| Silver linings from the coronavirus have been few and far between. One of the greatest, however, has been the rise in telehealth. Patients are able to get access to their doctors—even mental-health therapists—online, without driving to the office, paying for parking or sitting idly in the waiting room until the provider wraps up their previous appointment. But not everyone is benefiting. Those most in need might also be the least likely to be able to reap the benefits of telemedicine. A new study from researchers at the University of California in San Francisco found that one in three Americans aged 65 and older have trouble connecting with their doctors remotely. They may not have internet access or the technical skills to handle problems that crop up during the appointment. They may also struggle to communicate because of hearing, visual or cognitive problems. Those hit hardest are older, poor men, especially in rural areas. Patients with disabilities or who are in poor health face the steepest hurdles.  Everlywell's Covid-19 at-home test kit Courtesy: Everlywell In all, about 13 million Americans, or 38% of the adult population over age 65, aren't prepared for video appointments. A less demanding telephone visit wouldn't work for half of them, the researchers found. The Trump administration is attempting to address the issue. An executive order signed by President Trump Monday is intended to strengthen rural health care and could make permanent some technology payments that bolstered the use of telemedicine. Alex Azar, secretary of Health and Human Services, said his agency is working with Congress to expand regulatory reforms. The goal is "to make the telehealth revolution a permanent part of American medicine," he wrote in a July 31 op-ed in USA Today. Helping senior citizens get and use computer technology, however, may be more complicated than enhanced payments. Efforts to increase the use of telemedicine during the pandemic may have inadvertently exacerbated the problems. Mandating its use can cut many older adults off from their health-care providers, said Kenneth Lam, a fellow in geriatrics at UCSF and the lead author of the study published in JAMA Internal Medicine. He called for additional efforts to improve the technology used to connect and for the services available to reach a greater percentage of the older population.—Michelle Fay Cortez | 
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