Many older people don’t feel ready to use telemedicine, study finds
Key points to remember
- 13 million people aged 65 and over show a “non-preparation for telemedicine”.
- Technology issues, physical challenges and economic circumstances are contributing factors.
- The presence and support of caregivers can increase the chances of a successful telemedicine visit.
- Some patients may continue to see their doctor in the office for in-person care. In addition, some providers will make home visits.
Advances in telemedicine have made healthcare more accessible and convenient, especially during the coronavirus pandemic. However, new research from the University of California, San Francisco indicates that nearly 13 million seniors in America don’t feel ready to have a telemedicine visit with their doctor.se.se.ssssssssssssssse.se.ssssssssssssss
Telemedicine uses a web application or phone 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 having to physically travel to the office or clinic.
While it has grown in popularity over the past decade, telemedicine currently offers patients of all ages, but especially the elderly, one particular benefit: safety against exposure to COVID-19.
“During the [COVID-19] pandemic, we recommended that the majority of patients stay at home and not leave their homes for routine medical visits. This was especially true for elderly and frail patients who are at higher risk of complications from COVID-19 ”, Jeffrey Landsman, MD, Primary care provider at Mercy Personal Physicians in Lutherville, Maryland, says Verywell.
What is telemedicine (and isn’t)
Telemedicine (also known as telehealth or virtual health) is not a substitute for in-person care that you would receive in a doctor’s office or in a hospital. Instead, it can improve your healthcare experience by:
- Put you in touch with a doctor who can diagnose and treat medical conditions that do not require practical care.
- Help you with ongoing care for chronic illnesses and conditions that are relatively easy to treat, such as getting a prescription for conjunctivitis.
- Potentially providing you with a more affordable alternative to a doctor visit.
If you or your loved one suffers from a more urgent medical problem that requires medical attention (such as a fracture), it is always best to go to an emergency care center or emergency room.
5 reasons behind the digital divide
In August 2020, researchers at UC San Francisco reported that approximately 13 million seniors in the United States are “not ready” to have a video visit with their doctor.se.se.ssssssssssssssse.se.ssssssssssssss
In their report, which draws on responses to the 2018 National Health and Aging Trends Study, the researchers also identified several factors that contribute to the preparedness of older adults, including challenges related to aging. adoption of new technologies and physical disabilities.
Inexperience with technology
The study reported that 30% of seniors were not ready for telehealth, citing their inexperience with the technology. For example, some adults do not have devices connected to the Internet, such as a computer or tablet. Of those who do, many said they did not know how to use the devices.se.se.ssssssssssssssse.se.ssssssssssssss
“Most of the tours were done using Zoom, which requires downloading to your computer or cell phone,” said Landsman, who was not involved in the study. “A lot of my older patients didn’t know how to do this.”
However, supports provided by caregivers can help older people feel less confused and frustrated as they try to adapt to new technologies. Landsman adds that when caregivers download software and provide written instructions to seniors, it can improve the success of telehealth visits.
Jeffrey Landsman, MD
Most of the tours were done using Zoom, which requires downloading to your computer or mobile phone. Many of my older patients didn’t know how to do this.
– Jeffrey Landsman, MD
Distrust of technology
According to the University of Michigan’s National Survey on Healthy Aging, 49% of seniors said they were concerned about their privacy during telemedicine visits.se.se.ssssssssssssssse.se.ssssssssssssss
In telemedicine, confidentiality and security are closely linked.se.se.ssssssssssssssMany patients want to know how their health information is stored and shared, and whether the platform used for telemedicine is secure and immune to data breaches. Seniors who are used to meeting doctors in person might be particularly concerned about the security risks of telehealth.
“Our program has encountered situations in which patients do not feel comfortable being examined by video visit due to confidentiality concerns” Karen Abrashkin, MD, medical director of the Northwell Health House Calls Program and the Clinical Call Center in New Hyde Park, New York, told Verywell.
One in five seniors said physical disabilities, including difficulty hearing, speaking or seeing, were barriers to telehealth readiness. The study also found that dementia was a potential barrier. Caregivers can help older loved ones make a meaningful connection to telehealth by removing some of these barriers.
Daniel Devine, MD, internist, geriatrician and co-founder of Devine Concierge Medicine recommends three steps caregivers can take to help an older loved one who is struggling to adjust to telehealth:
- Evaluate adequate lighting during video calls
- Be present during the first telemedicine talks to ensure successful communication
- Make sure your loved one has assistive devices, such as hearing aids or glasses, if necessary.
In April 2020, analysts at Forrester Research predicted virtual doctor visits would hit 1 billion in 2020.se.se.ssssssssssssssHowever, several patient populations, including the elderly, may not be included in this statistic.
Higher rates of telemedicine unpreparedness were found in specific patient groups.se.se.ssssssssssssssse.se.ssssssssssssss
- Black and Hispanic patients
- Patients living in rural areas
- Patients with lower education and income levels
“Many low-income seniors are already struggling to pay for their medicine, food and shelter,” says Devine, adding that the additional costs of purchasing equipment (eg, computer or smartphone), as well as data mobile phones or Internet access, make telemedicine “a luxury that 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.se.se.ssssssssssssssse.se.ssssssssssssss
Lack of social support
Social support can increase the telemedicine readiness of older people. The study found that older people who received social support performed better with video tours than those who did not.se.se.ssssssssssssssse.se.ssssssssssssss
“We rely a lot on caregivers, whether they are family members or paid caregivers, to assist our patients during telehealth visits,” says Abrashkin. “They organize the visit for the patient, are at home with the patient and are able to handle all of the technical aspects that can be challenging.
Abraskin adds that Northwell Health House Calls has launched a pilot program using paramedics that enhance the telemedicine experience by taking vital signs and performing other baseline assessments.se.se.ssssssssssssssse.se.ssssssssssssss
Possible alternatives to video tours
If a video call is not practical, phone calls or in-person visits may be encouraged.
Even with the necessary technology and social support in place, video tours don’t always go smoothly. “Poor internet connection has been an intermittent problem requiring the conversion of a video call to a phone call,” says Devine.
Doctors believe that phone visits are not considered as effective as video visits. It is worth having a video tour, if possible.
“As a geriatrician, what I see on a visit is often just as important as what the patient tells me,” Devine explains.
Daniel Devine, MD
What I see on a visit is often as important as what the patient tells me.
– Daniel Devine, MD
Visits in person
Doctors use their clinical judgment to decide whether patients need an in-person visit, either at home or at the doctor’s office. Patients may also need an office, hospital or clinic follow-up to receive outpatient services after a telehealth consultation.
“[Doctors] may need to check lab work or do additional tests like x-rays or CT scans that require in-person evaluation, ”says Landsman. Fortunately, patients can often use telemedicine to talk to their providers about test results, which combines the benefits of in-person visits and virtual health.
If technological and physical challenges prevent access to health care, some seniors may 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 rather than telemedicine,” Devine said.
What it means for you
If you have an elderly loved one, telemedicine can provide a convenient way for them to manage their health. In the midst of the COVID-19 pandemic, having a virtual tour with their supplier can also help limit their exposure to the virus.
However, it can be difficult to adapt to the necessary technology and deal with physical disabilities that can be barriers to accessing health care through telemedicine. As a caregiver, your loved one can benefit from your support, even if it is just helping them organize a video visit.
If technological challenges or physical disabilities prevent 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 home visit.