SAN DIEGO—Jan. 25, 2023—The COVID-19 pandemic put extraordinary strain on the U.S. healthcare system, but it also accelerated the adoption of telehealth—especially among older adults, who were the least likely to engage in remote care beforehand.
For these patients, telehealth has proven to offer faster referral times, reduced travel, lower costs and a host of other benefits that make it an attractive option for a wide range of healthcare needs. Yet, many challenges have emerged for older adults who engage in remote care—challenges that telehealth services simply weren’t designed to address.
For example, older adults are far more likely than the average patient to experience technological barriers, cognitive issues, and physical limitations such as poor eyesight or hearing that can disrupt their telehealth experience. They also tend to have more complex medical histories, requiring greater coordination with other healthcare providers.
A first-ever set of principles and guidelines for providing telehealth to older patients is laid out in a new article published in the Journal of the American Geriatrics Society, a first step in ensuring that regardless of age, patients are able to reap the benefits of high-quality remote care.
“We’ve seen how telehealth can be a vital tool for caring for older adults, particularly those who are homebound, lack transportation, have mobility challenges or live in rural areas where specialists may be non-existent or difficult to access,” says Liane Wardlow, Ph.D., senior director of Clinical Research and Telehealth at West Health and a lead author of the study. “The challenges older patients experience with telehealth aren’t insurmountable; they can be addressed by designing remote care in a more intentional way.”
Weighing the vast potential of telehealth against the ongoing challenges of serving older patients, West Health in September 2021 convened a group of cross-disciplinary experts to produce the first-ever guidelines for offering telehealth safely and effectively to seniors. The group, called the Collaborative for Telehealth and Aging, includes healthcare providers, patient advocates and experts in geriatrics, telemedicine and more.
The principles and guidelines spelled out in the new article are the result of more than a year of iterative, consensus-driven work. The three principles offer general rules to guide behavior, while the guidelines provide specificity for each principles, with individual goals that programs and providers should aim to achieve. The principles state that telehealth care should be:
- Person-centered. Telehealth programs should be designed to meet the needs and preferences of older adults by considering their goals, family and caregivers, linguistic characteristics, and readiness and ability to use technology.
- Equitable and accessible. Telehealth programs should address individual and systemic barriers to care for older adults by considering issues of equity and access.
- Integrated and coordinated across systems and people. Telehealth should limit fragmentation, improve data sharing, increase communication across stakeholders, and address both workforce and financial sustainability.
As a next step, members of the Collaborative for Telehealth and Aging are working to create implementation strategies focused on how to operationalize the current recommendations.
“We recognize that creating and implementing solutions that adhere to the general principles and guidelines will depend greatly upon local context and the unique circumstances of health systems and the patients they serve,” Wardlow says. “A solution for a healthy 95-year-old may be vastly different than a solution for a homebound 65-year-old, and a solution in a rural area may be quite different from a solution in an urban area. Our goal is to leave room for flexibility while keeping a constant commitment to addressing healthcare disparities.”
In addition to Wardlow, authors of the article, “Development of telehealth principles and guidelines for older adults: A modified Delphi approach,” include Bruce Leff, M.D., Kevin Biese, M.D., Carly Roberts, MPH, Laurie Archbald-Pannone, M.D., Christine Ritchie, M.D., Linda V. DeCherrie, M.D., Neal Sikka, M.D., and Suzanne M. Gillespie, M.D. All are members of the Collaborative for Telehealth and Aging.
About West Health
Solely funded by philanthropists Gary and Mary West, West Health is a family of nonprofit and nonpartisan organizations including the Gary and Mary West Foundation and Gary and Mary West Health Institute in San Diego, and the Gary and Mary West Health Policy Center in Washington, D.C. West Health is dedicated to lowering healthcare costs to enable seniors to successfully age in place with access to high-quality, affordable health and support services that preserve and protect their dignity, quality of life and independence. Learn more at westhealth.org and follow @westhealth.
Journal of the American Geriatrics Society
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Development of telehealth principles and guidelines for older adults: A modified Delphi approach
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The following authors have conflicts that they acknowledge related to this manuscript. Dr. Biese is an advisor at Third Eye Tele Health and UNC Health Alliance Board member. Dr. DeCherrie is a board member of the American Academy of Home Care Medicine and an employee of Medically Home. Dr. Swati Gaur is the Treasurer for AMDA – The Society for Post-Acute and Long Term Care. Dr. Gillespie is a board member of AMDA – The Society for Post-Acute and Long Term Care. Mr. Hoffmeyer is employed by Avel eCare. Dr. Leff is a clinical advisor to Dispatch Health, Medically Home, CVS, and Chartis Group. He is also a member of the clinical advisory board of Home Instead/Honor, Patina Healthcare, MedZed and Medtronics. Dr. Leff is also a voluntary board member for the Alliance for Home Health Quality and Innovation and a member of the quality committee for Ascension Healthcare. Dr. Ritchie is a board member for the International Palliative Care Society. Dr. Sikka is the CMO/Founder of Snostik. Dr. Steckler is the President of the Washington, DC chapter of the American College of Emergency Physicians, a contractor for M Medical group, and is married to a board member of Dynamic Infrastructure. None of the other authors reported any conflicts.