JMIR Publications

ABSTRACT

Background:

The global population is aging at an accelerated pace, presenting significant challenges for healthcare and social systems worldwide. One key objective of healthy aging is to promote independent living, and emerging technologies such as smart homes offer promising support in achieving this goal. By facilitating daily activities and providing context-aware assistance, smart home environments are gaining increasing attention in the healthcare sector, particularly in the care of older adults. However, the interaction between elderly users and smart home technologies remains a complex area that demands deeper investigation.

Objective:

This study aims to conduct a systematic review of existing smart home solutions with healthcare functionalities, focusing on how these systems are designed to support interaction with older adults.

Methods:

A systematic literature review was carried out to identify and analyze interaction models in smart home systems specifically developed for elderly care. Primary studies were selected using a structured search and screening methodology. Data regarding interaction approaches, evaluation methods, and reported outcomes were extracted and analyzed in accordance with established guidelines to ensure methodological rigor and reliability.

Results:

Out of 1,564 articles initially retrieved, 96 met the eligibility criteria and were analyzed in detail. While all reviewed studies claimed to focus on older adults, only 51% reported participants’ age, and just 57% of those used 60+ as the threshold. Interaction modalities were predominantly visual and auditory, with 77% relying on implicit interaction. However, only 25% of the studies employed formal evaluation methods, and 16% did not evaluate user interaction at all. Additionally, only a minority of systems considered age-related adaptations such as cognitive load reduction or multimodal input options. Most studies prioritized technical performance over usability, with limited attention to older users’ needs, capabilities, or lived environments.

Conclusions:

This review highlights a significant misalignment between the design of health-oriented smart homes and the actual needs of older adults. Despite technological advances, many systems overlook inclusive design principles and fail to rigorously assess how older users interact with smart technologies. As the aging population continues to grow, future research must prioritize participatory design, demographic transparency, usability evaluation, and long-term real-world studies. Smart homes must evolve from technically innovative concepts to user-centered solutions that truly support healthy, independent aging.