Virtual care and telemedicine for elderly patients — what works and what doesn't

This article is for informational purposes only and does not constitute medical, legal, or financial advice. Please consult appropriate professionals for guidance specific to your situation.

Your parent has a follow-up appointment with their cardiologist. The appointment used to mean a trip to the hospital, an hour driving, parking, waiting in the reception area, more waiting in the exam room. Now the doctor's office has offered a telemedicine appointment instead. Your parent can do the appointment from home through a video call. It sounds easier. But you're wondering if it's actually okay, or if your parent really needs to be in person.

Telemedicine has become a normal part of healthcare, especially since the pandemic. For some situations and some patients, it's fantastic. For others, it's less useful and sometimes even problematic. Understanding when telemedicine actually works and when your parent really needs to be in person matters.

When Virtual Care Actually Helps

Telemedicine works really well for routine follow-up appointments where the doctor mostly needs to talk to your parent and check in on how they're managing their condition. If your parent is seeing the cardiologist for a follow-up three months after surgery, and the main purpose is to talk through how your parent is feeling, whether there are any concerning symptoms, and whether medication adjustments are needed, telemedicine can handle that.

The benefit is real: your parent doesn't have to travel. If your parent has mobility issues or difficulty driving, or if the appointment is far away, telemedicine removes a significant barrier. Your parent also gets to the appointment more easily, which might mean they're actually less tired and stressed, which might mean they communicate better with their doctor.

Telemedicine also works for initial consultations where the doctor is taking a history and understanding your parent's background. For medication reviews and adjustments. For follow-up on lab results. For discussing how side effects from medication are affecting your parent. For therapy or mental health appointments where talking is the whole point.

For certain specialties, like psychiatry or behavioral health or chronic disease management, telemedicine can be the primary way of receiving care and works very well. Your parent might have therapy or counseling appointments entirely through video, and that might be more convenient than driving somewhere.

Prescriptions can be filled based on telemedicine appointments. Your parent doesn't lose continuity of care just because it's virtual.

What Telemedicine Cannot Do

Telemedicine cannot involve a physical examination. The doctor cannot listen to your parent's heart or lungs. Cannot feel your parent's abdomen to check for lumps or pain. Cannot examine your parent's skin condition. Cannot assess range of motion or strength. Cannot take blood pressure, though your parent might have a blood pressure cuff at home that they can read to the doctor. Cannot do any of the physical assessment that's part of a comprehensive medical visit.

This matters more for some situations than others. If your parent has chest pain and the doctor needs to rule out a heart problem, telemedicine is not sufficient. Your parent needs to be examined. If your parent has a skin concern that needs to be evaluated, telemedicine might work if your parent can get a clear image on camera, but an in-person look is more reliable. If your parent is having neurological symptoms and the doctor needs to do specific tests, that requires in-person assessment.

Telemedicine also has real limitations if your parent has cognitive decline. If your parent has moderate or advanced dementia, they might not be able to participate clearly in a telemedicine appointment. They might not remember how to use the technology. They might not be able to describe their symptoms accurately. They might become agitated by the screen or confused about what's happening. For people with significant cognitive decline, in-person appointments where the doctor can also observe their behavior and functioning become more important.

If your parent is deaf or hard of hearing, telemedicine can be more difficult. Video quality might not be good enough for lip-reading. Background noise in your parent's home might make hearing worse. Your parent might need an interpreter, which adds complexity to a virtual appointment. Sometimes in-person appointments with proper accommodations work better.

Technology barriers are real too. Your parent might not have reliable internet. Your parent might not have a device capable of doing a video call. Your parent might not feel comfortable with the technology. If setting up the telemedicine appointment creates significant stress or requires you to come to your parent's house to get them logged on, that's a sign that telemedicine isn't actually more convenient.

Making Telemedicine Work For Your Parent

If your parent is having a telemedicine appointment, help set it up. Make sure your parent has a quiet, private space where they can hear and be heard. Test the technology beforehand so you know the video and audio work. Help your parent get logged on a few minutes early so they're not flustered. If possible, be present in the home during the appointment, not in the room with your parent, but available if something goes wrong or your parent forgets what the doctor asked.

Before the appointment, help your parent make a list of what they want to talk about. Because of the limitations of telemedicine, your parent might forget important things or might have trouble describing complex symptoms. A list helps. Write down current medications and dosages so your parent has them available. Think about questions in advance.

After the appointment, make sure you understand what the doctor recommended. If your parent needs any follow-up care, make sure that's scheduled. If your parent needs to come in for a physical exam at some point, make sure that's on the radar, not assumed to be optional just because the initial appointment was virtual.

Also be honest with your parent about whether telemedicine is actually working. If your parent seems confused or frustrated by the technology, if your parent doesn't feel like the doctor is really understanding what's going on, if you feel like important things are being missed, bring that up. It's okay to request an in-person appointment. Good doctors want to see their patients in person when it actually matters.

When Your Parent Needs to Go In Person

Trust your instinct. If your parent has new symptoms that need examination, in-person makes sense. If your parent is having a serious medical problem and you're not sure what's going on, telemedicine is not the place to start. If your parent has been seeing this doctor through telemedicine and hasn't had an in-person visit in more than a year, an in-person appointment becomes important, both for the doctor to actually examine your parent and for your parent to feel truly seen and evaluated.

If your parent is very sick or declining quickly, telemedicine is not sufficient. Your parent needs hands-on medical evaluation.

If your parent is anxious about a diagnosis or worried about their health, the human connection of an in-person appointment can be genuinely helpful. Your parent might communicate better when they're in the room with a doctor they can look at and who can look at them.

Telemedicine is a tool that works for some things and some people. It's not better or worse than in-person care universally. It's different, and sometimes it's more convenient, and sometimes it's not sufficient. The right approach is using each when it actually makes sense for your parent's specific situation.

How To Help Your Elders provides educational content for family caregivers. This is not a substitute for professional medical, legal, or financial advice. Every family situation is different — what works for one may not work for another.