Telemedicine for older adults: When virtual care works and when it doesn’t

(Aging Untold) — Telemedicine has become more widely used since the COVID-19 pandemic. More than 75% of U.S. hospitals now offer remote care, up from 35% a decade ago, according to Harvard Health.

While virtual visits offer convenience and greater access to care, they cannot replace hands-on physical examinations — especially for older adults, according to the Aging Untold experts.

When telemedicine works well

Dr. Rhea Rogers, a board-certified physician, said there are pros and cons to telemedicine, and it comes down to the circumstance for which it is being used.

“There’s going to be a role for telemedicine,” she said.

Telemedicine is useful for medical management, providing lab results, short-term monitoring and assessing responses to recent treatments.

She said it works well for follow-up visits, and mental health care is well-suited to telemedicine.

Aging expert Amy O’Rourke said telemedicine solves several problems for older adults and their caregivers.

It helps people who are behaviorally challenged and cannot easily get to a doctor’s office. It eliminates the need for caregivers to take time off work for appointments, and parents who are traveling with adult children can attend follow-up appointments without missing family events or vacations, O’Rourke added.

Virtual appointments also allow older adults to see physicians during inclement weather, O’Rourke said.

When in-person visits are necessary

What telemedicine cannot replace is a physical examination, Rogers said, and she would not use telemedicine for annual follow-ups.

“You get so much more of the complete picture with the patient when you have your hands on,” Rogers said.

Gerontologist Sam Cradduck said telemedicine is amazing until it becomes a substitute for care that requires doctors to use their hands, eyes and ears during an exam.

“It’s so much easier for me to lie to you over a phone or over a screen than it is if you’re looking at me and you can see physical changes and you can see that body change or whatever’s going on,” Cradduck said.

During in-person visits, older patients’ feet should be examined because they are the body’s foundation, she added.

Cradduck said telemedicine became widely used during COVID-19 when people could not or did not want to expose loved ones in doctor’s offices and questioned how doctors could properly examine patients who are complaining of shortness of breath or find lumps through a screen.

The hybrid approach

The hosts agreed that a hybrid approach combining telemedicine and in-person visits is best.

“I think the hybrid approach is what we’re all kind of recommending, that you have both,” O’Rourke said.

Rogers noted that caregivers should supervise loved ones during telemedicine visits to ensure they express real concerns instead of saying they feel fine. Having another person present also provides additional eyes and ears.

Aging-well coach Katherine Ambrose said telemedicine can help families maintain routines.

She said telemedicine can reduce pressure on caregivers, but families should not defer physical face-to-face appointments.

Five key takeaways

1. Telemedicine is best for: Medication refills, lab results, short-term monitoring, follow-up visits, mental health care, and situations where travel or weather make in-person visits difficult
2. In-person visits are necessary for: Annual exams, physical assessments, new symptoms like shortness of breath or lumps, foot examinations and comprehensive evaluations
3. Supervision matters: Have a caregiver or family member present during telemedicine visits to ensure older adults accurately communicate their concerns
4. Use a hybrid approach: Combine telemedicine convenience with regular in-person physical examinations
5. Know the limitations: Doctors cannot perform hands-on assessments through a screen