Optimizing Telehealth for Special Populations and Closing the Digital Divide: Addressing Social Determinants of Health in Virtual Care

Abstract

Between 2013 and 2016, cardiovascular disease affected an estimated 121.5 million American adults, who were 60–79 years old (77.2% of males and 78.2% of females). In the 80+ age group, 89.3% of males and 91.8% of females carried at least one cardiovascular disease diagnosis. Hypertension was accounted for in 80.0% of males; 85.6% of females in people over 75 (Benjamin et al. Circulation. 2018;137(12):e67–e492). The growing population of older adults (age ≥65 years) is expected to lead to higher rates of cardiovascular disease for which innovative strategies should be considered. The expansion of digital health (encompassing telehealth, telemedicine, mobile health, and remote patient monitoring), internet access and cellular technologies provides opportunities to enhance patient care and improve health outcomes-opportunities that became particularly relevant during the COVID-19 pandemic. Certain characteristics associated with aging such as insufficient dexterity, visual and hearing impairments, and cognitive dysfunction, found more commonly in older adults should be taken into consideration in the development and utilization of existing technologies. Older patients may also face barriers of transportation, geographic access, language, health literacy in addition to lack of independent control over their own care coordination which may be addressed by digital services. Strategic and appropriate implementation of digital strategies can help avoid inequities propagating digital divides among older adults across disease severities and socioeconomic distributions. A systematic approach, therefore, is needed to study and implement digital health strategies in older adults. This review will focus on current knowledge of the barriers, benefits and use of digital health in older adults for cardiovascular disease management.