JMIR Publications

ABSTRACT

Background:

Telehealth was essential for maintaining care continuity during the COVID-19 pandemic, leading to its rapid adoption across the United States. The expansion of telehealth has been heralded as a strategy for improving healthcare access and reducing health disparities, especially for older adults who face significant barriers to in-person care. However, data on telehealth use among socially and financially vulnerable older adults are limited, leaving unanswered questions about whether telehealth is improving access to care and promoting health equity for older Americans.

Objective:

This study characterized individual and structural factors associated with post-pandemic telehealth use among older adults living at home and receiving publicly funded home- and community-based services (HCBS), considering publicly funded HCBS receipt as an indicator of social and financial vulnerability.

Methods:

This cross-sectional study included older adults aged ≥ 65 years living at home with available telehealth use data who participated in the 2021-2022 survey wave of the National Core Indicators-Aging and Disability Adult Consumer Survey. We used complete-case multivariable logistic regression, adjusting for sociodemographic and health-related factors with state-level random intercepts, to examine the associations between telehealth use and covariates of interest (age, gender, race/ethnicity, ZIP code Rural-Urban Commuting Area Code, home internet access, self-perceived overall health, medical transportation access, lives alone, number of known non-Alzheimer’s disease and related dementias (ADRD) diagnoses, known ADRD diagnosis, and HCBS program/payer type). Based on the regression results, we estimated bivariate associations between home internet access and key sociodemographic variables (age, gender, race/ethnicity, and ZIP code RUCA) using Pearson’s chi-squared test.

Results:

Of the 3,680 participants, 1,467 (40%) were telehealth users and 2,213 (60%) were non-telehealth users. Significantly lower odds of telehealth were observed for older adults, males, Black individuals, those living in non-metropolitan areas, and recipients of Older Americans Act services (ORs between 0.66 and 0.80). Individuals with more than one known non-ADRD diagnosis (OR, 1.49 [95% CI, 1.02 - 2.17]) and those with an ADRD diagnosis (OR, 1.33 [95% CI, 1.07 - 1.66]) had higher odds of telehealth use. Home internet access was strongly associated with telehealth use (OR, 2.51 [95% CI, 2.15 - 2.92]). Follow-up bivariate analyses between home internet access and sociodemographic characteristics revealed that those of younger age, females, and White individuals had higher levels of internet access.

Conclusions:

Differences in telehealth use among older HCBS recipients living at home are associated with both individual and structural factors, raising concerns about whether telehealth is improving healthcare access and reducing health disparities. Future research should examine and clarify the underlying mechanisms driving these differences to identify and address barriers to telehealth adoption among vulnerable older adults.