions because psychological factors may be critical to Internet usage and learning. For example, the selective optimization with compensation model of successful aging [47] may be useful in helping older adults to cope with the barriers they face when adopting new learning. Compensation reminds older adults to consider the reality of a person’s capacities and the health barriers they face, selection refers to the ways older adults use to overcome such barriers, whereas optimization highlights the resources older adults have for achieving their goals.

Gender differences in Internet use have been documented in a number of studies, although in this study using Taiwanese data, men and women were not different in Internet adoption. However, they were different in Internet withdrawal, with men less likely to withdraw from Internet use than women were. In addition, for both men and women, the most common response for the reason for Internet withdrawal was for “psychological barriers” (eg, no time available, no meaningful use, or nothing worth reading/watching) followed by “health barriers” (eg, eyes or body deteriorating with Internet use). Although “psychological barriers” were the most important factor for Internet withdrawal among both men and women, women were more likely than men were to be affected by health and anthropic factors or accidental barriers. We suggest that in addition to focusing on health barriers, such as relearning to overcome cognitive declines, it is also important to work to reduce anthropic factors or accidental barriers, possibly by providing more resources, to encourage women to use new technology or take more learning opportunities.

This study has some limitations. First, this work was based on a cross-sectional survey and it may not be possible to draw any conclusions on the causal relationship between Internet user types and social engagement. Second, due to our data structure we only investigated Internet adoption and withdrawal behavior during 2007 and 2011. Given the rapidly changing nature of the Internet and technology adoption by older adults, we acknowledge that the dynamics of adoption and withdrawal may change over time. However, although the next generation of older adults will have extensive Internet experience, different problems and solutions may arise with regard to adoption and withdrawal behaviors due to the nature of the human learning process. Moreover, the rapid pace of technological change means that “future older generations” are likely to confront an array of technologies they little understand and generally find inaccessible. According to Hanson [48], understanding the general technology-related skills of older users, identifying the strategies successfully used by this population, and finding designs that are optimized for older adults’ abilities (eg, life experiences and knowledge) are the most promising directions for research into technology or computer use by older adults. We believe that factors and reasons associated with Internet adoption and withdrawal found in this study can help to inform education or care for the elderly, a subpopulation that is not in the mainstream or main working force of a nation, and who have special needs associated with their physical and psychological degeneration. Third, due to the limitations of secondary data, this study only examined basic sociodemographic correlates. Various factors that may be related to Internet adoption or withdrawal, such as having a disability or living alone, should be examined in future research. Fourth, the definition of Internet withdrawal remains unclear in the literature. In this study, we defined it as if those participants with Internet experience had not used the Internet during the previous month. This definition is justified because, based on the cognitive competence and memory function of older adults, if such individuals do not use the Internet for one month, then their likelihood of doing so again decreases. However, the specific definition of Internet withdrawal among older adults used in the literature needs to be explored more in the future.

A critical role of technology as an important health promotion strategy for older adults in low- and middle-income countries has been proposed [49]. Our study on factors associated with Internet adoption and withdrawal provides a new lens that can help health educators to understand strategies that foster older adults in learning, an important element for active aging. Specifically, this study examining factors and reasons associated with Internet adoption and withdrawal from nationally representative data on middle-aged and older adults in Taiwan found that the learning motivation and learning models for older adults may not be different by gender, but to prevent withdrawal from learning by middle-aged and older adults, it is important that the approach be different by gender. With our findings that women were more likely to be affected by health and anthropic factors or accidental barriers, we suggest that in addition to focusing on health barriers, such as relearning to overcome cognitive declines, it is also important to work to reduce anthropic factors or accidental barriers, possibly by providing more resources, to encourage women to take more learning opportunities. In addition, for health educators to design courses and activities, it is essential that learning satisfies older adults’ needs, such as keeping up with the world or job needs, such that they gain the knowledge and skills that could increase quality of life and assist them to transition into aging successfully.