There has been a rather seismic shift to telemedicine across the healthcare in response to the challenges the pandemic brought.

I have written about my experience with telemedicine here.

Many clinicians wrote back. Not surprisingly, they reported, younger patients seemed to embrace telemedicine more easily and even enthusiastically. Within the right set of circumstances, telemedicine can work really well for most. For example, see this.

There are exceptions, however. And elderly patients may be one.

A recent publication in JAMA caught my attention.

A team of geriatricians, based at the UCSF, set out to estimate the degree of “unreadiness” among elderly patients.

For telemedicine to work a patient must be able to get online, operate a phone or a computer, and communicate without the usual cues available during an in-person encounter. Telephone-based visits, much less optimal than video, are simpler, but still require well-functioning equipment, an ability to get to a phone, hear well and speak clearly. (For a precise list of conditions defining “unreadiness” please see the article).

The researchers analyzed data from the 2018 National Health and Aging Trends Study. Extrapolating from it, they estimated that as many as

13 million (38%) were not ready for video visits, predominantly owing to inexperience with technology.

… an estimated 20% of older patients were unready for telephone visits because of difficulty hearing, difficulty communicating, or dementia.

and

altogether, 72% of adults who were 85 years older met criteria for unreadiness.

These are staggering numbers.

Analyzing the demographics, they concluded:

“Unreadiness was more prevalent in patients who were older, were men, were not married, were Black or Hispanic individuals, resided in a nonmetropolitan area, and had less education, lower income, and poorer self-reported health.”

And called for telecommunication devices to be covered as a medical necessity especially given the link with.

But still for many patients, this won’t be enough.

For patients with…

dementia and social isolation, in-person visits are already difficult and telemedicine may be impossible.”

These patients and others will still need an old-fashioned home visit if our healthcare system is to be equal and fair to all.