A new study published in JAMA Ophthalmology investigated the associations between vision impairment (VI) and access to telehealth for older adults.
Give me some background first.
Specifically for older patients, telehealth can provide benefits such as:
- Convenient access to care for patients with substantial healthcare needs or mobility limitations
- Lessening the burden of transportation
- Lessening potential exposure to illnesses
- Heightening chances of earlier access to care
Now, talk about the study.
This cross-sectional study included medical beneficiaries aged 65+. Data collection took place from June 2020 to January 2021 and was gathered from the 2021 National Health and Aging Trends Study (NHATS). Data analysis was conducted in September 2023.
Investigators assessed the data of participants for:
- Near visual acuity (VA)
- Binocular distance (BOD)
- Ownership and understanding of digital devices
- Ability to send emails or texts
- Engagement in online activities
- Number of health and non-health-related activities performed online
Who was included in the study?
The study included 2,822 Medicare beneficiaries. Of the participants, 1,077 (32.3%) had some form of VI. Patient demographics were:
- Mean (SD) age 78.5 (5.6) years
- 1,605 female (54.7%)
The weighted percentages of the self-identified race and ethnicity categories were:
- 575 non-Hispanic Black (8.0%)
- 132 Hispanic (7.0%)
- 2,019 non-Hispanic White (81.7%)
- 63 non-Hispanic other race (3.4%)
- This included American Indian, Alaska Native, Asian, multiracial, Native Hawaiian, Pacific Islander, or other specified race
Findings?
The investigators found that older adults with VI were less likely to have access to digital technology than those without VI. However, there were no differences in health and non-health-related activities.
They also discovered no difference in the proportion of participants with or without VI who used telehealth for tasks such as ordering prescriptions online, completing a virtual visit, or contacting a medical professional online.
And the data?
In multivariable logistic regression models, the researchers found that when compared to participants without VI, older adults with any VI had lower odds of owning or knowledge of how to use a:
- Cellphone
- Odds ratio (OR), 0.58; 95%
- Confidence interval (CI), 0.38-0.88
- Computer
- OR, 0.61; 95%
- CI, 0.47-0.79
- Tablet
- OR, 0.68, 95%
- CI, 0.54-0.85
What was the data for participants with near VI?
In other (unspecified) models—compared to participants with no near VI—participants with near VI were found to have lower odds of ownership or knowledge of how to use a:
- Cellphone
- OR, 0.56; 95%
- CI, 0.36-0.87
- Computer
- OR, 0.57; 95%
- CI, 0.44-0.75
- Tablet
- OR, 0.65; 95%
- CI, 0.52-0.81
What about participants with CSI?
Compared to patients with no contrast sensitivity, patients with CSI had lower odds of knowledge or ownership of how to use a:
- Cellphone
- OR, 0.66; 95%
- CI, 0.45-0.99
- Computer
- OR, 0.72; 95%
- CI, 0.55-0.93
And participants with Distance VI?
Distance VI was associated with lower odds of having and knowing how to use a cellphone (OR, 0.63; 95% CI, 0.41-0.95).
Patients with worse distance acuity (per 0.1 logMAR) were found to be:
- Less likely to video call family or friends
- OR, 0.91; 95%
- CI, 0.84-0.98
- Order or refill prescriptions online
- OR, 0.90; 95%
- CI, 0.83-0.97
Limitations?
A limitation noted by the study authors was that participants were community-dwelling adults, meaning this data may have underestimated the technology knowledge of older adults who live alone or are in assisted living.
Further, the data was self-reported, which made recall bias a possibility. Additionally, the cross-sectional design of the study could not report on casual relationships.
Lastly, the researchers did not explore potential challenges and barriers to using digital technology.
Expert opinion?
The authors suggested that telehealth platforms require modifications to improve their accessibility, stating, “digital ownership and access are only the first step to telehealth equity as the telehealth platforms themselves require further modifications to enable the older adult population to use it.”
Take home.
This study highlights the potential disadvantages that older adults may face when accessing telehealth.
As such, improvements to telehealth platforms could lessen these disparities and heighten the accessibility of virtual care.