The COVID-19 pandemic has led to a sharp increase in telemedicine — doctor visits by video or phone. While some patients have adapted well, many older adults have been left behind, essentially cut off from medical care.

Estimates are that more than a third of adults 65 and over face potential problems seeing their doctor via telemedicine, particularly older, low-income men in remote or rural areas. Those with disabilities or in poor health related to diseases like diabetes — patients who require ongoing monitoring by medical personnel, but may not need or easily be able to make an office visit — face the biggest challenges, according to a University of California, San Francisco study.

Insurance regulations will also need to change, with telecommunication devices such as smartphones and tablets that make telemedicine possible becoming covered as a medical necessity.

The greatest difficulties seniors faced were with video visits, but even telephone visits pose a problem for many patients — 20 percent of them in the study.

Nearly 40 percent of all older adults in the United States were not ready for video visits, according to the study's estimates, which were based on information from a comprehensive 2018 nationwide survey of health trends among Medicare patients. The problem was mainly due to patients' lack of experience with the technology. Even with the help of someone who could set up a video visit for them, an estimated 32 percent would still be unready.

There are a number of reasons why seniors' find telemedicine hard to deal with. Some are physical or sensory; some are technological. Many older patients suffer from multiple disabilities, including poor eyesight or hearing, difficulty speaking or making themselves understood. And even today, some lack Internet-enabled devices.

The average patient in the study was nearly 80 years old. Those likeliest to experience problems were older, male, unmarried, Black or Hispanic, lived rurally or had less education, lower income or were in poorer health. The situation may have improved since the information was gathered in 2018. But simply hoping for this will not guarantee the elderly access to health care, especially if the current pandemic is prolonged. More needs to be done to ensure that they do have access.

Nearly 40 percent of all older adults in the United States were not ready for video visits.

We can help seniors overcome their technical inexperience by making telemedicine better suited to them and any disabilities they may have, the authors say. They offer a number of recommendations.

Devices that connect to the web more easily, those that make allowances for people with vision and hearing impairments with features such as close captioning, and policies establishing funding for programs to train older adults in the use of video devices are all the kinds of accommodations that would make telemedicine easier for seniors to use. In addition, having some doctors and health care workers keep their offices open during the pandemic will help ensure that the elderly continue to have access to medical care.

As telemedicine becomes more common, insurance regulations will also need to change, the study suggests, with telecommunication devices such as smartphones and tablets becoming covered as a medical necessity, especially for the poor.

For more information, see the article in JAMA Internal Medicine.