Evidence of Clinical Significance of Smart Medical Homes Technology
Impact on Health and Well-Being
Smart medical home development projects are driven by the belief that they can improve health, well-being, and quality of life for those who need them. What evidence do we have that smart technologies in the homes, indeed, make their residents healthier and happier? The honest answer, unsurprising given the novelty of the technology, is that we presently know little, because of the lack of rigorous studies into the effect of smart home technology on well-being. Below are some examples of attempts to compile reviews of scientific evidence, arranged chronologically.
Martin, Kelly, Kernohan, McCreight, and Nugent(2008) attempted to conduct a systematic review of studies of the impact of smart home technologies on their users’ health and well-being, as well as healthcare cost. However, although these researchers identified a large body of published works about smart home technologies for health, the handful of existing studies that addressed their clinical effectiveness did not meet the review’s quality criteria. The authors had to conclude that, at the time of the review’s publication, they could make no positive or negative statement about the effectiveness of smart health home technologies. The review was conducted as part of the Cochrane Collaboration, the international organization that gathers and summarizes quality research evidence in healthcare. Cochrane reviews apply stringent quality criteria to evidence evaluation. For example, the inclusion criteria for Martin et al. (2008) review required that studies had control groups, and that residents’ health and well-being were assessed at multiple points before and after the introduction of the technology.
In the same year, Demiris and Hensel (2008) did another systematic review that identified 21 smart home projects targeting older adults, and similarly concluded that “evidence for their impact on clinical outcomes is lacking.” Morris et al.(2013) reviewed published studies of feasibility (practicality) and effectiveness of smart home technologies aiming to “assist older people to live well at home” (p. 1). Upon narrowing their dataset to 21 studies that met the inclusion criteria - only one of which measured the effectiveness of the technology - these authors concluded that “given the modest number of objective analyses, there is a need for further scientific analysis of a range of smart home technologies to promote community living” (p. 1).
A 2016 systematic review of “smart homes and home health monitoring technologies for older adults” by Liu, Stroulia, Nikolaidis, Miguel-Cruz, and Ríos-Rincón (2016) was the latest effectiveness review that we were able to find when working on this chapter in the spring of 2020. The authors analyzed 48 published studies, 18 of which assessed residents’ clinical outcomes. While 12 of 18 reported some positive findings, not all provided high-quality evidence. The highest quality positive evidence came from four studies. One of these showed that, compared with a control group, frail older adults living in homes equipped with multiple smart features showed less decline in their cognitive and physical functions over a period of two years (Tomita, Mann, Stanton, Tomita, & Sundar, 2007). Another showed that, compared with control group participants, older adults living with chronic illness and co-occurring depression who received home health monitoring technology became significantly better at managing their illness (Gellis, Kenaley, & Ten Have, 2014). The third study demonstrated that home health monitoring leads to fewer disease exacerbations and hospital visits in older adults with chronic obstructive pulmonary disease (COPD) (Pedone, Chiurco, Scarlata, & Incalzi, 2013). Finally, one study showed that wireless monitoring improved blood pressure control in older adults living with kidney disease and hypertension (Rifkin et al., 2013). At the same time, there were several moderate- and high-quality studies that showed significantly negative impact of smart home technologies on their users, including in areas of managing living with COPD and heart conditions. The review also found that effectiveness of smart health monitoring technology was, unsurprisingly, related to its level of maturity.
In conclusion, at the present, the field is in acute need of high-quality studies of the impact of smart home technologies on residents’ health and well-being. These studies should focus on how technological systems impact specific important physical, emotional, cognitive, and social health outcomes. Other relevant outcome indicators may include frequency of healthcare utilization, reliance on caregivers, ability to perform activities of daily living and age in place, and sense of safety and security. At the present, some evidence suggests that smart technology in older adults’ homes contributes to their increased confidence and sense of safety and security, particularly when it comes to alerting caregivers in the event of a fall (Pietrzak, Cotea, & Pullman, 2014)
Special Case: Impact on Ability to Diagnose Depression and Dementia
In addition to improving health and well-being, smart medical home technology can also potentially be used for disease diagnostics. An interesting special case involves some promising pilot research, in which wearable accelerometers and environmentally embedded motion sensors help reliably identify signs of depression and early dementia in independently living older adults (Alberdi et al., 2018; Dawadi, Cook, & Schmitter-Edgecombe, 2016; Galambos, Skubic, Wang, & Rantz, 2013). Some of this research is based on developing classification models that involve processing massive amounts of longitudinal smart homes data. The work is grounded in the knowledge that both dementia and depression decrease activity level and changes sleep patterns. In addition, neurological changes associated with dementia lead to changes in gait and mobility. While at the present smart technology is not yet used for clinical diagnosis of these conditions, the possibility is on the horizon.