Smart-Home Technologies to Assist Older People to Live Well at Home

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Volume 1 • Issue 1 • 1000101
Aging Sci
ISSN:JASC an open access journal
Open AccessResearch Article
Journal of Aging Science
Morris et al., Aging Sci 2013, 1:1
http://dx.doi.org/10.4172/jasc.1000101
Keywords: Elderly; Older people; Smart-homes; Smart-technologies;
Home
Introduction
We conducted a systematic review and critical evaluation of the
eectiveness and feasibility of smart-home technologies to assist
older adults to live well, safely and independently at home. Improved
health and social care over recent years has increased life expectancy
worldwide. As a result nearly 7% of the world’s population is now over
65 years of age [1]. e proportion of older people is predicted to rise
approximately 20% by 2050 worldwide [1]. e increasing number
and proportion of older adults requires a greater focus on policies and
resources to meet their needs. Smart home technologies encourage and
allow elderly people to live longer in their own homes [2].
Increased longevity is oen associated with increased susceptibility
to diseases and injury [3]. Chronic diseases such as cancer, diabetes,
arthritis, heart disease and chronic obstructive pulmonary disease are
common in older adults. Falls and injuries are also more common in
elderly people [4]. It has been predicted that by 2035, the proportion of
people with dementia will double [5] and by 2050, the number of full-
time carriers will have tripled [6]. With the current trends in population
demographics, it is becoming increasingly dicult for governments
worldwide to fully support the health and social care systems [7]. e
use of smart technologies, including smart-homes could arguably
relieve the pressure on aged care health and social support services [8].
Smart homes are purpose designed living spaces that provide
interactive technologies and unobtrusive support systems to enable
people to enjoy a higher level of independence, activity, participation or
well-being than otherwise aorded [9,10]. e smart homes movement
links together the elds of housing, technology, engineering, sociology,
and healthcare in relation to robotics, sensors, tele-health, ergonomics,
communications, social care and safety [11,12]. Home based smart
technologies can sometimes enable people to live in their own home
*Corresponding author: Meg E. Morris, Departments of Physiotherapy and
Social Work, School of Allied Health, La Trobe University, Melbourne, Australia,
Tel: +61 3 9479 6080; Fax: +61 3 9479 5768; E-mail: m.morris@latrobe.edu.au
Received January 20, 2013; Accepted March 02, 2013; Published March 07,
2013
Citation: Morris ME, Adair B, Miller K, Ozanne E, Hansen R, et al. (2013) Smart-
Home Technologies to Assist Older People to Live Well at Home. Aging Sci 1: 101.
doi:10.4172/jasc.1000101
Copyright: © 2013 Morris ME, et al. This is an open-access article distributed
under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the
original author and source are credited.
Smart-Home Technologies to Assist Older People to Live Well at Home
Meg E. Morris1*, Brooke Adair1,3, Kimberly Miller2, Elizabeth Ozanne3, Ralph Hansen3, Alan J. Pearce1,4, Nick Santamaria3,5, Luan Viegas1,
Maureen Long1 and Catherine M. Said1
1Departments of Physiotherapy and Social Work, School of Allied Health, La Trobe University, Melbourne, Australia
2Department of Physical Therapy, University of British Columbia, Vancouver, Canada, and Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
3School of Health Sciences, The University of Melbourne, Melbourne, Australia
4Cognitive and Exercise Neuroscience Unit, School of Psychology, Deakin University, Melbourne, Australia
5Royal Melbourne Hospital, Melbourne, Australia
Abstract
Background: With the rapid population ageing that is occurring world-wide, there is increasing interest in “smart
home” technologies that can assist older adults to continue living at home with safety and independence. This
systematic review and critical evaluation of the world wide literature assesses the effectiveness and feasibility of
smart-home technologies for promoting independence, health, well-being and quality of life, in older adults.
Methods: A total of 1877 “smart home” publications were identied by the initial search of peer reviewed journals.
Of these, 21 met our inclusion criteria for the review and were subject to data extraction and quality assessment.
Results: Smart-home technologies included different types of active and passive sensors, monitoring devices,
robotics and environmental control systems. One study assessed effectiveness of a smart home technology. Sixteen
reported on the feasibility of smart-home technology and four were observational studies.
Conclusion: Older adults were reported to readily accept smart-home technologies, especially if they beneted
physical activity, independence and function and if privacy concerns were addressed. Given the modest number of
objective analyses, there is a need for further scientic analysis of a range of smart home technologies to promote
community living.
rather than being hospitalized or institutionalized [10]. Smart-home
technologies can also promote independent living and safety. is has
the potential to optimize quality of life and reduce the stress on aged-
care facilities and other health resources [13].
e challenge with smart-home technologies is to create a home
environment that is safe and secure to reduce falls, disability, stress,
fear or social isolation [14]. Contemporary smart home technology
systems are versatile in function and user friendly. Smart home
technologies usually aim to perform functions without disturbing
the user and without causing any pain, inconvenience or movement
restrictions. Martin and colleagues performed a preliminary analysis
of the acceptance of smart-home technologies [15]. e results from
this review were limited as no studies met inclusion criteria [15]. Given
however, the rapid progression of new smart home technologies, a new
systematic review of the literature is required. is paper addresses that
need by analysing the range of studies undertaken to assess the impact
of these technologies on the quality of life experienced by an ageing
population accessing these supports. e broader context incorporates
consideration of the social and emotional well-being needs of this
population. e current review aimed to answer the following research
question: “What is the eectiveness of smart-home technologies for

Citation: Morris ME, Adair B, Miller K, Ozanne E, Hansen R, et al. (2013) Smart-Home Technologies to Assist Older People to Live Well at Home.
Aging Sci 1: 101. doi:10.4172/jasc.1000101
Page 2 of 9
Volume 1 • Issue 1 • 1000101
Aging Sci
ISSN:JASC an open access journal
promoting health, well-being and quality of life enabling older
people to remain living at home and in the community”? Smart-
home technologies are generally installed in a person’s community
based residence. Therefore, we also investigated the feasibility,
acceptance and perceptions of these forms of technology in a home
environment.
Methods
Search strategy
e database search was conducted in November 2012 e following
databases were searched: MEDLINE, Web of Science, CINAHL, Scopus,
Rehabilitation Reference Center, Nursing Reference Center, Cochrane
Central Register of Controlled Trials, Inspec, Compendex, SocINDEX,
PsychINFO and Sociological Abstracts. ese databases were chosen
as they cover a broad range of disciplines ranging from health to social
sciences and the life sciences.
A variety of search terms synonymous with keywords such as
‘elderly’ and ‘smart homes’ were combined using Boolean logic. An
example of the search strategy utilized for the MEDLINE search is
given in table 1.
Study selection
A trained reviewer scanned the titles of the entire yield once
the search was completed. Duplicates and articles that did not
meet inclusion criteria were removed. e titles and abstracts of the
remaining articles were then reviewed independently by two trained
reviewers against pre-determined inclusion criteria. Studies that were
judged to be irrelevant were excluded. If the reviewers were unsure,
studies remained for review of the full text. Data extraction and quality
assessment were performed for the full texts that met inclusion criteria.
Any discrepancies in study inclusion or data extraction were reconciled
by mutual agreement.
Selection criteria
e selection criteria for this review are shown in table 2. Articles
were included if they were published in English, in a peer reviewed text,
and were available as full works. Because of the rapid progression in
technology [16] and the relative lack of information in earlier years
[15], articles published before January 2000 was excluded. is study
was interested in original information regarding the eectiveness or
feasibility of smart-home technologies. Accordingly, the search was
limited to intervention or feasibility studies. Narrative reviews and
other systematic reviews were excluded as they did not meet inclusion
criteria. For the purpose of this review, studies were considered to
assess the eectiveness of the smart home technology when they were
randomized control trials or if they incorporated an intervention
period with an assessment before and aerwards.
‘Home’ was defined as a person’s place of living, according to
the Merriam Webster Dictionary [17]. A ‘home’ environment may
include a private residence, supported accommodation, independent
living, retirement villages and service-integrated housing. Due to
issues with patents and intellectual information and residents not
wanting to make permanent modifications to their homes for the
purpose of a study, some researchers may choose to use purpose
built smart-homes which are often associated with laboratories. Such
settings were also included as people were able to live in the ‘house’
and the setting was therefore considered to be a ‘home’ environment.
Hospital environments and nursing home facilities sometimes
provide residents with considerable physical and psychological
assistance, often by trained professionals. Consequently studies in
nursing homes and hospitals were excluded.
roughout this study a broad denition of “older people” was
adopted as dened by MeSH denitions. ese were ‘middle-aged’ (aged
45-64 years), ‘aged’ (65-79 years) and ‘aged 80+ years’. us, studies
which included any participants 45 years or older were considered
for our systematic review. Tele-rehabilitation and tele-health have
been topics of interest in recent years, particularly with the ongoing
management of various chronic conditions [18].
is form of technology generally involves interaction with a
remote health practitioner and is therefore still reliant on the medical
system for support. Consequently, studies of tele-rehabilitation or
tele-medicine based management techniques were excluded from this
particular review and we reviewed that material separately. ere are
multiple forms of technology that may help to assist older adults in their
home environments. It was beyond the scope of this paper to review the
robotics, gaming or social inclusion literature. We have reviewed these
separately. Instead, the focus of this paper was specically on types
of technology that can be used in a home environment which either
interacts with or provides direct information to the user without the
need for another individual.
Data extraction and quality assessment
Data extraction was performed using a customized data extraction
form. Details such as the aims of the study, the settings where the study
Keyword Synonyms
Elderly Middle aged or Aged or Aged, 80 and over or Age* or Aging or Elder* or “Older adult*” or “Older person” or “Older people*”
Smart-home
“Smart home*” or “ambient assisted living” or “ubiquitous home*” or “ubiquitous technology*” or “electronic assistive technology*” or
“social alarm” or “telecare social alert platform*” or “environmental control system*” or “automated home environment*” or telehomecare
or “Home Automation”
Note: Synonyms for the two keywords were combined to create search strategy.
Table 1: Example of search strategy for MEDLINE.
Inclusion Criteria Exclusion Criteria
• Assessed smart-home technologies.
• Published in English and available in full-text from peer review journals.
• Assessed effectiveness or feasibility.
• Set in a home environment.
• Included participants aged ≥ 45 years.
• Published before January 2000.
• Set in other environments such as nursing homes or rehabilitations settings.
• Books, PhD or Masters theses and abstracts from conference presentations.
• Studies focussed on tele-health, tele-medicine or tele-rehabilitation.
• Narrative reviews and other systematic reviews.
Table 2: Inclusion and exclusion criteria.

Citation: Morris ME, Adair B, Miller K, Ozanne E, Hansen R, et al. (2013) Smart-Home Technologies to Assist Older People to Live Well at Home.
Aging Sci 1: 101. doi:10.4172/jasc.1000101
Page 3 of 9
Volume 1 • Issue 1 • 1000101
Aging Sci
ISSN:JASC an open access journal
was performed, the methods of recruitment and sampling, feasibility,
outcome measures and results were recorded. When considering the
appropriateness of dierent technologies it may be benecial to consider
the amount of assistance and training required for use. e role of smart-
home technologies is oen to assist residents by performing a task they
are no longer able to do. In this way, many smart-home technologies
should be able to work independent of the people who reside in the
house. As a result the level of assistance has not been reported in this
study. Due to the heterogeneity of results and the lack of randomized
controlled trials, a meta-analysis was not feasible in this study. Instead a
summative synthesis of results was performed [19].
As this study aimed to highlight intervention studies, the Downs
and Black [20] quality checklist was chosen. is tool has been
specically designed to assess the quality of randomized or non-
randomized intervention studies [20]. e tool has 27 items which
are generally answered as ‘yes’, ‘no’ or ‘unable to determine’. Scores
are assigned to each answer and are summed to create a total quality
score. e last item of this tool was found to be ambiguous. Similar to
previous studies which also used this tool, the last item was removed
resulting in a 26-item checklist [16,21,22]. e highest possible score in
the revised version of the tool was 27.
Results
e initial search of the selected databases yielded a total of 1877
publications. e number of articles assessed at each stage of this review
is shown in gure 1. Many articles were excluded because they focused on
describing dierent forms of smart-home technology and the electronic
architecture behind them, rather than assessing their eectiveness or
feasibility [23]. Several studies were initially considered appropriate for
inclusion but following more detailed review were excluded for various
reasons. One study tested a new program but was excluded because the
reviewers felt the technology included more tele-health than smart-
home components [24]. A study by Croser et al. [25] was originally
included as it investigated the eectiveness of dierent technologies on
activities of daily living in people with various disabilities. On closer
review it was noted that although the study included one person older
than 45 (58 years old) it also included data from three children (aged
6-13 years) [25]. eoretically, the feasibility and eectiveness of smart-
home technologies may be dierent in children compared with the
elderly. Consequently this study was excluded.
Study characteristics
In total, 21 studies underwent data extraction. A description of each
of the articles included in this review is provided in table 3. One assessed
the eectiveness of smart-home technologies and was also assessed for
its methodological quality [26]. Sixteen studies reported on feasibility
or perception of smart-technologies [27-43]. ree studies, based on
an observational design, described how smart technologies worked
with various participants and oen combined qualitative comments
regarding feasibility [44-46]. One study was described as a cohort study
and described the ability to perform activities of daily living using a
form of smart-technology [45]. is study did not use a control group
or perform comparison measures and therefore was not considered to
report on the eectiveness of the smart-home technology [45].
According to the National Health and Medical Research Council
of Australia guidelines, the level of evidence of most of the studies was
grade IV. Most studies assessed the various sensors available for use in
smart-homes. Five studies were set in purpose built smart-homes or
residences already incorporating smart-technologies [30,36,41,43,46].
ree studies used focus groups to discuss the potential for smart-
technologies and were therefore not based in any particular setting
[27,35,39]. Consequently the settings for these studies were recorded
as not applicable.
Participant characteristics
e characteristics of the participants in the included studies are
shown in table 4. e sample size ranged 1-78. While some studies
included younger people the age of the participants in most studies
was over 65 years. e health characteristics of study participants
were heterogeneous. Some studies included healthy older adults, while
others included participants with neurological decits. Four studies
assessed the perceptions of carriers, facility sta or family members of
elderly people [35-39,43].
Feasibility of smart-home technologies
Details regarding the feasibility of smart-technologies as reported in
dierent studies are provided in table 5. Four studies identied possible
safety issues. ese included an increased risk of tripping on misaligned
carpet [30], systems failing during emergencies [37], the possibility that
incorrect medication dosages could be taken but not recorded [41]
and concerns regarding the functioning of home adaptations during
power outages [42]. Nine studies identied privacy issues arising
from utilization of smart-home technologies [28,29,31-35,42,43]. Two
reported that privacy was a barrier to people choosing to install and
use smart-home technologies [28,29]. Most of the participants reported
that cameras and monitoring systems invaded their privacy and le
them with a sense that they were being watched.
Many of the studies did not document the cost of the smart-
technologies nor the level of training required to use it. Two reported
‘low cost’ technology [40,44], one quoted less than $400 [26] and one
study reported that the highest price to retro-t a home was €13500
[42]. Four studies reported satisfactory use with only brief training
provided when the technology was installed or before the assessments
were performed [26,30,45,46].
Overall the studies that assessed perceptions and acceptability
found that smart-home technologies were generally readily accepted
1877 records identified through
database search
1102 records after duplicates
removed
716 records screened 563 records excluded
153 full-text articles
assessed for eligibility
132 full-text articles
excluded
21 studies included in
qualitative synthesis
386 records excluded: languages other
than English, conference abstracts,
books and theses
1 study assessing
effectiveness
20 studies describing use, feasibility,
acceptability and perceptions
Figure 1: Yield of studies identied during each step of this review.

Citation: Morris ME, Adair B, Miller K, Ozanne E, Hansen R, et al. (2013) Smart-Home Technologies to Assist Older People to Live Well at Home.
Aging Sci 1: 101. doi:10.4172/jasc.1000101
Page 4 of 9
Volume 1 • Issue 1 • 1000101
Aging Sci
ISSN:JASC an open access journal
Study Level of
evidence Study design Study aims Description of ST Setting of ST Region Sampling
strategy
Beckwith [43] IV Qualitative Acceptance and perceptions
Door switches, movement sensors,
bed load cells, individual tracking
badges.
Residential care
already equipped
with ST
North
America ND
Boll et al. [27] IV Qualitative Acceptance and usability Reminder system/ personal
household assistant. NA Europe ND
Carabalona et
al. [46] IV Descriptive/
qualitative
To compare usability of
different types of BCI.
BCI-method to enable interaction and
control of devices using EEG signals.
Smart home built
in laboratory
setting
Europe Consecutive
Courtney [28] IV Qualitative Acceptance and perceptions Bed, kitchen and motion detectors
and fall sensors.
Residential care
facility-no skilled
nursing care
North
America ND
Courtney et al.
[29] IV Qualitative Acceptance Sensors: Bed, motion, kitchen safety
and falls detection. Retirement Village North
America ND
Craig et al. [45] III-2 Cohort study Effectiveness of ST at
assisting ADLs
Hands free environmental control
system e.g., using brain signals to
control their television.
Home Australia/
Oceania ND
Study Level of
evidence Study design Study aims Description of ST Setting of ST Region Sampling
strategy
Davenport [30] IV Qualitative Initial reactions of an elderly
person in a smart-house
Smart wave (microwave), oor
tracking system, security system and
voice activated applications.
GatorTech smart
house
North
America ND
Demiris et al. [31] IV Qualitative Acceptance and perceptions
Including bed sensors, gait monitor,
stove sensor, motion sensor and
video sensor
Retirement Village North
America ND
Demiris et al. [32] IV Qualitative Acceptance and perceptions
Various sensors including motion,
pressure temperature sensors
throughout facility
Retirement Village North
America ND
Demiris et al.
(2008) [33] IV Qualitative Perceptions and expectations Sensors and cameras-minimal
description Retirement Village North
America ND
Franco et al. [34] IV Qualitative Feasibility Sensors to detect electricity use to
determine activities Home Europe ND
Govercin et al.
[35] IV Qualitative Requirements and feasibility
for sensors
Optical fall sensors and wearable fall
sensor NA Europe ND
Study Level of
evidence Study design Study aims Description of ST Setting of ST Region Sampling
strategy
Johnson et al. [36] IV Qualitative Feasibility and acceptance
Floor tracking system, remote
monitoring system, voice activated
commands, smart wave, smart doors
GatorTech smart
house
North
America ND
Judge et al. [37] IV Qualitative Perceptions and feasibility Speech-driven environmental control
systems Home Europe Convenience
Lofti et al. [44] IV Descriptive Ability of sensors to monitor
activity
Standard set of sensors – movement
and door entry point. Home Europe ND
Martin et al. [38] IV Qualitative Feasibility and perceptions
Electronic sensor and user interface
eg sensors for door, presence and
kitchen utensils
Supported
accommodation Europe Convenience
Rosenberg [39] IV Qualitative
Readiness of signicant others
and dementia sufferers to use
ST
Assistive technologies such as
devices for planning and reminders,
cell phones, GPS, and a remote
control.
NA Europe ND
Suryadevara and
Mukhopadhyay
[40]
IV Qualitative Elderly wellness monitoring
Sensors dispersed around the home
to detect ADLs. Including on beds,
chairs, attached to panic buttons and
kitchen and living room appliances.
ND – assume
home Asia ND
Study Level of
evidence Study design Study aims Description of ST Setting of ST Region Sampling
strategy
Tang et al. [41] IV Qualitative Impact on adherence to
medication plan
Multimedia healthcare system that
incorporates an online medication
plan, recognition of medicine
information and advice, coupled with a
reminder system.
Smart-home (set
in a university
laboratory)
Asia ND
Tomita et al. [26]II RCT Effectiveness of smart-home
technologies
Multiple sensors, remote controls and
security system Home North
America
Consecutive
van Hoof et al.
[42] IV Qualitative Acceptance and feasibility
Unattended Autonomous Surveillance
System (incorporating sensors and
voice controls)
Home with
increased
services
Europe ND
Note: Intervention study has been highlighted in bold. ST=Smart-home technologies; level of evidence=grades suggested by the NHMRC; ND=not documented; NA=not
applicable; BCI=brain-computer interface; EEG=Electroencephalography, ADLs=activities of daily living; RCT=randomised controlled trial; GPS=global positioning system.
Table 3: Study characteristics.

Citation: Morris ME, Adair B, Miller K, Ozanne E, Hansen R, et al. (2013) Smart-Home Technologies to Assist Older People to Live Well at Home.
Aging Sci 1: 101. doi:10.4172/jasc.1000101
Page 5 of 9
Volume 1 • Issue 1 • 1000101
Aging Sci
ISSN:JASC an open access journal
Study N Age (years) Health characteristics Gender
Mean (SD) Range Male Female
Beckwith [43] 29 ND ND 9 residents (dementia), 10 family members, 8 direct-care staff, 2 managers ND ND
Boll [27] 74 66 (5.3) ND Only characteristic described was hearing impaired (unsure of number) ND ND
Carabalona [46] 9 Median=49 ND Neurodegenerative diseases 3 6
Courtney [28] 14 ND >65 ND ND ND
Courtney et al. [29] 11 ND >65 ND ND ND
Craig et al. [45] 10 42.9 (8.9) ND Neurological-SCI and profound disability 8 2
Davenport [30] 1 78 NA Healthy older adult 0 1
Demiris et al. [31] 14 ND >65 ND 5 9
Demiris et al. [32] 9 ND >65 ND ND ND
Demiris et al. [33] 15 ND >65 ND 7 8
Franco et al. [34] 13 83 ND Health older adults, one with Alzheimer’s Disease 2 11
Govercin et al. [35] 22
Group 1=75
Group 2=68
Group 3=66
Group 1: 68-84
Group 2: 60-76
Group 3: 50-85
Group 1: mod-severe disability with mild-severe risk of falling; Group 2: slight disability with
low falls risk; Group 3: healthy relatives of participants with severe falls risk 6 16
Study N Age (years) Health characteristics Gender
Mean (SD) Range Male Female
Johnson et al. [36] 18 77 68-92 Heterogeneous group-group with mobility and visual impairments and one with no
signicant impairments 6 12
Judge et al. [37] 12 50*36-68 MND, SCI, MS, ACS, quad ND ND
Lofti et al. [44] Unclear ND ND Dementia ND At least 1
Martin et al. [38] 7 NA NA Carers of people with dementia ND ND
Rosenberg et al. [39] 16 ND 45-78 Signicant others of people with dementia 5 11
Suryadevara et al.
[40] 4 ND ND ND ND ND
Tang et al. [41] 5 ND >60 Patients needing to take a particular medication 4 1
Tomita et al. [26]78 Smart homes=72 (6.0)
Control=75.6 (3.4) ND Elderly people living at home with chronic health conditions but no cognitive
impairments 9 69
Van Hoof et al. [42] 12 79.2 (at rst interview) 63-87 Heterogeneous group 2 10
Note: Intervention study highlighted in bold. SD=standard deviation; ND=not documented; MND=motor neuron disease, SCI=spinal cord injury, MS=multiple sclerosis,
ACS=Arnold-Chiari syndrome, quad=quadriplegia; *=some ages missing in description therefore calculated mean age may be incorrect.
Table 4: Participant characteristics.
Study Potential safety issues Potential privacy issues Cost Training*
Beckwith [43] ND Some disagreement between author and participants regarding
privacy issues ND ND
Boll et al. [27] ND Discussed but not encountered ND ND
Carabalona et al. [46] ND ND ND Manual provided before testing
Courtney [28] ND Privacy concerns caused rejection of some technologies ND NA
Courtney et al. [29] ND Some participants rejected smart home technologies due to
privacy concerns ND NA
Craig et al. [45] ND ND ND Brief instructions pre-trial in
home
Davenport [30] Misaligned carpet may cause tripping ND ND Training in voice commands
and given a list of commands
Demiris et al. [31] ND Privacy concerns (n=2) ND NA
Demiris et al. [32] ND Some participants felt that video monitoring may impact on privacy ND ND
Demiris et al. [33] ND Voiced concerns regarding possible privacy violations resulting
from use of cameras ND NA
Franco et al. [34] ND 12 people did not like being monitored ND ND
Study Potential safety issues Potential privacy issues Cost Training*
Govercin et al. [35] ND Some felt optical sensors invaded privacy ND NA
Johnson et al. [36] ND ND ND NA
Judge et al. [37]
People described system failure during
emergencies, in particular recognition
of voice or commands
ND ND ND
Lofti et al. [44] ND ND “low cost” ND
Martin et al. [38] ND ND ND ND

Citation: Morris ME, Adair B, Miller K, Ozanne E, Hansen R, et al. (2013) Smart-Home Technologies to Assist Older People to Live Well at Home.
Aging Sci 1: 101. doi:10.4172/jasc.1000101
Page 6 of 9
Volume 1 • Issue 1 • 1000101
Aging Sci
ISSN:JASC an open access journal
Rosenberg et al. [39] ND Safety considered more important than privacy while
utilising technology eg GPS ND NA
Suryadevara et al. [40] ND ND “low-cost” ND
Tang et al. [41] Possibility raised that the wrong
dosage could be taken ND ND ND
Tomita et al. [26] ND ND <$400 Instructions on set-up and the option
of ongoing assistance if necessary
Van Hoof et al. [42]
Concerns about not being able to open
electronic doors with a power outage.
Some false alarms noted.
One participant had the ST removed from her home due
to privacy concerns. <13500€ ND
Note: Intervention study highlighted in bold. *=if study documented whether training was required or provided in order to use the smart-technology; ND=not documented;
NA=not applicable because using focus groups to assess perceptions of smart-technology therefore not performed in a particular setting; GPS=global positioning system.
Table 5: Feasibility of smart-home technologies.
and thought to be helpful [28,30-33,35-46]. The breakdown of the
results for these studies is provided in table 6.
Eectiveness of smart-home technologies
One randomized controlled trial was identied in this systematic
review [26]. is study compared the change in functional status in
people who had smart-technologies installed in their homes compared
to those with no home modications. Results from this study suggest
that functional status and cognition deteriorate in the general elderly
population and that the use of smart technologies may help to maintain
these aspects and encourage ageing in place [26]. e results from this
study are shown in table 6.
Quality assessment
Most of the articles identied in this review were qualitative and few
were intervention studies. e investigation by Tomita et al. [26] scored
18 points out of a possible 27. Several factors were not reported in the
article, which impacted on the overall quality assessment score. ese
included the lack of investigation or reporting of adverse events and the
brief description of the source population, blinding, recruitment and
sampling methodology.
Discussion
is systematic review highlights the wide range of smart home
technologies currently available to support older adults to live at
home. ese included passive and active sensors, monitoring systems,
environmental control systems and electronic aids to daily living. While
a large number of appliances may be available, the review also identied
the relatively small number of studies that actually investigated their
eectiveness at helping the older adults to live independently at home.
e majority of articles identied in this systematic review were
qualitative in design. Some documented whether older adults were
able to use smart-home technologies. Other articles addressed the
preferences for dierent technologies and the overall acceptability
of devices in the home environment. Qualitative research assists
evidence-based, patient-centred care [47,48] and is arguably crucial
when attempting to implement changes in the homes of older people.
is systematic review found that older adults and health professionals
considered smart home technologies to be benecial. ese forms of
technology were thought to increase safety and security around the
home. Many participants felt that smart-technologies may help to
improve their independence. While it was not formally addressed in
the identied studies, it is possible that improvements in safety, security
and independence may also have a positive eect on quality of life in
this population.
e results of this review identify important feasibility issues that
should be considered in the development and implementation of the
smart home technologies. e primary barrier to the adoption of smart-
home technologies by older adults was privacy concerns [28,29,31-
35,39,42,43]. Privacy is therefore a crucial consideration in the design of
future smart-home technologies. Most smart-home technologies could
be used with little assistance or training. Some safety concerns were
identied related to malfunctioning of technology; highlighting the
importance of contingency systems for events such as power outages.
While the included articles reported varied costs, there were few reports
about the cost of smart-technologies. With further commercialization, it
is possible that the cost of smart home technologies will reduce, thereby
increasing their availability and utilization in home environments.
e results showed that smart-home technologies could accurately
detect abnormal movement or behaviours [44] and were appropriate
methods to control various electronic devices [45,46]. To date,
one randomized controlled trial has been performed to assess the
eectiveness of smart-home technologies in an elderly population [26].
Longitudinal studies are likely to be required to adequately assess the
eectiveness of smart-technologies. Moreover, multiple factors, such
as nances, social circumstances, family and level of independence are
considered when a person chooses where they will live. For example,
a study may assess how long people with smart-technologies can live
in their own homes compared with people who do not live in a smart-
home. Even if the smart-technologies can physically assist a person, they
may move out due to nancial stress or to be closer to family members.
Future studies may need to consider these aspects in their design, and at
least comment on confounders if they cannot be controlled.
Many of the studies identied in this review were performed in
North America or Europe. More research may be benecial to assess
the feasibility of smart-technologies specically in Oceania and Africa.
Recently, Western governments have recommended major expansion
of housing support services [49]. For example, the Australian aged-
care housing industry is now incorporating new technologies to assist
older people to live more independently at home and in supported
accommodation [50]. eoretically, people living in rural or remote
areas may have dierent experiences to smart-technologies to people
in larger cities. It may also be appropriate to consider assessing the
feasibility and eectiveness of smart-home technologies in dierent
communities as well as dierent countries.
One limitation of this study was the decision to limit the search to
articles published in English. e technological advances oen found
in other regions, such as Asia, may mean that other studies have been
conducted on this topic but have been published in other languages
and were consequently missed. Given the volume of articles, it was
not feasible to include all forms of technology that may assist elderly
people to live at home. As a consequence, articles reporting on studies

Citation: Morris ME, Adair B, Miller K, Ozanne E, Hansen R, et al. (2013) Smart-Home Technologies to Assist Older People to Live Well at Home.
Aging Sci 1: 101. doi:10.4172/jasc.1000101
Page 7 of 9
Volume 1 • Issue 1 • 1000101
Aging Sci
ISSN:JASC an open access journal
Study Dosage Key dependent
variable
Primary outcome
measure Results D+B score
Courtney et al. [29] NA NA NA Privacy was a barrier for the adoption of smart home technology for some participants. More
often perception of need was the main reason for whether technologies were accepted or not. NA
Craig et al. [45] NA NA NA
Time taken to select an option decreased slightly with 3 occasions (p=0.03), mean number
of errors decreased signicantly (p<0.05). With practice most participants were able to
reduce their time to select (small reductions). Mean likert score for potential of ST to control
devices in their own home 9.45 (SD=0.76) [1=not useful, 10=very useful].
NA
Davenport [30] NA NA NA The house was able to successfully track the participant's location and frequency with
which ST were utilised. NA
Demiris et al. [31] NA NA NA Most smart technologies were perceived as useful and most participants would agree to
installation in their own home. Findings indicate an overall positive attitude. NA
Demiris et al. [32] NA NA NA Residents expressed overall positive perceptions of the sensor technologies and did not
feel that these interfered with their daily activities NA
Demiris et al. [33] NA NA NA
Overall positive response to ST. Emphasised that devices installed in their homes can be of
great benet when they are reliable, user friendly, can detect a range of emergencies, require
minimal action on the part of the user, have low maintenance costs and are not obtrusive.
NA
Study Dosage Key dependent
variable
Primary outcome
measure Results D+B score
Franco et al. [34] NA NA NA Daily and nocturnal activity could be well differentiated. The probability of having eaten, taken
a bath and going to the toilet could be calculated each day, with eating the most accurate. NA
Govercin et al. [35] NA NA NA Wearable sensors were preferred over optical sensors because they worked outside the
home. Those with an increased risk of falls were less concerned about privacy. NA
Johnson et al. [36] NA NA NA
Favoured applications depended on individual impairments. Applications that most
people favoured were the smart front door and voice activated commands. Many
participants felt the STs were a good idea but not appropriate for them at the time.
NA
Judge et al. [37] NA NA NA Participants felt the ST is occasionally unreliable but can help to improve independence. NA
Lofti et al. [44] NA NA NA Was able to detect abnormal behaviors that occurred with medication changes, such as
wandering in the middle of the night. NA
Martin et al. [38] NA NA NA
Overall staff perceived technology in a positive way and felt that ST supported their
work. The service model is innovative and assists care staff to manage risks in a
vulnerable population.
NA
Study Dosage Key dependent
variable
Primary outcome
measure Results D+B score
Rosenberg et al.
[39] NA NA NA
Patient's signicant others were ready to accept technology if it benetted the
patients. Technology that enhanced safety, promoted an active lifestyle and
maintained intellectual abilities of the patients were welcomed. Ensuring technologies
were incorporated into existing habits, were exible and non-stigmatizing were
essential for acceptability.
NA
Suryadevara et al.
[40] NA NA NA The sensor system registered when a participant was unwell and spent more time in
bed and also when they spent longer amounts of time sitting on one day NA
Tang et al. [41] NA NA NA
Usability: 3 participants found it easy to use.
Adherence to medication: The context-aware prompting resulted in signicantly better
adherence (90.1%) as compared to the non-prompting (75.8%).
NA
Van Hoof et al. [42] NA NA NA Most participants felt that STs could be used to support ageing-in-place and could be
benecial where traditional approaches may fail NA
Study Dosage Key dependent
variable
Primary outcome
measure Results D+B score
Tomita et al. [26]
2 years
full time
in home
Functional status
Primary: FIM.
Secondary: IADL,
mobility subsection
of SIP and CHART
All functional motor measures except for the FIM Motor deteriorated signicantly in the
control group but not in the intervention group: SIP Movement (p<0.001); IADL (p<0.05);
CHART Mobility (p=0.002). FIM cognition scores were signicantly higher in intervention
group (p=0.006).
18
Beckwith [43] NA NA NA Ambient intelligence technologies can contribute to increased safety (especially to
reduce falls). NA
Boll et al. [27] NA NA NA
Participants felt that reminders regarding security and safety were important. The evaluation
results show a preference for acoustic presentations, alone or in combination with visual and
tactile output. Many participants felt they would be willing to use the ST in the future.
NA
Carabalona et al.
[46] NA NA NA
The two forms of BCI require the user to have reasonable memory and the good cognitive
function. High degrees of satisfaction were found for both types. Users found the BCI that
used icons harder to use than the one which relied on spelling out the task-accuracy for
the character/letter speller=80%, icon speller=50%.
NA
Courtney et al. [28] NA NA NA
Participants agreed to some STs but felt they wanted to be able to choose which ones
they needed. Privacy can be a barrier to acceptance of ST unless the participant felt they
needed a particular ST.
NA
Note: Quality assessment scores, dosage and dependent variables are only reported for intervention studies. Intervention study highlighted in bold. D+B=Downs and
Black quality checklist. ST=smart-home technologies; BCI=brain-computer interface; NA=not applicable; ND=not documented; FIM=Functional Independence Measure;
IADL=Duke Older Americans Resources and Services Procedures’ IADL; ADL=activities of daily living; SIP=functional mobility subsection of Dysfunction section of Sickness
Impact Prole; CHART=Craig Handicap Assessment and Reporting Technique.
Table 6: Study results.

Citation: Morris ME, Adair B, Miller K, Ozanne E, Hansen R, et al. (2013) Smart-Home Technologies to Assist Older People to Live Well at Home.
Aging Sci 1: 101. doi:10.4172/jasc.1000101
Page 8 of 9
Volume 1 • Issue 1 • 1000101
Aging Sci
ISSN:JASC an open access journal
of telemedicine were kept for a separate analysis. ere appears to be
some cross-over between technologies considered under the guise
of telehealth and those under smart-homes. e exclusion criteria
and search terminology created a manageable yield for this review
but may have resulted in the exclusion of important articles of what
some researchers may consider to be smart-home technologies. While
appropriate for this review, limiting the articles to studies set in a home
environment may have excluded important results collected during
laboratory-based investigations.
Conclusion
A variety of smart-home technologies are available that
are readily accepted by older adults and their family members,
healthcare professionals and carriers. The feasibility and utilization
of smart-technologies can be improved by addressing issues related
to safety and privacy. In addition, exploring how feelings of safety
and more control over one’s life contributes to social and emotional
well-being as well as the capacity to continue participating in outside
interests and activities. While the outcomes and cost effectiveness of
these forms of technology remains to be assessed, they appear to
show some potential for helping older adults to live longer, safely
and independently in their own homes.
Acknowledgements
This work was supported by a Grant from the Institute for a Broadband-
Enabled Society (IBES). The authors of this study would like to thank Tania Celeste
for assistance in developing the search terminology employed during this review.
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Citation: Morris ME, Adair B, Miller K, Ozanne E, Hansen R, et al. (2013) Smart-Home Technologies to Assist Older People to Live Well at Home.
Aging Sci 1: 101. doi:10.4172/jasc.1000101
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