JAMA study warns telemedicine not suitable for 38% of patients over 65

Barriers to adoption include hearing issues, lack of tech abilities and visual difficulties.
By Laura Lovett
12:29 pm

While telemedicine may be having a boom, a new study published in JAMA warns that it may not be suitable for everyone. 

The study, which looked at data from adults over the age of 65, found that over a third of people weren’t ready for video visits. Researchers sited issues ranging from difficulty in hearing to tech issues. 

“Although many older adults are willing and able to learn to use telemedicine, an equitable health system should recognize that for some, such as those with dementia and social isolation, in-person visits are already difficult and telemedicine may be impossible,” authors of the study wrote. “For these patients, clinics and geriatric models of care such as home visits are essential.”


The study estimated that 38% of the13 million seniors in the U.S. are not ready for virtual visits, mainly because of inexperience with technology. That number dropped to 32% if they were provided social support for how to set up the call. 

Telephone visits also posed a challenge for an estimated 20% of those over the age of 65, according to researchers, who attribute this challenge largely to hearing issues. 


Researchers conducted a cross-sectional study using data from the 2018 National Health and Aging Trends Study. According to researchers, the study is “nationally representative of Medicare beneficiaries aged over 65 or older.”

Researchers then looked for markers that would make these patients unready to use telemedicine. These markers included difficulty hearing on the phone, even with aids; issues in speech or making oneself understood; suspected dementia; visual difficulties; lack of access to internet-connected device; and not using email, texts, or internet within a month. 

A total of 4,525 older adults were included in the study. Of those, 43% were men and 57% were women. The average age was 79.6. The majority of participants were white (69%), but also included Black (21%) and Latinx (6%) individuals. Four percent identified as “other,” which included many backgrounds such as American Indian, Asian Native Hawaiian and individuals of more than one race. 


Within the last few months, telemedicine has grown in popularity due to the coronavirus pandemic. The technology is not only becoming more mainstream, but also permanent. Earlier this week, President Donald Trump signed an executive order to make permanent the temporary flexibilities for telehealth allowed during the height of the pandemic. This means that Medicare will cover telehealth visits at no additional cost and that co-payments can be waved for the services. While the services may be more readily available, this study questions whether everyone is ready for the change. 

“There has been a massive shift to telemedicine during the coronavirus disease 2019 (COVID-19) pandemic to protect medical personnel and patients, with the Department of Health and Human Services and others promoting video visits to reach patients at home,” authors of the study wrote. “Video visits require patients to have the knowledge and capacity to get online, operate and troubleshoot audiovisual equipment, and communicate without the cues available in person.” 


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