JMIR Publications

ABSTRACT

Background:

The global population of older adults is rapidly increasing while the number of relative caregivers is declining. This creates a critical need for solutions that support caregiving and enable older adults to age in place while maintaining their independence. Many existing caregiving technologies focus on easing caregivers' burdens through surveillance-based systems, which often prioritize caregivers' needs over those of older adults. Such designs can unintentionally disempower older adults by devaluing their autonomy and decision-making capabilities.

Objective:

This study explores older adults’ and designers’ reactions to a technology-enabled system called LifeTomorrow that was built centering older adults as the primary users. The system aims to support their autonomy to make informed choices and desire for independent living, while balancing their social and functional needs with those of informal caregivers.

Methods:

A total of 37 participants—including older adults, caregivers, and designers—engaged in two iterative rounds of user studies to explore daily caregiving needs and technology usage. The system's design and features were refined based on these insights. A qualitative thematic analysis was conducted using the framework of self-determination theory to evaluate how the system fulfills the basic psychological needs of competence, autonomy, and relatedness.

Results:

The analysis underscored the system's value to older adults and their caregivers and its fulfillment of basic human psychological needs (competence, autonomy, and relatedness), consistent with the goals of supporting a high quality of life for older users and caregivers. We found that relatedness is fostered through features enabling remote connection and communication, such as chat functions and shared health data. Autonomy is supported by empowering older adults to manage their health information, to make informed choices about data sharing, and to benefit from safety features like fall detection and emergency calls. Competence is enhanced through accessible design elements, including intuitive navigation, high-contrast visuals, and multi-generational usability. These features allow older adults and caregivers to confidently engage with the system targeted at improving their overall quality of life.

Conclusions:

Through evaluation of the LifeTomorrow system, this study suggests possibilities for using a holistic, inclusive solution to support safe and independent aging in place, and prioritizing the autonomy and empowerment of older adults while addressing caregivers' needs for support and connection. By centering older adults as active participants rather than passive recipients of care, the system exemplifies a shift toward equitable, user-centered technology in caregiving. Future research should investigate the long-term impacts of such systems on aging-in-place outcomes. Clinical Trial: We conducted two studies, which were determined to be exempt by the MIT Committee on the Use of Humans as Experimental Subjects (COUHES) with protocol numbers E-5008 and E-5079.