Objective To deeply understand the intelligent management need for endocrine therapy-related symptoms in elderly breast cancer patients and their adult-child caregivers from the perspective of digital reverse mentoring, and to provide a reference for promoting intelligent symptom management. Methods A descriptive qualitative study was conducted.Using purposeful sampling, 10 pairs of elderly breast cancer patients and their adult-child caregivers were recruited for semi-structured interviews.Data were analyzed using content analysis. Results Three themes and eight sub-themes were extracted:inadequate symptom management triggering the need for intelligent management （timely symptom reporting; breaking spatio-temporal constraints; providing professional support）; digital reverse mentoring from adult children bridging the digital divide barriers (access divide; usage divide; literacy divide); and intergenerational interaction behaviors influencing digital reverse mentoring effectiveness （active engagement from both parties led to effective reverse mentoring; passive engagement from either party led to poor reverse mentoring）. Conclusion The inadequacy in managing endocrine therapy-related symptoms triggers the need for intelligent management among elderly breast cancer patients and their adult-child caregivers, yet this need is hindered by the digital divide.It is necessary to leverage digital reverse mentoring to establish a new, aging-appropriate model of intelligent symptom management involving intergenerational parti-cipation.