The Effectiveness of Telehealth on Self-Management for Older Adults with a Chronic Condition: A Comprehensive Narrative Review of the Literature

Background and Purpose: Due to the rapid changes in diets and lifestyles, great health care demand of chronic diseases is a grand challenge worldwide. With global aging, older adults become the major victims of chronic diseases. In United States, over 80% of older adults (55+ years old) live with at least one chronic condition, and 68% live with at least two. The heavy burden of chronic diseases among older adults accelerates the demand of self-management. Tele-health is especially promising for older adults with chronic condition(s) to improve access to health services, obtain self-management skills, enhance communication with health care providers, improve clinic outcomes, and have better quality of life. The purpose of the present study was to explore the effects of tele-health technologies on self-management among older adults with chronic condition(s). According to the goals of self-management discussed above, we sought to answer the following research questions: 

1.         Are tele-health technologies effective on improving self-care skills among older adults with chronic condition(s)?

2.         Are tele-health technologies effective on improving self-monitoring behaviors among older adults with chronic condition(s)?

3.         Are tele-health technologies effective on improving clinical outcomes among older adults with chronic condition(s)?

Methods: by using the PRISMA statement guidelines, clinical trial studies on tele-health of self-management for older adults with chronic condition(s) published in peer reviewed journals before March 16, 2017 were reviewed systematically. Systematic searching was conducted in six major medical databases (PubMed, Psych Info, Web of Science, Cinahl, Ovid Medline and Cochrane) by combining with keywords related to tele-health strategies, self-management, chronic conditions, and older adults. All studies were screened and coded by two independent reviewers and consensus was achieved. To guarantee included studies are trusted evidence, the following potential biases were assessed: selection biases, performance biases, detection biases, attrition biases, and reporting biases.

Results: The initial search yielded 366 potential articles.  After duplicates were removed, 325 records were left. Of the remaining 325 records, 68 articles were included based on screening title and abstract, and then 31 were identified for full-text review. Within the included 31 articles, there were 14 studies of long-distance communication technologies, 3 studies of web-based technologies, 9 studies of home-health monitoring systems, 4 studies of tele-education technologies, and 1 study regarding a telehealth program applying multiple telehealth technologies

Conclusions and implications: our findings suggest that tele-health technologies can effectively improve older patients’ self-care skills, self-monitoring behaviors, and clinical outcomes with a range of chronic conditions.  However, such effectiveness is short-term improvements. The long-term effectiveness of interventions on self-management are unknown. Furthermore, it is critical to consider racial diversity and culture-related acceptance differences when using telehealth technologies. Additionally, health providers play an important role in the success of tele-health interventions. Social workers can play a critical role of promoting active interaction between patients and the health care providers, which can prevent patients from dropping out from tele-health program. Consistent interaction and communication between patients and their health care providers is necessary for effective tele-health interventions.