Is Telehealth in the Future of Older People?

Older people experienced a radical change in their lifestyles during the COVID-19 pandemic. They felt trapped in their dwellings, legitimately fearing exposure to contagious outside worlds.  

However, even awful events may have silver linings. To cope with their imposed dwelling-centered way of life, older people embraced gerontechnological solutions, which many had downplayed or ignored. They found new and productive ways to get needed goods and services and interact with family and friends without leaving their homes.  

They became more frequent users of digital technology, relying on internet-equipped computers, iPads, and smartphones to access e-commerce providers such as Amazon to purchase all kinds of merchandise or food delivery apps to get their groceries or evening meals.  

They discovered how apps such as FaceTime or Skype enabled them to communicate with family members via video. They accessed online libraries to read their favorite books and bank websites to manage their checking accounts. They could even feel fully present at their internet-streamed religious services. 

One important category of services saw notably accelerated use during the pandemic. Older people could consult with their doctors and clinics in the comfort of their homes. They discovered that telehealth (or telemedicine) solutions could sometimes substitute for in-person doctor or clinic visits and help keep the continuity of their healthcare. 

So, What Does Telehealth (or Telemedicine) Include? 

Using their familiar smartphones, iPads, and internet-connected computers, older people communicate with their doctors, physician assistants, nurse practitioners, and mental health counselors. These telehealth visits occur "virtually" through online video chats or video conferencing, such as Zoom or similar platforms. Telehealth solutions may also include traditional telephone consultations.  

These virtual care visits achieve similar goals as conventional in-person healthcare appointments: to diagnose, monitor, manage, and treat a person's health conditions.  

The telehealth umbrella also includes using medical providers' online messaging portals to provide lab test results. Thus, older people can quickly check if their blood profiles reveal a bacterial infection or if their sugar and cholesterol readings are normal. 

Telehealth solutions are also a good fit for older people who use wearable devices (e.g., smartwatches, adhesive patches) with sensors measuring their vital signs or other physiological indicators. These devices can digitally transmit their findings to healthcare providers for review in virtual care sessions. 

Divergent Opinions of Healthcare Professionals 

Healthcare professionals have mixed reactions to telehealth solutions (particularly videoconferencing). After the virus scare, they relied less on this alternative, but their current use levels are still higher than in pre-pandemic times.  

Detractors argue that older people's health issues demand onsite diagnostic and treatment procedures—that is, hands-on assessments and care—which online video sessions simply cannot accomplish. They point out that online video facial interactions do not capture crucial nonverbal body cues—how a patient looks, moves, or acts. Making comprehensive "whole person" assessments and achieving good patient rapport is difficult.  

Consequently, they argue that telehealth "does not suit every clinical situation or individual patient preference." They fear that virtual visits risk poorer patient outcomes than in-person visits.  

They also assert that telehealth visits are not profitable. They complain about restrictive and expensive regulatory policies, the lack of uniform national performance standards, lower private and public insurance reimbursement levels, the extra costs of staff training, the need to buy and manage equipment and software to operate telehealth, and the difficulties of integrating telehealth clinical data with how they schedule, bill, and store (physically and electronically) their patients' health records. They lament lost clinical time because they must help some patients use technology to conduct their visits.  

Adding to the negatives are those unscrupulous providers guilty of fraudulent telehealth claims, such as selling older people unnecessary medical equipment and prescriptions.  

Proponents have a different take. 

They emphasize that telehealth solutions do not have to be an all-or-nothing proposition. Many health issues—regular preventative checkups for chronic conditions, postoperative care, and mental health problems—can be managed and treated with virtual care or a combination of onsite appointments and virtual care. 

Telehealth solutions hold particular promise for those "with chronic disease and multiple health problems, who require frequent office visits, ongoing  monitoring, and disease management." Defenders also point to the convenience of reviewing lab results with online patients and prescribing future courses of action. 

The Perspective of Older Consumers 

Older patients tend to favor telehealth solutions more than healthcare providers. Immunocompromised older people are particularly anxious about being around others with sicknesses and germs. 

Older people's family members also appreciate the telehealth approach. Wherever they live, they can be looped into their loved ones' virtual visits and join the conversation. 

Obtaining healthcare becomes physically and financially easier. Finding affordable transportation to destinations is often difficult for those with mobility limitations. Accessibility is especially an issue for older people living in "healthcare deserts," such as rural areas or towns, where doctors and clinics are scarce, especially medical specialists and mental health practitioners. Consequently, telehealth solutions may be an antidote for those guilty of not showing up for their onsite medical appointments. 

Both older patients and their providers lose out because of these missed visits. When older people do not see their doctors promptly, they suffer from poorer health outcomes and higher mortality rates. Healthcare providers experience lower productivity and lost revenue. 

Fear of Technology 

However, not all older consumers are enthusiastic about telehealth solutions. They shy away from virtual care for the same reasons they reject other gerontechnological innovations. They are reluctant to embrace solutions that seem too complicated to use and deviate from their past practices. Still others have poor access to broadband and video-capable devices. Others fear losing the trusting doctor-patient relationship. 

They also realistically worry about patient privacy and data security violations or being charged higher out-of-pocket costs because of inadequate insurance coverage.  

Predicting the Future of Telehealth 

Although not a perfect nor necessarily a standalone alternative, telehealth solutions are one effective strategy for older people to address their physical and mental healthcare needs.  

Over the next two decades, the disproportionately large growth of older people in their late 70s and older will steadily lead to a higher demand for telehealth solutions. This group is at greater risk of healthcare problems even as their mobility limitations make it more challenging for them to access the destinations of their doctors and clinics. More telehealth options will be a win-win for these patients and their doctors.  

In the future, a larger share of older people will also adopt wearable devices informed by artificial intelligence algorithms that digitally transmit an increasingly extensive array of personal health information to their doctors and clinics. Thus, the salience of telehealth solutions will increase. 

The future old—a more educated and resilient group—will want more, not fewer, choices in how they receive their healthcare. Responding to the realities of this changing elder consumer market, private and public healthcare insurers and government agencies will change their practices, regulations, and policies to make it easier and more affordable to use telehealth solutions.  

For all these reasons, experts in the United States and Canada are optimistic that telehealth solutions will regain their earlier market share and that this already multibillion-dollar industry will become increasingly attractive to patients and their healthcare providers. 

About the Author 

Stephen M. Golant, Ph.D., is a leading national speaker, author, and researcher on the housing, mobility, transportation, and long-term care needs of older adult populations. He is a Fellow of the Gerontological Society of America, a Fulbright Senior Scholar award recipient, and a Professor Emeritus at the University of Florida. Most recently, he received the prestigious M. Powell Lawton Award from the Gerontological Society of America for his significant contributions to gerontology. Golant's latest book is Aging in The Right Place, published by Health Professions Press. You can contact Stephen at [email protected].