麻豆传媒

Telemedicine is increasingly seen as a key component of healthcare in the future, but many older adults are being left behind, a pair of studies in JAMA Internal Medicine suggested.

More than 41% of Medicare beneficiaries with high-speed Internet access at home, reported Eric Roberts, PhD, of University of Pittsburgh, and Ateev Mehrotra, MD, MPH, of Harvard Medical School. Nearly as many didn't have a smartphone with a wireless data plan, and one out of four didn't have either option.

And more than one-third of those older than 65 may have because they're inexperienced with technology and/or have disabilities that interfere with it, according to Kenneth Lam, MD, of the University of California San Francisco, and co-authors.

"I'm very concerned we are overlooking issues of virtual access for older adults," Lam told 麻豆传媒. "As long as clinics remain virtual, older people can't get in."

"It's like having a clinic up a flight of stairs with no ramp or elevator," he continued. "We need to realize that providing telecommunications devices -- like smart phones and tablets, and preferably geriatric-friendly ones -- in the current environment is like building a ramp to get to a virtual clinic."

Older adults account for 25% of physician office visits and often have multiple morbidities and disabilities, Lam and co-authors noted. While HHS and other organizations have promoted video visits to reach patients at home especially during the COVID-19 pandemic, these consults require patients to be able to get online, operate and troubleshoot audiovisual equipment, and communicate without the cues available during a personal visit, they added.

In their analysis, Lam and colleagues looked at 2018 data on 4,525 older adults from the of Medicare beneficiaries. The average patient in the study was 79.6 years old; 69% were white, 21% were Black, and 6% were Hispanic.

The researchers defined "telemedicine unreadiness" as meeting any of the following criteria:

• Difficulty hearing well enough to use a telephone, even with hearing aids
• Problems speaking or being 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
• Not using email, texting, or the Internet in the past month

Overall, 38% of Medicare beneficiaries -- representing 13 million older adults -- were unready for video visits. Even if people who provided social support could set up a video visit, 32% of older adults still were unready. An estimated 20% of older patients were unready for either telephone or video visits because they had difficulty hearing, difficulty communicating, or dementia.

In the other JAMA Internal Medicine study, Roberts and Mehrotra looked at 638,830 community-dwelling Medicare beneficiaries in the 2018 . They found that 41.4% had no access to a desktop or laptop computer with a high-speed Internet connection at home, 40.9% did not have a smartphone with a wireless data plan, and 26.3% lacked either form of digital access.

The proportion of Medicare beneficiaries with digital access was even lower among people who were 85 or older, widowed, had a high school education or less, were Black or Hispanic, received Medicaid, or had a disability.

"Whether this disparity in access to technology has led to a disparity in care remains to be seen," Roberts told 麻豆传媒. "We're still observing the effects of COVID and disruption in care patterns. But our study highlights a reason to be concerned that the rapid conversion of paid visits to telemedicine could widen disparities for certain populations."

While telephone visits remain an option, "the inability to see a patient and provide visual diagnosis may limit the level of care a provider can deliver," Roberts added.

"If it's a simple visit like a cholesterol medication refill, you can do that over the phone. Medically, that's pretty safe," Lam noted. But phone consults aren't always the best option.

"Older patients are more likely to face a Catch-22," Lam pointed out. "I'm more worried about a frail 90-year-old person with abdominal pain compared to a 24-year-old -- can they get groceries? can they get out of bed? -- so I want to see them more. Yet, the 90-year-old person is less likely to be able to get online with a video visit to get a better assessment. They are also at greater risk if they seek care in person because if they contract COVID, they're more likely to die."

Older people are online more than ever before and "I do not want to paint an ageist picture of our elders as Luddites because it's not true," he added. "But it's also not true that virtual care is '' as an early editorial about telemedicine claimed."

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