Emerging and Evolving Applications of Telemedicine for older adults: A Scoping Review

INTRODUCTION: The rate of utilization of virtual care has remained steady after dramatic initial growth in the wake of the COVID-19 pandemic. During the pandemic, telehealth was primarily used to limit in-person patient-physician interactions while still allowing patients to meet meaningfully with their providers. Following the pandemic, virtual care has continued to adapt to enhance the care of older adults, but many opportunities remain to tailor telecare for the geriatric population. However, as virtual care usage increased, some barriers to utilizing this care modality have emerged. Digital literacy amongst older adults is often limited, and they may need help in order to fully utilize new innovations (Adrien et al. 2022). Thus, pandemic-induced rapid up-scaling of virtual care may have disenfranchised segments of the population, including older adults (Tan-McGrory et al. 2022), despite improving access to care and reducing costs for other segments. Thus, we aimed to conduct a scoping review to identify early evidence of barriers to care unique to older adults. We identify the challenges geriatric patients face with virtual care and the financial, social, physical health, and digital safety barriers that must be overcome if virtual care is to be adopted widely. METHODS: We reviewed literature published from March 1(st), 2020, to June 1(st), 2022. March 2020 was set as this is the time when a significant transition to virtual care took place due to the COVID-19 pandemic. Literature was identified using ‘virtual care’ and ‘geriatric’ as search terms. This produced 189 results. It included 1 editorial, 22 perspective pieces, 133 studies, 27 reviews, 3 study protocols, and 3 unrelated searches. Within these results, 1 editorial, 2 perspective pieces, 6 studies, and 3 reviews were included based on relevance. RESULTS: We identified several barriers to access virtual care for the geriatric population. We divided these into barriers related to aging, financial considerations, psychosocial concerns, and safety concerns. Aging barriers included physical limits such as diminished vision, hearing, and mental acuity (Wilson et al 2021). Financial considerations include costs of both software and hardware related to virtual care access. Psychosocial concerns include living in urban versus metropolitan areas, level of education, and cultural background. Safety concerns included data privacy and targeted advertisement in the elderly. When scheduling for virtual care modalities with geriatric patients, 38% of the patients were not ready for their video call appointments, and 20% were unprepared for telephone-based appointments (Lam et al 2020). In a study on homebound patients, providers frequently demonstrated a poor grasp of the barriers that their patients face. 72% of providers were unaware of whether their patients had access to stable internet, and 65% of providers were did not know if their patients could afford a cellular data plan. Nearly half (48%) of providers were unaware of whether their patients owned or had access to a device capable of facilitating a video-based appointment (Kalicki et al, 2021). These issues are paramount given that older adults comprise 15.2% of the U.S. population in 2016. CONCLUSIONS: Barriers to telecare are not always obvious, and frequently not considered in detail during treatment planning with a patient and risk becoming entrenched. Systematic identification of the types of barriers that exist will pave the way for a more equitable virtual geriatric psychiatry landscape. (Lam et al, 2020). THIS RESEARCH WAS FUNDED BY: This work is supported in part by an unrestricted gift from the Eric Warren Goldman Charitable Trust.