For UVA Health geriatrician Laurie Archbald-Pannone, MD, the pandemic-driven transition to telehealth inspired a years-long effort to optimize this technology not only for her patients, but for all older adults.
In collaboration with West Health Institute and Mid-Atlantic Telehealth Resource Center (MATRC), Pannone developed the Collaborative for Telehealth for Aging. This effort brings together more than two dozen experts from across the country.
The objective? Establish a framework of best practices for all clinicians to ensure that telehealth hastens — rather than hinders — care for older patients. These guidelines will soon be available to care clinicians nationwide via the Center of Excellence for Telehealth and Aging (CE4TA), an online resource center and community.
What the Pandemic Taught Us
Like most health systems, UVA Health quickly pivoted to telehealth in March 2020 in response to COVID restrictions. “There were times when it worked great. And there were times when it could have been implemented better,” says Archbald-Pannone, who has worked since 2008 at the UVA geriatrics outpatient clinic at the Jefferson Area Board for Aging. She adds, “We’ve now had time to bring together experts to assess the data and see what we’ve learned about telemedicine over the past couple of years.”
A few key takeaways from the collaborative’s assessment:
- It's wrong to assume telemedicine would not appeal to older adults.
- Telemedicine visits are comparable to in-person visits in terms of clinical outcomes.
- We have to know when telemedicine is the right tool to use and how to tailor it to meet their needs.
“What we’ve learned not just from our work, but nationally through large-scale surveys, is that, like any demographic, the population of older adults is diverse. Some people are very interested in new technology and new ways of doing things, and some are not,” says Archbald-Pannone.
“When we are developing telehealth programs, we have to be sure that we are not excluding those older adults who are open to using it and make sure they can use it efficiently and effectively.”
3 Principles to Guide Telehealth Practices for Older Adults
To help providers and health systems implement age-friendly telehealth practices, the Collaborative for Telehealth for Aging created a roadmap. The guidelines are based on 3 main principles.
Older patients should remain the center of decision-making related to their healthcare, including their goals, care preferences, and wishes regarding caregiver and family involvement.
To allow patients to make these decisions, it’s important to communicate a patient’s choices clearly. “The technology and concept of telehealth is foreign to many older adults, so the collaborative even considered how we might shape the language and explain this in a way they might understand,” says Kathy Wibberly, PhD, director of MATRC and director of research at the UVA Karen S. Reuban Center for Telehealth.
Equitable & Accessible
The same level of quality care should be available to all people regardless of age, socioeconomic status, physical or cognitive ability, or health and technological literacy.
“If done well, telehealth can increase access to especially vulnerable populations,” says Archbald-Pannone. “However, if accessibility is not a deliberate decision, then it may lead to further healthcare disparities. We have to account for factors like limited technology or limited resources to be sure we’re not furthering that gap.”
Integrated & Coordinated
Care provided via telemedicine should be integrated and coordinated with all other care provided to older adults.
“If you’re doing a telemedicine visit as a specialist, then the primary care physician should have access to that encounter. We’re all part of the care team,” says Archbald-Pannone.
“We have to ensure telemedicine visits aren’t standing alone, but that they’re part of our integrated system that all providers involved in the patient’s care have access to.”
Optimizing Your Telehealth Program for Older Adults
The CE4TA online resource center launches in January. In addition to sharing specific guidelines that adhere to the principles above, the new website will feature toolkits and practical resources, program recognition, as well as case studies.
“We’re curating the best of the best, those programs that align with the principles and guidelines for age-friendly telehealth. We’ll make those case studies available online so people can see examples,” says Wibberly.
“There are so many advantages of telehealth for older adults,” she adds. “We just have to adapt the way we use this technology — it may be a simple fix like increasing font size — so that it is accessible to this patient population.”