Home monitoring technologies have existed at least since the 1990s as a way of helping at-risk older adults age in place. The first such technologies were video monitoring systems used to observe accidents or unsafe behaviors. As technology improved, video monitoring gave way to home-based sensors to detect smoke, temperature changes, or door and window alarms. These systems allow more privacy than video monitoring, but still involve direct observation by dispatchers. More recently, motion-sensor based monitoring technologies have emerged. These do not directly report observations from the home, but detect deviations from normal behavioral patterns in the home. As an example, the system may observe that every morning, an older adult has used their front door or opened their refrigerator door, If neither occured one morning, the system could alert a caregiver.
The advances and design of these technologies were developed by university researchers, and are now being developed and sold by private companies for home use. A forthcoming article provides a framework to help older adults, clinicians, caregivers, and other interested parties decide if a motion sensor-based technology is appropriate for them or their loved one. Drawing from clinical ethics literature, the author provides a model to make informed decisions in regard to the use of motion sensor technology.
The first step proposed in the article involves establishing three areas of informed decision making: information, comprehension, and voluntariness. Although the companies who market these systems provide some useful information, more information is likely to be needed in any specific case. The author suggests that data limits of the system, likely add-on and follow-up costs, and data security may need to be considered for an informed decision. Once this information is obtained, it is necessary to ensure that the user, caregiver, and other involved parties comprehend the information and are clear about misconceptions regarding what the system can and cannot do. Finally, the user must be free to explore other options or opt out of the system if she or he is dissatisfied with it, to ensure that the decision is being made voluntarily.
Once these three areas have been established, the technology can be evaluated on the basis of three other factors: effectiveness, obtrusiveness, and quality of life. Motion sensors will not be effective for every case, as they can only detect the amount of time spent in a particular location, and not specific behaviors. Thus, depending on what behaviors are of potential concern, the system could provide either false alarms or false comfort. The extent to which the system seems obtrusive will also vary by user, as will the user’s sense that the system contributes to his or her quality of life. If the system does not provide more by way of effectiveness and quality of life than it costs in obtrusiveness, it is impractical.
Beyond providing an ethics-based decision making framework, the article also suggests two lines of further research. Empirical studies of cases where these systems have been purchased can be used to assess whether older adults and surrogate decision makers are making informed and ethical decisions. Further, it may be useful to study whether individuals, family members, and health care professionals come to similar conclusions about the effectiveness, obtrusiveness, and contribution to quality of life of sensor-based technologies.
Bruce CR. Informed decision making for in-home use of motion sensor-based monitoring technologies. Gerontologist. 2011 [e-pub ahead of print]