Is research on ‘smart living environments’ based on unobtrusive technologies for older adults going in circles? Evidence from an umbrella review

Tannou, Thomas; Lihoreau, Thomas; Couture, Mélanie; Giroux, Sylvain; Wang, Rosalie H.; Spalla, Guillaume; Zarshenas, Sareh; Gagnon-Roy, Mireille; Aboujaoudé, Aline; Yaddaden, Amel; Morin, Lucas; Bier, Nathalie

doi:10.1016/j.arr.2022.101830

Cited by 8 publications

(14 citation statements)

References 46 publications

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“…Residents may interact with a smart home through various interfaces involving voice, touch, motion, or gestures [19]. Although many specialized smart home products and services are in development for older adults with health needs [4], there is also a proliferation of technology for general consumers that offers desirable functions for older adults to enhance environmental comfort (eg, automated control of lights or thermostat), safety (eg, home security systems and automated door locks), and daily activity performance (eg, kitchen appliances).…”

Section: Smart Homesmentioning

confidence: 99%

“…Smart homes entail a combination of products and services that make up a smart environment (also referred to as active and assisted living systems). In addition to being, for the most part, at a low level of maturity and with little strong evidence of effectiveness [4][5][6][7], smart home technology may be slowly adopted because of unmitigated ethical concerns [4].…”

Section: Introductionmentioning

confidence: 99%

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Proactive and Ongoing Analysis and Management of Ethical Concerns in the Development, Evaluation, and Implementation of Smart Homes for Older Adults With Frailty

Wang¹,

Tannou²,

Bier³

et al. 2023

JMIR Aging

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Successful adoption and sustained use of smart home technology can support the aging in place of older adults with frailty. However, the expansion of this technology has been limited, particularly by a lack of ethical considerations surrounding its application. This can ultimately prevent older adults and members of their support ecosystems from benefiting from the technology. This paper has 2 aims in the effort to facilitate adoption and sustained use: to assert that proactive and ongoing analysis and management of ethical concerns are crucial to the successful development, evaluation, and implementation of smart homes for older adults with frailty and to present recommendations to create a framework, resources, and tools to manage ethical concerns with the collaboration of older adults; members of their support ecosystems; and the research, technical development, clinical, and industry communities. To support our assertion, we reviewed intersecting concepts from bioethics, specifically principlism and ethics of care, and from technology ethics that are salient to smart homes in the management of frailty in older adults. We focused on 6 conceptual domains that can lead to ethical tensions and of which proper analysis is essential: privacy and security, individual and relational autonomy, informed consent and supported decision-making, social inclusion and isolation, stigma and discrimination, and equity of access. To facilitate the proactive and ongoing analysis and management of ethical concerns, we recommended collaboration to develop a framework with 4 proposed elements: a set of conceptual domains as discussed in this paper, along with a tool consisting of reflective questions to guide ethical deliberation throughout the project phases; resources comprising strategies and guidance for the planning and reporting of ethical analysis throughout the project phases; training resources to support leadership, literacy, and competency in project teams for the analysis and management of ethical concerns; and training resources for older adults with frailty, their support ecosystems, and the public to support their awareness and participation in teams and ethical analysis processes. Older adults with frailty require nuanced consideration when incorporating technology into their care because of their complex health and social status and vulnerability. Smart homes may have a greater likelihood of accommodating users and their contexts with committed and comprehensive analysis, anticipation, and management of ethical concerns that reflect the unique circumstances of these users. Smart home technology may then achieve its desired individual, societal, and economic outcomes and serve as a solution to support health; well-being; and responsible, high-quality care.

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Section: Smart Homesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Proactive and Ongoing Analysis and Management of Ethical Concerns in the Development, Evaluation, and Implementation of Smart Homes for Older Adults With Frailty

Wang¹,

Tannou²,

Bier³

et al. 2023

JMIR Aging

Self Cite

View full text Add to dashboard Cite

show abstract

“…32 Devices that are discreet or easy to hide from visitors may increase adoption by providing some aid or peace of mind without making it obvious to everyone who enters the space that the person who lives there is using assistive devices. 35 Special consideration should be given to how easy it is to use the technology in high-stress or crisis situations, as this is when people struggle with much-needed technology the most. 18 Technologies should come with good customer service and customer support to enable simple troubleshooting and instruction that is geared toward the technical proficiency of the specific user.…”

Section: User-friendlymentioning

confidence: 99%

“…18 There is a general preference for assistive technologies that enhance the user's sense of control and confidence by providing meaningful, well-timed prompts instead of frequent alerts, reminders, and instructions that can become overwhelming. 35…”

Section: Intelligentmentioning

confidence: 99%

Technologies to Increase Freedom for People Living With Dementia

Clark,

Mierzwinski-Urban,

Mason

et al. 2023

cjht

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What Is the Issue? Dementia refers to symptoms affecting cognition (including memory), behaviour, and mood, which can significantly impact daily activities and independence. Conditions that may contribute to the development of dementia include Alzheimer disease (AD), Parkinson disease, and stroke. As the population ages, the number of people in Canada living with dementia will continue to increase. More than 60% of people with dementia live at home rather than in a long-term care facility. Approximately 40% of people aged 80 and older who have dementia reside in long-term care facilities, while others stay in their homes. When living at home in the community, support is needed to maintain safety, independence, and quality of life for both the person living with dementia and their caregiver(s). Most of the assistive technologies used to help support people with dementia to live in their homes are paid for by the user and not by provincial or territorial insurance programs, highlighting issues of equity of access related to income. What Is the Technology? A variety of technologies, including medical devices and consumer electronics, are available that can be used with the intention of helping people living with dementia stay in their homes. Technologies to support the care of people living with dementia can be broadly grouped into 2 categories: technologies related to diagnosis, assessment, and early risk identification and technologies related to management and rehabilitation. This report primarily focuses on technologies that aim to provide management and rehabilitation; these aim to support people with dementia (and their caregivers) – allowing people to live in their homes and communities for longer. These are often classified as assistive devices and include GPS trackers, fall monitoring systems, and connected technologies that can increase and simplify access to services such as food or grocery delivery, pharmacies, and telehealth. What Is the Potential Impact? User-friendly, connected, and effective technologies that allow freedom for people living with dementia may also reduce caregiving stress; however, most randomized trials of assistive technologies have not demonstrated the usefulness of these technologies in real-world settings in a way that support them being formally incorporated into dementia management. The use of supportive technologies may help people living with dementia stay safely in their homes for longer, thereby reducing the burden on long-term care facilities and providing potential savings to the health care system. What Else Do We Need to Know? There is a constant conflict between safety and privacy for people living with dementia who may not always be aware of their current state of cognition and may not be able to provide adequately informed consent for the continued use of monitoring technologies. The evidence suggests further research into the effectiveness of these technologies in real-world settings is required to understand better their usefulness and place in therapy for people living at home with dementia. There remains a lack of consensus on the effectiveness of these technologies and a lack of guidance for their use.

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“…Technology has been featured prominently in the design of senior living. However, a recent review suggests that smart living environments based on unobtrusive technologies had low-to-moderate effectiveness to support older adults to age in place, and that such technologies are not mature enough for widespread adoption [ 16 ]. Some communities have developed aging in place models that include different categories of services: daily living needs, physical and mental health needs, and self-fulfilment needs such as continuous learning, leisure, etc.…”

Section: Introductionmentioning

confidence: 99%

Implementing Aging in Place in Hong Kong: Meeting the Needs and Aspirations of Older Adults and Their Caregivers Living in Private Housing

Woo,

Mok,

Chu

et al. 2024

IJERPH

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A policy of aging in place should be accompanied by physical and social environments that support healthy aging. This article describes how a property development company in Hong Kong sought to elicit the views of older people and their caregivers towards elderly services through a market research company, using questionnaire surveys followed by focus groups. Over 80% of all participants rated healthy dietary habits and exercise, maintaining mental and spiritual health, and maintaining a generally healthy lifestyle as important. Current health concerns include long waiting times for care at public hospitals, lack of carer should dependency occur, and lack of information about what services are available in the community. Interests in services in their neighbourhood include medical care (82%), healthy lifestyle activities (66%), and home care support (55%). There was considerable interest in the provision of services that improve brain and physical function, as well as general health checks. Carers were willing to pay more for services compared with older adults themselves. The findings inform the development of pilot models of aging in place as a sustainable financial model.

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Is research on ‘smart living environments’ based on unobtrusive technologies for older adults going in circles? Evidence from an umbrella review

Cited by 8 publications

References 46 publications

Proactive and Ongoing Analysis and Management of Ethical Concerns in the Development, Evaluation, and Implementation of Smart Homes for Older Adults With Frailty

Proactive and Ongoing Analysis and Management of Ethical Concerns in the Development, Evaluation, and Implementation of Smart Homes for Older Adults With Frailty

Technologies to Increase Freedom for People Living With Dementia

Implementing Aging in Place in Hong Kong: Meeting the Needs and Aspirations of Older Adults and Their Caregivers Living in Private Housing

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