Barriers to Telemedicine: A Cross-Sectional Study of Readiness in Frail Adults Attending a Geriatric Outpatient Service

Abstract Background Telemedicine refers to the delivery of healthcare services at a distance through the use of communication technologies. While it improves access, particularly in rural or underserved areas, it presents challenges including technology limitations and concerns regarding examination quality, continuity of care, and patient satisfaction. Telemedicine unreadiness encompasses sensory barriers (hearing and vision impairments), environmental limitations (lack of internet-enabled devices or digital access), and negative attitudes toward technology use. The COVID-19 pandemic accelerated telemedicine uptake to minimise in-person contact and protect both patients and healthcare providers, leading to widespread promotion of virtual consultations for home-based care. Methods As part of a quality improvement project, patients attending a geriatric outpatient service between February and March 2021 were contacted by a geriatric trainee. Informed consent was obtained either during the clinic visit or via telephone. Patients, or their next of kin when appropriate, completed a structured telephone questionnaire assessing physical impairments, technical access, and attitudes toward telehealth. Data on comorbidities and frailty status were extracted from medical records. Statistical analysis was conducted using STATA 14, including subgroup comparisons between frail and pre-frail individuals. Results Among 51 participants (mean age 81.7 years; 49% female), the median Clinical Frailty Score was 4, and 57% had dementia. Sensory impairments were present in 78% of patients. Environmental barriers were common: 82% had limited digital access, only 24% had a home computer, and just 10% used the internet regularly. Although 59% had family support, 90% had at least one sensory or environmental barrier to telehealth. Frail individuals were less likely to have used telemedicine and held more negative attitudes. Despite 43% acknowledging time-saving benefits, 92% still preferred face-to-face care. Conclusion Telemedicine remains unsuitable as a primary care model for many frail adults. Hybrid approaches, caregiver support, and simplified digital platforms are essential to promote equitable access.