Critical Synthesis of Structural Disparities, Methodological Gaps, and Implementation Boundaries
The synthesis of contemporary literature demonstrates that while telemedicine provides an indispensable mechanism for chronic disease monitoring and elderly assistance (Omboni et al., 2022), its effective integration in peripheral and southern regions remains constrained by institutional, infrastructural, and evaluative bottlenecks. Evidence from the Italian National Health Service reveals a divergence between administrative aspirations and frontline clinical workflows, where healthcare professionals and managers consistently identify organizational fragmentation and deficient digital infrastructure as pivotal operational hurdles (De Rosis et al., 2023). Although remote platforms mitigate geographical isolation and sustain care continuity during health crises (Omboni et al., 2022), the prevailing implementation models often overlook the idiosyncratic vulnerabilities of aging populations residing in underserved territories. A significant research gap persists in the conceptualization and empirical evaluation of telemedicine acceptance in decentralized contexts. Current scholarship frequently relies on heterogeneous measurement practices and conflicting theoretical frameworks, which impairs cross-regional comparability and obscures the nuanced socio-technical barriers experienced by rural cohorts (Rural Telehealth Review, 2026). Moreover, institutional analyses often neglect how localized digital literacy deficits and caregiver dynamics mediate system utilization among frail older adults. This evidence review faces distinct methodological limitations. The reliance on secondary literature restricts direct validation across specific territorial health authorities, and the rapid evolution of digital health legislation across decentralized jurisdictions may alter long-term generalizability. Consequently, future research must establish harmonized evaluation metrics that account for regional systemic inequalities and long-term clinical outcomes across aging demographics.