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Background:
Systematic Review

Healthy Aging in Place with the Aid of Smart Technologies: A Systematic Review

by
Ming Hu
1,*,
Soojin Han
2,
Siavash Ghorbany
3 and
Kai Zhang
2
1
School of Architecture, University of Notre Dame, Notre Dame, IN 46556, USA
2
Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, NY 12144, USA
3
Department of Civil and Environmental Engineering and Earth Science, University of Notre Dame, Notre Dame, IN 46556, USA
*
Author to whom correspondence should be addressed.
Encyclopedia 2024, 4(4), 1918-1932; https://doi.org/10.3390/encyclopedia4040125
Submission received: 13 November 2024 / Revised: 10 December 2024 / Accepted: 11 December 2024 / Published: 19 December 2024
(This article belongs to the Collection Encyclopedia of Digital Society, Industry 5.0 and Smart City)
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Abstract

:
This study evaluates the current scope of smart technology applications that support aging in place and identifies potential avenues for future research. The global demographic shift towards an aging population has intensified interest in technologies that enable older adults to maintain independence and quality of life within their homes. We conducted a systematic review of the scientific literature from Web of Science, PubMed, and ProQuest, identifying 44 smart technologies across 32 publications. These technologies were classified into three categories: nonmobile technologies for individual monitoring, nonmobile technologies for home environment monitoring, and wearable technologies for health and activity tracking. Notably, the research in this area has grown significantly since 2018; yet, notable gaps persist, particularly within the traditional disciplines related to aging and in the use of quantitative methodologies. This emerging field presents substantial opportunities for interdisciplinary research and methodological advancement, highlighting the need for well-developed research strategies to support the effective integration of smart technology in aging in place.

1. Introduction

According to the 2019 World Population Prospects, by 2050, it is anticipated that the global older adult population (>60) will double [1]. The number of persons aged 80 years or older is expected to triple between 2020 and 2050, reaching 426 million [1]. Further, it was estimated that one in six people globally will be over the age of 65, up from one in eleven in 2019 [2]. The aging population is already undergoing a significant transition, with extensive research highlighting its profound implications for nearly all sectors of society, including the building and financial markets. Additionally, the growing demand for a high quality of life in older age, encompassing aspects such as housing and social connections, is expected to continue increasing.
Previous research shows that older populations prefer to remain independent at home and aging in place tends to improve older adults’ quality of life, including their physical and mental health [3,4]. Moreover, the economic benefits of supporting older adults in remaining in place, rather than at nursing facilities, has also influenced policymakers and health providers as it alleviates the cost burden on the health care system. This review defines “place” as an older adult’s home.
Smart technology for aging in place refers to devices that enable older people to live independently in a place they wish to remain, usually at home. It not only includes devices related to managing home environments for older adults but also the relationship that smart technology has with older adults and how it impacts their living environments later in life. In this research, smart home technology encompasses a wide array of interconnected devices and systems installed within a home to enhance the safety, health, and comfort of older adults. These technologies include the environmental monitoring systems that regulate conditions like temperature, humidity, and air quality; health and safety monitoring systems such as fall detection sensors and emergency alert devices; assistive technologies like automated lighting controls, voice-activated assistants, and GPS trackers; wearable technologies including smartwatches that track health metrics; and integrated home automation systems that unify various smart devices into a single, remotely controllable interface.
In recent decades, the literature on “aging in place” has expanded in line with the globally increasing older population. With this demographic shift, emerging smart technology has garnered academic attention to how smart technology supports older adults in maintaining their health and quality of life. However, the range and scope of the studies on the effects of smart technology on older adults aging in place have not been explored yet. To address this gap, this study presents a systematic review of scientific articles on aging in place and smart technology. The review identifies the types and applications of smart technologies, evaluates their benefits—including cost savings and physical and mental health improvements—and examines the barriers to their adoption. The paper is organized as follows: Section 2 explains the materials used and the procedure for this review, Section 3 outlines the descriptive statistics, and Section 4 examines the findings from the in-depth review. The discussion and conclusion are drawn in Section 5.

2. Method and Materials

The method used in this study is a combination of a systematic review and bibliometric analysis. The literature databases used for the review were Web of Science, PubMed, and ProQuest. The following keywords and similar search terms were used in the initial search in each database: “aging in place”, “housing”, “smart technology”, and “health.” Some of the similar search terms include “healthy aging”, “older adults”, “elderly care”, “senior citizens”, “smart home technology”, “home automation”, “assistive technology”, “ambient assisted living”, “Internet of Things (IoT) in elderly care”, “connected home devices”, “monitoring technology”, “sensor technology”, “fall detection technology”, and “health monitoring sensors”. In addition to the keywords, we also restricted the publications to those that were available in full text, written in English, and published in scientific academic journals. As shown in Figure 1, a protocol for this study was developed based on the preferred reporting items for the systematic review and meta-analysis (PRISMA) protocol guidelines [5]. It comprises four stages: (a) identify the publications, (b) screen the publications, (c) assess the eligibility of the publications based on predefined criteria, and (d) conduct the synthesis and form a conclusion.
As illustrated in Figure 1, using the keywords, 300 publications were initially retrieved from Web of Science, and 298 publications from PubMed. The included disciplines and fields were the medical sciences, nursing, public health, engineering, informatics, and the social sciences. To narrow down the publications, we first screened the papers retrieved from Web of Science and PubMed by reading the abstracts of those 598 papers, of which the papers that either overlapped (n = 14 papers) or addressed places that were not the older adults’ own homes (e.g., city, nursing home, n = 458) were excluded. From the initial screening, 126 papers were selected for a full-text assessment, during which the following criteria were used: (i) this study explored the effects of smart technology on aging in place (at one’s home); (ii) this study relied on empirical data to measure the effects and draw a conclusion; and (iii) this study focused on the potential implications, barriers, or benefits of smart technology on older adults’ lives. The full-text assessment produced 32 papers that were eligible for the final systemic review, synthesis, and conclusion building, consistent with the purpose of this study.

3. Descriptive Statistics

A total of 32 publications were included in the final full-text review (refer to Table 1), with more than half of the papers (about 59.4%) published after 2018 and only two papers published before 2010, indicating a recent growing interest in smart technology that aids aging in place. As illustrated in Figure 2a, the 32 journals can be divided into three disciplinary categories: 15 journals (about 46.9%) were in the medical/nursing/public health field, 15 journals (about 46.9%) were in the engineering/information technology field, and two journals (about 6.3%) were in the social science field. Most of the studies were in the medical/nursing/public health and engineering fields, since healthy aging is a topic in the public health research domain, while smart technology-aided healthy aging in place has been a topic of interest since 2018. Smart technologies often refer to smart sensors, monitors, and communication devices (refer to Section 4.1 for the smart technology types), thus falling under the engineering and information technology domain. However, a lack of activity (potentially, a lack of interest) from the social sciences is a concern, as the fast-aging global population will significantly impact social transformations in the next several decades.
Figure 2b indicates the geographic distribution of the publications, with most studies conducted in Western developed countries. Specifically, 15 (about 46.8%) out of 32 journals were from Europe, 10 (about 31.2%) were from the U.S. and Canada, and two (about 6.2%) were from Australia. Only four studies (about 12.5%) were conducted in Asia: one in Singapore, one in Taiwan, one in China, and one in Hong Kong. One journal did not specify the region of the study. No studies were identified from South America or Africa. These findings demonstrate the extreme asymmetrical nature between societal demand and research efforts and investments. East and Southeast Asia have the largest populations of older adults (over 260 million), followed by Europe and North America (over 200 million) [2].

4. Results

In the following sections, the types of smart technologies are first explained, followed by the physical and mental health benefits. Lastly, the barriers to adoption are outlined.

4.1. Types of Smart Technologies

Figure 3 identifies the fact that these smart technologies can be divided into nonmobile and mobile categories. The former includes the smart home devices and monitoring sensors that are installed in homes at fixed locations, which can be further categorized based on two primary functions. The first function focuses on the home’s physical environment and condition monitoring, where smart devices and sensors are used to measure and monitor the home environment—including the temperature, humidity, lighting, and carbon dioxide levels—to ensure it is healthy and livable. Other sensors—such as a stove alarm, a bed sensor, or window sensors—are employed to help ensure the home’s safety and avoid fire hazards and burglary. Besides the individual sensors and home devices, whole building systems integrated with voice-assisted smart speakers (e.g., Google Nest Hub) and virtual home assistant equipment were also studied [6,7,8,9,32]. Altogether, fifteen nonmobile technologies were found in this category [6,8,9,10]. The second function focuses on detecting older adults’ physical activity or health abnormalities, such as a fall detection sensor, motion-activated camera, or inactivity detector. Twenty smart technologies were found in this category [7,8,9,10,11,12].
The second technology type is autonomous mobile devices for an ambient assisted living context [13,14,15]. Three studies analyzed smart wearable devices, such as wrist-worn monitoring devices, smartwatches, or wearable body sensors [33]. These wearable devices are used with software to collect and process motion and physiological data that can be later used to communicate with clinicians. Other types of technologies included in the studies were computers, social networking services (SNSs), wireless sensor tags and plugs, and medicine dispensers [6,7,11,17]. The most advanced smart technology studied was a robot, Care-O-bot, which was tested in a home-like environment to investigate the interactions between the robot and older adult participants, informal caregivers, and professional caregivers. The findings showed the older adults were more keen to accept the robot over their caregivers and relatives, which differs from public perception [16]. Out of the nine smart mobile technologies identified, key finders and GPS tracking bracelets were the most popular. Key finders can help older adults find items, and GPS tracking bracelets can track and locate older adults and be used as a two-way speech communication device [12].

4.2. Physical Health Benefits

4.2.1. Monitoring Home Conditions

A benefit of using smart technology among older adults is the ability to detect emergency situations. All 32 studies found that older adults preferred to use smart technology for home safety. That means this function of smart technologies was preferred over the other functions. Home security systems and devices were preferred, such as smart thermostats, carbon monoxide alarms, automatic stove shut-off devices, door sensors, remote home monitoring systems, or emergency alert systems [15]. Various experimental studies indicated an increased sense of security among older adult participants after using smart home sensors during the study period. Even the older adults who were uncertain about or unsure of how to use the smart technologies were interested in future use for home safety. These findings demonstrate the positive attitude of older adults toward new and smart technologies [5]. In emergency situations, the monitoring systems respond by automatically alerting health care staff or family members when abnormal signals are detected at an older person’s home. For instance, sensors installed in a bathtub trigger an alarm if the water rises above normal levels, indicating an accident may have occurred [18].

4.2.2. Monitoring Older Adults’ Physical Conditions

Age-related declines in vision, muscle mass, flexibility, and balance increase the risk of emergencies such as falls and heart attacks. Smart technology significantly benefits older adults in these emergencies by monitoring the physical health conditions that require immediate interventions. Fall detection sensors, for example, are among the most studied smart technologies, as falls are the leading cause of injury among people aged 65 or older [34]. In the United States, the fall-related death rate for older adults increased by 30% from 2007 to 2016, with projections of seven deadly falls every hour by 2030 [35]. One in five falls leads to serious injuries—such as bone fractures or a cerebral hemorrhage—that can be life-threatening for older adults [35]. Fall detection sensors installed in high-risk areas like kitchens and bathrooms, along with emergency call systems, can promptly detect and respond to such incidents. A study in the United States found that older adults who had experienced fall accidents were more likely to use smart home technologies than those who had not [7]. Similarly, research in Canada and the United Kingdom showed that older adults were more inclined to adopt digital devices after experiencing health issues [18].
Wearable devices equipped with sensors can also help older adults react to unusual biological signs, such as a sudden increased heartbeat or blood pressure spike right after certain activities. In a study in Hong Kong, older adults described that following device alerts, they stopped exercising or took medication in response [19]. These experiences suggest that smart technology can help older adults respond appropriately before the situation becomes serious, as well as monitor their daily physical health.
Detecting significant deviations from normal activity patterns is particularly important for older adults living alone. Smart sensors can monitor a range of activities—such as presence in a specific room, motion patterns (e.g., walking, sitting, eating, sleeping), and hygiene practices based on appliance use and energy consumption. When abnormal patterns are detected, such as prolonged inactivity or signs of a medication overdose, the sensors can alert caregivers for a timely intervention [20]. This capability is especially valuable for remote caregivers and seniors living alone, ensuring a rapid response to potential emergencies.

4.2.3. Benefits of Long-Term Independent Living

Smart technology offers significant benefits to older adults by enhancing their functional capabilities and independence, which are essential for aging in place. Automation and assistive technologies, such as smart home systems, help older adults manage their home environments more efficiently and overcome everyday challenges [6,21,22] Successful aging in place involves two stages: the first stage focuses on maintaining functional independence and avoiding unsafe conditions, while the second stage involves providing appropriate assistance without over-intervention when functional or cognitive limitations arise, such as memory disorders.
In the first stage, smart technologies like wearable devices and multi-sensor systems can collect health data (e.g., heart rate), which helps determine the necessary medical interventions. For example, motion sensors and cameras in the home can help health practitioners detect unusual health patterns, enabling a timely intervention to prevent potential health risks and emergencies. Automated systems in kitchens and bathrooms also allow for the remote control of appliances, simplifying household chores. In the studies conducted in Hong Kong and Australia, older adults highlighted the ease of controlling home appliances through mobile phone applications such as managing lighting, stoves, and windows [19,23]. Additionally, they expressed a desire for automated reminders for medication regimens, daily schedules, or shopping lists or to record grocery bills [19].
In the second stage, smart technologies can improve the quality of life of older adults with physical limitations, especially for those with memory disorders (e.g., dementia). For example, a study using GPS tracker bracelets integrated into a home assistance system found that the family caregivers of individuals with mild dementia felt more secure and less worried with these technologies [12]. Another study in Greece demonstrated that older adults with cognitive impairments experienced improvements in sleep quality, cognitive performance, and reduced anxiety after using a smart home monitoring system [24]. These findings suggest that smart technologies can play a critical role in supporting older adults to age in place safely and independently.

4.3. Mental Health Benefits (Social Connectivity)

4.3.1. Maintaining Social Connections and Improvements in Mental Health

The literature found that smart technology benefits older adults by serving as a channel to maintain family relationships and social ties. Most older adults surveyed in the studies had smart technology devices, especially smart phones, because their adult child or grandchild had recommended them to have one for routine check-ins [18]. Even though some older adults did not like having smart technology devices, due to the technical complexity and their reliance on younger family members’ guidance on how to use them, they decided to keep them because the convenient communication eased their family members’ worries. Some older adults even mentioned that asking for a younger family member’s help when using these smart devices could foster a relationship with their grandchildren. By doing so, younger family members can understand older adults’ stress regarding new technology, and older adults can learn how to use new technologies and better understand the culture of younger generations [18]. This benefit of multigenerational relationships is advantageous as communication through smart devices does not create locational barriers or cost much money [18].
The use of IoT-based devices encourages older adults to strengthen their social connections with others. In the same manner, social network platforms, i.e., communication technologies based on the internet, can function as a “digital gathering place” among older adults [18]. Given that much of the empirical evidence indicates social isolation as a predictor of cognitive decline among older adults [36,37,38], utilizing these technologies to maintain social ties with others offers significant mental health benefits later in life. This is further supported by the research demonstrating that older adults using smartphones to keep in touch with others were less likely to feel isolated or have a mental illness. Consistently, older adults who had these technologies were in regular contact with someone and went out to meet social contacts more often, which was helpful for their mental wellbeing [11,25].

4.3.2. Positive Image of Using New Technologies

Some older adults perceived the ownership of smart technology as a new symbol of one’s social status. Since it is typically difficult for older adults to keep up with the rapid pace of emerging technologies, for some older adults, utilizing smart technology and being socially connected with others using the technology are regarded as positive [26]. Older adults maneuvering smart devices consider themselves the new generation of older adults, who can afford the devices (economic status) and understand innovative technology (social and cultural status).

4.4. Cost Benefits

Smart technologies for aging in place offer a significant potential for cost savings, both in terms of direct healthcare costs and long-term care expenses. The adoption of these technologies can reduce the need for frequent hospital visits, delay the transition to long-term care facilities, and lower the overall burden on healthcare systems. This section delves deeper into the various aspects of the cost benefits, providing a more comprehensive analysis.

4.4.1. Reduction in Healthcare Costs

The cost benefits of smart technologies can be explained from two perspectives. First, smart technologies can provide older adults easier access to a health care system and can lead to a further reduction in health expenses. Smart technology and IoT have ushered in a new era of eHealth systems, where professional health care practitioners can provide patient-tailored adaptive interventions based on the direct observations collected through smart technology [14]. With eHealth systems equipped with smart technology, older adults who have limited mobility can access clinical advice and medications without having to visit a doctor in person or waiting a long time to be treated [14]. Multiple studies indicate that eHealth technologies can yield substantial benefits and cost savings by reducing unnecessary hospital visits and by delaying admission to long-term care facilities [14,39]. The development and deployment of eHealth systems have intensified since the COVID-19 pandemic. The most recently published studies focused on patients’ health data collecting methods, the interpretation of the observed patterns, and personalized clinical guidance interventions [24,27].

4.4.2. Long-Term Care Cost Savings

From another perspective, IoT-based home assistant systems may have some upfront costs, but they can lead to long-term cost savings. A study on the effects of commercially available virtual home assistants, like Amazon’s Echo and Alexa and Google Home, demonstrated that using the devices was associated with a lower level of burden for caregivers and a lower degree of care required by older adults [32]. Consequently, these functions allow older adults, even those living alone, to manage everyday life at home and monitor their health without the help of personal care attendants. This long-term independence can have substantial cost-saving benefits. According to the Genworth Cost of Care Survey for 2004–2020, the annual cost for a private room in a nursing home is around USD 105,000, while a full-time in-home care professional’s median monthly salary is USD 4500 [40]. Both options can present a considerable burden to the older adults who live on a limited fixed income.

4.4.3. Economic Benefits for Caregivers

Smart technologies also deliver economic benefits to caregivers by reducing their physical and financial burdens. With smart home systems, caregivers can monitor the health and safety of their loved ones remotely, decreasing the need for a constant physical presence and the associated costs of missed work or hiring additional help. This is particularly important for family caregivers who often balance their caregiving responsibilities with their careers. Devices like Amazon Echo or Google Home have been associated with reducing a caregiver’s burden by enabling older adults to perform tasks independently, such as controlling home appliances, managing medications, and even making emergency calls. This reduction in a caregiver’s burden translates into economic savings, as caregivers can reduce the number of hours spent on caregiving tasks, potentially increasing their productivity and income.

4.4.4. Addressing Financial Barriers

Despite the long-term savings, the upfront cost of smart technology can be a barrier to adoption for many older adults, particularly those on a fixed income. Purchasing and installing devices often require a substantial initial investment, and these costs are rarely covered by insurance or public health programs. Furthermore, the ongoing costs for maintenance, updates, and potential repairs can add to the financial burden.
To address this issue, it is crucial for governments and organizations to step in with financial assistance programs, subsidies, or incentives to make smart technologies more accessible. For instance, public health agencies could subsidize the costs of essential devices, especially for older adults in low-income households. These initiatives would not only promote equity in technology adoption but also reduce overall healthcare costs for society by enabling a broader use of these cost-saving technologies. Partnerships with private sectors could also explore innovative financing models, such as pay-as-you-go plans, to reduce the upfront cost barrier.

4.4.5. Long-Term Financial Sustainability

In the long term, the financial sustainability of smart technology for aging in place will depend on the continued development of affordable and scalable solutions. As technology advances and becomes more widespread, the costs of these systems are expected to decrease, making them more accessible to a larger segment of the population. Additionally, the integration of smart technologies into broader healthcare and insurance frameworks could further reduce the costs and promote widespread adoption. Ultimately, the cost benefits of smart technologies for aging in place are clear, but they must be weighed against the initial financial barriers and the need for continued investment in affordable, user-friendly solutions. By addressing these challenges, smart technology can play a crucial role in reducing healthcare costs and improving the quality of life for older adults.

4.5. Barriers to Smart Technology Adoption

4.5.1. Privacy Concerns

The most significant barrier that limits older adults from using smart technology is privacy concerns. Although a few older adult participants reported they were not concerned about privacy or confidentiality after using smart technology, most of the older adults worried that their health data and personal information recorded in the devices would be stored and shared by a third party [6,7,10,26,29,30]. Data confidentiality runs alongside distrust in new technology among older adults. With emerging digital crimes, older adults hesitate to adopt new smart technologies, with concerns about hacking, phishing, financial fraud, the leaking of personal information, and data ownership [9,18].
Interestingly, many older adults consider the invasion of privacy as a compromise for the safety benefits of smart technology [30]. This privacy pragmatism concept was described in many studies. A study on smart devices among older adults showed that the least desired device was a remote home monitoring system because they felt they were under surveillance at home and that smart devices, such as voice assistant devices, were always listening [7]. At the same time, the older adults in most of the studies also recognized that these smart devices that collect users’ physical health data, monitor home environments, or enable clinicians to use the data are also necessary for safety and preparedness for emergencies [6,7,15].

4.5.2. Lack of Understanding of Technology

The second largest barrier that older adults face is a lack of understanding of the technical terms used in relation to smart technology. Most older adults in the studies said they struggled to keep up with the rapid pace of changes in technology. A limited understanding of new technology impedes older adults from adopting it, especially in the initial stages [17]. Older adults stated that the manuals and descriptions with technical terms and the complicated interface of the smart technology devices were perplexing [24]. They needed to rely on others to set up the default features of the devices [30]. Afterwards, they did not know how to set up the system again or change it, so they worried whether the initial setting made by others would be saved or if it would malfunction [18]. Furthermore, since they struggled to understand the technical language used with smart devices, they could not properly perceive the usability and utility of the devices [25,28]. Some older adults stated they did not want a smartphone because they could not distinguish the functional differences of the device from a conventional phone [18].
Studies have been conducted to provide solutions to help older adults overcome these technological barriers. Research shows that older adult participants were able to adopt new technology in three steps. First, they needed to identify the problems that could be resolved by the new device. Second, they needed to show curiosity about the device’s functions. Third, after fulfilling their curiosity, they could adjust their daily behaviors to fully apply the new device to their daily life. Another study also showed that older adults were likely to have more advanced smart home technologies once their technology anxiety was resolved [31]. Technology training programs also demonstrated an effective way for older adult participants to more easily adopt new smart devices and to encourage health-promoting activities [7]. Altogether, if an appropriate educational program is provided to appease technology anxiety and teach the multiple functionalities of the devices, it will build the confidence of older adults in accepting and using smart technology.

4.5.3. Cost of Devices

While smart technologies can bring long-term savings, the upfront cost is the third potential barrier, which refers to the financial cost of purchasing and maintaining smart devices. Dasios and colleagues compared the range of activities monitored and hardware on sensor nodes with their respective costs. The authors point out that the multiple sensors and microcontrollers and the required software for a home care monitoring system were expensive [13]. Although there have been studies to achieve cost effectiveness, it is typically expensive to purchase, install, and maintain a smart home system [29]. For instance, the cost range for home automation is still relatively high, from USD 150 to USD 4500, depending on the installation location. For older adults, spending a large amount on these devices may not be a priority or option [41].
A few older adults in the studies hesitated to own smart devices for economic reasons, due to electricity consumption or subscription fees [42]. In addition to paying bills, a lack of usage contributed to the perception of a device being expensive [18]. Some studies show that older adults use a limited range of functions for smart home devices—such as checking the weather, listening to music, and the automated control of lighting—which could be related to their lack of understanding of the functions [22].

4.5.4. Technical Defects

The fourth barrier is related to technical defects, such as false alarms, incomplete algorithms, incorrect programming, battery efficiency, and a lack of functionality of “smart” technology devices (only basic tasks are available) [22]. A few studies pointed out that some sensors failed to detect the motion of the users, which made older adults perceive the smart devices as useless. The reliability of smart devices can become a major obstacle to older adults adopting these technologies.

5. Discussion and Conclusions

This systematic review focuses on understanding the current implementation of smart technologies for aging in place. Forty-four smart technologies were identified from the 32 publications. Three types of smart technologies were found in the literature: the nonmobile technologies used to monitor older adults’ conditions (e.g., motion sensors), the nonmobile technologies used to monitor home conditions (e.g., temperature/humidity sensors), and the mobile wearable technologies used to monitor older adults’ movements and health conditions (e.g., GPS trackers).
The benefits of smart technologies encompass both physical and mental health. Physically, these technologies help by (a) detecting emergencies at home, such as fires or falls, (b) monitoring the health conditions that require immediate intervention, and (c) enhancing functional capabilities and independence in daily activities, thereby supporting aging in place. These benefits can result in both short- and long-term cost savings by mitigating risks and reducing the need for labor-intensive personal care. In addition to these financial and physical health advantages, smart technologies offer significant social and mental health benefits. Research indicates that social isolation—defined by factors such as living alone, limited social networks, infrequent social activities, and a lack of support—can adversely affect older adults’ wellbeing, increasing their risk of depression, anxiety, and mortality. Smart technology can foster online social participation, potentially serving as a therapeutic tool to improve health outcomes. However, the current research is limited in exploring other mental health aspects, such as illness prevention and mindfulness strategies, highlighting a notable gap in the field.
The barriers to integrating smart technologies can be summarized as privacy concerns, a lack of understanding of the technologies, the high initial cost of purchasing and installing them, and technical defects. While numerous studies indicate that information and communication technologies, smart phones, and social network applications promote the social participation of young adults [43], there is little empirical research on the effect of technology on the social (dis)connectedness of older adults. More social science research on the topic is needed. In addition, smart technologies need to be easy to use even by individuals with visual or hearing impairments, which are common among older adults. One critical issue to consider is the digital divide, particularly its third level, which pertains to disparities in the effective and meaningful use of digital technologies. While smart technologies for aging in place have the potential to empower older adults and enhance their quality of life, they may inadvertently exacerbate this divide. For instance, older adults with lower levels of digital literacy, limited access to technical support, or cognitive impairments may struggle to adopt and benefit from these technologies. On the other hand, smart home systems and wearable devices could help narrow the digital divide if accompanied by a user-centered design, accessible interfaces, and robust training programs that cater to the diverse needs of older adults. Furthermore, policy initiatives, such as government-subsidized programs to provide devices and digital literacy training, could reduce the inequities and enable a broader participation in digital technologies. Future research should examine how the implementation of smart technologies affects the digital divide, particularly for underserved older adult populations, and identify strategies to ensure equitable access and use.
The literature review observed three characteristics of smart technology’s use in aging in place. First, most of the literature was published after 2018 except the studies on the cost–benefit of smart technologies, indicating this is an emerging field with many knowledge gaps to fill. Cost studies on smart technologies are particularly needed to provide empirical evidence. Second, although the older adult population and their health has long been studied in academic fields—such as demography, sociology, economics, social welfare, and gerontology—there has been little research on the impact of emerging technologies on this population, when compared to other disciplines. Third, there is a lack of quantitative, consistent, and robust research methods. Most studies did not provide quantitative data for smart technologies or examine the effects of smart technology used by older adults, indicating that the current literature on the effects of smart technology on aging in place is exploratory research—not explanatory research. Even for the studies using empirical data, the data referred to older adults’ attitudes toward the smart technology, rather than the effects of the smart technology. Only nine studies measured and examined the effects using empirical data and employing statistical methods with a bivariate analysis. The remaining studies were limited to a descriptive statistical analysis. This is largely because there is currently no scientifically reliable and valid method to evaluate the effectiveness of smart technology. Since the studies did not use consistent measurements, there is a need for more quantitative studies. Research that examines the effectiveness of smart technologies on specific physical and mental health outcomes would provide important evidence to support programmatic or policy initiatives that incorporate smart technology to support aging in place. Related to the lack of empirical data, the potential benefits and barriers discussed in the included studies were also theoretical. For instance, the long-term health care savings benefits can be explained, but no actual data can predicate the value. Moreover, from this review, we concluded there is also an extreme asymmetry between societal demands and research efforts and investment, with about 12% of research originating in East and Southeast Asia, which face the world’s largest older adult population.
Most of the studies reviewed were qualitative in nature, and the study samples were generally limited (see Table 1). Only a few studies using surveys or quantitative methods employed probability sampling to recruit older adults, thereby restricting the generalizability of the findings to the broader older adult population. Due to these sample limitations, many studies did not capture a diverse range of socio-demographic and health-related characteristics—such as educational attainment, marital status, living arrangements, income, medical history, and physical or cognitive disabilities—which are likely associated with smart technology use among older adults. While smart technology is now relatively accessible to older adults, the data collected in these studies may not be representative of the entire senior population. Consequently, the small sample sizes and lack of quantitative data limit the ability to generalize the findings from this review.
There are two limitations of this systematic review. First, there were geographic limitations in the search, which were related to language. The language of the searched papers was limited to English; therefore, we may have excluded important studies published in other languages. For example, Japan has one of the highest aging populations globally. Consequently, many studies have been conducted on this topic, but due to the language limitations, we did not find any relevant papers in our search. Second, the scope of the smart technologies included in the studies was narrow. As mentioned in the text, this review mainly focused on smart home devices equipped with a set of monitoring sensors. It is imperative to broaden the understanding of how smart technologies change aging in place for older adults and study a broader range of smart technologies that older adults have used and will use in the future. Moreover, the results of this study were from the studies related to “aging in place” which considered “home” as the “place”. Therefore, future researchers are suggested to compare these findings with the other types of a “place” to assess if the smart technology preferences and barriers remain the same.

Author Contributions

M.H. and K.Z. designed the study; S.H. conducted the initial literature review, data collection, and analysis; M.H. and S.H. wrote the initial article; and S.G. and K.Z. worked on the revision. All authors have read and agreed to the published version of the manuscript.

Funding

This study was supported by the National Science Foundation Grant Award #2317971, #2430623, and the Department of Energy Subaward #23-1007.

Data Availability Statement

The data that support the findings of this study are available upon request from the corresponding author, MH. The data are not publicly available because they contain information that could compromise the privacy of the building owners.

Acknowledgments

The authors thank the colleagues in our university research group, the three reviewers, and the journal editor for the constructive feedback that has helped improve the article.

Conflicts of Interest

The authors declare no conflicts of interest.

References

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Encyclopedia 04 00125 g001
Figure 1. Flowchart of the review process (PRISMA flow diagram).
Figure 1. Flowchart of the review process (PRISMA flow diagram).
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Figure 2. Journal classification: (a) disciplinary categories and (b) location categories.
Figure 2. Journal classification: (a) disciplinary categories and (b) location categories.
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Figure 3. Classification of smart technologies.
Figure 3. Classification of smart technologies.
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Table 1. Summary of smart technologies and statistical methods of included studies.
Table 1. Summary of smart technologies and statistical methods of included studies.
AuthorYearMethodTech Type
Choi et al. [6]2020Quantitative studyIoT smart home devices (multipurpose sensors to detect motion, temperature and luminosity, voice-assisted smart speaker, door and window sensor, monitoring cameras)
Arthanat et al. [7]2019QuantitativeCarbon monoxide alarm, manually programmable thermostat, auto set thermostat, motion sensor lights, backup generator, home security system, voice-activated assistant, emergency alert system, water leak detector, motion-activated camera, auto shutoff stove, smart home control, remote monitoring
Choi et al. [8]2021Quantitative studyIoT smart home devices (multipurpose sensors to detect motion, temperature, and luminosity, voice-assisted smart speaker, door and window sensor, monitoring cameras)
Chaparro et al. [9]2021Qualitative studySmart sensors to detect fall and physical activity, voice assistant, calendar reminder, home monitoring system
Borelli et al. [10]2019Quantitative and QualitativeWall light for indoor localization, armchair for sitting posture monitoring, wall panel and mobile devices
Jachan et al. [11]2021Quantitative studySmart home solution (tablet, stove safety, lightening control, LED strip, visual doorbell, door detector, automatic switch, inactivity detector, fall detection sensors, home emergency call)
Nauha et al. [12]2018Qualitative studySmart technologies (smart flower stand, fall alarm, bed alarm, medicine dispenser, GPS safety bracelet, web chat tablet computer, motion sensor, reminder with motion sensor, motion sensor, calendar clock, talking album, weighted ball blanket, therapy apron, and cube)
Dasios et al. [13]2015Qualitativean AAL-based prototype system for elderly home care monitoring based on the recording of environmental parameters
Barakat et al. [14]2013Qualitative studyeHealth Technology (e.g., remote telecare and AAL, mobile health, and fall detection systems)
Offermann-van Heek et al. [15].2019Quantitative studyAmbient assistive technology (microphone system, camera, motion detector, smart watch, emergency button)
Bedaf et al. [16]2017QualitativeRobot that contains image sensors that can detect learning and detection
Arthanat [17]2021Quantitative studyIndividualized community and home-based access to technology training (ict training) program
Freeman et al. [18]2020Quantitative and Qualitativedigital/video game console, internet at home, SNSs, email, cellphone, computer
Wong et al. [19]2017Qualitative studySmart home devices
Yu et al. [20]2019Quantitative study (pilot study)Unobtrusive sensors in multiple rooms to monitor temperature, humidity, pressure water meter, and electricity meter
Wu et al. [21]2018Quantitative studySmart home environment, ambient sensors, and on-body sensors
Chung et al. [22]2021Quantitative studyVoice-operated smart speaker
Charness et al. [23]2016Quantitative studyWrist-worn health monitoring device
Lazarou et al. [24]2016QuantitativeHome monitoring system (camera sensor, sleep sensor, bracelet, wireless tags and plugs, mobile devices in an Ambient Assisted Living (AAL) context)
Corbett et al. [25]2021Qualitative and Quantitative studyVirtual home assistant equipment
Woods and Kong [26]2020Qualitative studySmart eldercare technologies
Rocha et al. [27]2015QuantitativeMobile system equipped with a set of wellbeing sensors, home system to collect medical data, wearable light device (WLD) that has ECG instruments, an SpO2 meter, a temperature sensor and a fall and mobility sensor
Bock et al. [28]2016Qualitative studyMulti-sensors to detect and collect data on individual’s motion, home temperature, luminosity, and humidity
Cao et al. [29]2022Qualitative studySmart home sensors (motion sensors and smart plug, door contact, key tag, a mobile app)
Street et al. [30]2022Qualitative studySmart technology
Demiris et al. [31]2008Qualitative studyIn-Home Monitoring (wireless sensors to detect motions, stove temperature sensors, bed sensors)
Aggar et al. [32]2022Quantitative studySmart home technology and assistive technology (Google Hub, smart watches, Chromecast, Phillips Hue Smart Lightning, smoke detector, light strips, smart mop, smart lock, smart doorbell, motion sensor, security camera)
Houston et al. [33]2004Quantitative studySensors, Smart home technologies
National Council on Aging [34]2022Quantitative studySmart home devices
Centers for Disease Control and Prevention [35]2022Quantitative studySmart home devices
Santini et al. [36]2020Qualitative studySmart technology
Cacioppo et al. [37]2014Quantitative studySmart sensors to detect fall and physical activity, voice assistant, calendar reminder, home monitoring system
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Hu, M.; Han, S.; Ghorbany, S.; Zhang, K. Healthy Aging in Place with the Aid of Smart Technologies: A Systematic Review. Encyclopedia 2024, 4, 1918-1932. https://doi.org/10.3390/encyclopedia4040125

AMA Style

Hu M, Han S, Ghorbany S, Zhang K. Healthy Aging in Place with the Aid of Smart Technologies: A Systematic Review. Encyclopedia. 2024; 4(4):1918-1932. https://doi.org/10.3390/encyclopedia4040125

Chicago/Turabian Style

Hu, Ming, Soojin Han, Siavash Ghorbany, and Kai Zhang. 2024. "Healthy Aging in Place with the Aid of Smart Technologies: A Systematic Review" Encyclopedia 4, no. 4: 1918-1932. https://doi.org/10.3390/encyclopedia4040125

APA Style

Hu, M., Han, S., Ghorbany, S., & Zhang, K. (2024). Healthy Aging in Place with the Aid of Smart Technologies: A Systematic Review. Encyclopedia, 4(4), 1918-1932. https://doi.org/10.3390/encyclopedia4040125

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