CLARITY (Collaborative Ageing Research) Group, North Bristol NHS Trust, UK.
CLARITY (Collaborative Ageing Research) Group, North Bristol NHS Trust, UK; Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK.
J Am Med Dir Assoc. 2024 Apr;25(4):676-682. doi: 10.1016/j.jamda.2023.08.028. Epub 2023 Oct 16.
Many older people regularly access digital services, but many others are totally excluded. Age alone may not explain these discrepancies. As health care services offer more video consultations, we aimed to determine if living with frailty is a significant risk factor for digital exclusion in accessing video consultations, and if this changes if a person has a support network to help with access.
We undertook a muticenter cross-sectional survey across South West England.
Patients in primary care, hospital at home, and secondary care services were enrolled between February 21 and April 12, 2022.
The primary outcome was complete digital exclusion defined as no individual access or network support access to video consultations. Secondary analysis looked at the person's digital exclusion when ignoring any network support. The association between frailty and outcomes was analyzed with logistic regression. In addition, older people's digital skills, motivation, and confidence were examined.
255 patients were included in the analysis. The median age was 63 years (interquartile range 43-77) with 148 (57%) women. Complete digital exclusion was rare (5.1%). Only 1 of 155 who were not frail (Clinical Frailty Scale 1-3) experienced complete digital exclusion compared with 12 of 99 (10.7%) who were living with frailty (Clinical Frailty Scale 4-8). There was no association between frailty and complete digital exclusion. Frailty was associated with individual digital exclusion when no network support was available to assist.
When taking into account a person's support network, complete digital exclusion from video consultation was rare. When no support network was available, frailty was associated with individual digital exclusion. Health care services should ask about a person's support network to help people living with frailty access video consultations.
许多老年人经常使用数字服务，但也有许多老年人完全被排除在外。仅年龄可能无法解释这些差异。随着医疗保健服务提供更多的视频咨询，我们旨在确定在访问视频咨询时，虚弱是否是数字排斥的一个重要危险因素，如果一个人有支持网络来帮助访问，是否会改变这种情况。
我们在英格兰西南部进行了一项多中心横断面调查。
初级保健、家庭医院和二级保健服务中的患者于 2022 年 2 月 21 日至 4 月 12 日期间入组。
主要结局是完全数字排斥，定义为没有个人访问或网络支持访问视频咨询。二次分析忽略任何网络支持时的个人数字排斥情况。使用逻辑回归分析虚弱与结局之间的关系。此外，还检查了老年人的数字技能、动机和信心。
共有 255 名患者纳入分析。中位年龄为 63 岁（四分位距 43-77），其中 148 名（57%）为女性。完全数字排斥很少见（5.1%）。在没有虚弱（临床虚弱量表 1-3）的 155 人中，只有 1 人经历了完全数字排斥，而在患有虚弱（临床虚弱量表 4-8）的 99 人中，有 12 人经历了完全数字排斥。虚弱与完全数字排斥之间没有关联。当没有网络支持来协助时，虚弱与个人数字排斥有关。
当考虑到一个人的支持网络时，从视频咨询中完全排斥数字服务的情况很少见。当没有支持网络时，虚弱与个人数字排斥有关。医疗保健服务机构应该询问患者的支持网络，以帮助患有虚弱的患者访问视频咨询。
