Effectiveness of Ambulatory Telemedicine Care in Older Adults: A Systematic Review

Abstract

Background: Disparities in healthcare access and delivery, caused by transportation and health workforce difficulties, negatively impact individuals living in rural areas. These challenges are especially prominent in older adults.

Design: We systematically evaluated the feasibility, acceptability, and effectiveness in providing telemedicine (TMed), searching the English-language literature for studies (January 2012 to July 2018) in the following databases: Medline (PubMed); Cochrane Library (Wiley); Web of Science; CINAHL; EMBASE (Ovid); and PsycINFO (EBSCO).

Participants: Older adults (mean age = 65 years or older, and none were younger than 60 years).

Interventions: Interventions consisted of live, synchronous, two-way videoconferencing communication in nonhospital settings. All medical interventions were included.

Measurements: Quality assessment, using the Cochrane Collaboration's Risk-of-Bias Tool, was applied on all included articles, including a qualitative summary of all articles.

Results: Of 6616 citations, we reviewed the full text of 1173 articles, excluding 1047 that did not meet criteria. Of the 17 randomized controlled trials, the United States was the country with the most trials (6 [35%]), with cohort sizes ranging from 3 to 844 (median = 35) participants. Risk of bias among included studies varied from low to high. Our qualitative analysis suggests that TMed can improve health outcomes in older adults and that it could be used in this population.

Conclusions: TMed is feasible and acceptable in delivering care to older adults. Research should focus on well-designed randomized trials to overcome the high degree of bias observed in our synthesis. Clinicians should consider using TMed in routine practice to overcome barriers of distance and access to care. J Am Geriatr Soc 67:1737-1749, 2019.

Keywords: effectiveness; older adult; rural; telemedicine.

FIGURE 1:

Flow Diagram of Study Selection Process for the Systematic Review. We reviewed n=36 systematic review bibliographies, which accounted for n=535 additional records of studies for review (accounted for in the flow diagram as ‘additional records identified through other sources.’). These articles were accounted for in the flow diagram.