JMIR Publications

ABSTRACT

Background:

The COVID-19 pandemic has amplified the important role of telehealth to safe continuity of care. Regional variation in internet access and telehealth use are well-documented, but how neighborhood factors, including pervasiveness of broadband internet, affects older adults’ telehealth in the context of internet access is not known.

Objective:

To assess how individual and neighborhood characteristics, including pervasiveness of neighborhood broadband internet subscription, affect engagement in telehealth among older adults with internet access.

Methods:

Cross-sectional study of 5,117 community-living older adults who participated in the 2017 National Health and Aging Trends Study with census-tract level data for participants’ place of residence from the American Community Survey.

Results:

Of an estimated 35.3 million community-living older adults, 21.1 million (59.7%) were internet users, and of this group, more than 1 in 3 (35.8%) engaged in telehealth. In a multivariable regression model that adjusted for individual and neighborhood-level factors, age, education, income, and pervasiveness of neighborhood broadband internet subscription were associated with engagement in telehealth: race, health, county metropolitan status, and neighborhood social deprivation were not. Among internet users, living in a neighborhood at the lowest (versus highest) tertile of broadband internet subscription was associated with being 40% less likely to engage in telehealth (aOR=0.60, 95% CI: 0.42, 0.87), all else equal.

Conclusions:

Neighborhood broadband internet stands out as a mutable characteristic that is consequential to telehealth participation.