Acceptability and Usability of Telemedicine for Older Veterans in a Pilot Sample: Mixed Methods Study

Telemedicine offers promising solutions for improving access to care among older adults with chronic conditions, but there is limited evidence on how older patients navigate and engage with video telehealth in their home environments.

This study aimed to assess older adults' acceptability, usability, comfort, and engagement with pharmacist-led telemedicine visits conducted at home using behavioral observation separate from the telehealth platform.

This descriptive mixed methods pilot study included a convenience sample of 20 older adult veterans (aged ≥65 years, ≥2 chronic conditions, and ≥5 medications) recruited from a Veterans Affairs (VA) health care system. A project manager observed and video-recorded participant preparation for and conduct during in-home telemedicine visits with a clinical pharmacist. Recordings were coded using structured protocols to assess verbal and nonverbal behavior, technological challenges, and environmental factors. Trained and reliable coders rated verbal and nonverbal comfort, frustration, and engagement during technology setup and the telemedicine appointment using Likert-type impression scales (intercoder reliability was good, Cohen κ=0.81). Video data were also transcribed and coded for behavioral events (eg, troubleshooting, verbal expressions of age or technology ability, and nonverbal adaptation) and analyzed using rapid qualitative analysis.

Participants expressed moderate engagement and comfort with technology overall. Verbal and nonverbal engagement significantly increased from setup to appointment (Z=2.03, P=.002). Technology-related challenges (eg, audio lag and troubleshooting) occurred in over half the visits but were often resolved through participant adaptation or support from the research staff. Participants displayed both frustration (eg, sighing and leaning away) and adaptability (eg, propping up tablets and retrieving medications). Verbal expressions reflected a mix of technology confidence and age-related limitations. Environmental distractions were present in some visits (eg, dogs barking or phones ringing), but also allowed for rich clinical engagement (eg, home tours and direct observation of medications).

In this small pilot sample of older veterans, participants generally remained engaged during in-home telemedicine visits despite technological and contextual barriers, suggesting that home-based telemedicine may be acceptable for some older adults when support is available. Addressing technical support, home environment considerations, and age-related perceptions of technology may increase telehealth usability and satisfaction among aging populations.