Differences in Challenges to Using Telehealth Among Older Adult Video and Telephone Users With Frailty: Retrospective Observational Study

Background: The shift to video care during the COVID-19 pandemic exacerbated disparities in health care access, especially among high-need, high-risk older adults with frailty. Objective: The objective of this study was to quantify the ability of high-need, high-risk older veterans to use video visits for health care and identify factors associated with successful video visit completion. Methods: Veterans in a Veterans Affairs Frailty Intervention and Treatment (FIT) clinic underwent a physical, functional, psychological, social, and technology assessment at baseline. During the pandemic, the FIT clinic switched to televisits. We sorted patients into 4 groups: video visit, telephone visit, reached but no visit, and unable to contact. We performed a t test to compare normal variables and a chi-square test to compare categorical variables to identify factors associated with completing a video visit versus a telephone visit. Results: We attempted to contact 110 patients from the FIT clinic. They were 73.5 (SD 5.6) years old on average. A total of 46 (41.8%) patients were White, 46 (41.8%) patients were Black, and 17 (15.5%) patients were Hispanic. Sixty-seven (60.9%) patients had at least some college education, and 49 (44.5%) patients were very confident in filling out medical forms. Of the 110 patients, 72 patients were reached, and 65 patients agreed to a televisit. Of the 65 patients who agreed to a televisit, 19 (29.2%) patients completed a video visit, while 37 (57%) completed a telephone visit. A total of 19 patients out of 25 (76%) of those who scheduled a video visit completed it successfully. Compared with those who completed a telephone visit, veterans who completed a video visit were more likely to have access to a computer with a camera, microphone, and high-speed internet/data plan, as well as the ability to use email and be confident in internet use. They were more likely to have a higher health literacy score and be cognitively intact with a Montreal Cognitive Assessment score of ≥26, and were less likely to experience issues with walking, stepping, and balance. Conclusions: Our study found that completing a video visit requires access to technology, the ability to use it, and a willingness to do so. Among older veterans with frailty, only a quarter completed a video visit, and this group comprised patients who already had access to video-capable technology, used it, and were comfortable with it. They were also more often physically and cognitively intact compared with those who used telephone visits. Strategies to expand the use of video visits in the care of older adults include screening older adults to identify individuals most likely to succeed and increasing access to simple home telehealth technology.