'There's a whole world, and i ain't in it': older adults' experiences with technology during the covid-19 shelterin-place orders

Background: Concerns have been raised regarding older adults' access to and comfort with technologies to overcome physical distancing restrictions during the COVID-19 pandemic. Our objective was to better characterize the 'digital divide' older adults may have experienced during shelter-in-place. Methods: Semi-structured in-depth interviews were conducted with a purposive sample of 13 community-dwelling older adults with diverse experiences with technology, recruited from two community sites and a geriatrics practice in San Francisco. Concurrent data analysis using a grounded theory approach was completed by two independent coders to identify salient themes. Results: Participants were 77 years on average (range 64-93), 69% female, 23% Black, 69% lived alone, and 54% reported at least one ADL impairment. Two themes emerged in how participants positively adapted to COVID-19 restrictions and emotionally coped through the use of technology. First, many reported discovery of new technologies to maintain or develop new connections, including Zoom-based community groups and telehealth services ('there's all kinds of virtual programs where you can exercise'). Second, older adults were resourceful in identifying community resources and enlisting family members to learn ('I had to ask one of my granddaughters how to make the chat thing work'). Two themes emerged regarding barriers to technology use. First, older adults identified internal barriers such as stigma and shame and concerns about privacy or overuse of technology ('my daughters have said that I overshare, so I don't want to set myself up'). Second, identified external barriers included lack of support for sudden breakdowns (from family and/or community), difficulty navigating technical details (passwords, upgrades, security protocols), and perceived structural ageism ('we act as if seniors can't hold that information'). Overall, participants described virtual interaction as inferior to in-person, but noted that video interaction was preferable to phone and 'better than nothing.' Conclusions: While technology was central to many older adults' ability to adapt to COVID-19 restrictions, barriers and frustrations were common. Identified facilitators and barriers can inform technology-based interventions that bridge the digital divide among older adults to improve health, social well-being, and quality of life.

Older adults with anxiety have higher avoidance of in-person medical visits during the covid-19 pandemic

Background: The COVID-19 pandemic continues to have detrimental effects on older adults' mental health while rapidly transforming access to medical care. Our objective was to determine if anxiety surrounding the pandemic may be associated with increased avoidance of in-person medical visits, even when visits were perceived as needed. Methods: We conducted phone-based surveys from April 7th, 2020 to October 27th, 2020 with 155 older adults age ≥60 from two community sites and an academic geriatrics outpatient clinical practice. Healthcare system access was assessed with questions on telehealth use, the number of delayed in-person medical appointments or procedures, and avoidance due to fear of the coronavirus of in-person medical visits participants perceived as 'needed'. Anxiety was measured with the Generalized Anxiety Disorder 2-item (GAD-2) scale. We used bivariate statistics to determine the association between the rate of healthcare utilization and anxiety. We also assessed freetext comments for expression of anxiety or concerns about access to medical care. Results: Participants were on average 75 years old (SD=10), 50% of whom had hearing or vision impairment, 26% had difficulty bathing, 64% lived alone, and 92% had accessed telehealth clinical services. Approximately 52% reported worries about delayed medical care and 41% reported avoiding an in-person medical visit that they felt was needed due to fear of COVID-19;55% of avoided visits were routine or preventive, 43% specialist appointments, and 8% urgent care/ED visits. Individuals screening positive for anxiety were more likely to avoid in-person medical visits (60% versus 47%, p=0.006). Open-ended responses revealed worries about delays in routine medical care (e.g. injections, vaccines, dental visits), fears that non-COVID health needs were deemed non-essential, and difficulty accessing the health system due to restrictions. Conclusion: Older adults who screened positive for anxiety were more likely to avoid needed in-person medical visits, and had a broad range of visit types they felt were needed. Clinicians should work with older patients, particularly those who are anxious, to provide safe and accessible options for seeking in-person care and reassure patients that non-COVID related health concerns are still a priority.