Older Adults and Their Clinicians Benefitted From Shift to Telehealth

The shift to telehealth prompted by the pandemic benefitted older adults, groups unable to access care, and their clinicians who could decrease costs while increasing care quality, says Ipsit Vahia, MD, associate chief of the division of geriatric psychiatry at McLean Hospital. While there are still many steps to take to fortify this expanded access to care via telehealth, Dr Vahia details all of the ways that utilizing virtual care is benefiting older adults who face practical challenges to receiving care due to restrained movement and limited transportation options.

Dr Vahia recently spoke at the virtual Psych Congress Regionals on this topic and other frequently asked questions about the ever-evolving field of technology and telehealth. To stay up to date on more conference news, insights, and updates, visit our newsroom.

Missed Part 1: Hybrid Models of Care Offer Treatment Flexibility? Watch it here.

Read the transcript:

Ipsit Vahia, MD: Hello, my name is Ipsit Vahia. I'm a geriatric psychiatrist. I serve as the associate chief of geriatric psychiatry at McLean Hospital in Belmont, Massachusetts. I'm also an assistant professor of psychiatry at Harvard Medical School and in addition to my divisional role, I serve as the medical director of the Institute for Technology and Psychiatry at McLean, and I'm also the director of McLean's Technology and Aging lab. I divide my time between patient care, administrative work, and running my research lab.

Older adults may have been some of the biggest beneficiaries of the switch to telecare that the pandemic facilitated. This is because for a lot of older adults there are practical challenges. Not all older adults are as physically mobile. They may suffer from chronic ailments like back pain. Some older adults may be wheelchair bound. Others may be functional, but they may not be able to drive as effectively. This is especially true for older adults that are living independently, but have cognitive challenges and they may have diagnoses even of mild cognitive impairment or early stage dementia—things that preclude in some states having a driving license at all, or in other states, while they're legally allowed to drive,  it may not always be safe for them to do so.

In all of these scenarios that may otherwise limit access to care, having virtual or hybrid options available gives them a way to stay more connected to care than they might otherwise have been.

We also find that for a lot of older adults that need maintenance care or routine follow ups, the practical challenges of driving may pose their own burden. A lot of older adults, for example, that use transportation services are bound by schedules that they don't control. So for example, a half an hour visit might actually involve them having to spend four hours when you add up the waiting time for the transportation as well as commute time. For other older adults, if there is adverse weather rainstorm, for example, or snow or icy roads, that poses its own disincentive to attend a clinic visit, traffic can be an independent, if not challenge, inconvenience.

In some urban centers, we often find that even little things like parking for older adults on fixed incomes, for example, that need repeated visits, the cost of parking can add up. Telehealth eliminates a lot of these major or minor barriers to access and it can smoothen the process. In the clinic that I run, for instance, we found that once we switch from in-person care to telecare, the average number of visits that we would have across our clinical services went up by 30%. This was attributable almost entirely to the fact that we were able to see folks virtually rather than having to come in for every visit in person.

We're only starting to scratch the surface of what might be possible in terms of designing services for older adults that incorporate virtual care. A good example is psychotherapy services and group-based psychotherapy services. We've known that that group-based psychotherapies can, for example, serve a number of individuals, but designing a group-based psychotherapy service is quite challenging because of the logistics of coordinating several older adults that otherwise have transportation challenges or scheduling challenges and to get them all together. We are finding even in our own clinical practice that since virtual or hybrid care became available, able to design ways to deliver highly sophisticated, cutting edge manualized psychotherapy interventions, many of which can be done in group formats, and to be able to do them virtually means that we can just create services while minimally increasing overheads to the healthcare system. But while optimizing available resources in a way that's very convenient for patients.

What this is doing is it's enabling us to scale up the number of different services we can provide. It's facilitating translation of psychotherapies that may have been developed for research settings, but turning them into clinical service that anyone can access, and it's allowing us to reach patients in ways that are easy for them and just increases the amount and the quality and the type of care that they can receive.

Now, this is based on the example of one clinic. I think when geriatric psychiatry services around the country start doing this more routinely, it provides one avenue for us to increase the care that can be offered to older adults, even those that might be restricted by geography or by transportation or cognitive challenges, and hopefully this will turn into better mental health outcomes for all of them. So this has yet to be demonstrated. I think we're very early in the stages of doing this.

But this decentralization of mental health care is seen across the board as a vastly positive factor because care is getting to people and care is getting to places that may have had a hard time accessing it. Much work still needs to be done. I think the issue of equitable distribution of this care needs to be addressed. All of hybrid care is predicated on the idea that everyone has access to technology, whether it be devices or reliable wifi or affordable data plans. This is not the case. So I think a further strengthening of infrastructure needs to take place, but I think thus far it's really opening up new avenues that we are only starting to figure out how to leverage.

Ipsit Vahia, MD, is a geriatric psychiatrist, clinician, and researcher. He is medical director of geriatric psychiatry outpatient services at McLean Hospital and the McLean Institute for Technology in Psychiatry. He is also director of the Technology and Aging Laboratory. His research focuses on the use of technology and informatics in the assessment and management of older adults and currently, he oversees a clinical and research program on aging, behavior, and technology. He has published extensively in major international journals and textbooks.

Dr Vahia serves on the American Psychiatric Association (APA) Council on Geriatric Psychiatry and the Geriatric Psychiatry Committee of the American Board of Psychiatry and Neurology. He has served on the board of directors of the American Association for Geriatric Psychiatry (AAGP) and on the editorial boards of 5 journals including his current role as social media editor of the American Journal of Geriatric Psychiatry. He is a recipient of several prestigious awards including the 2016 AAGP Barry Lebowitz Award and the 2014 APA Hartford Jeste Award.