Older Adults With Functional Limitations and Their Use of Telehealth During COVID-19
Yijung K. Kim1 & Shannon Ang2
1Texas Aging & Longevity Center, The University of Texas at Austin
We examined whether functional limitations affected older Medicare beneficiaries' access to computer, Internet use, and telehealth utilization in 2020.
Every additional functional limitation was associated with a 3-percentage point decrease in the probability of using the Internet.
Every additional functional limitation was associated with a 2-percentage point increase in the probabiltiy of using video-based telehealth services.
Those with a consistent Internet use were more likely to use emails/texts/portal messages to communicate with a healthcare provider.
More functional limitations were associated with a higher probability of using emails/texts/portal messages for those who received informal technological support from family and friends.
The COVID-19 context changed the circumstances of many older adults who may not have needed to go online before the pandemic struck. Before 2020, pre-pandemic restrictions (e.g., geographic, administrative) around Medicare-eligible telehealth services had made it difficult to assess this relationship consistently. With access to telehealth services relatively equalized across the country due to COVID-19, we take this opportunity to assess how prior Internet use experience is associated with digital health equity among older adults with functional limitations. Data analysis using the National Health and Aging Trends COVID-19 Supplementary Survey on Medicare beneficiaries 70 years and older show that every additional functional limitation was associated with a 3-percentage point decrease in the probability of using the Internet, and 2-percentage point increase in the probabiltiy of using video-based telehealth services. Past internet use and receiving informal help with technology from family and friends also predicted Medicare beneficiaries' telehealth usage during the early phase of the COVID-19 pandemic. This project shows healthcare access may have been more difficult for older adults with functional limitations during the COVID-19 pandemic, especially for those with little prior experience with the Internet, or those without friends/family to provide technological support.
The novel coronavirus (COVID-19) outbreak in 2020 put the promises and pitfalls of digital health care to the test, as social distancing measures forced healthcare providers to postpone or shift most routine medical visits online1. To facilitate older adults’ transitions to telehealth during the public health emergency, the Centers for Medicare & Medicaid Services (CMS) expanded the scope of remote medical visits covered by Medicare and lifted existing geographic or location restrictions, leading to many welcome changes in attitudes toward and structures surrounding telehealth2. As a result, early reports estimate that more than one in four community-dwelling Medicare beneficiaries overall had a telehealth visit between the summer and fall of 20203. The rate is similarly high for the Medicare beneficiaries 70 years and older, with studies showing that the adoption of video-based telehealth grew from ~4% pre-pandemic to ~21% in 20204. However, there are growing concerns that a rapid expansion of technology could further marginalize older adults with functional limitations, who often contend with other forms of social exclusion5-7. Older adults who are homebound, institutionalized, or have greater limitations in physical capacity are less likely to own Internet-enabled devices or go online8, less likely to use e-mail/text messaging for communication9, and more likely to discontinue using everyday technology over time10, compared to those older adults without comparable health limitations. If harnessed well, telehealth or other forms of online services have the potential to improve health care access and quality for individuals experiencing mobility restrictions or transportation challenges4.
This project examined whether the social distancing measures have changed the digital participation among older Medicare beneficiaries with functional limitations and whether prior Internet use and informal social support served as essential resources.
Functional Limitations and Technology Use
Figure 1. Average marginal effects for logistic regression models predicting computer access, use of the Internet, and use of telehealth services (i.e., video calls, text/email/portal) to communicate with a healthcare provider during COVID-19; N=3,151
The Role of Recent Internet Use
Figure 2. Predicted probabilities of using emails/texts/portal messages to communicate with a healthcare provider during COVID-19, varying by the number of functional limitations and recent Internet use. Shaded area indicates confidence interval. AME=average marginal effects. **p <.01. N=3,151
The Role of Technology Support from Family and Friends
Figure 3. Predicted probabilities of using emails/texts/portal messages to communicate with a healthcare provider during COVID-19, varying by the number of functional limitations and technology support from family and friends. Shaded area indicates confidence interval. AME=average marginal effects. **p <.01. N=1,458