This study investigated the factors influencing the adoption of smart healthcare among middle-aged and older adults in Guangzhou, a city marked by concurrent trends of rapid digitalization and population aging. By integrating the "digital divide" as a core dimension into the Andersen behavioral model, a four-dimensional analytical framework was constructed and empirically tested using binary logistic regression. The results showed a 76.5% willingness rate to use smart healthcare services. Factors significantly enhancing willingness included self-rated good health (OR=2.635), the presence of chronic diseases (OR=2.615), prior experience with smart healthcare services (OR=2.979), and the ability to conduct online consultations (OR=2.676). Educational level (OR=2.532) also remained a significant factor. Notably, after accounting for the digital divide, the influence of some traditional demographic variables diminished. 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 "usage" skills and "knowledge" application. It is recommended that hierarchical and differentiated practical training and volunteer support programs be implemented through collaboration between community organizations and medical institutions.