The COVID-19 pandemic has led to a significant increase in video visits between patients and their doctors, but for many older adults, the shift has cut them off from care, rather than connecting them, according to researchers from UC San Francisco.

More than a third of adults over age 65 face potential difficulties seeing their doctor via telemedicine, with the greatest challenges experienced by older, low-income men in remote or rural areas, especially those with disabilities or poor health, they suggest, in JAMA Internal Medicine.

“Telemedicine is not inherently accessible, and mandating its use leaves many older adults without access to their medical care. We need further innovation in devices, services and policy to make sure older adults are not left behind during this migration.”

— study lead author Kenneth Lam, MD, a clinical fellow in geriatrics at UCSF

Older adults account for a quarter of U.S. medical office visits and often suffer from multiple morbidities and disabilities. The U.S. Department of Health and Human Services and other organizations have promoted video visits to reach patients at home, but these visits require patients to have the knowledge and capacity to get online, operate and troubleshoot audiovisual equipment, and communicate without the cues available during a personal visit.

These Could Pose Difficulties for Older Adults

In the study, Lam and his colleagues analyzed 2018 data on 4,525 patients from the National Health and Aging Trends Study of Medicare beneficiaries age 65 or older. They examined various scenarios that would pose difficulties with a video visit, including poor hearing or eyesight; problems speaking or making oneself understood; possible or probable dementia; owning no Internet-enabled devices or lack of awareness in how to use them; and no use of email, texting or Internet in the past month. The average patient was 79.6 years old, and 69% white, 21% Black, and 6% Hispanic, a media release from University of California – San Francisco explains.

Overall, for 2018, the researchers estimated that 38% of all older Americans – 13 million total – were not ready for video visits, and 72% of those 85 or older were not, primarily due to inexperience with technology, followed by physical disability. Even with third-party support, 32% (10.8 million) of older adults still were unready, and 20% (6.7 million) could not even handle a telephone visit due to dementia or difficulty hearing or communicating.

A lack of readiness was more prevalent in patients who were older, male, unmarried, Black or Hispanic, lived rurally, and had less education, lower income and poorer self-reported health, the researchers add, in the release.

“To build an accessible telemedicine system, we need actionable plans and contingencies to overcome the high prevalence of inexperience with technology and disability in the older population. This includes devices with better designed user interfaces to get connected, digital accommodations for hearing and visual impairments, services to train older adults in the use of devices and, for some clinicians, keeping their offices open during the pandemic.”

— Kenneth Lam

[Source(s): University of California – San Francisco, EurekAlert]

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