This study investigated the factors influencing the adoption of smart healthcare among middle-aged and older adults in Guangzhou, a city characterized by the concurrent trends of rapid digitalization and population aging. By integrating the digital divide as a core dimension into Andersen's behavioral model, the study constructed a four-dimensional analytical framework. Binary logistic regression was used for empirical testing. The results showed a 76.5% willingness rate to use smart healthcare services among the respondents. Factors including good self-rated health status (OR=2.635), the presence of chronic diseases (OR=2.615) significantly increased willingness to use such services. Prior experience with smart healthcare services (OR=2.979) and the ability to use the online medical consultation service (OR=2.676) also played important facilitating roles. Educational level (OR=2.532) remained a significant factor. Notably, after incorporating the digital divide, the influence of some traditional demographic variables weakened. The study concludes that the use of smart healthcare among this population in Guangzhou is primarily driven by health needs and constrained by the digital divide, with the key barrier having shifted from access to deficiencies in the application of usage skills and knowledge. The study recommends that community organizations and medical institutions work collaboratively to provide stratified, diversified practical skill training and volunteer assistance.