Relevant studies on ageing – related issues

- Reviews of home technologies

Ali, E. E., Chew, L., & Yap, K. Y.-L. (2016). Evolution and current status of mhealth research: a systematic review. BMJ Innovations, bmjinnov–2015–000096.  
This systematic review provides a chronological overview of how mhealth research has evolved with changes in mobile technologies. The review involved a PubMed search complemented by manual searching of all issues of the Journal of Medical Internet Research and Telemedicine Journal and eHealth, from inception to January 2015. Articles reporting the evaluation of mhealth interventions in any patient group for any health-related outcomes were analysed without restrictions on the study design. A total of 3476 publications were obtained from the PubMed search and manual searching of eHealth journals. Analysis was based on an abstract review of 515 (14.8%) original research articles, which fulfilled preset inclusion criteria. Three distinct time periods were identified on the basis of mobile devices used in mhealth research. Personal digital assistants (PDAs) dominated mhealth research in the years before 2007 (17 of 33 articles, 51.5%). Basic and feature phones were the main methods of mhealth intervention from 2007 to 2012 (95 of 193 articles, 49.2%). After 2012, smart devices (smartphones, tablet PCs and iPod touches) were highly used in mhealth research (173 of 289 articles, 59.9%). Despite a growing focus on infectious diseases and maternal and child health in the most recent years, non-communicable conditions continued to overshadow the trend of mhealth research. Overall, mHealth research has evolved over the past decade in terms of the mobile devices employed, health conditions addressed and its purpose. While chronic medical conditions have clearly been the focus of mhealth research, a shift in trends is expected as the application of mhealth interventions spreads to other under-studied areas. Future research should continue to leverage on the advancements and ubiquitous nature of mobile devices to make healthcare accessible to all.

Bemelmans, R., Gelderblom, G. J., Jonker, P., & de Witte, L. (2012). Socially Assistive Robots in Elderly Care: A Systematic Review into Effects and Effectiveness. Journal of the American Medical Directors Association, 13(2), 114–120.e1.  
The ongoing development of robotics on the one hand and, on the other hand, the foreseen relative growth in number of elderly individuals suffering from dementia, raises the question of which contribution robotics could have to rationalize and maintain, or even improve the quality of care.  The objective of this review was to assess the published effects and effectiveness of robot interventions aiming at social assistance in elderly care.  We searched, using Medical Subject Headings terms and free words, in the CINAHL, MEDLINE, Cochrane, BIOMED, PUBMED, PsycINFO, and EMBASE databases. Also the IEEE Digital Library was searched. No limitations were applied for the date of publication. Only articles written in English were taken into account. Collected publications went through a selection process. In the first step, publications were collected from major databases using a search query. In the second step, 3 reviewers independently selected publications on their title, using predefined selection criteria. In the third step, publications were judged based on their abstracts by the same reviewers, using the same selection criteria. In the fourth step, one reviewer made the final selection of publications based on complete content.  Finally, 41 publications were included in the review, describing 17 studies involving 4 robot systems. Most studies reported positive effects of companion-type robots on (socio)psychological (eg, mood, loneliness, and social connections and communication) and physiological (eg, stress reduction) parameters. The methodological quality of the studies was, mostly, low.  Although positive effects were reported, the scientific value of the evidence was limited. The positive results described, however, prompt further effectiveness research in this field.
Chen, Y.-R. R., & Schulz, P. J. (2016). The Effect of Information Communication Technology Interventions on Reducing Social Isolation in the Elderly: A Systematic Review. Journal of Medical Internet Research, 18(1).  
Background The aging of the population is an inexorable change that challenges governments and societies in every developed country. Based on clinical and empirical data, social isolation is found to be prevalent among elderly people, and it has negative consequences on the elderly’s psychological and physical health. Targeting social isolation has become a focus area for policy and practice. Evidence indicates that contemporary information and communication technologies (ICT) have the potential to prevent or reduce the social isolation of elderly people via various mechanisms.  Objective This systematic review explored the effects of ICT interventions on reducing social isolation of the elderly.  Methods Relevant electronic databases (PsycINFO, PubMed, MEDLINE, EBSCO, SSCI, Communication Studies: a SAGE Full-Text Collection, Communication & Mass Media Complete, Association for Computing Machinery (ACM) Digital Library, and IEEE Xplore) were systematically searched using a unified strategy to identify quantitative and qualitative studies on the effectiveness of ICT-mediated social isolation interventions for elderly people published in English between 2002 and 2015. Narrative synthesis was performed to interpret the results of the identified studies, and their quality was also appraised.  Results Twenty-five publications were included in the review. Four of them were evaluated as rigorous research. Most studies measured the effectiveness of ICT by measuring specific dimensions rather than social isolation in general. ICT use was consistently found to affect social support, social connectedness, and social isolation in general positively. The results for loneliness were inconclusive. Even though most were positive, some studies found a nonsignificant or negative impact. More importantly, the positive effect of ICT use on social connectedness and social support seemed to be short-term and did not last for more than six months after the intervention. The results for self-esteem and control over one’s life were consistent but generally nonsignificant. ICT was found to alleviate the elderly’s social isolation through four mechanisms: connecting to the outside world, gaining social support, engaging in activities of interests, and boosting self-confidence.  Conclusions More well-designed studies that contain a minimum risk of research bias are needed to draw conclusions on the effectiveness of ICT interventions for elderly people in reducing their perceived social isolation as a multidimensional concept. The results of this review suggest that ICT could be an effective tool to tackle social isolation among the elderly. However, it is not suitable for every senior alike. Future research should identify who among elderly people can most benefit from ICT use in reducing social isolation. Research on other types of ICT (eg, mobile phone–based instant messaging apps) should be conducted to promote understanding and practice of ICT-based social-isolation interventions for elderly people.

Khosravi, P., & Ghapanchi, A. H. (2016). Investigating the effectiveness of technologies applied to assist seniors: A systematic literature review. International Journal of Medical Informatics, 85(1), 17–26.  
Background Recently, a number of Information and Communication Technologies have emerged with the aim to provide innovative and efficient ways to help seniors in their daily life and to reduce the cost of healthcare. Studies have been conducted to introduce an assistive technology to support seniors and to investigate the acceptance of these assistive technologies; however, research illustrating the effectiveness of assistive technologies is scant. Method This study undertakes a systematic literature review of ScienceDirect, PubMed, ProQuest and IEEE Explore databases to investigate current empirical studies on the assistive technologies applied in aged care. Our systematic review of an initial set of 2035 studies published from 2000 to 2014 examines the role of assistive technologies in seniors’ daily lives, from enhancements in their mobility to improvements in the social connectedness and decreases in readmission to hospitals. Results This study found eight key issues in aged care that have been targeted by researchers from different disciplines (e.g., ICT, health and social science), namely, dependent living, fall risk, chronic disease, dementia, social isolation, depression, poor well-being, and poor medication management. This paper also identified the assistive technologies that have been proposed to overcome those problems, and we categorised these assistive technologies into six clusters, namely, general ICT, robotics, telemedicine, sensor technology, medication management applications, and video games. In addition, we analyzed the effectiveness of the identified technologies and noted that some technologies can change and enhance seniors’ daily lives and relieve their problems. Our analysis showed a significant growth in the number of publications in this area in the past few years. It also showed that most of the studies in this area have been conducted in North America. Conclusion Assistive technologies are a reality and can be applied to improve quality of life, especially among older age groups. This study identified various assistive technologies proposed by ICT researchers to assist the elderly. We also identified the effectiveness of the proposed technologies. This review shows that, although assistive technologies have been positively evaluated, more studies are needed regarding the outcome and effectiveness of these technologies.

Peetoom, K. K. B., Lexis, M. A. S., Joore, M., Dirksen, C. D., & Witte, L. P. D. (2015). Literature review on monitoring technologies and their outcomes in independently living elderly people. Disability and Rehabilitation: Assistive Technology, 10(4), 271–294.  
Purpose: To obtain insight into what kind of monitoring technologies exist to monitor activity in-home, what the characteristics and aims of applying these technologies are, what kind of research has been conducted on their effects and what kind of outcomes are reported. Methods: A systematic document search was conducted within the scientific databases Pubmed, Embase, Cochrane, PsycINFO and Cinahl, complemented by Google Scholar. Documents were included in this review if they reported on monitoring technologies that detect activities of daily living (ADL) or significant events, e.g. falls, of elderly people in-home, with the aim of prolonging independent living. Results: Five main types of monitoring technologies were identified: PIR motion sensors, body-worn sensors, pressure sensors, video monitoring and sound recognition. In addition, multicomponent technologies and smart home technologies were identified. Research into the use of monitoring technologies is widespread, but in its infancy, consisting mainly of small-scale studies and including few longitudinal studies. Conclusions: Monitoring technology is a promising field, with applications to the long-term care of elderly persons. However, monitoring technologies have to be brought to the next level, with longitudinal studies that evaluate their (cost-) effectiveness to demonstrate the potential to prolong independent living of elderly persons.Implications for RehabilitationInsight was obtained of what kind of technologies exist to monitor activity of daily living, what their functionalities and outcomes of using these technologies are to prolong independent living of non-institutionalised elderly people.Five main groups of monitoring technologies exist with a wide range of functionalities. Research into the use of monitoring technologies is widespread but in its infancy, consisting mainly of small-scale studies and including few longitudinal studies.Research into the use of monitoring technologies demonstrated that the systems are able to monitor daily activities and have the potential of prolonging independent living of elderly people.

Piau, A., Campo, E., Rumeau, P., Vellas, B., & Nourhashemi, F. (2013). Aging society and gerontechnology: A solution for an independent living? The Journal of Nutrition, Health & Aging, 18(1), 97–112.  
Recent studies report that the majority of older adults wish to live in their own homes, for as long as possible. This creates a growing interest in technologies to enable older people to remain living independently at home. The purpose of this article is to provide a narrative review of current technology appropriate for older adults’ home use. The key research questions were as follow: 1- What is the evidence demonstrating that gerontechnologies are effective in enabling independent living? 2- What are devices designed specifically for frail elderly persons ? Several publications were identified about devices targeting social isolation (videophonic communication, affective orthotic devices or companion-type robots, personal emergency response systems [security]), autonomy loss (technologies for maintenance of autonomy in the activities of daily living) and cognitive disorders (cognitive orthotics, wandering management systems, telemonitoring). Very few articles dealt specifically with the frail older person. In particular, there was extremely limited evidence on use and efficacy of these devices within this population. There is a need to obtain a consensus on definition of the technologies, and also to revisit work strategies and develop innovative business models. To meet this goal, we need to create a network of technological companies, aging services organizations, end-users, academics, and government representatives to explore the real needs of the frail older population and to develop and validate new devices promoting aging at home.

Pietrzak, E., Cotea, C., & Pullman, S. (2014). Does smart home technology prevent falls in community-dwelling older adults: a literature review. Informatics in Primary Care, 21(3), 105–112.  
BACKGROUND: Falls in older Australians are an increasingly costly public health issue, driving the development of novel modes of intervention, especially those that rely on computer-driven technologies. OBJECTIVE: The aim of this paper was to gain an understanding of the state of the art of research on smart homes and computer-based monitoring technologies to prevent and detect falls in the community-dwelling elderly. METHOD: Cochrane, Medline, Embase and Google databases were searched for articles on fall prevention in the elderly using pre-specified search terms. Additional papers were searched for in the reference lists of relevant reviews and by the process of ‘snowballing’. Only studies that investigated outcomes related to falling such as fall prevention and detection, change in participants’ fear of falling and attitudes towards monitoring technology were included. RESULTS: Nine papers fulfilled the inclusion criteria. The following outcomes were observed: (1) older adults’ attitudes towards fall detectors and smart home technology are generally positive; (2) privacy concerns and intrusiveness of technology were perceived as less important to participants than their perception of health needs and (3) unfriendly and age-inappropriate design of the interface may be one of the deciding factors in not using the technology. CONCLUSION: So far, there is little evidence that using smart home technology may assist in fall prevention or detection, but there are some indications that it may increase older adults’ confidence and sense of security, thus possibly enabling aging in place.

Shelton, B. E., & Uz, C. (2015). Immersive technology and the elderly: a mini-review. Gerontology, 61(2), 175–185.  
Technologies that provide immersive experiences continue to become more ubiquitous across all age groups. This paper presents a review of the literature to provide a snapshot of the current state of research involving the use of immersive technologies and the elderly. A narrative literature review was conducted using the ScienceDirect, EBSCOhost, Springerlink and ERIC databases to summarize primary studies from which conclusions were drawn into a holistic interpretation. The majority of the studies examined the effect of immersive technologies on elder peoples’ age-related declines, including sensory and motor changes (vision, hearing, motor skills), cognitive changes and social changes. Various immersive technologies have been described and tested to address these age-related changes, and have been categorized as ‘games and simulations’, ‘robotics’ and ‘social technologies’. In most cases, promising results were found for immersive technologies to challenge age-related declines, especially through the increase of morale.

van den Berg, N., Schumann, M., Kraft, K., & Hoffmann, W. (2012). Telemedicine and telecare for older patients—A systematic review. Maturitas, 73(2), 94–114.  
Telemedicine is increasingly becoming a reality in medical care for the elderly. We performed a systematic literature review on telemedicine healthcare concepts for older patients. We included controlled studies in an ambulant setting that analyzed telemedicine interventions involving patients aged ≥60 years. 1585 articles matched the specified search criteria, thereof, 68 could be included in the review.  Applications address an array of mostly frequent diseases, e.g. cardiovascular disease (N = 37) or diabetes (N = 18). The majority of patients is still living at home and is able to handle the telemedicine devices by themselves. In 59 of 68 articles (87%), the intervention can be categorized as monitoring. The largest proportion of telemedicine interventions consisted of measurements of vital signs combined with personal interaction between healthcare provider and patient (N = 24), and concepts with only personal interaction (telephone or videoconferencing, N = 14).  The studies show predominantly positive results with a clear trend towards better results for ‘behavioral’ endpoints, e.g. adherence to medication or diet, and self-efficacy compared to results for medical outcomes (e.g. blood pressure, or mortality), quality of life, and economic outcomes (e.g. costs or hospitalization).  However, in 26 of 68 included studies, patients with characteristic limitations for older patients (e.g. cognitive and visual impairment, communication barriers, hearing problems) were excluded.  A considerable number of projects use rather sophisticated technology (e.g. videoconferencing), limiting ready translation into routine care. Future research should focus on how to adapt systems to the individual needs and resources of elderly patients within the specific frameworks of the respective national healthcare systems.

Wagner, F., Basran, J., & Bello-Haas, V. D. (2012). A Review of Monitoring Technology for Use With Older Adults: Journal of Geriatric Physical Therapy, 35(1), 28–34.  
Background: Many Americans are living longer and recent studies report that the majority of older adults wish to live as independently as possible in their own homes, for as long as possible. This creates a need for effective monitoring, and technology has much to offer. Purpose: The purpose of this article is to provide a narrative review of current monitoring technology appropriate for older adults’ home use. Methods: A review of current literature provides a comprehensive discussion of the development of this technology. Discussion: In the past several years, advancements have been made in the area of monitoring the movement and activity of older adults in their home environment. This technology may benefit older individuals by assisting them to remain living in their own homes for as long as possible. Unobtrusive monitoring and wearable technology, which is clothing or accessories that incorporate computer or electronic technology, are rapidly expanding areas of development. Various applications of this technology may assist in falls detection and overall safety. In addition, continuous monitoring of an older adult’s specific movements or activity can identify changes in day-to-day activity levels, which may indicate a change in medical status. Conclusion: Although many devices are still at the developmental stage, the future of this technology may offer older adults a level of increased safety and security in their homes.

- Adoption and use of gerontechnology


Ancker, J. S., Witteman, H. O., Hafeez, B., Provencher, T., Van de Graaf, M., & Wei, E. (2015). ‘You Get Reminded You’re a Sick Person’: Personal Data Tracking and Patients With Multiple Chronic Conditions. Journal of Medical Internet Research, 17(8).  
Background Consumer health information technologies (HIT) that encourage self-tracking, such as diet and fitness tracking apps and disease journals, are attracting widespread interest among technology-oriented consumers (such as ‘quantified self’ advocates), entrepreneurs, and the health care industry. Such electronic technologies could potentially benefit the growing population of patients with multiple chronic conditions (MCC). However, MCC is predominantly a condition of the elderly and disproportionately affects the less affluent, so it also seems possible that the barriers to use of consumer HIT would be particularly severe for this patient population.  Objective Our aim was to explore the perspectives of individuals with MCC using a semistructured interview study. Our research questions were (1) How do individuals with MCC track their own health and medical data? and (2) How do patients and providers perceive and use patient-tracked data?  Methods We used semistructured interviews with patients with multiple chronic diseases and providers with experience caring for such patients, as well as participation in a diabetes education group to triangulate emerging themes. Data were analyzed using grounded theory and thematic analysis. Recruitment and analysis took place iteratively until thematic saturation was reached.  Results Interviews were conducted with 22 patients and 7 health care providers.

Chen, K., & Chan, A. H. S. (2011). A review of technology acceptance by older adults. Gerontechnology, 10(1), 1–12.  
We present a review of empirical research on technology acceptance by older people based on 19 published studies, analyze the results, and evaluate findings and limitations. Research on technology usage and acceptance by older people has not yet given sufficient consideration to age-specific or age-related factors. We conclude that the technology acceptance model (TAM) is a useful model, but to better understand technology acceptance behavior of older people, additional variables are to be included, related to biophysical and psychosocial characteristics, abilities and problems experienced by older people.

Dahler, A. M., Rasmussen, D. M., & Andersen, P. T. (2016). Meanings and experiences of assistive technologies in everyday lives of older citizens: a meta-interpretive review. Disability and Rehabilitation: Assistive Technology, 0(0), 1–11.  
Purpose: The purpose of this study was to synthesize the available qualitative studies on the meaning of assistive technologies (AT) in elderly people’s everyday lives in order to identify central concepts, themes, and findings from existing research. Method: A systematic search of the literature was conducted, using predetermined search strategies. Exclusion criteria were, in accordance with the meta-interpretive approach, developed iteratively during the reading of abstracts and articles. Interpretations from the studies were used as data for thematic analysis and synthesis of findings. Results: Review of these studies show that older people not only have positive attitude towards AT, but also that acceptance of technologies is a potentially stressful process where trust towards technologies and other people are of importance. Older people have ambivalent experiences with technology, as it gives rise to possibilities as well as constraints, and safety as well as worries.

de Veer, A. J. E., Peeters, J. M., Brabers, A. E., Schellevis, F. G., Rademakers, J. J. J., & Francke, A. L. (2015). Determinants of the intention to use e-Health by community dwelling older people. BMC Health Services Research, 15.  
Background In the future, an increasing number of elderly people will be asked to accept care delivered through the Internet. For example, health-care professionals can provide treatment or support via telecare. But do elderly people intend to use such so-called e-Health applications? The objective of this study is to gain insight into the intention of older people, i.e. the elderly of the future, to use e-Health applications. Using elements of the Unified Theory of Acceptance and Use of Technology (UTAUT), we hypothesized that their intention is related to the belief that e-Health will help (performance expectancy), the perceived ease of use (effort expectancy), the beliefs of important others (social influence), and the self-efficacy concerning Internet usage.  Methods A pre-structured questionnaire was completed by 1014 people aged between 57 and 77 (response 67%). The hypothesized relationships were tested using nested linear regression analyses. 

Fischer, S. H., David, D., Crotty, B. H., Dierks, M., & Safran, C. (2014). Acceptance and Use of Health Information Technology By Community-Dwelling Elders. International Journal of Medical Informatics, 83(9), 624–635.  
Objectives With the worldwide population growing in age, information technology may help meet important needs to prepare and support patients and families for aging. We sought to explore the use and acceptance of information technology for health among the elderly by reviewing the existing literature.  Methods Review of literature using PubMed and Google Scholar, references from relevant papers, and consultation with experts.  Results Elderly people approach the Internet and health information technology differently than younger people, but have growing rates of adoption. Assistive technology, such as sensors or home monitors, may help ‘aging in place,’ but these have not been thoroughly evaluated. Elders face many barriers to using technology for healthcare decision-making, including issues with familiarity, willingness to ask for help, trust of the technology, privacy, and design challenges.  Conclusions Barriers must be addressed for these tools to be available to this growing population. Design, education, research, and policy all play roles in addressing these barriers to acceptance and use.

Papa, F., Cornacchia, M., Sapio, B., & Nicolò, E. (2016). Engaging technology-resistant elderly people: Empirical evidence from an ICT-enabled social environment. Informatics for Health and Social Care, 0(0), 1–18.  
This paper presents a qualitative investigation on user reactions, opinions, and sentiments about a TV-based technological solution developed within the EasyReach Project of the EU Ambient Assisted Living Joint Program to promote social interaction of less educated elderly people, that is, those individuals who, because of poor scholarization, low income, and, possibly, linguistic barriers, still find it difficult to use computers in order to improve their socialization. Experimental data were collected by extensive trials involving 40 real-end users. A methodology called ‘scenario engagement’ was applied to get participants engaged in a live demonstration with the mediation of a facilitator who assisted elderly people to interact with the system. Results point out that the system can be effectively employed to foster social interaction, particularly when it is introduced in a collective use environment (e.g., Senior Center). Although the focus of the investigation was on information and communication technology-enabled social environments, the end users themselves strongly suggested to include in future system releases extra functions considered as essential opportunities for their potential digital lives: that is, medical or health services and bridges toward public administration.

Peek, S. T. M., Wouters, E. J., Luijkx, K. G., & Vrijhoef, H. J. (2016). What it Takes to Successfully Implement Technology for Aging in Place: Focus Groups With Stakeholders. Journal of Medical Internet Research, 18(5), e98.  
Background: There is a growing interest in empowering older adults to age in place by deploying various types of technology (ie, eHealth, ambient assisted living technology, smart home technology, and gerontechnology). However, initiatives aimed at implementing these technologies are complicated by the fact that multiple stakeholder groups are involved. Goals and motives of stakeholders may not always be transparent or aligned, yet research on convergent and divergent positions of stakeholders is scarce. Objective: To provide insight into the positions of stakeholder groups involved in the implementation of technology for aging in place by answering the following questions: What kind of technology do stakeholders see as relevant? What do stakeholders aim to achieve by implementing technology? What is needed to achieve successful implementations? Methods: Mono-disciplinary focus groups were conducted with participants (n=29) representing five groups of stakeholders: older adults (6/29, 21%), care professionals (7/29, 24%), managers within home care or social work organizations (5/29, 17%), technology designers and suppliers (6/29, 21%), and policy makers (5/29, 17%). Transcripts were analyzed using thematic analysis. Results: Stakeholders considered 26 different types of technologies to be relevant for enabling independent living. Only 6 out of 26 (23%) types of technology were mentioned by all stakeholder groups.

Renaud, K., & van Biljon, J. (2008). Predicting Technology Acceptance and Adoption by the Elderly: A Qualitative Study. In Proceedings of the 2008 Annual Research Conference of the South African Institute of Computer Scientists and Information Technologists on IT Research in Developing Countries: Riding the Wave of Technology (pp. 210–219). New York, NY, USA: ACM.  
Technology adoption has been studied from a variety of perspectives. Information systems, Sociology and Human-Computer Interaction researchers have come up with various models incorporating factors and phases to predict adoption that, in turn, will lead to persistent use. Technology acceptance by the elderly mobile phone user has received less attention and no model currently exists to predict factors influencing their technology adoption. A literature study yielded a set of acceptance factors (derived mostly from quantitative studies) and adoption phases (derived mostly from qualitative studies) that could influence and predict mobile phone adoption by the elderly user. We confirmed a subset of these factors by consulting findings from research into the context of senior mobile phone users, including the needs and limitations of these users. We then verified the factors qualitatively by means of structured interviews with senior mobile phone users. The interviews included the use of scenarios as well as a mobile phone design activity. Triangulating the quantitative findings from literature with the qualitative findings from this study led to a set of interlinked acceptance factors and adoption phases that we present as the Senior Technology Acceptance& Adoption model for Mobile technology (STAM). This paper makes a contribution to understanding technology acceptance by senior users and should be of interest to researchers, designers and decision-makers on technology adoption, especially mobile features and services.
Sharkey, A., & Sharkey, N. (2010). Granny and the robots: ethical issues in robot care for the elderly. Ethics and Information Technology, 14(1), 27–40.  
The growing proportion of elderly people in society, together with recent advances in robotics, makes the use of robots in elder care increasingly likely. We outline developments in the areas of robot applications for assisting the elderly and their carers, for monitoring their health and safety, and for providing them with companionship. Despite the possible benefits, we raise and discuss six main ethical concerns associated with: (1) the potential reduction in the amount of human contact; (2) an increase in the feelings of objectification and loss of control; (3) a loss of privacy; (4) a loss of personal liberty; (5) deception and infantilisation; (6) the circumstances in which elderly people should be allowed to control robots. We conclude by balancing the care benefits against the ethical costs. If introduced with foresight and careful guidelines, robots and robotic technology could improve the lives of the elderly, reducing their dependence, and creating more opportunities for social interaction

Sorell, T., & Draper, H. (2014). Robot carers, ethics, and older people. Ethics and Information Technology, 16(3), 183–195.  
This paper offers an ethical framework for the development of robots as home companions that are intended to address the isolation and reduced physical functioning of frail older people with capacity, especially those living alone in a noninstitutional setting. Our ethical framework gives autonomy priority in a list of purposes served by assistive technology in general, and carebots in particular. It first introduces the notion of ‘presence’ and draws a distinction between humanoid multi-function robots and non-humanoid robots to suggest that the former provide a more sophisticated presence than the latter. It then looks at the difference between lower-tech assistive technological support for older people and its benefits, and contrasts these with what robots can offer. This provides some context for the ethical assessment of robotic assistive technology. We then consider what might need to be added to presence to produce care from a companion robot that deals with older people’s reduced functioning and isolation. Finally, we outline and explain our ethical framework. We discuss how it combines sometimes conflicting values that the design of a carebot might incorporate, if informed by an analysis of the different roles that can be served by a companion robot.

Steele, R., Lo, A., Secombe, C., & Wong, Y. K. (2009). Elderly persons’ perception and acceptance of using wireless sensor networks to assist healthcare. International Journal of Medical Informatics, 78(12), 788–801.  
Purpose This is an exploratory study carrying out qualitative research into the perceptions, attitudes and concerns of elderly persons towards wireless sensor network (WSN) technologies in terms of their application to healthcare. This work aims to provide guidance on the dimensions and items that may be included in the development of a more in-depth questionnaire to further validate the importance of the identified factors as well as the relationships between them. This study aims to contribute to opening up a communication channel between users and researchers, informing the research community in relation to applications and functionalities that users deem as either desirable, inadequate or in need of further development. Methods Focus groups were conducted with elderly individuals who were still living independently. To explore elderly persons’ perceptions and thoughts on current wireless sensor network (WSN) technologies and designs, discussion points were designed from concepts identified from various user acceptance theories and models. Participants were given an introduction to explain the functionality and capabilities of WSN and motes and were shown a sample mote, the Crossbow Mica2Dot. Participants were then asked to discuss their perceptions and concerns towards the likelihood of using a WSN-based healthcare system in their home. Findings We have identified sixteen concepts in relation to the elderly participants’ perception, concerns and attitudes towards WSN systems. Those concepts were further classified into six themes describing the determinants that may affect an elderly person’s acceptance of WSNs for assisting healthcare. Some of our exploratory findings in this study indicate for example that independence is highly valued by elderly people and hence any system or technology that can prolong that independence tends to be highly regarded, that privacy of WSN health data might not be as important as typically considered, and there are also indications that cost may be the most prominent determinant influencing an elderly person’s acceptance of WSNs. Conclusions Our findings indicate that participants’ attitudes towards the idea of wireless sensor networks for health monitoring are generally positive. The exploratory findings along with the literature suggest a number of relationships which can be used in future survey design and model building.

Wild, K., Boise, L., Lundell, J., & Foucek, A. (2008). Unobtrusive In-Home Monitoring of Cognitive and Physical Health: Reactions and Perceptions of Older Adults. Journal of Applied Gerontology, 27(2), 181–200.  
Although the potential benefits of unobtrusive in-home sensing technologies for maintaining health and independence of older adults have been highlighted in recent research, little is known about their views toward such technology. The aims of this project were to identify monitoring needs and expectations of community-residing elderly and their family members. Focus groups were presented with examples of in-home monitoring devices and data output; participants were asked to consider whether the data showed information that was meaningful to them, and how and to whom they would like to have such data disseminated. Content analysis of transcripts revealed four dominant themes: maintaining independence, detecting cognitive decline, sharing of information, and the trade-off between privacy and usefulness of monitoring. The acceptance by elderly of unobtrusive in-home monitoring was closely tied to perceived utility of data generated by such systems. Privacy concerns appeared to be less of an issue than anticipated in this sample.

Yusif, S., Soar, J., & Hafeez-Baig, A. (2016). Older people, assistive technologies, and the barriers to adoption: A systematic review. International Journal of Medical Informatics, 0(0).  
Background Older people generally prefer to continue living in their own homes rather than move into residential age care institutions. Assistive technologies and sensors in the home environment and/or bodily worn systems that monitor people’s movement might contribute to an increased sense of safety and security at home. However, their use can raise ethical anxieties as little is known about how older persons perceive assistive and monitoring technologies. Objectives To review the main barriers to the adoption of assistive technologies (ATs) by older adults in order to uncover issues of concern from empirical studies and to arrange these issues from the most critical to the least critical. Method A 4-step systematic review was conducted using empirical studies: locating and identifying relevant articles; screening of located articles; examination of full text articles for inclusion/exclusion; and detail examination of the 44 articles included. Results Privacy is a top critical concern to older adults, registering a 34% of the total articles examined. Two other equally potent barriers to the adoption of ATs were trust and functionality/added value representing 27 and 25 per cent each respectively of the total studies examined. Also of serious concerns are cost of ATs and ease of use and suitability for daily use (23%) each respectively, perception of ‘no need’ (20%), stigma (18%), and fear of dependence and lack of training (16%) each respectively. These underlying factors are generation/cohort effects and physical decline relating to aging, and negative attitudes toward technologies such as the so-called ‘gerontechnologies’ specifically targeting older adults. However, more and more older adults adopt different kinds of ATs in order to fit in with the society. Conclusions The identified underlying factors are generation/cohort effects and physical decline relating to aging, and negative attitudes toward technologies. The negative attitudes that are most frequently associated with technologies such as the so-called ‘gerontechnologies’ specifically targeting older adults contain stigmatizing symbolism that might prevent them from adopting them.

Zambianchi, M., & Carelli, M. G. (2016). Positive Attitudes towards Technologies and facets of Well-being in Older Adults. Journal of Applied Gerontology, 0733464816647825.  
The current study investigates the relevance of positive attitudes toward Internet technologies for psychological well-being and social well-being in old age. A sample of 245 elderly people (Mean age = 70; SD =9.1) filled in the Psychological Well-Being Questionnaire, the Social Well-Being Questionnaire, and Attitudes Toward Technologies Questionnaire (ATTQ). Favorable attitudes toward Internet technologies showed positive correlations with overall social well-being and all its components with the exception of social acceptance. Positive correlations with overall psychological well-being and two of its components, namely, personal growth and purpose in life, were also found. Two hierarchical multiple regression models underscored that positive attitudes toward Internet technologies constitute the most important predictor of social well-being, and it appears to be a significant predictor for psychological well-being as well. Results are discussed and integrated into the Positive Technology theoretical framework that sustains the value of technological resources for improving the quality of personal experience and well-being.

Zwijsen, S. A., Niemeijer, A. R., & Hertogh, C. M. P. M. (2011). Ethics of using assistive technology in the care for community-dwelling elderly people: An overview of the literature. Aging & Mental Health, 15(4), 419–427.  
Objectives: This article provides an overview of the international literature on the most important ethical considerations in the field of assistive technology (AT) in the care for community-dwelling elderly people, focused on dementia. Method: A systematic literature review was performed. Results: A total of 46 papers met the inclusion criteria. Three main themes were found. The first theme, personal living environment, involves the subthemes privacy, autonomy and obtrusiveness. The second theme, the outside world, involves the subthemes stigma and human contact. The third theme, the design of AT devices, involves the subthemes individual approach, affordability and safety. The often referred to umbrella term of ‘obtrusiveness’ is frequently used by many authors in the discussion, while a clear description of the concept is mostly absent. Conclusion: When it comes to AT use in the care for elderly people living at home, ethical debate appears not to be a priority. The little discussion there relies heavily on thick concepts such as autonomy and obtrusiveness which seem to complicate the debate rather than clarify it, because they contain many underlying ambiguous concepts and assumptions. Most encountered ethical objections originate from the view that people are, or should be, independent and self-determinant. It is questionable whether the view is correct and helpful in the debate on AT use in the care for (frail) elderly people. Other ethical approaches that view people as social and reciprocal might be more applicable and shed a different light on the ethical aspects of AT use.

- Gerontechnology in Singapore


Chan, C., Mehta, K., Tan, K., Chui, Y., Hassan, S., & Koh, B. (2013). Designing e-Service for an Ageing Society. ICIS 2013 Proceedings. Retrieved from  
Contemporary societies are experiencing a proliferation of e-services that is fast changing how people go about their daily lives. With the rapid ageing of many societies, the rising ubiquity of e-services is exacerbating digital divide and digital inequality as these e-services are not designed to facilitate senior citizens’ adoption and usage. The aim of this research is to explore the situated usage of e-services among senior citizens in designing useful e-services for an ageing society. The emphasis on e-services usage among senior citizens as situated practice led to the adoption of Bourdieu’s Practice Theory as the theoretical sense-making lens. Preliminary analysis revealed the saliency of disposition, bodily capital, cultural capital, economic capital and social capital in senior citizens’ use of e-service. This research has implications to both theory and practice. It proposes an approach of e-services design that holds potential to reshape societies in becoming more inclusive and age-friendly.

Jung, Y., Li, K. J., Janissa, N. S., Gladys, W. L. C., & Lee, K. M. (2009). Games for a better life: effects of playing Wii games on the well-being of seniors in a long-term care facility. In Proceedings of the Sixth Australasian Conference on Interactive Entertainment (p. 5). ACM. Retrieved from  
In the current study, we examined the impact of playing Nintendo Wii games on the psychological and physical well-being of seniors in a long-term care facility. A six week-long intervention was held in SASCO Senior Citizens’ Home, a long-term care facility in Singapore. Forty five residents aged between 56 and 92 years old participated in the longitudinal field experiment. Results showed that playing Wii games had a positive impact on the overall well-being of the elderly, compared to a control group that played traditional board games. Implications for future applications of Wii in interventions for the elderly are discussed.

Lim, F. S., Foo, M., Kanagalingam, D., Lim, R., Bahadin, J. bte, Tan, K. L., … Chee, E. (2007). Enhancing chronic disease management through telecare – the Singapore Health Services experience. Journal of Telemedicine and Telecare, 13(suppl 3), 73–76.  
A telecare project has been established which allows outpatients to monitor their own health with the assistance of SingHealth clinicians. Communication takes place through a Web portal and/or by mobile phone text messaging (SMS). The pilot service has been used by local and overseas patients with chronic diseases such as heart failure, hypertension, renal failure, diabetes and suspected occupational asthma. Through the telecare system, which was developed in-house, clinicians can configure a personalized monitoring plan (vital signs and symptoms) for each patient and follow up with interactive charts. The patient’s health data are transmitted to the telecare system by the patient or care-giver, through a Web portal or by SMS messages. If a patient’s health indicators fall outside predefined thresholds, clinicians can be alerted by SMS. Patients and clinicians can also communicate through the portal. Apart from chronic disease management, the system has also been used to replace one of the regular clinic reviews for well-controlled primary care patients with hypertension and to facilitate the diagnosis of occupational asthma through monitoring peak flow values during periods at work and away from work. The responses from clinicians and patients have been favourable. Patients have benefited medically from the interventions and their quality of life has improved.
Ng, J., Tan, O., Wong, A., & Kiat, K. W. (2012). Older Adults’ Attitudes Toward Homes Service Robots. In Proceedings of the Workshop at SIGGRAPH Asia (pp. 87–90). New York, NY, USA: ACM.  
World population ageing is a global concern, and to Singapore, this is no different. Today, 15 percent of the total population is of age 60 and above. By 2050, Singapore will be the world’s 4th largest ageing nation, after Japan, Macao and Korea, with 38% of the population above 60 years of age [United Nations, 2012]. Older adults in Singapore (as in many Asian societies) are traditionally supported by their families. This demographic shift will potentially increase the burden on their families, the working adults and their children. Home service robots are looked upon as potential aids to improve the quality of life of older adults, help them live independently and help relieve the stress of their caregivers. Before any technology can be useful, their potential users must be willing to accept and use them. Vacuum cleaning robot, such as the Roomba, have already been used and accepted in homes in the United States [Enzer, et al. 2009; Forlizzi 2007], and is available commercially in Singapore. However, beyond vacuum cleaning, are users in Singapore, particularly older adults, willing to accept other kinds of interactive home service robots or humanoid robots to assist them in other household tasks? What kind of assistance do they expect from the robot? How should a robot behave or look to warrant their acceptance in their homes? These are some questions our team seeks to address.

Toh, H. J., Chia, J., Koh, E., Lam, K., Magpantay, G. C., Leon, C. M. D., & Low, J. A. (2015). Increased Engagement in Telegeriatrics Reduces Unnecessary Hospital Admissions of Nursing Home Residents. In M. Helfert, A. Holzinger, M. Ziefle, A. Fred, J. O’Donoghue, & C. Röcker (Eds.), Information and Communication Technologies for Ageing Well and e-Health (pp. 81–90). Springer International Publishing. Retrieved from  
Due to the lack of expert clinical involvement in the nursing homes of Singapore, frail and older nursing home residents become frequent unnecessary users of acute care services. Telegeriatrics, a pilot programme implemented by an acute hospital in Singapore used videoconferencing to provide timelier geriatric care, which could reduce transfers to the acute hospital. We assess the impact of the level of engagement with Telegeriatrics has on nursing home to hospital transfer rates. From December 2010 to March 2015, a total of 579 telemedicine consultation episodes were conducted in two nursing homes. Hospital admission rates were monitored over a 2-year period and compared against the nursing home’s level of engagement with Telegeriatrics. The findings show a reduction in hospital admission rate for both nursing homes. There was a significant decrease of 33 % in hospital admission rates in the more-engaged nursing home while the less-engaged nursing home reported a 2 % increase. The results show that, by improving the availability of specialist support and with increased engagement in Telegeriatrics, unnecessary hospitalizations could be reduced. This leads to elimination of stress and disruption for the resident, as well as reduced costs and quicker medical care.

Vrijhoef, B. (2014). Political and Regulatory Environment for Smart Home Technology from the Perspective of Singapore. In J. van Hoof, G. Demiris, & E. J. M. Wouters (Eds.), Handbook of Smart Homes, Health Care and Well-Being (pp. 1–6). Springer International Publishing. Retrieved from  
Singapore is an affluent urbanized society with an aging population situated in Southeast Asia. Singapore’s total population is around 5.40 million (in 2013), with 4.6 % of its GDP spent on healthcare (in 2011) and an average life expectancy of 82.3 years for a newborn Singapore resident (in 2012). As a result of various drivers, a number of likely shifts and changes to Singapore’s healthcare system are foreseen. ICTs are regarded as potentially playing a significant role as enablers of the changes required. Singapore is ranked second highest out of 144 countries to leverage ICTs for improved competitiveness and well-being (in 2013). Notwithstanding this achievement, also for Singapore, a spectrum of critical challenges needs to be addressed for making transformative changes in healthcare. Three recent developments indicate Singapore’s strategy to strengthen its environment for the use of ICTs for health, including smart home technology.

Wai, A. A. P., Devi, S. S., Biswas, J., & Panda, S. K. (2011). Pervasive Intelligence System to Enable Safety and Assistance in Kitchen for Home-Alone Elderly. In B. Abdulrazak, S. Giroux, B. Bouchard, H. Pigot, & M. Mokhtari (Eds.), Toward Useful Services for Elderly and People with Disabilities (pp. 276–280). Springer Berlin Heidelberg. Retrieved from  
With growing aging population, elderly with physical or cognitive impairments may end up staying alone at home. Kitchen is generally the most vulnerable place at home as mishandling of devices or improper kitchen activities could lead to hazardous and life threatening situations. In this paper, we have proposed pervasive intelligence system that augment existing kitchen environment with sensors, actuators and processing intelligence. We have first identified possible safety issues and, then deploy sensors to recognize what happened and actuators to control kitchen settings. We have developed 3-stage processing with hierarchical inference approach to determine abnormalities in the kitchen. According to the severity of abnormalities, the proper appliances control or reminder escalation to appropriate personal will be issued to alleviate or minimize the undesirable consequences.

Wee, W. T. B. (2008). A Mini-study of Singapore Elderly Acceptance to Portable Medical Home Systems. In Proceedings of the 2Nd International Convention on Rehabilitation Engineering & Assistive Technology (pp. 271–276). Kaki Bukit TechPark II,, Singapore: Singapore Therapeutic, Assistive & Rehabilitative Technologies (START) Centre. Retrieved from  
Singapore, like many developed countries, is facing an aging population. By 2030, the number of dependents would have increased considerably. In order to provide quality of elderly care by then, care givers must start using technologies to assist them. This paper aims to present current perception of the elderly on portable medical home monitoring devices and systems. Design considerations would be discussed for such a system.