Telehealth Use and COVID-19: Assessing Older Veterans' Perspectives

Video telehealth (VT) technology has increased mental health treatment access for veterans. Although veterans report high levels of satisfaction with VT, age disparities remain. Older adults in the general population face several barriers to using new technology, reflecting a "digital divide" between age cohorts. This trend continued during the COVID-19 pandemic, as older veterans were less likely to use VT-and more likely to use the telephone-for mental health visits than younger veterans. Although VT use has grown considerably during the pandemic, few studies have investigated older veterans' VT use relative to telephone services. Older veterans (aged 65+) who completed at least one telephone or VT visit in an outpatient geriatric mental health clinic during the first 6 months of COVID-19 received a telehealth satisfaction questionnaire via U.S. mail. While respondents (N = 66) reported moderate levels of satisfaction with VT and telephone appointments, there was less interest in using telehealth exclusively postpandemic. Fewer telephone users reported having access to email and internet and greater barriers to using VT. Veteran rurality was not associated with access to internet or email and did not affect telehealth ratings. Analyses of treatment engagement showed that the rate of missed appointments did not change during COVID-19. Post hoc qualitative analysis of open-ended comments revealed themes of barriers and needs, as well as positive and negative telehealth experiences that were consistent with quantitative findings. Despite experiencing barriers to using VT, older veterans identified potential benefits and solutions to enhance participation across the older adult population. Impact Statement Although older veterans were satisfied with telehealth during the COVID-19 pandemic, there may be growing interest in returning to in-person geriatric mental health services. Telephone only users were less likely to have internet and email access and perceived greater barriers to using video telehealth than those reporting any video telehealth use. Our results provide several avenues for improving best practices in telehealth services and increasing access to virtual mental health care within the older adult population.