JMIR Publications

ABSTRACT

Successful adoption and sustained use of smart home technology in the management of frailty in older adults has been limited. Unmitigated ethical concerns are important factors restricting older adults and their care ecosystems from benefiting from use of smart home technology. We propose that proactive and ongoing analysis and management of ethical concerns is the crux of successful development, evaluation, and implementation and sustainable use of smart homes by older adults with frailty. We review intersecting concepts from bioethics, specifically principlism and ethics of care, and technology ethics that are salient to smart homes in the management of frailty in older adults. Concepts of privacy and security, individual and relational autonomy, informed consent and supported decision-making, social inclusion and isolation, stigma and discrimination, and equity of access are essential to incorporate when analyzing smart home technology for this population. We present recommendations and opportunities for older adults and their care ecosystems and the research, technical development, clinical, and industry communities to collaborate to create a framework, resources and tools for proactive and ongoing analysis and management of ethical concerns in smart home applications for older adults with frailty. Older adults with frailty require nuanced consideration when incorporating technology into care because of their complex health and social status and vulnerability. With committed and comprehensive analysis, anticipation of, and management of ethical concerns, reflecting the unique circumstances of older adults with frailty, smart homes may have a greater likelihood of accommodating users and their contexts, achieving their desired individual, societal, and economic outcomes, and serving as solutions to support health, well-being, and responsible, high-quality care.