Image by ? . little . but ! loud .? via Flickr

The Internet has enabled patients to take a more active role in the health care process. 1 While the Internet has contributed to societal change, and provided opportunities to revolutionize health care 2 , 3 , it may be said that for the elderly population, it is more of an ‘evolution’ than ‘revolution’. In a recent survey by the University of Pittsburgh 4 , it was discovered that 62% of the residents of Pittsburgh and surrounding Allegheny County had access to the Internet. However, the average older adult in Allegheny County, the second largest population of older adults in the nation 5 , had the lowest levels of computer ownership and more limited access to the Internet than other county residents. Furthermore, these elderly adults, who make up 17.8% (228,416) of the county’s 1,281,666 residents lacked the essential knowledge of how to use the Internet to locate health information. Nationally, research 6 shows that older Americans are in danger of being cut off from one of the most provocative communication mediums of the 21st century. In the United States, elderly adults make up 13% of the population with only 4% using the Internet. Overall, 56% of America is online and out of that percentage, only 15% age 65 and over have direct access to the Internet. 7

Medical care in America has generally been regarded by many as the best and of the highest quality throughout the world. However, research 8 has shown that the deaths of over 98,000 people annually may be due to medical errors. The physician, once thought to be an oracle of medical knowledge, has been found to practice medicine based on a combination of their instinct, experience, and sometimes outdated education. This has created a system prone to mistakes due to the wide range of variability in practice, knowledge, and education. To perpetuate this illusion of the infallibility of the physician, tradition has taught the individual that their role in the health care process is one of passive recipient, i.e., “The Doctor knows best.” Hospitals, physicians, and health care professionals purport to know what is best for their patients, thus the patient should allow the providers unrestrained ability to make the major decisions regarding the care that is given. Research, however, shows that the adoption of a passive role is a matter of blind faith8, 9 , 10 and can be counter-productive in diagnosis and treatment.

The majority of patients prefer to leave their medical decisions to their physicians. 11 , 12 Not only is this the case for older and less educated patients 13 , 14 , 15 , 16 , 17 , 18 , but physicians perpetuate this trend as their experience and education increases. 19 , 20 Over the years, studies have shown that patients over 60 years of age have a lower desire for control over their health care when compared to younger adults. 21 , 22 , 23 , 24 , 25 Moreover, older patients and men are more likely to let the physician make decisions regarding their treatment. 26 This suggests that the elderly tend to have an external locus of control when it comes to health beliefs 27 , as opposed to an internal locus of control, over their health care. This phenomenon appears to exist across disease classifications10,12, 14,16,25.

Although the majority of patients prefer to let their physician make the decisions, the more a patient learns about their illness, the more likely they are to ask questions of their physician. 28 , 29 , 30 , 31 , 32 Studies have shown that patients who ask questions, elicit treatment options, express opinions, and state their preferences regarding treatment during office visits with their physicians have measurably better health outcomes than those who do not communicate.8, 33 , 34 , 35 , 36 , 37 Therefore, this study explored the impact the Internet had on the elderly with regard to their participation in their own health care. Did they use the Internet to become more informed health consumers, and as a more informed consumer, did they assume a more active role in their own health care.