Prioritizing Older Adults: Ethics and Equitability Reflections in Implementing and Deploying Active Assisted Living Systems

Abstract

Purpose Despite advances in modern medicine allowing older adults to live longer and with increasingly complex needs, health and care provision has not kept up with the growing needs of this group (Hoffman et al., 2021). Active or Ambient Assisted Living (AAL) systems—comprised of IoT devices and designed to improve quality of life, aid in independence, and create healthier lifestyles—have great potential to facilitate personalized, efficient care (Kushniruk et al., 2021). Still, little guidance exists for practical and ethical implementation (Fadrique et al., 2020). This project aims to explore how AAL may be feasibly integrated into the continuum of care and provide actionable steps for deployment while considering the concerns and perspectives of users. Method Using qualitative measures, the present study will evaluate the literature on (1) what impacts a user’s autonomy, (2) what concerns arise regarding equitability, and (3) the unintended impacts of introducing AAL technologies. The study applies a Public Health and Ethics (PHE) lens, which incorporates the moral implications of public health actions, interventions, and policies, focusing on promoting the common good, protecting population health, and respecting individual rights and autonomy by using systematic frameworks. We will utilize a PHE systematic framework developed by Marckmann and colleagues, which helps researchers analyze the ethical considerations surrounding privacy, data security, consent, and potential discrimination of AAL technology users (Marckmann et al., 2015).  Finally, a grey literature scan of existing standards and guidelines on the ethical implementation and deployment of IoT devices in AAL systems will be conducted. Results and Discussion Our exploratory literature review highlights the factors users identify that affect their autonomy in AAL systems, as well as barriers to equitable deployment of AAL technologies existing at the meso (community and institutional) and micro (household and individual) levels (World Commission on the Ethics of Scientific Knowledge and Technology, 2023). Based on these results, we will present recommendations for mitigating equitability issues, ensuring fair access to AAL systems for all demographics and addressing unintended impacts from a PHE perspective. The grey literature scan on existing standards and guidelines on the ethical implementation and deployment of IoT devices in AAL systems identified gaps and inconsistencies in the current standards. Based on the grey literature scan results, we will provide recommendations on how to update the guidelines for the ethical implementation and deployment of AAL technologies. Overall, this study provides actionable insights for stakeholders involved in implementing, deploying, and regulating AAL systems to maximize benefits while minimizing risks for older adults and promoting equitable access to care. AAL systems have the potential to significantly impact the autonomy, equitability, and public health outcomes of older adults. Implementing AAL technologies must be approached carefully while considering ethical issues and likely unintended consequences. Possible trade-offs or compromises in autonomy may occur with the implementation and deployment of AAL systems. Further research is needed to address gaps in the literature and inform practical strategies for effectively integrating AAL technologies into the continuum of care at the macro (health systems and social policy) level.