What to know as telehealth goes mainstream

A 2019 pilot study conducted at Brigham and Women's Hospital in Boston, for instance, suggested that patients heal better at home, which echoed the experience of other academic

institutions, including Johns Hopkins and Mayo Clinic, studying the hospital-at-home model. Patients discharged earlier and treated at home with methods like remote vital-sign monitoring via

a skin patch and, when necessary, in-home services from a home health aide, physical therapist or social worker fared much better than those who remained in the hospital. What's more,

they were more active and were readmitted less often. Their care was cheaper, too, resulting in out-of-pocket savings, as compared with that of a hospital control group. Product innovations

in at-home diagnostics that are used to deliver a wider range of health care digitally could also benefit older Americans in the future, expanding current options like wearable or

implanatable devices, such as glucose sensors that monitor blood sugar levels for diabetics. Routine diagnostic tests for an array of ailments, ranging from urinary tract infections to

cholesterol screening, will soon be possible at home, experts say. WHERE TELEMEDICINE MAY FAIL OLDER ADULTS Of course, telehealth represents challenges for older Americans, and there are

times when a face-to-face visit is vital. Getting to know your physician at an initial meeting is likely better accomplished in person. So, too, is receiving any serious health news, says

Edward Lee, M.D., chief information officer at the Permanente Federation, the coalition of medical groups that are part of Kaiser Permanente. “Certainly if a physician needs to have a

difficult conversation, such as a diagnosis of cancer or an end-of-life conversation, it's hard to substitute the need to hold a patient's hand when the situation arises, and an

in-person visit is more appropriate." "Certainly if a physician needs to have a difficult conversation, such as a diagnosis of cancer or an end-of-life conversation, it's hard

to substitute the need to hold a patient's hand when the situation arises, and an in-person visit is more appropriate." Edward Lee, M.D. Plus, phone or video appointments can

prove difficult for those with dementia or someone who has difficulty hearing or communicating, according to Lam's own recent _JAMA_ study. In that study he found that more than a third

of adults over 65 (or about 13 million older adults) were not ready for telemedicine in the form of video visits; this number rose to 72 percent for those over age 85 because of

inexperience with the technology or physical disability, such as difficulty hearing, communicating, poor eyesight or dementia. Lam also points out that the benefits telehealth can provide in

managing chronic conditions might be fewer for older adults, who are often sicker. “Certainly with multiple chronic conditions and multiple disabilities, I feel I can diagnose their

conditions better in person,” he says. “And because of the social isolation many seniors experience, providing the dignity of in-person visits is very important." Getty/AARP And other

obstacles remain. More than 26 percent of Medicare beneficiaries lack digital access at home, according to an August 2020 study by University of Pittsburgh researchers published in _JAMA._ 

This made it difficult for them to have video visits with medical professionals. Perhaps not surprising, the proportion of Medicare enrollees who lacked a high-speed internet connection or a

smartphone with a wireless data plan — which are necessary for digital access — was substantially higher among those who were 85 or older, widowed, of lower socioeconomic status or in

communities of color. Seniors without digital access would have to rely on audio-only visits (by phone), which these researchers noted might not be adequate in situations where visual

monitoring or diagnosis is critical. "Telehealth does increase access to care for patients who otherwise wouldn't get it or who are fearful to go out of their homes or can't

take time off work,” says Lee of the Permanente Federation. “But at the same time, we can't ignore the fact that not everyone knows how to use the technology or has a smartphone. We

don't want to widen health care disparities.” Part of the solution is making broadband a public utility in much the same way electricity became widely available in the early part of the

past century to increase access for everyone. “Universal broadband is one of the ingredients, but seniors also need support, like a digital concierge,” says Andrew Gettinger, M.D., chief

clinical officer in the Office of the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services. “But these are all steps in the direction of

a new ecosystem which is potentially far more powerful than going to see a doctor once or twice a year. Home health is very rich and provides a whole new way of caring for folks."