This is what we have known for many years: medical care alone does not equate to better health outcomes. Current research by the U.S. National Library of Medicine shows that healthcare accounts for 10% to 20% of the modifiable factors in population health outcomes. The largest share of contributors—the other 80% to 90%—is called the Social Determinants of Health (SDoH). According to the WHO, these factors-including transportation and food security-are determined by the allocation of funds, power and resources at the global, national and local levels.
We also know that access to technology and reliable information is essential for making healthy decisions and accessing healthcare now, so it should be formally regarded as the main social determinant. It can be said that during the pandemic, technology-related issues—from gaining trust—have had a life-changing impact on our country’s communities, especially the elderly and ethnic minorities.
This technological gap is not a “future challenge”: it is expanding every day and must be resolved with the same empathy and sense of urgency.
Unfortunately, most of our high-risk groups are still disadvantaged by technology.According to a University of Michigan National Opinion Survey on Healthy Aging, The elderly in the United States have trust issues. 49% of respondents expressed concern about privacy during telemedicine visits. More importantly, socioeconomics makes the situation worse. In the JAMA report, “Assessing the telemedicine readiness of older Americans during the Covid-19 pandemic,” 13 million elderly (38%) reported that they were “not ready” for telemedicine visits (according to a paper in JAMA Internal Medicine). Sadly, this proportion is even higher among people with lower socioeconomic status. high.
Whether it is due to indifference, mistrust, confusion, or just personal preference, as health care services “digitize”, the experience and outcomes of American seniors may get worse. Too many older people lack the support of digital health advocates—not to mention any health advocates. Every day, the elderly fall into the cracks of lack of care coordination, and their inability to obtain technology will further expand these cracks.
Older people deserve sympathy from the healthcare system.
Close your eyes and think about older relatives who may not be proficient in technology. Now think about how they would feel if they need urgent care and you are not around, and someone they don’t know is calling and telling them “Zoom call with the doctor on call.” They may feel depressed, scared or very angry.
When my mother had a heart attack, I witnessed how difficult it is to navigate the healthcare system and how this experience significantly slowed the rate of recovery. This is a serious wake-up call. For seniors without family advocates, navigating our technology-dependent healthcare system can be daunting and difficult to resist. Communication through digital platforms can make our seniors feel isolated, neglected, misunderstood, and often deprived of their rights in how to best manage their care.
We need a greater sense of urgency for two more and more important reasons.
First, we have a serious backlog problem. Covid-19 has created an unprecedented backlog of canceled surgeries and delayed treatments, which are now prioritized over routine examinations and follow-ups. For example, delayed breast cancer surgery for young mothers may now take precedence over follow-up by oncologists for older patients. Delaying treatment has a knock-on effect on everyone-especially the elderly, even if they are healthy, they need closer monitoring and care. Digital health can be a powerful weapon in our national provider’s arsenal. They continue to work overtime to catch up, but only if patients can effectively interact with them digitally.
Second, our supply and demand for professionals is reversed. We simply don’t have the manpower to see everyone face to face. The population over 65 in the United States is the largest in its history. This population jumped from 41 million in 2011 to 71 million in 2019, an increase of 73%. The growth is not over. It is estimated that by 2030, there will be 73 million elderly people in the United States-just in time for the severe shortage of nursing staff. By 2030, the United States will need 1.2 million newly registered nurses. California alone has a shortage of 44,500 nurses. This is of course the reason for the surge in telemedicine. But for this patient group, does it really soar? If 38% of elderly people are still not ready for telemedicine, this will not be the case.
So what should we do? I recommend embedding the four priorities into solutions that go beyond Internet connectivity and screens.
Priority 1: Empathy
Closing the technology gap requires placing older people in care centers. Just like UX and UI design, the personal journey must start from a high-level perspective. The journey must not include any assumptions, but recognize the real-world emotional and physical challenges that some seniors face when seeking and receiving care. For example, if an elderly person does not have a family spokesperson, can we provide one? If older people are deterred by technology, how do we seek to understand why and how to provide real resources to help them overcome these feelings? What is empathy in action? How to access the care team 24/7 to help seniors browse their options, whether it’s coordinating appointments or simply arranging transportation.
Priority 2: Equipment
Overcoming technology aversion requires equipping older people with tools, training, and access rights. This means advocating for additional benefits that make iPads, smartphones, or other connected devices more affordable, but also packaging these devices with the hardware and training needed for older people to become independent, confident users. Ultimately, the way, time, and location of care must go beyond two options: office visits or Zoom phones. Technology should be extended to provide 24/7 assistance, coordinate care between providers, and actually send resources to their doorstep.
Priority 3: Education
Every solution should be based on trustworthy information and education. It is important to take the time to review and provide data-based information to help older people with care. A good example is to provide older people with simple tools to identify risk factors for age-related diseases (such as diabetes or heart disease), while providing them with structured advice and resources to guide them on what to do next. A timely example of doing this is similar to our recent virtual town hall series of events to answer member questions and share important information related to Covid-19.
Priority 4: Empowerment
Empowering the elderly and their care team is the last but crucial step. This includes providing caregivers and care teams with insightful and actionable health data to spot trends, make real-time care decisions to improve daily results, and even predict necessary health interventions. But we must go further. We must authorize patients to receive care in the most suitable way for them, and provide them with health data electronically or otherwise, so that they can take control of their care. This “data fluidity” gives the ecosystem a unique mission around putting the elderly first. This means that efforts can and must be where they are—whether virtual or face-to-face, at home or in a nursing facility—while breaking down the fears and barriers surrounding technology-based care. When we participate, we focus on ensuring that they understand how and why this technology supports their personal health.
It is time to add technology as an important social determinant of health. The sooner we work to ensure that technology can simplify access to quality care, the sooner we can prove to seniors that technology is indeed on their side. Once they see this, they will be able to benefit from the full potential of digital health solutions.
Photo: ipopba, Getty Images
