Evidence and User Considerations of Home Health Monitoring for Older Adults: Scoping Review

Andrew Chan; Rachel Cohen; Katherine-Marie Robinson; Devvrat Bhardwaj; Geoffrey Gregson; Jeffrey W Jutai; Jason Millar; Adriana Ríos Rincón; Atena Roshan Fekr

doi:10.2196/40079

Evidence and User Considerations of Home Health Monitoring for Older Adults: Scoping Review

JMIR Aging. 2022 Nov 28;5(4):e40079. doi: 10.2196/40079.

Authors

Andrew Chan^{1

2}, Rachel Cohen^{3

4}, Katherine-Marie Robinson^{5

6}, Devvrat Bhardwaj⁷, Geoffrey Gregson^{1

2}, Jeffrey W Jutai^{8

9}, Jason Millar^{5

6}, Adriana Ríos Rincón^{1

2}, Atena Roshan Fekr^{3

4}

Affiliations

¹ Faculty of Rehabilitation Medicine, Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada.
² Innovation and Technology Hub, Glenrose Rehabilitation Research, Edmonton, AB, Canada.
³ KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
⁴ Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.
⁵ School of Engineering Design and Teaching Innovation, Faculty of Engineering, University of Ottawa, Ottawa, ON, Canada.
⁶ Department of Philosophy, Faculty of Arts, University of Ottawa, Ottawa, ON, Canada.
⁷ Department of Electrical Engineering and Computer Science, Faculty of Engineering, University of Ottawa, Ottawa, ON, Canada.
⁸ Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
⁹ LIFE Research Institute, University of Ottawa, Ottawa, ON, Canada.

PMID: 36441572
PMCID: PMC9745651
DOI: 10.2196/40079

Abstract

Background: Home health monitoring shows promise in improving health outcomes; however, navigating the literature remains challenging given the breadth of evidence. There is a need to summarize the effectiveness of monitoring across health domains and identify gaps in the literature. In addition, ethical and user-centered frameworks are important to maximize the acceptability of health monitoring technologies.

Objective: This review aimed to summarize the clinical evidence on home-based health monitoring through a scoping review and outline ethical and user concerns and discuss the challenges of the current user-oriented conceptual frameworks.

Methods: A total of 2 literature reviews were conducted. We conducted a scoping review of systematic reviews in Scopus, MEDLINE, Embase, and CINAHL in July 2021. We included reviews examining the effectiveness of home-based health monitoring in older adults. The exclusion criteria included reviews with no clinical outcomes and lack of monitoring interventions (mobile health, telephone, video interventions, virtual reality, and robots). We conducted a quality assessment using the Assessment of Multiple Systematic Reviews (AMSTAR-2). We organized the outcomes by disease and summarized the type of outcomes as positive, inconclusive, or negative. Second, we conducted a literature review including both systematic reviews and original articles to identify ethical concerns and user-centered frameworks for smart home technology. The search was halted after saturation of the basic themes presented.

Results: The scoping review found 822 systematic reviews, of which 94 (11%) were included and of those, 23 (24%) were of medium or high quality. Of these 23 studies, monitoring for heart failure or chronic obstructive pulmonary disease reduced exacerbations (4/7, 57%) and hospitalizations (5/6, 83%); improved hemoglobin A1c (1/2, 50%); improved safety for older adults at home and detected changing cognitive status (2/3, 66%) reviews; and improved physical activity, motor control in stroke, and pain in arthritis in (3/3, 100%) rehabilitation studies. The second literature review on ethics and user-centered frameworks found 19 papers focused on ethical concerns, with privacy (12/19, 63%), autonomy (12/19, 63%), and control (10/19, 53%) being the most common. An additional 7 user-centered frameworks were studied.

Conclusions: Home health monitoring can improve health outcomes in heart failure, chronic obstructive pulmonary disease, and diabetes and increase physical activity, although review quality and consistency were limited. Long-term generalized monitoring has the least amount of evidence and requires further study. The concept of trade-offs between technology usefulness and acceptability is critical to consider, as older adults have a hierarchy of concerns. Implementing user-oriented frameworks can allow long-term and larger studies to be conducted to improve the evidence base for monitoring and increase the receptiveness of clinicians, policy makers, and end users.

Keywords: clinical evidence; concerns; gerontechnology; home health monitoring; older adults; smart homes; telemonitoring; user-centered frameworks.

©Andrew Chan, Rachel Cohen, Katherine-Marie Robinson, Devvrat Bhardwaj, Geoffrey Gregson, Jeffrey W Jutai, Jason Millar, Adriana Ríos Rincón, Atena Roshan Fekr. Originally published in JMIR Aging (https://aging.jmir.org), 28.11.2022.

Publication types

Review