JMIR Publications

ABSTRACT

Background:

Despite increasing availability of telemedicine video visits during the COVID-19 pandemic, older adults have greater challenges in getting care through telemedicine.

Objective:

We aimed to better understand the barriers to telemedicine in community dwelling older adults in order to improve their access and experience to virtual visits.

Methods:

We conducted a mixed methods needs assessment of older adults at two independent living facilities (Sites A and B) in Northern California between September 2020 and March 2021. Voluntary surveys were distributed. Semi-structured interviews followed for participants who provided contact information. Surveys ascertained participants’ preferred devices as well as comfort level, support, and top barriers regarding telephonic and video visits. Qualitative analysis of transcribed interviews identified key themes.

Results:

Survey respondents’ (N=249) average age was 84.6 (SD = 6.6) and 77% were female. At site A, 89% had a bachelor’s degree or beyond and 99% listed English as their preferred language. At Site B, 43% had a bachelor’s degree or beyond, and 13% preferred English, while 73% preferred Mandarin. Regarding video visits, 37% of all participants felt comfortable connecting with their healthcare team through video visits. Regarding top barriers, participants at Site A reported not knowing how to connect to the platform (24%), not being familiar with the technology (22%), and having difficulty hearing (15%), whereas at Site B, the top barriers were not being able to speak English well (55%), lack of familiarity with technology and the internet (37%), and lack of interest in seeing providers outside of clinic (35%). Three key themes emerged from follow up interviews (n=15): 1) perceived limitations of video visits; 2) the overwhelming process for learning the technology for telemedicine; and 3) desire for in-person or on-demand help with telemedicine.

Conclusions:

Significant barriers exist for older adults in connecting with their healthcare team through telemedicine, particularly video visits. The largest barriers include difficulty with technology or using the video visit platform, language barriers, and lack of desire to see providers virtually. Efforts to improve telemedicine access for older adults should take into account patient perspectives.