Using nudges to promote health among older adults: A scoping review

Background: Nudge is an attempt to easily and cheaply influence an individual's health judgments, decisions, or behaviors in nuanced and predictable ways. To date, there are no published reviews of the evidence for or against nudges as health promotion strategies in older adults. Objective: This review aims to summarize what is known about the impact of various nudges that target different kinds of health behavior in older adults. Design: A scoping review. Review methods: We conducted a comprehensive search across the PubMed, Web of Science, Embase, EBSCOhost, and the Cochrane Library databases from the earliest available date to March 2024. To gain a broad understanding of this field, we used relevant search terms related to 'nudge' and 'older adult'. All articles selected and data extracted were double-checked. Nudges were summarized and analyzed according to Thaler's dual-systems theory taxonomy. Results: Overall, 18 articles were selected. Nudges have been applied to reduce overuse in healthcare (n = 7), enhance vaccination uptake (n = 4), raise dietary intake (n = 3), increase physical activity (n = 1), improve lifestyle management (n = 1), improve hand hygiene (n = 1), and improve terminal treatment (n = 1). Twelve nudges were used to promote health for older adults. Type I nudges included environmental cues, reminders, default options, and feedback. Type II nudges were framing, social norms, social comparison, highlighted suggested choices, pre-commitment, accountability justification, expert authority, and gamification. Most, but not all, nudges have proven to be feasible and effective for health promotion among older adults. Conclusions: This encouraging evidence suggests there is potential for nudges to promote health among older adults. Future research should tailor nudges to individual and cultural characteristics, explore the most effective nudges and long-term effects, expand nudges to more health domains, implement age-friendly digital nudges, and analyze the nursing economics of nudges. Registration: Open Science Framework websites (OSF.IO/PGY25).