JMIR Publications

ABSTRACT

Background:

During the COVID-19 pandemic there was a rapid adoption of telehealth care services as a public health strategy to maintain access to essential healthcare. In Australia, there has been increasing optimism for the expansion of telehealth services. However, little is known about the patterns and determinants of telehealth adoption among older adults, with concerns that an expansion of telehealth services may only be of benefit to those who already have better access to healthcare.

Objective:

Leveraging data collected by The Sax Institute’s 45 and Up COVID Insights study collected between November 2020 and April 2022, the objective of this study was to identify and describe the socio-demographic and health-related determinants of telehealth adoption and usage among a cohort of older Australians. We hypothesised that health-related factors would be key determinants of telehealth adoption for Australians aged ≥ 65 years, during the COVID-19 pandemic.

Methods:

A repeated cross-sectional design was employed. The relationships between telehealth usage (classified as either low, moderate or high) and selected socio-demographic and health-related characteristics were assessed using logistic regression techniques. Variable selection and findings were situated within the Technology Acceptance Model, the Unified Theory of Acceptance and Use of Technology, theoretical frameworks.

Results:

Of the 21,830 participants aged ≥ 65 years, the proportion who indicated adopting telehealth ranged from 51% at Survey 1 in 2020 to 39% by Survey 5 in 2022. High levels of telehealth use were associated with being female, age < 85 years, living in a major city, co-habiting with others and being from the most socio-economically disadvantaged areas (deciles 1-3). Individuals with a disability, chronic disease, multimorbidity, lower perceived quality of life and those experiencing missed or delayed care were significantly more likely to use telehealth across all levels (P < .001). A temporal association was observed whereby participants who engaged with telehealth services before, or early in the pandemic (as assessed at Survey 1) were more likely to continue telehealth use when assessed at Survey 5 in 2022 (P < .001).

Conclusions:

This research contributes to the broader understanding of telehealth adoption and use among older adults. As telehealth models of care expand, there is an opportunity to tailor these services to the needs of older adults particularly those living with chronic diseases and multimorbidity by employing targeted strategies that overcome barriers to accessing specialised healthcare services. Clinical Trial: Not applicable