Meeting At The Crossroads

Telehealth and Geriatric Care

Meeting at the Crossroads is a new column dedicated to bringing members of various SAEM interest groups and academies together to explore the areas where they intersect. In this inaugural column, Erica Olsen, MD, chair of the SAEM Telehealth Interest Group sits down with.James Kenny, MD, a member of SAEM’s Academy of Geriatric Emergency Medicine (AGEM) to discuss telehealth as a tool for delivering care to geriatric patients.

Dr. Olsen: Thank you for meeting with me today. I think our first conversation on this topic took place after the spring COVID surge subsided in New York City and we realized that a significant number of our virtual urgent care visits came from geriatric patients (older than 65 years of age). Dr. Kenny: Yes, as we looked more closely at some of the patient characteristics, we saw that in several instances these geriatric patients had never accessed this telehealth service previously, yet they were able to do so in the midst of a crisis. Dr. Olsen: Let’s talk about that for a minute… as a telehealth provider, I can say that from my experience, family members — either adult children and/or grandchildren — are sometimes involved in assisting geriatric patients with access. What is your take on that? Dr. Kenny: I think family members and caregivers can be valuable partners for older patients during telehealth visits. We have some preliminary data from our emergency department (ED) that more than 40 percent of patients 65 years of age and older required some form of assistance during their telehealth encounter. Caregivers have the potential to help older patients navigate obstacles such as using unfamiliar technology, adjusting the audio for patients with hearing difficulties, and providing an accurate history for patients with dementia or other cognitive impairments. Dr. Olsen: I agree that family members were helpful. For those patients who do

not have family or caregivers nearby, we need to consider how we may facilitate access for this vulnerable population. For example, we may offer to assist with downloading apps and provide education for all of our geriatric patients during their ED stay, or we may consider delivering technology and WiFi to patients in conjunction with our community paramedicine programs. Dr. Kenny: Another area where telehealth may be integrated into ED operations is in the management of our stable geriatric patients who may be discharged home with close follow-up or observation. Some geriatric EDs have developed pathways where discharged patients have robust follow-up via phone calls. Integrating telehealth into such models may provide a more comprehensive reassessment. Dr. Olsen: Right, it sounds like you’re talking about remote patient monitoring (RPM) whereby patients utilize home monitoring kits containing things like tablets, glucometers, pulse ox devices, blood pressure machines, scales to detect fluid retention, and cardiac monitors and then this information is transmitted to

medical professionals who determine whether or not a patient needs to come into the emergency department. It has potential to cut down on unnecessary ED visits and downstream effects of this, but it also provides patients with a level of security to know that they can receive guidance if and when they need to at their fingertips. Dr. Kenny: Yes, we may also consider providing support and guidance to our geriatric patients that reside in long-term care facilities. Some health systems utilize telehealth for EM providers to consult with community skilled nursing facilities (SNFs). In this way they may partner to assist with determining who may stay in place and who should come to the hospital. This communication bridge between the ED and SNF benefits all parties, especially the patient. Dr. Olsen: It sounds like we agree that telehealth has the potential to enhance emergency medical care for our geriatric patient population. The recent expansion of covered services through CMS/ Medicare has allowed many patients and providers to experience these capabilities (some, for the first time). We will need to keep this conversation going and continue to research these services if we want Congress to consider more permanency of these waivers that were temporarily put into effect during the COVID national health crisis.

BIOGRAPHIES

Dr. Olsen is the director for virtual health services in the department of emergency medicine at Columbia University Irving Medical Center / New York Presbyterian Hospital. She is the chair of SAEM's Telehealth Interest Group.

Dr. Kenny is the medical director for the Columbia Geriatric Emergency Department at New York–Presbyterian Hospital. He is a member of SAEM's Academy of Geriatric Emergency Medicine.