Individuals over 55 reported fewer telehealth appointments overall, and it was less likely for this older demographic to actually complete an appointment over a video call in instances when they did have a virtual appointment. A total of 148,402 patients who had scheduled a virtual appointment towards the pandemic’s onset made up the study. While the study focused on telehealth as a whole, it stands to reason that online therapy also is less accessible for older people. As a critical form of telehealth, therapy is an important resource for all ages, especially during a time of such loss and turmoil. According to the World Health Organization (WHO), 15% of individuals aged 60 and over have a mental disorder.
Impact of the Digital Divide
The digital divide is the separation of people who do and don’t have access to the internet and the understanding of how to use it fully. “There are two main reasons seniors find themselves unable to access valuable online mental health therapy and other healthcare,” says Sarah Johnson, an RN and the health ambassador for Family Assets. One reason is pure happenstance. They find themselves on the wrong side of the digital divide, which is to say they are not digital natives and are therefore often both unaware of or unskilled with much of the technology required to take advantage of these new healthcare options. The other is access and basic ownership of necessary technology. In a 2017 report from Pew Research, adults aged 65 to 69 were twice as likely to go online and four times as likely to own a smartphone than those 80 or older. Out of all individuals over 65, 34% reported little confidence in themselves to use any electronic device for online tasks, and 48% said they typically need someone else to set up and provide instruction on a new device. “Online therapy requires a strong Wi-Fi or broadband connection, access to technology, and a certain willingness to use telehealth which can come from their perception of the effectiveness of telehealth,” says Brian Wind, PhD, the chief clinical officer of Journey Pure and former co-chair of the American Psychological Association’s advisory committee for employee assistance. In a 2017 report from Frontiers In Psychology, researchers asked adults aged 65 to 76 about the perceived and actual barriers they faced in using tablet computers, a form of technology none of them had used before. Common issues included a lack of instruction, feelings of inadequacy, health-related barriers, and cost.
Socioeconomic Barriers
Johnson explains that socioeconomic status is another barrier to online therapy for older people. “In developing countries around the world, a large number of seniors live in poverty. They simply don’t have the resources to purchase the hardware required to take advantage of these new healthcare opportunities,” she says. In the U.S., as well, older people may not be able to afford the technology necessary for conducting online therapy sessions. According to the National Council on Aging, 25 million Americans over the age of 60 are economically insecure, meaning they live at or below the poverty line. One-third of senior households end the month with no money or even in debt. As of 2013, 61.3% of households led by someone 60 years of age or older were in debt. If a person doesn’t have enough to pay—or can just cover—their bills, buying new or used technology isn’t possible. In the Pew Research report, 87% of seniors with yearly earnings of at least $75,000 had broadband at home, compared with only 27% of seniors making less than $30,000 per year.
Telehealth Challenges Other Demographics
Older people weren’t the only ones identified in the JAMA study to be less likely to schedule a telehealth appointment. Being female, Black or Latinx and having a lower household income were all linked to a lower frequency of video calls. As for scheduling fewer appointments of any kind, being Asian, on Medicaid, or not fluent in English were all reported factors. “Language barriers can reduce the accessibility of online therapy to patients,” says Wind. “There may also be a lack of understanding of which conditions can be addressed by telehealth and which conditions need to be addressed in an in-person consultation.” As of 2018, 67.3 million people spoke a language other than English at home in the United States.
Increasing Accessibility to Online Therapy
With the convenience of online therapy probably lasting far longer than the pandemic, society must address any lack of access or understanding of technology. “To increase accessibility, we may need broader policies that equip disadvantaged groups with access to digital devices and broadband,” says Wind. Wind continues, “Education schemes will be required both to get these groups and seniors comfortable with the use of digital devices for their healthcare needs and the health conditions that can be effectively and completely treated via telehealth.” Boosting the profile of online therapists who speak a variety of languages is another crucial step. “We also need broader measures such as diversifying the pipeline of physicians and nurses, reducing bias and translation services that will improve the accessibility to healthcare for both telehealth and physical consultations,” says Wind. Online therapy doesn’t have to be a permanent switch, but can help older people and other at-risk groups safely receive the mental health care they need during this challenging time. “It’s unlikely that we’ll ever be able to fully transition to telehealth even for medical conditions where a physical consultation is not necessary at all,” says Wind. “There will be a group of people who will prefer physical consultations even if they have access to digital devices, have technological knowledge and understanding, and a strong Wi-Fi connection.” The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page. Know someone who may need help navigating a digital appointment or doesn’t have access to a device? Offer your assistance or even loan a piece of equipment if possible. Working together can ensure more people have access to the therapy they need as the pandemic continues.
