Telehealth with older adults: Getting it right

(Via Journal of the American Geriatrics Society) Telehealth has tremendous potential to improve healthcare access, efficiency, and safety; the COVID pandemic has only made this more evident. The high number of excess deaths and decreased utilization of medical care early in the pandemic, especially for individuals over age 65, make the case for continued utilization of telehealth in an older adult population post pandemic.

Though having telehealth available for older adults has clear advantages, it is equally clear that guidelines need to be in place to facilitate its optimal deployment and use. This is especially true for complex or vulnerable older patients. The West Health Institute-supported Collaborative for Telehealth and Aging created and organized a set of such guidelines (see Figure 1) into three main categories: (1) patient-centered, (2) equitable and accessible, and (3) integrated and coordinated. Each of these domains must be considered if high-quality telehealth-facilitated care will be delivered to older adults. Reviewing the results of the study by Bhatia et al., which was directed at an older adult population likely to have the best possible experience of telehealth visits, through the lens of these domains elucidates significant considerations as to how telehealth is best offered to older adults.

The collaborative for telehealth and aging's principles for age-inclusive telehealth

PERSON-CENTERED

It is imperative that what matters to patients, including their goals of care (and when applicable, the caregivers' goals) are identified and kept front and center throughout telehealth visits.5 Consider the Bhatia et al. survey, which was directed at patients who utilized telehealth with their PCPs, with whom they presumably had preexisting relationships. Their experiences highlight many concerns about how telehealth may often not be patient centered. For example, many participants expressed concern that telehealth visits were shorter and more superficial than in-person visits. Twenty-two percent of respondents stated that their PCP was less likely to ask about multiple health problems and focus primarily on the chief complaint in a telehealth visit when compared to an office visit. Many respondents stated that they were less likely to share worries or concerns during telehealth visits than during office visits. These challenges related to going beyond a single surface concern into patients' deeper concerns and goals of care may be exacerbated when telehealth visits are not with PCPs and are instead with physicians with whom patients do not have a preestablished relationship. To provide person-centered care via telehealth it imperative that in every encounter the provider (1) has access to, and confirms, any relevant advance care planning documents, (2) takes the time needed to understand exactly why the patient is seeking care that day (what matters to the patient and/ or caregiver), and (3) at the end of each visit asks if the patient and/ or caregiver has any additional concerns they would like addressed during this visit outside of the chief complaint. Continue reading…