Older Adults with Vision Issues Report Lower Digital Technology Use

Varshini Varadaraj, MD, MPH

Credit: Johns Hopkins University

A new cross-sectional national study identified an unbalanced divide in the use and knowledge of digital health technology between older adults with and without vision impairment in the United States.¹

Among nearly 3000 Medicare beneficiaries, individuals with vision impairments exhibited a reduced likelihood of digital technology access, suggesting the need for education and proper technology to increase the equitable use of telemedicine.

“Approximately 30% of Americans 71 years or older have vision impairment, and as the US population continues to age, it is crucial to identify trends in use patterns among older adults with disabilities that could further prevent them from engaging with telehealth,” wrote the investigative team, led by Varshini Varadaraj, MD, MPH, Johns Hopkins Disability Health Research Center, Johns Hopkins School of Nursing.

Older patients with disabilities often experience barriers to care, including mobility limitations, transportation issues, and the need for caregiver assistance.² Telehealth offers the potential to reduce health-related disparities by virtually connecting them to healthcare professionals and eliminating the need for an in-person physician visit.

Recent takeaways from the COVID-19 pandemic have identified disparities in key digital determinants of health, from lack of proper broadband access to the confidence in digital telehealth platforms favoring the young.³ Disproportionate telehealth use may impact older adults with vision impairment, who lack access to the technology but experience significant healthcare needs.

Varadaraj and colleagues collected data from the 2021 National Health and Aging Trends Study (NHATS), a nationally representative sample of Medicare beneficiaries 65 years and older, between June 2020 and January 2021.¹ The sample was limited to community-dwelling adults with complete vision data (distance, near, and contrast). Race and ethnicity data were assessed due to associations with differences in the rates of vision impairment and health care utilization.

Overall, the analysis evaluated 14 self-reported outcomes on digital technology access from the technological environment component of the NHATS. Vision impairment exposures, including binocular distance and near visual acuity, and contrast sensitivity with habitual correction, were measured by investigators.

Among 2822 Medicare beneficiaries, 1605 were female (54.7%) and the mean age was 78.5 years. Participants self-identified as Black (8.0%), Hispanic (7.0%), non-Hispanic White (81.7%), and non-Hispanic other race (3.4%). Of the population, 1077 (32.3%) reported any vision impairment.

Upon multivariable logistic regression, older adults with any vision impairment had a reduced likelihood of having and knowing how to use a cell phone (odds ratio [OR], 0.58; 95% CI, 0.38 - 0.88), computer (OR, 0.61; 95% CI, 0.47 - 0.79), or tablet (OR, 0.68; 95% CI, 0.54 - 0.85), compared with peers without impairments.

Meanwhile, any vision impairment was also associated with lower odds of sending messages by email or text (OR, 0.58; 95% CI, 0.45 - 0.75) and going online besides sending an email or text (OR, 0.64; 95% CI, 0.49 - 0.83). Varadaraj and colleagues indicated no other associations were observed between any vision impairment status and digital health- or non-health-related experiences.

Other models showed near visual impairment was linked with a lower likelihood of knowing how to use a phone, computer, or tablet, compared with no near visual impairment. Contrast sensitivity impairment was correlated with lower odds of having and knowing how to use a phone or computer, while distance visual impairment was only associated with reduced odds of having and knowing how to use a cell phone.

Models examining digital associations of individual continuous visual impairment measures revealed adults with worse distance visual acuity (per 0.1 logMAR) were less likely to visit with family or friends on a video call (OR, 0.91; 95% CI, 0.84 - 0.98) and to order or refill prescriptions online (OR, 0.90; 95% CI, 0.83 - 0.97).

“With the expansion and potential of telemedicine to help the older adult population better connect with health care, it is necessary to identify those who may lack digital technology access and develop equitable strategies to improve the accessibility of telemedicine, including for those with vision impairment, to improve overall well-being,” Varadaraj and colleagues wrote.

References

1. _{Thomas J, Almidani L, Swenor BK, Varadaraj V. Digital Technology Use Among Older Adults With Vision Impairment. JAMA Ophthalmol. Published online April 04, 2024. doi:10.1001/jamaophthalmol.2024.0467}
2. _{Varadaraj V, Swiatek KS, Chung SE, et al. Caring for Older Adults With Self-Reported Vision Impairment: Findings from the National Study of Caregiving. Am J Ophthalmol. 2021;227:211-221. doi:10.1016/j.ajo.2021.03.031}
3. _{Richardson S, Lawrence K, Schoenthaler AM, Mann D. A framework for digital health equity. NPJ Digit Med. 2022;5(1):119. Published 2022 Aug 18. doi:10.1038/s41746-022-00663-0}