Demystifying the Digital Divide: Disparities in Telerehabilitation Readiness Among Older Adults in the United States

ABSTRACT

Objective

To estimate readiness of older rehabilitation users in the United States to participate in video-based telerehabilitation and assess disparities in readiness among racial and ethnic minoritized populations, socioeconomically disadvantaged populations, and rural-dwelling older adults.

Design

Retrospective cohort study using nationally representative survey data from the National Health and Aging Trends Study from 2015 and 2020. Survey-weighted regression models, accounting for complex survey design, were used to generate estimates of readiness and evaluate disparities across racial and ethnic, socioeconomic, and geographic subgroups. Odds ratios (OR) and 95% confidence intervals (CI) were estimated for each comparison.

Setting

Home or community rehabilitation environments

Participants

A cohort of 5,274 home or community-based rehabilitation users aged 70 years or older, representing a weighted 33,576,313 older adults in the United States.

Interventions

Not applicable.

Main Outcome Measure(s)

Video-based telerehabilitation readiness was defined consistent with prior work; unreadiness was defined as lacking ownership of internet-enabled devices, limited proficiency of use, or living with severe cognitive, visual, or hearing impairment. Telerehabilitation readiness was categorized as "Ready" or "Unready".

Results

Approximately 2 in 3 of older rehabilitation users were categorized as ready to participate in video-based rehabilitation. Significantly lower rates of readiness were observed among those living in rural areas [OR=0.75, 95% CI: 0.60-0.94], financially strained individuals [OR=0.37, 95% CI: 0.26-0.53], and among individuals identifying as Black or Hispanic [as compared to non-Hispanic White older adults: Non-Hispanic Black [OR=0.23, 95% CI: 0.18-0.30; Hispanic [OR=0.17, 95% CI: 0.11, 0.27)].

Conclusions

Our findings highlight significant disparities in the readiness to uptake video-based telerehabilitation. Policy and practice interventions to address telerehabilitation readiness should focus not only on improving broadband access but also on technology ownership and training to ensure equitable adoption in populations with lower baseline readiness.