Telehealth Access and Use Among Older Adults Post-COVID-19: Heterogenous Effects on Cognitive Functioning

Area of Science:

• Gerontology
• Health Services Research
• Cognitive Science

Background:

• Medicare telehealth waivers post-COVID-19 offer insights into older adults' digital health engagement.
• Longitudinal analysis of telehealth use and cognitive function in aging populations is crucial.

Purpose of the Study:

• To examine the longitudinal relationship between telehealth access/use and cognitive functioning in Medicare beneficiaries aged 70+.
• To investigate if telehealth's impact on cognition differs across cognitive performance levels.

Main Methods:

• Longitudinal cohort study (2021-2023) of 3,116 Medicare beneficiaries (aged 70+).
• Categorization of telehealth access/use: no device access, basic internet, broader internet use, telehealth use.
• Unconditional quantile regression with fixed effects to analyze associations across the cognitive distribution.

Main Results:

• Lack of internet device access correlated with cognitive decline; telehealth use correlated with better cognitive functioning.
• Telehealth use showed cognitive benefits primarily at the lower end (10th percentile) of the cognitive performance distribution.
• Digital access and usage patterns were largely stable, with limited upward mobility in digital engagement.

Conclusions:

• Stable digital engagement patterns emphasize the need for early interventions promoting internet access and digital literacy in older adults.
• Targeted interventions are essential to increase telehealth access for seniors at risk of cognitive impairment, maximizing its cognitive benefits.