There has been a massive shift to telehealth care delivery in response to the COVID-19 pandemic, but a new study finds that nearly four in ten older adults are not ready for video visits, primarily due to inexperience with technology.
The research, recently published in JAMA Internal Medicine, noted that video visits require patients to have the knowledge and capacity to get online, operate and troubleshoot audiovisual equipment, and communicate without the cues available in person. Many older adults may be unable to do this because of disabilities or inexperience with technology, so researchers examined how many older adults may be left behind in the U.S. in the migration to telemedicine.
The study of more than 4,500 U.S. adults included 2018 data from the National Health and Aging Trends Study, which is nationally representative of Medicare beneficiaries aged 65 or older.
Envisioning telemedicine as direct-to-patient video visits, the researchers defined unreadiness as meeting any of the following criteria for disabilities or inexperience with technology: difficulty hearing well enough to use a telephone (even with hearing aids); problems speaking or making oneself understood; possible or probable dementia; difficulty seeing well enough to watch television or read a newspaper (even with glasses); owning no internet-enabled devices or being unaware of how to use them, or; no use of email, texting, or internet in the past month.
From their analysis, the researchers were able to estimate that of all older adults in the U.S., 13 million (38 percent) were not ready for video visits, predominantly owing to inexperience with technology. Assuming individuals in the role of social supports knew how to set up a video visit, the estimated number of older adults who were still unready was 10.8 million (32 percent). Telephone visits may reach more patients, the study’s authors noted, but nonetheless, an estimated one in five older patients were unready for telephone visits because of difficulty hearing, difficulty communicating, or dementia.
What’s more, unreadiness was more prevalent in patients who were older, were men, were not married, were Black or Hispanic individuals, resided in a nonmetropolitan area, and had less education, lower income, and poorer self-reported health; altogether, 72 percent of adults who were 85 years or older met criteria for unreadiness.
Importantly, the researchers pointed out, older adults account for 25 percent of physician office visits in the U.S> and often have multiple morbidities and disabilities.. They noted that 13 million older adults may have trouble accessing telemedical services, and a disproportionate number of those may be among the already disadvantaged. Telephone visits may improve access for the estimated 6.3 million older adults who are inexperienced with technology or have visual impairment, but phone visits are suboptimal for care that requires visual assessment, they stated.
As such, the researchers concluded, “Policies should recognize and bridge this digital divide. As of early 2020, the Centers for Medicare & Medicaid Services [CMS] was reimbursing telephone visits at rates matching in-person and video visits, aligning reimbursement with reality for those who cannot use video visits. As telemedicine becomes ubiquitous, telecommunication devices should be covered as a medical necessity, especially given the correlation between poverty and telemedicine unreadiness. Furthermore, accessibility accommodations, such as closed captioning for those with hearing impairment, should be extended to virtual visits.”
Indeed, during the public health emergency, CMS added 135 services such as emergency department visits, initial inpatient and nursing facility visits, and discharge day management services, that could be paid when delivered by telehealth. Just this week via a new proposed rule, CMS is proposing to permanently allow some of those services to be done by telehealth, including home visits for the evaluation and management of a patient (in the case where the law allows telehealth services in the patient’s home), and certain types of visits for patients with cognitive impairments.
