Telemedicine Is Here: Experts Offer Tips for Seniors
Virtual medical visits have been invaluable for many during the COVID-19 pandemic, but older adults may still need help managing them -- especially if they are hard of hearing.
That's according to doctors at Johns Hopkins University, in Baltimore. Writing in the Aug. 11 Annals of Internal Medicine, they offer some practical advice on navigating "telemedicine."
First and foremost, they say, it should be assumed that any older adult will have some difficulty hearing during a virtual visit.
Hearing loss is very common: About half of Americans older than 75 have some difficulty with hearing, according to the U.S. National Institutes of Health.
Yet those hearing issues have not necessarily been diagnosed.
"Many people don't even realize they have hearing loss," said Dr. Carrie Nieman, of the Cochlear Center for Hearing and Public Health at Johns Hopkins.
But the issue may come to the fore, she said, when older patients have a telemedicine visit. The volume or quality of the sound -- whether over the phone or Zoom -- can present a problem, as can the lack of in-person visual cues.
One way to manage, Nieman said, is for both doctors and patients to use headphones or a headset -- which amplify sound and drown out background noise. "You can get fairly inexpensive ones," she noted.
A video visit is preferable to a phone call, Nieman said, since it allows doctors and patients to see each others' expressions and gestures. And that visual information can give doctors an idea of whether a patient is understanding what's being said.
But the reality is, not all older adults have the devices or internet access needed for videoconferences. Other times, there are privacy concerns: "Some patients don't want you to see their home," Nieman said.
All of those issues are more likely to be barriers for low-income seniors. Doctors need to be aware of that, Nieman said, and -- even though video is ideal -- ask patients what type of telemedicine visit they prefer.
It's true that many telemedicine visits during the pandemic have been by phone call, according to Dr. Ateev Mehrotra, an associate professor of health care policy at Harvard Medical School, in Boston.
Many patients are used to phone calls being a courtesy, he pointed out. So one issue that has come up is money: Patients are often surprised, and unhappy, to get a bill for a telemedicine visit done by phone.
However, telemedicine -- which has been around for decades -- is here to stay. It grew to a "staggering" degree during the pandemic, Mehrotra said, and "we can't go back."
Old-fashioned medical visits will never be replaced, he stressed, and as doctors' offices have reopened in recent months, telemedicine visits have declined. But Mehrotra expects that going forward, around 8% of doctor visits will be of the remote variety.
That means it's important to keep improving the quality of those interactions, according to Nieman. Along with using headsets whenever possible, she said, doctors should make sure they are in a well-lit area for video visits -- and use captioning options for all patients by default.
According to Mehrotra, doctors sometimes have to act as technology specialists, instructing patients to "unmute" or adjust the volume on their devices.
But basic communication skills are always key, according to Nieman: Doctors should speak slowly and clearly, look for visual cues that their patients are having trouble hearing or understanding, and see if patients can "teach back" the information they were just given.
And patients should not be afraid to speak up about any communication issues.
"You can ask your doctor to slow down, or to say things a different way if you're not understanding," Nieman said.
Families can also be a big help, she said. That can mean helping older relatives set up the technology, and figure out details like lighting and camera position. But they may also want to be there for the appointment, Nieman said.
According to Mehrotra, that has been one of the pluses of telemedicine visits: Older patients have been able to include their adult children on visits, regardless of where they live.
The nonprofit Aging in Place has more on telemedicine for seniors.
SOURCES: Carrie Nieman, MD, MPH, assistant professor, otolaryngology-head and neck surgery, Johns Hopkins University School of Medicine, Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore; Ateev Mehrotra, MD, MPH, associate professor, health care policy, Harvard Medical School, Boston; Annals of Internal Medicine, Aug. 11, 2020, online