Ethical considerations of digital health technology in older adult care

摘要

Digital health technology has the potential to revolutionise geriatric care. The digital divide has decreased among older adults,1The Lancet Healthy LongevityTackling the digital divide.Lancet Healthy Longev. 2021; 2: e601Summary Full Text Full Text PDF Google Scholar and over a third of adults aged 50 years and older in the USA already use technology for health or independence.2Kakulla B Older adults embrace tech for entertainment and day-to-day living.https://www.aarp.org/research/topics/technology/info-2022/2022-technology-trends-older-americans.htmlDate: December, 2021Date accessed: July 20, 2023Google Scholar Device types are broad (eg, wearable and non-wearable sensors, tablets, telephones, computers, cameras, robots, and voice-activated technology) and have the potential to improve two key health-care domains: monitoring (eg, activity, sleep, glucose, blood pressure, heart rate, falls, frailty, cognitive function, and medication or treatment adherence)3Mir N Curry G Lee NK Szmulewitz RZ Huisingh-Scheetz M A usability and participatory design study for GeRI, an open-source, remote cancer treatment toxicity and frailty monitoring platform for older adults.J Geriatr Oncol. 2023; (published online July 22.)https://doi.org/10.1016/j.jgo.2023.101595Google Scholar, 4Shi C Babiker N Urbanek JK Grossman RL Huisingh-Scheetz M Rzhetsky A Free-living wrist and hip accelerometry forecast cognitive decline among older adults without dementia over 1-year or 5-years in two distinct observational cohorts.NPJ Aging. 2022; 8: 7Crossref Google Scholar, 5Gresham G Schrack J Gresham LM et al.Wearable activity monitors in oncology trials: current use of an emerging technology.Contemp Clin Trials. 2018; 64: 13-21Crossref PubMed Scopus (91) Google Scholar, 6Finco MG Cay G Lee M et al.Taking a load off: user perceptions of smart offloading walkers for diabetic foot ulcers using the technology acceptance model.Sensors (Basel). 2023; 232768Crossref Scopus (2) Google Scholar, 7Najafi B Veranyan N Zulbaran-Rojas A et al.Association between wearable device-based measures of physical frailty and major adverse events following lower extremity revascularisation.JAMA Netw Open. 2020; 3e2020161Crossref Scopus (16) Google Scholar and service delivery (eg, remote provider visits, education, reminders, and health information sharing). These technologies could enhance quality of life, improve health care access, enable earlier detection of health issues, and foster patient and caregiver engagement. Although these technologies have the potential to improve care for older adults, important ethical considerations must be addressed to reduce to the digital divide and health disparities. In this Comment, we outline three crucial ethical considerations for digital health technology in older adult care: equity, privacy, and data responsibility. We also provide suggestions for future research and actions to address each ethical consideration before health technology should be broadly deployed in clinical contexts. Technology equity requires equalising access to all elements required for technology use across people with varying technology literacy. These elements include high-quality internet; technology set-up and support; open-source data and algorithms; and program usability, adoption, and adaptability. Inequities are present in all of these domains. For example, older adults with lower income continue to have lower access to smartphones, tablets, computers, and home broadband.8Vogels EA Digital divide persists even as Americans with lower incomes make gains in tech adoption.https://www.pewresearch.org/short-reads/2021/06/22/digital-divide-persists-even-as-americans-with-lower-incomes-make-gains-in-tech-adoption/Date: June 22, 2021Date accessed: September 25, 2023Google Scholar, 9Lam K Lu AD Shi Y Covinsky KE Assessing telemedicine unreadiness among older adults in the United States during the Covid-19 pandemic.JAMA Intern Med. 2020; 180: 1389-1391Crossref PubMed