Louis Fink, a cardiologist at Catholic Medical Center, spends a lot of his time these days acting as an IT specialist for older patients.
Turn the video on. Turn the mute button off.
Even with adult children trying to help them connect to the internet, some just give up and resort to a phone call with the doctor.
Barbara Schwartz, a 92-year old patient of Fink’s, considers herself pretty technically savvy. She gave up on the computer years ago, but she knows her way around an iPad. Even so, she relies on her children to set up her telehealth appointments from her Peterborough home.
“I’ve reached the point in my life where I know what I know,” she said.
Everything else, like setting up a video conference call with her doctor, can be handled by her four children. Schwartz said her experience with telehealth has been overall positive – Fink makes her feel comfortable even in unconventional settings. Still, she hopes her next appointment will be in person.
Since the pandemic has closed down doctor’s offices for regular appointments, older adults have been thrust into a largely unknown virtual world of healthcare. Macaulee Cassaday, a founder of a national program designed to patiently guide seniors through technology, said enrollment in her classes has almost doubled.
Faced with unfamiliar programs and “computerese,” as one doctor called it, many turned to Cyber-Seniors for help.
The program offers one-on-one tutoring to teach older adults the steps to log in to Zoom. For some, video calling came naturally and they pick it up after the first tutoring session. Others never fully got it, she said.
Cassaday gets between 50 and 60 seniors at her weekly virtual calls. She is careful to teach computer etiquette beforehand to prevent the call from sliding into chaos.
When their computer camera is angled at the ceiling, she gently reminds them to center their face on the screen. Maybe most importantly, she teaches them to mute themselves when they aren’t talking.
“I tell them, ‘if you’re playing CNN in the background, it’s going to be so loud’,” she said. “It’s always the news programs.”
Other features of telehealth aren’t so easily taught.
Cassaday said many seniors are struggling to grasp of the scale of virtual calls. Understanding that 50 people are all on the same call can be difficult for people who haven’t lived their lives online, interacting with thousands of people on a daily basis.
Others aren’t used to staring at their own faces while having a conversation, especially in a vulnerable situation like a doctor’s appointment.
Some of the seniors in the program are just using telehealth until they can safely go to their doctor’s appointments in-person. For others, learning to use video calling has opened a new world of virtual interaction.
Ellen Flaherty, a doctor from the Centers for Health & Aging at Dartmouth-Hitchcock Hospital, said many of the activities the center had previously offered to seniors in-person have transitioned online.
Older adults who have previously been hesitant to learn to use video calling have started actively participating in Zoom tai chi and support groups. Some never would have participated, had they not been pushed to learn the skills from telemedicine appointments.
Flaherty has even noticed that there are participants outside of New England regularly conferencing in for the events.
Now that many adults have developed the skill set to interact with the virtual world, Flaherty thinks Zoom could be used to combat isolation in the population.
However, where some have found a new world of interaction, others have been further isolated, as they struggle to develop their technical skills.
Becky Bukowski, the Senior Program Coordinator at Concord Parks and Recreation, said she knows a couple of people from the community center who don’t use computers. Some of them, even though they had health concerns, have had to forgo doctors’ appointments altogether during the pandemic.
“I don’t know if I know anyone who would prefer telehealth over in-person visits,” she said.
A recent study found that more than a third of adults over 65, about 13 million older adults, were not prepared for video telemedicine visits because of inexperience with technology or physical disability.
Fink said some of his patients have declined to meet virtually, saying they’d contact him if there was an emergency.
The virtual platform has played an important role in healthcare during the pandemic but Fink said it leaves out an important aspect of his job as a doctor.
“I miss the physical contact,” he said. “I’m someone who shakes hands with patients. The piece you’re missing is seeing people live.”