JMIR Publications

ABSTRACT

Background:

Real-world behavioural and physiological functioning, including heart rate variability, daily mobility, and sleep patterns, reflects key markers of ageing and early neurodegenerative decline, yet these features may not be adequately reflected by periodic clinical visits. Wrist-worn wearable devices offer a promising approach for continuous, passive monitoring of these functional domains. However, evidence regarding feasibility, usability, and acceptability in real-world observational settings among community-dwelling older adults in China remains limited.

Objective:

This study primarily aimed to evaluate the feasibility and acceptability of using wrist-worn wearable devices to monitor behavioural and physiological function in community-dwelling older adults under naturalistic conditions. As a secondary objective, the study descriptively characterised baseline behavioural and physiological patterns among participants with high device engagement.

Methods:

We enrolled 486 community-dwelling older adults from the Beijing region of the China-Aging cohort, each of whom received a Huawei Band 8 commercial wrist-worn wearable device. Device engagement was categorised using predefined wear-time criteria, with participants classified into three groups (high, medium, and low) based on achieving ≥10 hours of daily wear-time across ≥3 consecutive days. Demographic characteristics, health status, and cognitive and functional measures (MMSE and Barthel ADL Index) were compared across groups. Usability, acceptability, and perceived burden were assessed using a structured user experience survey.

Results:

Of 486 participants, 224 (46.1%) were classified into the high engagement group, 156 (32.1%) into the medium engagement group, and 106 (21.8%) into the low engagement group. Demographic characteristics, MMSE scores, and ADL scores were comparable across groups, except for significantly better self-rated health status in the high engagement group (p = 0.005). Among high engagement participants, mean daily heart rate was 72.1 bpm (SD 8.6) and median daily step count was 6,177 steps/day (IQR: 4,249–8,872). Sleep data were successfully recorded in 86.5% of participants, with a median duration of 7.23 hours/night. User experience survey responses (n = 106) indicated generally positive usability and experiences, with median ratings of 4 out of 5 across most items. From open-ended questions, commonly reported barriers included device discomfort, data synchronisation issues, and battery life.

Conclusions:

Wrist-worn wearable devices are feasible, acceptable, and usable for real-world behaviour and physiology monitoring in community-dwelling older adults in China. Engagement varied across individuals and was influenced by both individual factors and modifiable usability barriers. These findings support the potential utility of wearable technologies for longitudinal monitoring of everyday functioning outside clinic-based assessments in older adults. However, it is important to address the implementation barriers before large-scale implementation and to support long-term user engagement. Further research is warranted to examine the long-term stability and clinical relevance of wearable-derived behavioural measures in relation to age-related functional decline.