| Nonverbal communication and body language |
Usual forms of virtual care (ie, phone calls and video calls) eliminate nonverbal communication, including facial expressions and body language. |
“…you do miss some of the eye contact and the body language, and I make the point that when people communicate, they often talk about the words only being about 7%, the tone being 38% of the…body language being 55%, so email or a phone, you might get the tone but you don't get the body language and that's, and, sometimes that's very important. I know, how many times that I noticed body language, that I would ask another question, and bingo, the real problem would come out, where it wouldn't have come up if you hadn't been able to observe the body language” [James, 75 years, male, Ba]
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| Technology |
Virtual care can be difficult to access for older adults who either do not have access to sufficient technology at home or do not know how to use the technology they have to engage in virtual care. |
“I worry about that. And for people who don’t have access! I mean everybody doesn’t have a computer at home, or they have a computer, but they barely don’t know how to use it. I talk to people, and they say, well, you know, my son will help me, my daughter will help me, my grandkids will help me. But other than that, they don’t know how…they don’t use it. Or they might use it just for…phone conversation…you know, for e-email kind of stuff, and that’s it. And so, they don’t get it…they don’t get to use. They don’t have real access, and now…the library is being closed now. People have even less access.” [Helen, 77 years, female, B]
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| Verbal communication |
Participants are concerned about the ability of both patients and doctors to express themselves in virtual visits. They mentioned that people with cognitive or hearing difficulties may find accessing virtual care especially difficult due to the challenges of understanding. |
“Maybe I didn't explain it well enough to them. I'm not a nurse, you know, and I just know how it feels to me, I probably don't have an experience and that, whatever is happening to me, this time when I would call, you know. So, it might be my terminology, my reporting might not be as good as they might need.” [Sharon, 82 years, female, B] “Yes, and if they have hearing problems, that might be, a deterrent too because…or cognitive problems where they, have problems understanding” [Shirley, 77 years, female, B] “We have a tendency to save the important questions ‘til the end. That's a known fact, is that people are having a physical or whatever, you go through all the steps. And as they're walking out the door they say, 'Oh, by the way, I've been having chest pains’.” [Helen, 77 years, female, Fb]
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| Physical examination |
Although participants believed that many health issues can be successfully discussed virtually, several participants also expressed concerns over the lack of physical and tactile examination during virtual appointments. The general concern behind this was that doctors would be more prone to accidentally missing something if the patient was not physically in front of them. |
“I just want to say that it is very limited. Sometimes, when you have a problem and you're seeing a doctor, you want him to look, with his own eyeballs to see the actual thing. You…to see your skin, in the real thing not…not done through a camera, and you want him to poke you, you know, or feel. There's so much in an examination, that should be done tactile, as opposed to only visual. Only visual, you miss so much without the tactile attached to it.” [Richard, 76 years, male, B]
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| Care continuity and coordination |
Participants felt that because virtual care usually meant that their provider was physically seeing them less often than they would with in-person care, the continuity of care and ability of physicians to coordinate care activities suffered. |
“The cons would be, perhaps a lack of follow up sometimes, because you’re not seeing anything done. Like if I go to his office and he gives me a referral to someone or if he’s…you just don’t see that referral happening through you, you see him doing it, and sometimes that doesn’t happen as quickly as it could.” [Nancy, 66 years, female, B]
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| Social isolation and health care as a social experience |
Health care visits can be vital social experiences for older adults. Switching to a virtual format removes much of the social activity and personality from appointments. |
“I think if I really needed to see the doctor, she would let me go in and talk to her. And I think I still need that if I do need it. And that would be most likely for an emotional situation more than anything” [Judith, 75 years, female, F] “And also, for some people the doctor's visit is one of your social experiences. The more you live alone, like I live alone, these kinds of contacts are part of your…socialization, your contacts…like going to the library, going to the doctor, these are all things where people have contact with others. So, if you make these things more virtual, you cut back on people's contacts with the outside world.” [Helen, 77 years, female, B]
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