Telemedicine for Seniors: Helping Patients Get the Most Out of Their Visits

Out of necessity, the ongoing COVID-19 pandemic jump-started the widespread adoption of telemedicine. Most patients have welcomed the convenience and protective advantages offered by the technology, including the elderly. Despite the impressive rise in utilization rate within this demographic, however, telemedicine for seniors still presents significant, more personal challenges that cannot be ameliorated by changes in legislation alone. For this particular population—coined “unready for telemedicine”—any long-term solutions should consider factors that contribute to unreadiness, such as hearing or sight disability, challenges with speaking or conveying thoughts, possible dementia, lack of an internet-capable device, or not having used email, text messages, or the internet in the last month.

Researchers at the University of California, San Francisco, have recently published their analysis of telemedicine usage among adults age 65 and older with a mean age of 79.6 years, based on data gathered in 2018 by the National Health and Aging Trends. The analysts concluded that in 2018, roughly 13 million (38 percent) of older adults in the U.S. were considered “unready” to engage in telemedicine for seniors. Inexperience with technology emerged as the largest obstacle. However, even with social supports to address the technology angle, one-third of older adults still remained unready. The researchers estimated that one out of every five older adults was hampered by either dementia or difficulties involving hearing and/or communicating.

An accompanying study examining the 2018 American Community Survey, also published in JAMA Internal Medicine, supports these findings and additionally reveals that one-quarter of elderly Medicare beneficiaries had neither a home computer with internet access nor a smartphone with a wireless data plan. For those who did possess internet access in some form, the lack of geriatric-friendly smartphones and tablets often interfered with the use of telemedicine for seniors. Overall, older adults, who comprise one-fourth of physician office visits, are often afflicted by multiple morbidities and disabilities. The researchers expressed concern that this disparity in access to technology and the internet may result in a disparity in the care provided for this demographic, suggesting that home visits and other non-traditional forms of healthcare delivery may be a more effective strategy for this population.

To help patients feel more comfortable with telemedicine for seniors and hold more productive video visits, the following lists offer suggestions on how your practice can put older adults more at ease.

DO:

Prior to the video visit, provide written instructions with a large font size, screen shots, and concise language.
Use video, rather than audio only, to provide visual cues and lip reading.
When you speak, look directly into the camera to mimic eye contact.
If the patient is hearing-impaired, recommend headphones or a headset, or confirm the patient is wearing hearing aids.
For video visits, use captioning when available.
Make sure your face is lit evenly from the front, and focus the camera on your face.
Speak slowly and clearly.
Enlist an interpreter to translate on the patient’s side of the call.
Watch for cues that the patient doesn’t understand, like responding inappropriately or looking to someone else for a response. You can repeat your statement slowly; if the patient still does not understand, rephrase the statement/question.
Reflect back the patient’s emotions to ensure you understand correctly.
Ask the patient to repeat your instructions back to you to confirm understanding.
Afterwards, provide written instructions or summaries when possible.
Be sensitive to patients’ preferences, such as using a computer versus a smartphone.

DON’T:

Assume that older adults are not interested in telemedicine.
Raise your voice; noise-canceling software may distort the sounds.
Neglect your background; a “busy” visual background or other sounds, such as an HVAC, can distract patients trying to focus on you.
Put a light source behind you; this creates a dark silhouette and darkens your face.

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