Based on a paper by Robert J Campbell, EdD and David A Nolfi, MLS, AHIP
Edited Article by Dr. Don Rose, Writer, Life Alert

Introduction

Much has been written about the Internet's potential to revolutionize health care delivery. As younger populations increasingly utilize Internet-based health care information, it will be essential to ensure that the elderly become adept at using this medium for health care purposes, especially those from minority, low income, and limited educational backgrounds.

This paper presents the results of a program designed to teach elderly adults to use the Internet to access health care information. The objective was to examine whether the training led to changes in participant's perceptions of their health, perceptions of their interactions with health care providers, health information–seeking behaviors, and self-care activities.

The days of the physician-centered, paternalistic model of health care, when physicians seemingly provided all answers and all direction, are rapidly fading. Although many health care systems in industrialized countries continue to move toward a shared decision-making model, many seniors learned to interact with their health care providers when the paternalistic model was prevalent. To become independent consumers of health care, seniors must learn to find the health information needed in order to participate in the shared decision-making model. As increasing numbers of seniors go online, the Internet can provide needed health information, but seniors must become both health and “health information” literate. More research is needed to determine whether Internet use increases seniors' levels of participation, alters their decision-making processes, and most importantly, whether it has a positive impact on seniors' overall health.
The Digital Divide
Use of the Internet continues to grow exponentially across all age groups in the United States. One study reports that 77% of 18- to 29-year-olds, 75% of 30- to 49-year-olds, 58% of 50- to 64-year-olds, and 22% of adults 65 and older have access to the Internet. Another study reports that more than 80% of adult users (or 93 million) have searched the Internet for health information. Of that 93 million, roughly 5 million adults age 65 and older have used the Internet to access and use health care information. Although the discrepancy in Internet use among age groups decreases each year, a large gap exists between seniors who frequently use the Internet to find health care information and those who do not. This gap is of grave concern because the move toward managed care places a greater burden on patients to make decisions about their own health care.

Furthermore, U.S. government agencies are now beginning to place an increasing amount of information relevant to Medicare and other programs on the Internet (in fact, one option to sign up for the Medicare drug benefit card is to register via the Internet). Seniors who lack access to the Internet -- as well as the skills necessary to find, retrieve, and evaluate information -- are at a distinct disadvantage in managing their health care.

Of the 22% of US adults aged 65 and older using the Internet, it is estimated that 66% use the Internet to locate health information. Initial studies suggest the majority of senior users are highly educated white females, with high economic standing, who own personal computers connected to the Internet. Elderly males and elderly members of ethnic minority groups lag behind in using the Internet to locate health care information. In 2003, only 11% of African Americans aged 65 and older reported using the Internet for any purpose.
A Cause for Concern
Providing seniors with the requisite skills to use the Internet to locate health information is important for four reasons:
  • Of all medical expenditures in the United States, 40% are for persons 65 and older. With the senior population expected to rise from its current proportion of 12.4% to more than 20% in the year 2030, medical expenditures for seniors will continue to grow.
  • Research shows that care for seniors for conditions such as dementia, mobility disorders, pressure ulcers, urinary incontinence, and end-of-life care falls well short of practice guidelines.
  • Americans 65 and older are at constant risk of functional decline by either having to live with a disability or suffering from a chronic illness.
  • Substantial disparities exist in the quality of care delivered to ethnic minority patients, who are more susceptible to cardiovascular disease and cancer.
The ability to locate relevant health care information benefits seniors by helping them to ask better questions of their health care providers. Several studies show that patients who ask questions, elicit treatment options, express opinions, and state preferences during physician office visits have measurably better health outcomes than those who do not. Exposing seniors to Internet-based practice guidelines and standards of care should increase the likelihood that they will receive the proper treatment and take preventive measures.

The authors hypothesized that teaching seniors to use the Internet to search for health care information and to evaluate the quality of information found would result in (1) reduced reluctance to use computers and increased willingness to use the Internet to find health care information; (2) increased willingness to use external health care information to manage their health care; (3) adoption of a more active role in managing their health care; and (4) increased perception of control over their own health and wellness.
Methods
This study began in September 2001 with recruitment of volunteers to participate in 5-week training seminars. Classes within each seminar lasted 2 hours and consisted of lecture and hands-on training. Baseline surveys were administered prior to the course, 5-week follow-up surveys were administered immediately after the course, and final surveys were mailed one year later. Two additional questionnaires included multiple choice and qualitative questions, designed to measure participants' Internet utilization and levels of health care participation.

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