Many older adults not ready for telehealth

Many older adults were not ready to shift to telehealth services during the COVID-19 pandemic, according to research published in JAMA Internal Medicine.

“There has been a massive shift to telemedicine during the [COVID-19] pandemic to protect medical personnel and patients, with the Department of Health and Human Services and others promoting video visits to reach patients at home,” Kenneth Lam, MD, a clinical fellow in the division of geriatrics in the department of medicine at the University of California, San Francisco, and colleagues wrote. “Video visits require patients to have the knowledge and capacity to get online, operate and troubleshoot audio visual equipment, and communicate without the cues available in person.”

To investigate the readiness of older adults in the United States to access telehealth services, Lam and colleagues conducted a cross-sectional study using 2018 data from the National Health and Aging Trends study, a nationally represented sample of Medicare beneficiaries aged 65 years and older.

Older adult readiness for telehealth

Lam and colleagues defined unreadiness to access telehealth among participants as not being able to hear well enough to use a phone, having issues with speaking or conveying thoughts, possibly being affected by dementia, not being able to see well enough to read a newspaper or watch TV with glasses, not owning or being able to use a device that can connect to the internet, or not using the internet, emailing or texting in the last month.

They assessed 4,525 adults (mean age, 79.6 years) for unreadiness for telehealth based on four scenarios: video visits; video visits for those with social supporters, assuming that the supporters were telehealth ready; telephone visits with disability criteria limited to difficulty speaking, difficulty communicating or dementia, and technology criteria lowered to absence of a telephone; and telephone visits, assuming patients had social supporters who were telehealth ready.

Based on the findings, the researchers estimated that in 2018, 13 million older adults — or 38% of all older adults in the United States — were not ready to engage in telehealth visits. They noted that this was mostly due to inexperience with technology.

When the researchers considered social supports for older adults who were able to set up video visits, 10.8 million older adults — or 32% of older adults in the U.S. — were still not ready for telehealth visits.

Although telephone visits may be able to reach more patients, Lam and colleagues estimated that 20% of older adults were not ready to engage in telephone visits due to difficulty hearing, difficulty communicating or dementia.

Lam and colleagues noted that to address this digital divide, telecommunications devices should be treated and covered as a medical necessity, and features like closed captioning should be included in video visits.

“Although many older adults are willing and able to learn to use telemedicine, an equitable health system should recognize that for some, such as those with dementia and social isolation, in-person visits are already difficult and telemedicine may be impossible,” Lam and colleagues wrote. “For these patients, clinics and geriatric models of care such as home visits are essential.”

Medicare beneficiaries and telehealth

In another study published in JAMA Internal Medicine, Eric T. Roberts, PhD, assistant professor of health policy and management at the University of Pittsburgh Graduate School of Public Health, and colleagues examined disparities in access to technology for video telehealth visits among Medicare beneficiaries.

“In response to the [COVID-19] pandemic, Medicare temporarily expanded its coverage of telemedicine to all beneficiaries, included visits in the patient’s home, and began paying for audio-only visits at the same rate as video and in-person visits,” the researchers wrote.

Roberts and colleagues analyzed data from the nationally representative 2018 American Community Survey to determine the prevalence of Medicare beneficiaries who did not have a desktop or laptop computer with high-speed internet, a smartphone with wireless data plan, or either.

A total of 638,830 surveyed adults — representing 54,749,082 community-dwelling Medicare beneficiaries when weighted — were included in the study.

Of those, 41.4% (95% CI, 40.4-42.4) did not have access to a desktop or laptop computer with internet connection at home, 40.9% (95% CI, 40.0-41.8) did not have a smartphone with a wireless data plan and 26.3% (95% CI, 25.5-27.1) did not have access to either.

According to the researchers, the proportion of beneficiaries with digital access was lower for those with a high school education or lower, those who were Black or Hispanic, and those below the federal poverty level.

The researchers also found that many older beneficiaries did not have digital access, with no access in 38.4.% (95% CI, 37.2-39.6) of those aged 80 to 84 years and 50% (95% CI, 48.7-51.2) of those aged 85 years or older.

“Our results underscore a need to address disparities in digital access among patients,” Roberts and colleagues wrote.

They suggested expanding programs that provide reduced-cost phone and internet services to families with incomes below the poverty level and addressing the needs of patients who may require assistance to use technology for video telehealth visits.

“Addressing these factors associated with digital access in populations with low socioeconomic status will be important as the use of telemedicine increases,” Roberts and colleagues wrote.

References:

Lam K, et al. JAMA Intern Med. 2020;doi:10.1001/jamainternmed.2020.2671.

Roberts ET, et al. JAMA Intern Med. 2020;doi:10.1001/jamainternmed.2020.2666.