Frailty, Lack of Caregiver Affect Older Adults' Ability to Use Virtual Care Visits

By Carolyn Crist

March 23, 2021

NEW YORK (Reuters Health) - Older adults who are frail or don't have a caregiver present may not be able to access virtual care visits with their doctors, especially video-based sessions, according to a group of geriatrics specialists in Canada.

In addition, those who can use a computer may still prefer to access virtual care via phone rather than video, Dr. Jennifer Watt of the University of Toronto and colleagues write in Age and Ageing.

"Prior to the COVID-19 pandemic, access to virtual (either telephone or videoconference) consultations and follow-up care with healthcare providers was not widely available in Ontario," Dr. Watt told Reuters Health by email.

Virtual visits were often used to provide care to older adults in rural and distant communities in Canada, the authors write, but the COVID-19 pandemic dramatically shifted the use of virtual care everywhere, including in urban areas.

"Much emphasis was being placed on the potential of videoconference platforms to revolutionize health care," Dr. Watt said. "However, my colleagues and I recognized that some patients in our geriatric medicine clinic, particularly those who did not have a caregiver to help them access a videoconference platform for their appointment, were less likely to access videoconference assessments."

The team reviewed the medical records of all patients assessed virtually in the geriatric-medicine clinic at St. Michael's Hospital in Toronto between March 17 and July 13, 2020. They looked for patient-related factors that could lead to inequities in accessing care, including age, sex, language, immigration history, education, frailty, computer ability, a history of cognitive impairment, and caregiver involvement with the appointment.

Among the 330 patients included, 227 had telephone visits and 103 had videoconference visits. The median age was 83, and 55% were women. Caregivers weren't available for about 45% of both phone-based and video-based assessments. About a third of the patients who could independently use a computer - or 32 of 98 patients - participated in video assessments.

Patients with frailty or who didn't have a caregiver present had significantly lower odds of using video rather than phone. There were no significant differences in the other factors, including cognitive status and computer ability.

If a patient didn't have a caregiver present for the virtual appointment, the probability of receiving a videoconference compared with a phone visit was less than 50%, regardless of frailty or computer ability, the authors write.

For instance, an 80-year-old woman with a high frailty score who had the ability to use a computer, had post-secondary education, didn't have cognitive impairment and had a caregiver present had a 60% probability of using video; without a caregiver, that dropped to 15%.

"People should consider asking older adults known to them if they would like help accessing or using computers and videoconference platforms," Dr. Watt said. "Some older adults are very proficient at using technology, but other older adults are not, and they may appreciate your kindness in asking."

Several studies of virtual visits during the COVID-19 pandemic have found that inequities exist for older adults, the authors write. Caregivers and clinicians should consider ways to support older adults with video appointments and use phone-based appointments when helpful.

"The most poignant example of how this is a big health issue is COVID vaccination. Older adults at home are looking for ways to get vaccinated but sometimes cannot navigate the patient portals to do so," said Dr. Kenneth Lam of the University of California, San Francisco. Dr. Lam, who wasn't involved with this study, has written about the barriers that older adults have faced with telemedicine during the pandemic.

Moving forward, healthcare providers should consider patient preferences and agency in using technology, he said, including whether older adults even want telemedicine access and how best to serve patients where they are now.

"We need to be willing and able to be tech support for the older people in our lives, especially around navigating vaccines and assisting them with medical care," Dr. Lam told Reuters Health by email. "But aging is also hard, and medical services should continue to be flexible in providing services that cater to older adults, too."

SOURCE: Age and Ageing, online February 24, 2021.


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