- 13 million people aged 65 or older demonstrate “telemedicine unreadiness.”
- Issues with technology, physical challenges, and economic circumstances are contributing factors.
- Caregiver presence and support can increase the chances of a successful telemedicine visit.
- Some patients might be able to continue to see their doctor at the office for in-person care. Additionally, some providers will make house calls.
Advances in telemedicine have made healthcare more accessible and convenient, particularly during the coronavirus pandemic. However, new research from the University of California, San Francisco indicates that nearly 13 million older adults in America do not feel ready to have a telemedicine visit with their doctor.
Telemedicine uses a web application or a telephone call to help connect doctors and patients remotely. Through these visits, patients can manage medical conditions such as diabetes, respiratory infections, and even depression without needing to physically go to the office or clinic.
While it’s been gaining popularity over the last decade, telemedicine currently offers patients of all ages, but especially older adults, a particular advantage: safety from exposure to COVID-19.
“During the [COVID-19] pandemic we were recommending that the majority of patients stay home and not leave their homes to go to routine doctor’s visits. This was especially true for frail, elderly patients who are at higher risks for complications from COVID-19,” Jeffrey Landsman, MD, Primary Care Provider at Mercy Personal Physicians in Lutherville, Maryland, tells Get Meds Info.
What Telemedicine Is (and Isn’t)
Telemedicine (also called telehealth or virtual health) doesn’t replace the in-person care that you would receive in the doctor’s office or a hospital. Instead, it can enhance your experience with healthcare by:
- Connecting you with a doctor who can diagnose and treat medical conditions that don’t need hands-on care.
- Helping you follow-up on care for chronic medical conditions and relatively easy to treat ailments, such as getting a prescription for pink eye.
- Potentially provide you with a more affordable alternative to a doctor’s office visit.
If you or your loved one has a more urgent medical condition in need of medical care (such as a broken bone) it’s still best to go to an urgent care center or the emergency room.
5 Reasons Behind the Digital Divide
In August 2020, researchers from UC San Francisco reported that an estimated 13 million older adults in the United States are “unready” to have a video visit with their doctor.
In their report, which drew from 2018 survey responses from the National Health and Aging Trends Study, the researchers also identified several contributing factors to seniors’ unreadiness, including the challenges of adopting new technology and physical disabilities.
Inexperience with Technology
The study reported that 30% of older adults were unready for telehealth, citing their inexperience with technology. For example, some adults don’t have Internet-enabled devices, such as a computer or tablet. Of those who do, many reported not knowing how to use the devices.
“Many of the visits were done using Zoom, which requires a download to your computer or cell phone,” Landsman says, who was not involved with the study. “Many of my older patients did not know how to do this.”
However, supportive measures provided by caregivers can help seniors feel less confused and frustrated when trying to adapt to new technology. Landsman adds that when caregivers download software and provide written instructions for older adults, it can improve the success of telehealth visits.
Jeffrey Landsman, MD
Many of the visits were done using Zoom, which requires a download to your computer or cell phone. Many of my older patients did not know how to do this.
Mistrust of Technology
According to the University of Michigan’s National Poll on Healthy Aging, 49% of older adults reported being concerned about privacy during telemedicine visits.
In telemedicine, privacy and security are closely linked. Many patients want to know how their health information is stored and shared, and whether the platform being used for telemedicine is secure and immune to data breaches. Older adults who are used to face-to-face encounters with doctors might be especially worried about the security risks of telehealth.
“Our program has encountered situations in which patients do not feel comfortable being examined via video visit due to privacy concerns,” Karen Abrashkin, MD, medical director at Northwell Health House Calls Program and Clinical Call Center in New Hyde Park, New York, tells Get Meds Info.
One out of five older adults reported that physical disabilities, including difficulty hearing, speaking, or seeing, were barriers to telehealth readiness. The study also found dementia to be a potential barrier. Caregivers can help older loved ones make a meaningful telehealth connection by addressing some of these barriers.
Daniel Devine, MD, internist, geriatrician, and co-founder of Devine Concierge Medicine recommends three steps caregivers can take to support an older loved one struggling to adapt to telehealth:
- Assess for adequate lighting during video calls
- Be present during the first few telemedicine interviews to ensure successful communication
- Make sure your loved one has assistive devices, such as hearing aids or glasses, if needed.
In April 2020, analysts at Forrester Research predicted that virtual health visits would reach 1 billion in 2020. However, several patient populations, including older adults, might be missing from this statistic.
Higher rates of telemedicine unreadiness were found in specific patient groups.
- Black and Hispanic patients
- Patients living in rural areas
- Patients with lower levels of education and income
“Many lower-income older adults are already struggling to afford their medications, food, and shelter,” Devine says, adding that the additional costs of buying hardware (e.g., computer or smartphone), as well as mobile data or Internet access, make telemedicine “a luxury some cannot afford.”
The study suggests that the Centers for Medicare & Medicaid Services (CMS) should cover the costs of telecommunication devices as a medical necessity, especially as telemedicine becomes more universal.
Lack of Social Support
Social support can increase older adults’ telemedicine readiness. The study found that older adults who had social support did better with video visits than those who did not.
“We rely heavily on caregivers, either family members or paid caregivers, to assist our patients with telehealth visits,” Abrashkin says. “They set up the visit for the patient, are at the home with the patient, and are able to handle all of the technical aspects that can pose challenges.”
Abraskin adds that Northwell Health House Calls started a pilot program using EMTs who enhance the telemedicine experience by taking vitals and performing other basic assessments.
Possible Alternatives to Video Visits
If a video call is impractical, phone calls or in-person visits may be encouraged.
Even with the necessary technology and social support in place, video visits don’t always go smoothly. “Poor internet connection has been an intermittent problem requiring conversion from a video call to a phone call,” Devine says.
Physicians feel telephone visits are not considered as effective as video visits. It’s worth the effort to have a visit through video, if possible.
“As a geriatrician, what I see during a visit is often equally as important as what I am being told by the patient,” Devine says.
Daniel Devine, MD
What I see during a visit is often equally as important as what I am being told by the patient.
Doctors use their clinical judgment to decide if patients need an in-person visit, either in their home or at the doctor’s office. Patients might also need to follow-up at the office, hospital, or clinic to receive outpatient services after a telehealth consult.
“[Doctors] may need to check lab work or do additional testing like X-rays or CAT scans that require an in-person evaluation,” Landsman says. Fortunately, patients can often use telemedicine to speak with their providers about test results, which blends the benefits of in-person visits and virtual health.
If technological and physical challenges prevent access to healthcare, some older adults might need in-person visits instead of phone or video calls.
“Patients with dementia, severe vision loss, or advanced hearing loss will benefit from in-person visits over telemedicine,” Devine says.
What This Means For You
If you have an elderly loved one, telemedicine can provide them with a convenient way to manage their health. In the midst of the COVID-19 pandemic, having a virtual visit with their provider can also help limit their exposure to the virus.
However, it can be hard to adapt to the necessary technology and address physical disabilities that can be barriers to accessing healthcare via telemedicine. As a caregiver, your loved one can benefit from your support—even if it’s just helping them set up a video visit.
If technological challenges or physical disabilities are keeping telehealth from being a viable option, your loved one’s doctor might still be willing to see them in the office or even make a house call.