Barriers to Telemedicine Video Visits for Older Adults in Independent Living Facilities: Mixed Methods Cross-sectional Needs Assessment

Abstract

Background Despite the increasing availability of telemedicine video visits during the COVID-19 pandemic, older adults have greater challenges in getting care through telemedicine. Objective We aim to better understand the barriers to telemedicine in community-dwelling older adults to improve the access to and experience of 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. Semistructured interviews were then conducted with 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) years, and 76.7% (n=191) of the participants were female. At site A, 88.9% (111/125) had a bachelor’s degree or beyond, and 99.2% (124/125) listed English as their preferred language. At site B, 42.9% (51/119) had a bachelor’s degree or beyond, and 13.4% (16/119) preferred English, while 73.1% (87/119) preferred Mandarin. Regarding video visits, 36.5% (91/249) of all participants felt comfortable connecting with their health care team through video visits. Regarding top barriers, participants at site A reported not knowing how to connect to the platform (30/125, 24%), not being familiar with the technology (28/125, 22.4%), and having difficulty hearing (19/125, 15.2%), whereas for site B, the top barriers were not being able to speak English well (65/119, 54.6%), lack of familiarity with technology and the internet (44/119, 36.9%), and lack of interest in seeing providers outside of the clinic (42/119, 35.3%). Three key themes emerged from the follow-up interviews (n=15): (1) the perceived limitations of video visits, (2) the overwhelming process of learning the technology for telemedicine, and (3) the desire for in-person or on-demand help with telemedicine. Conclusions Substantial barriers exist for older adults in connecting with their health care team through telemedicine, particularly through video visits. The largest barriers include difficulty with technology or using the video visit platform, hearing difficulty, language barriers, and lack of desire to see providers virtually. Efforts to improve telemedicine access for older adults should take into account patient perspectives.

Determining the Factors that Impede or Facilitate the Utilization of Telemedicine (Video Visits) for Geriatric Patients

“…In addition, other findings such as a patient's previous experience with using other software for video communication are consistent with literature, which shows that older adults can benefit from using streamlined platforms that are not only easy to use but may already be in use by the patients, so as to facilitate familiarization with the telemedicine platform adopted. 14 Also, caregiver technical assistance as a facilitator to the use of telemedicine is a finding that is supported by other studies. 14 , 19 , 20 Unsurprisingly, many older adults with dementia, cognitive impairment, or audiovisual problems have an even greater need for caregiver assistance than other older adults who do not have these concerns.…”

“… 14 Also, caregiver technical assistance as a facilitator to the use of telemedicine is a finding that is supported by other studies. 14 , 19 , 20 Unsurprisingly, many older adults with dementia, cognitive impairment, or audiovisual problems have an even greater need for caregiver assistance than other older adults who do not have these concerns. 20 …”

“…While some studies have investigated the barriers and facilitators of telemedicine in the older adult population, what made this study unique is that we sought multiple perspectives and conducted it in the early days of the pandemic, where there were a lot of upheavals and adjustments due to how telemedicine was rapidly introduced, causing providers and patients to adopt and use it quickly, 14 and giving older adult patients very little choice in terms of their preferred telemedicine experience. In addition, our study built on previous studies by providing recommendations about how the telemedicine care delivery process could be improved for older adult patients from the perspectives of the patients and other stakeholders.…”

“…In a recent study conducted by Mao et al, 14 the researchers sought to understand the barriers to telemedicine video visits in older adults to improve the experience of virtual visits as well as access to remote care. They found the largest barriers to be difficulty with technology, difficulty hearing, linguistic barriers, and an unwillingness to meet with providers virtually.…”

“… 13 Yet, while much has been studied about technology use in older adults, not much is known about the self-reported telemedicine experiences of the older adults themselves. 14 In addition, the barriers and facilitators faced by their caregivers, and health care workers as they made adjustments to care giving during the pandemic has not been studied extensively.…”