Does neurocognition contribute to age-related deficits in the online navigation of electronic patient health portals?

Objective: The internet serves an increasingly critical role in how older adults manage their personal health. Electronic patient portals, for example, provide a centralized platform for older adults to access lab results, manage prescriptions and appointments, and communicate with providers. This study examined whether neurocognition mediates the effect of older age on electronic patient portal navigation. Participants and Methods: Forty-nine younger (18-35 years) and thirty-five older adults (50-75 years) completed the Test of Online Health Records Navigation (TOHRN), which is an experimenter-controlled website on which participants were asked to log-in, review laboratory results, read provider messages, and schedule an appointment. Participants also completed a neuropsychological battery, self-report questionnaires, and measures of health literacy and functional capacity. Results: Mediation analyses revealed a significant indirect effect of older age on lower TOHRN accuracy, which was fully mediated by global neurocognition and the domains of executive functions, episodic memory, and processing speed, but not attention. An exploratory follow-up model testing the inverse mediation pathway demonstrated that TOHRN accuracy was also a significant partial mediator of the relationship between older age and poorer global neurocognition. Conclusions: Findings indicate a possible bidirectional mediating relationship between age-related difficulties with neurocognition and navigating electronic patient health portals. Future studies might examine the possible benefits of both structural (e.g., human factors web design enhancement) and individual (e.g., training and compensation) cognitive supports to improve the navigability of electronic patient health portals for older adults.