Background: As hospital care becomes increasingly reliant on technology, it is important to address disparities in access and use of technology among hospitalized patients. While access to technology itself is becoming more widespread, older inpatients may still experience technology-related disparities due to varying abilities to use/obtain support for technology use. We sought to compare access, use, and need for support to use technology for healthcare between younger and older patients.
Methods: This was a cross-sectional observational study conducted at an urban academic hospital. Adult inpatients were surveyed about technology access, use, and need for support. eHealth literacy (eHL) was measured using the eHealth Literacy Scale (eHEALS). Participants were divided into three subgroups by age: < 50, 50-64, and ≥65 years. Kruskal Wallis tests and chi-squared tests were used to compare ordinal and categorical responses to the survey, respectively. Logistic regression and ordered logistic regression were performed to analyze the association between age/eHL and eHL/technology attitudes, respectively.
Results: Of the 106 participants included in this sub-study, the median age of participants was 57.5 years; (< 50: n=38; 50-64: n=38; ≥65 n=30). Most participants identified as female (63%, 67/106) and Black (72%, 76/106). While access to technology, including a computer, tablet, smartphone, or non-smartphone, was similar across age groups, use of technology differed. Use of internet several times a day was more common in younger participants [81% (30/37) < 50 years vs. 68% (23/34) 50-64 years vs. 38% (10/26) ≥65 years (p< 0.01)]. Older adults were more likely to report “encountering challenges when using technology every time:” 17% (5/29) of participants ≥65 years vs. 15% (5/34) of participants 50-64 years vs. 8% (3/37) of participants < 50 years (p< 0.01). The younger age group had the largest proportion of participants who had downloaded an app to manage health (57%; 20/35) compared to 43% (13/30) of participants 50-64 years and 32% (7/22) of participants ≥65 years. Greater than one-fifth (22%; 2/9) of participants ≥65 years reported the reason preventing downloading such an app was “too difficult” while this was not the response for the younger groups. Participants ≥65 years also reported being less confident in their ability to learn new technology (48%, 14/29) vs. < 50 years (73%, 27/37) and 50-64 years (57%, 20/35; p< 0.05). Older participants (≥65 years and 50-64 years) were more likely to have low eHL versus younger participants (< 50 years; OR: 4.0, p< 0.01) (figure). Participants with low eHL were more likely to lack confidence in their ability to complete tasks online (adjusted OR: 12.61, p< 0.001) and learn how to use new technology for healthcare (adjusted OR: 6.15, p< 0.001) as well as lack interest in doing so (adjusted OR: 3.18, p< 0.01), even when adjusted for age (table).
Conclusions: In our cohort, a large proportion of older inpatients are not using technology in their daily lives and lack confidence in doing so. Older participants were also more likely to have low eHL, which itself was associated with lack of confidence in ability to learn how to use new technology for healthcare. Therefore, when incorporating technology into the care of patients, it is important to ensure older patients have assistance needed to improve their use of technology in addition to continuing to offer low-tech options for those who prefer it.
