Amid the pandemic, older people struggle with technology, face telehealth challenges, and are socially isolated

The increase in medical telephone service 3:22

(Kaiser Health News) - Family reunions in Zoom and FaceTime. Online ordering from supermarkets and pharmacies. Telehealth appointments with doctors.

This has saved the lives of many older adults who stayed home during the coronavirus pandemic. But the unprecedented change in virtual interactions has a downside: large numbers of older people cannot participate.

These include older adults with dementia (14% of those over the age of 71), hearing loss (almost two-thirds of those over the age of 70), and vision problems (13.5% of those over the age of 65) that can have difficulties using digital devices and programs designed without regard to their needs. (Think of the small icons on the screens, hard-to-read typefaces.)

Many older adults with limited financial resources also cannot afford the devices or associated Internet service fees. (Half of older adults living alone and 23% of those living in two-person households cannot afford basic necessities.) Others are not adept at using technology and lack the assistance to learn.

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During the pandemic, which has particularly affected older adults, this division between the "haves" and the "have-nots" technology has serious consequences.

Older adults in the “have” group have more access to virtual social interactions and telehealth services, and more opportunities to secure essential supplies online. Meanwhile, the "have-nots" are at greater risk of social isolation, giving up medical care, and have no access to food or other necessary items.

Dr. Charlotte Yeh, medical director of AARP Services, observed difficulties associated with technology this year when she was trying to teach her 92-year-old father remotely how to use an iPhone. She lives in Boston; her father lives in Pittsburgh.

Yeh's mother had always handled communication for the couple, but she was in a nursing home after being hospitalized for pneumonia. Due to the pandemic, the place had closed to visitors. To speak to her and other family members, Yeh's father had to turn to technology.

But several impediments got in the way: Yeh's father is blind in one eye, has severe hearing loss and a cochlear implant, and had trouble hearing conversations on the iPhone. And it was harder than Yeh expected to find an easy-to-use iPhone app that accurately translates speech into subtitles.

Often family members try to organize Zoom meetings. For this, Yeh's father used a computer but still had problems because he couldn't read the very small letters in Zoom. A tech-savvy granddaughter solved that problem by connecting a tablet with a separate transcription program.

When Yeh's 90-year-old mother came home in early April, doctors treating her for metastatic lung cancer wanted to arrange telehealth visits. But this could not happen through the cell phone (the screen was too small) or your computer (too difficult to move). Doctors could examine the lesions around the older woman's mouth only when she was holding a tablet at the correct angle, with a phone flashlight pointed at her for more light.

"It was too complicated," said Yeh. Her family had the necessary resources to solve these problems; many do not, she said. Yeh's mother passed away in July; her father now lives alone, making her more dependent on technology than ever.

Telehealth challenges and interventions

When SCAN Health Plan, a Medicare Advantage plan with 215,000 members in California, surveyed its most vulnerable members after the pandemic hit, it found that about a third did not have access to the technology needed for a telehealth appointment. The Centers for Medicare and Medicaid Services had expanded the use of telehealth in March.

Other barriers also stood in the way of remote service for Scan members. Many people needed translation services, which are difficult to organize for telehealth visits. "We realized that language barriers are a great thing," said Eve Gelb, Scan's senior vice president of healthcare services.

Nearly 40% of plan members have vision problems that interfere with their ability to use digital devices; 28% have a clinically significant hearing disability.

"We need to target interventions to help these people," said Gelb. Scan is considering sending community health workers to the homes of vulnerable members to help them conduct telehealth visits. Plus, he plans to give members easy-to-use devices, with essential features already set up, to keep at home, Gelb said.

Landmark Health serves a highly vulnerable group of 42,000 people in 14 states, providing services in patients' homes. Her average patient is almost 80 years old, with eight medical conditions. After the first few weeks of the pandemic, Landmark discontinued in-person home visits because personal protective equipment, or PPE, was in short supply.

Instead, Landmark tried to provide care remotely. She soon discovered that less than 25% of patients had appropriate technology and knew how to use it, according to Nick Loporcaro, the executive director. "Telehealth is not a panacea, especially for this population," he said.

Landmark plans to experiment with what he calls "facilitated telehealth" - non-medical staff members bringing devices to patients' homes and administering telehealth visits. (You now have enough personal protective equipment - EPP - for this to be possible.) And it's also looking for technology that it can provide to members.

An alternative that catches your eye is GrandPad, a tablet loaded with apps for seniors designed for adults over 75. In July, the National PACE Association, whose members run programs that provide comprehensive services to frail older people living in their homes, announced a partnership with GrandPad to encourage adoption of this technology.

"Everyone is struggling to move into this new remote care model and looking for options," said Scott Lien, the company's co-founder and CEO.

PACE Southeast Michigan purchased 125 GrandPads for highly vulnerable members after closing five centers in March where seniors receive services. The devices have been "remarkably successful" in facilitating video-transmitted telehealth and social interactions and allowing nurses and social workers to address emerging needs, said Roger Anderson, senior director of operational support and innovation.

Another alternative is iN2L technology (short for It's Never Too Late), a company that specializes in caring for people with dementia. In Florida, under a new program sponsored by the state Department of Elder Affairs, iN2L tablets loaded with dementia-specific content have been distributed to 300 nursing homes and care facilities.

The goal is to help older people with cognitive disabilities virtually connect with friends and family and participate in online activities that facilitate social isolation, said Sam Fazio, senior director of quality care and psychosocial research at the Alzheimer's Association, a partner in the effort. But due to budget constraints, only two tablets are shipped to each long-term care community.

Families report that it can be difficult to schedule adequate time with loved ones when only a few devices are available. This happened to Maitely Weismann's 77-year-old mother after she moved to a staffed Los Angeles memory care center in March. After seeing how difficult it was to connect, Weismann, who lives in Los Angeles, gave her mother an iPad and hired an assistant to make sure mother and daughter could talk every night.

Without the assistant's help, Weismann's mother would end up accidentally pausing the video or turning off the device. "She probably wanted to reach out and touch me, and when she touched the screen she would go blank and panic," Weismann said.

What is needed in the future? Laurie Orlov, founder of the blog "Aging in Place Technology Watch", said that nursing homes, care centers and senior communities need to install Wi-Fi services throughout the community, something that many lack.

“We need to enable Zoom meetings. We need the ability to put voice technology in individual rooms, so that people can access Amazon Alexa or Google products, "he said. “We need more group activities that allow multiple residents to communicate with each other virtually. And we need providers to bundle connectivity, devices, training and service in packages designed for older adults. ”

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