COVID-19 Exposes Geriatric Telemedicine Unreadiness

Kenneth Lam, MD

The coronavirus 2019 (COVID-19) pandemic and its ubiquitous, lasting effects have largely spurred a great shift to and dependence on telemedicine. With an increasing need to protect patients and medical personnel, the Department of Health and Human Services has recommended and encouraged the use of such virtual (video and audio) consultations that would reach patients at home. 

However, a recent research letter co-authored by Kenneth Lam, MD, et. al, identified a severe shortcoming in readiness to this shift among older US patients during the pandemic.

Lam and colleagues conducted an assessment using 2018 data from the National Health and Aging Trends Study, which is nationally representative of Medicare beneficiaries aged 65 years and older, and a cross-sectional study of 4525 community-dwelling patients.

They sought to identify demographic patterns in the target population, and understand which subpopulations were more or less prepared for the healthcare shift to telemedicine.

The use of telemedicine requires a knowledge and capacity to operate technical equipment, get online, and troubleshoot any audio or visual issues, yet many older patients are considered unready to make this shift, investigators noted. The study defined ‘unreadiness’ in video visits based on criteria ranging from communication and auditory disabilities to limited/no access to the internet and other communicative technologies.

Investigators continued with consideration to the fact that telephone consultations are generally an accepted alternative to video telemedicine visits.

A multivariable logistic regression was used to assess the odds of unreadiness for video visits by age, sex, race/ethnicity, rurality, marital status, educational level, income, and self-rated health.

Data from the study showed that 1925 (43%) of the 4525 adults analyzed were men, 2600 (57%) were woman, and the mean age was 79.6 (SD: 6.9) years. Most (n = 3119 [69%]) were non-Hispanic White; 952 (21%) were non-Hispanic Black, and 273 (6%) were Hispanic individuals.

According to these demographics and analyses, the investigator estimated that in 2018, 13 million (38%) of all older adults were considered not ready for video visits. With removal of older adults who had individuals in their social networks who were knowledgeable in setting up video visits for them, the total decreased to 10.8 million (32%). 

About 20% of patients were considered unready for telephone visits due to communicative disabilities.

Lam and colleagues noted that the demographics typically facing unreadiness in this shift to telemedicine were older, men, Black or Hispanic, residents of nonmetropolitan areas, those with less education and lower income, and poorer self-reported health. 

Investigators acknowledged limitations including patients who were lost to follow-up, and a selection bias resulting from that. 

Overall, they urged a great need for policymakers to address and close this gap in the geriatric population. It is necessary, they argued, to offer accessibility in patients with visual or auditory impairments and provide easier access to telecommunication devices.

“Although many older adults are willing and able to learn to use telemedicine,” they concluded, “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. For these patients, clinics and geriatric models of care such as home visits are essential.”

This research letter, “Assessing Telemedicine Unreadiness Among Older Adults in the United States During the COVID-19 Pandemic,” was published online in JAMA Internal Medicine