Choi Namkee G, DiNitto Diana M, Lee Othelia EunKyoung, Choi Bryan Y
Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, United States.
School of Social Work, University of North Carolina at Charlotte, Charlotte, NC, United States.
J Med Internet Res. 2020 Jun 3;22(6):e17294. doi: 10.2196/17294.
The number of older adults with vision impairment (VI) is growing. As health care services increasingly call for patients to use technology, it is important to examine internet/health information technology (HIT) use among older adults with VI.
This study aimed to examine (1) the rates of internet/HIT use among older adults with VI compared with a matched sample of their peers without VI, (2) associations of VI with internet/HIT use, and (3) association of HIT use with psychological distress, assessed with the Kessler-6 screen.
Data were obtained from the 2013 to 2018 US National Health Interview Survey. Older adults (aged ≥65 years) with self-reported VI were matched with older adults without VI, in a 1:1 ratio, based on age, sex, number of chronic medical conditions, and functional limitations (N=2866). Descriptive statistics and multivariable logistic regression models, with sociodemographic factors, health conditions, health insurance type, and health care service use as covariates, were used to examine the research questions.
In total, 3.28% of older adults (compared with 0.84% of those aged 18-64 years) reported VI, and 25.7% of them were aged ≥85 years. Those with VI were significantly more socioeconomically disadvantaged than those without VI and less likely to use the internet (adjusted odds ratio [aOR] 0.64, 95% CI0.49-0.83) and HIT (aOR 0.74, 95% CI 0.56-0.97). However, among internet users, VI was not associated with HIT use. HIT use was associated with lower odds of mild/moderate or serious psychological distress (aOR 0.62, 95% CI 0.43-0.90), whereas VI was associated with greater odds of mild/moderate or serious distress (aOR 1.84, 95% CI 1.36-2.49). Health care provider contacts were also associated with higher odds of internet or HIT use.
Compared with their matched age peers without VI, older adults with VI are less likely to use HIT because they are less likely to use the internet. Socioeconomically disadvantaged older adults experiencing a digital divide need help to access information and communication technologies through a fee waiver or subsidy to cover internet equipment and subscription and ensure continuous connectivity. Older adults with VI who do not know how to use the internet/HIT but want to learn should be provided instruction, with special attention to accessibility features and adaptive devices. Older adults with a low income also need better access to preventive eye care and treatment of VI as well as other health care services.
视力受损的老年人数量正在增加。随着医疗保健服务越来越多地要求患者使用技术，研究视力受损的老年人对互联网/健康信息技术（HIT）的使用情况变得很重要。
本研究旨在探讨（1）与视力正常的同龄人匹配样本相比，视力受损老年人的互联网/HIT使用率；（2）视力受损与互联网/HIT使用之间的关联；（3）使用HIT与心理困扰之间的关联，通过凯斯勒6项量表进行评估。
数据来自2013年至2018年美国国家健康访谈调查。根据年龄、性别、慢性疾病数量和功能限制，将自我报告视力受损的老年人（年龄≥65岁）与视力正常的老年人以1:1的比例进行匹配（N = 2866）。使用描述性统计和多变量逻辑回归模型，将社会人口学因素、健康状况、健康保险类型和医疗服务使用作为协变量，以研究这些研究问题。
总体而言，3.28%的老年人（相比18 - 64岁人群中的0.84%）报告有视力受损，其中25.7%的人年龄≥85岁。视力受损者在社会经济方面比视力正常者处于更不利的地位，使用互联网（调整优势比[aOR] 0.64，95%置信区间0.49 - 0.83）和HIT（aOR 0.74，95%置信区间0.56 - 0.97）的可能性更低。然而，在互联网用户中，视力受损与HIT使用无关。使用HIT与轻度/中度或重度心理困扰的较低可能性相关（aOR 0.62，95%置信区间0.43 - 0.90），而视力受损与轻度/中度或重度困扰的较高可能性相关（aOR 1.84，95%置信区间1.36 - 2.49）。与医疗保健提供者的接触也与使用互联网或HIT的较高可能性相关。
与视力正常的同龄人相比，视力受损的老年人使用HIT的可能性较小，因为他们使用互联网的可能性较小。经历数字鸿沟的社会经济弱势老年人需要通过费用减免或补贴来帮助他们获取信息和通信技术，以支付互联网设备和订阅费用并确保持续连接。对于不知道如何使用互联网/HIT但想学习的视力受损老年人，应提供指导，特别关注可及性特征和适应性设备。低收入的视力受损老年人也需要更好地获得预防性眼部护理和视力受损治疗以及其他医疗保健服务。
