Older Adults With VI Less Likely to Have Access to Digital Technology

A new study published in JAMA Ophthalmology found that older adults living in the United States who had vision impairment (VI) were less likely to have accessible digital technology. This could be a unique barrier for this population to receive care through telemedicine, an important tool in older adults.

Health disparities in older adults could be mitigated using telemedicine to support clinical health care and other medical services. Disparities in the accessibility of these services exist, however, as 25% of the United States lacks broadband internet access. Older adults have also been found to use telemedicine less than adults who are aged 56 years and younger. Older adults with VI are also at a disadvantage in these cases, due to the prolonged exposure to digital screens. This study aimed to assess what the discrepancies in digital technology access were in older adults with VI when compared with other patients.

Older man with laptop | Image credit: Mediaphotos - stock.adobe.com

Data from the 2021 National Health and Aging Trends Study were used for the present study. The data collected a sample of patients 65 years and older who were Medicare beneficiaries. All data were collected from June 2020 to January 2021. Race and ethnicity were collected through self-report due to race and ethnicity being associated with rates of both VI and health care use.

There were several outcomes that were assessed during this study. These included the availability and understanding of a digital device, ability to send messages through text or email, engagement in online activities, and how many health-related and non-health-related activities they perform online. Cellphones, computers, and tablets were all considered in this study. Health activities included refilling prescriptions, contacting medical professionals, getting health information, and telehealth visits.

Near visual acuity (VA) and binocular distance were recorded for all participants. Age, sex, race, ethnicity, living arrangement, education, and income were all recorded based on self-reporting along with comorbid conditions.

There were 2822 Medicare beneficiaries who were included in this study who had a mean (SD) age of 78.5 (5.6) years and were 54.7% female. The study group featured participants who were primarily non-Hispanic White (81.7%), with non-Hispanic Black (8.0%) and Hispanic (7.0%) being the second and third most reported ethnicities. VI was reported in 32.3% of the participants, with participants more likely to have VI if they were older, non-Hispanic Black, had more comorbidities, and had less income.

Older adults with any VI had a lower prevalence of knowing how to use a cell phone (–6.0%; 95% CI –7.4% to 4.8%), computer (–16.5%; 95% CI, –18.5% to –14.5%), and tablet (–15.9%; 95% CI, –16.6% to –15.0%) compared with older adults without VI. Adults with any VI also had a lower prevalence of sending emails or texts (–18.7%; 95% CI, –19.8% to –17.6%) and going online outside of emailing and texting (–18.7%; 95% CI, –19.9% to –17.3%).

Lower odds of having and knowing how to use a phone (OR, 0.58; 95% CI, 0.38-0.88), computer (OR, 0.61; 95% CI, 0.47-0.79), or tablet (OR, 0.68; 95% CI, 0.54-0.85) was associated with any VI compared with those who did not have VI in a multivariable logistic regression analysis. Lower odds of sending messages through text or email (OR, 0.58; 95% CI, 0.45-0.75) and using the internet for anything besides email or text (OR, 0.64; 95% CI, 0.49-0.83) were associated with older adults with VI.

There were some limitations to this study. All participants were community-dwelling adults, which could underestimate the knowledge of older adults living by themselves or in assisted living. The cross-sectional design could not report on causal relationships. Recall bias is possible due to the self-reported nature of the data. Challenges and barriers to using the digital technology was not touched on in this data.

The divide in the use of digital technology was illustrated between older adults with VI compared with those without. The older population of the US could be at a disadvantage in connecting with telemedicine due to this discovery. The researchers recommend that developing equitable strategies to address the issue should be at the forefront of future work in this area.

Reference

Thomas J, Almidani L, Swenor BK, Varadaraj V. Digital technology use among older adults with vision impairment. JAMA Ophthalmol. Published online April 4, 2024. doi:10.1001/jamaophthalmol.2024.0467