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Abstract

Older adults (OA) may consider smart home technology (SHT) as a means of aging in place. Family members may feel peace of mind by seeing sensor data patterns of their loved ones, signifying when activity patterns are “typical” or “unusual.” Understanding both the perspectives of OAs and their families will help practitioners making SHT recommendations. Investigators used a phenomenological approach, eliciting both OA (n = 5) and family members’ (n = 4) experiences. In-depth older adult interviews occurred 8-months post-installation and family interviews occurred 2-months post-installation. Interviews were recorded, transcribed, and analyzed for themes. Older adult themes included: don’t need it-not worth it; it changed/didn’t change anything, and could be helpful for someone else. Family member themes included: she loves alexa and [It] gave her peace of mind. While OAs and families described similar criteria for who would benefit from SHT, they differed in whether such technology was personally useful.

Keywords

aging assistive devices community qualitative methodology

Introduction

Smart home technology (SHT) is a category of electronic aids for living, that are stationary within the home. Such technology is considered helpful to people of all ages, especially for older adults (OAs) who want to stay in their home rather than live in congregate settings. Examples of generally available SHT include motion sensors and smart speakers. Examples of health-related SHT include bed and door sensors that measure continuous time in bed or in the bathroom. While there are many studies examining OAs’ views on SHT, there are fewer that examine how family members feel about their loved one using SHT, and even fewer comparing the OAs and family members’ experiences. This study explored OAs’ SHT-adoption experiences and how their family members’ views aligned and diverged.

It is common knowledge that OAs, prefer to stay in their own home rather than move to assisted living or long-term care. Smart home technology shows great promise as a means to extend time at home for many OAs (Aggar et al., 2023; Choi et al., 2021; Dermody et al., 2024; Kilcullen et al., 2022; Le et al., 2016; Liu et al., 2016; S. T. M. Peek et al., 2014; S. T. Peek et al., 2016; Pirzada et al., 2022; Tural et al., 2021). Some perceived SHT benefits include its capacity to serve as a memory aid, decrease reliance on others, improve quality of life, provide quick access to emergency services, and give peace of mind for both the OA and their family (Aggar et al., 2023; Choi et al., 2021; Davenport et al., 2012; Dermody et al., 2024; Maswadi et al., 2022; S. T. M. Peek et al., 2014). Despite seeing potential benefits, many OAs are slow to adopt the technology (Liu et al., 2016; S. T. Peek et al., 2016; Pirzada et al., 2022; Tural et al., 2021).

There are many concerns and barriers (see Table 1) that have been identified as having an effect on OAs’ SHT adoption. While concerns and barriers have been referred to as separate factors within the literature, they do appear to relate to one another with each falling under one of three categories related to 1) the individual/person, 2) the technology itself or 3) the social context. An example of an individual concern might be worry about having difficulty with learning to use technology; a corresponding barrier could be having a lack of understanding about computers. An example of a technology related concern might be false alarms; while a corresponding barrier would be the level of false alerts. In the social context, an OA may have concerns about being a burden to others; with barriers being data security issues and the technology showing the person is no longer capable of living independently.

Table 1.

Smart Home Technology Concerns and Barriers.

Factor	Concerns	Barriers
Individual
	Difficulty learning to use it (Bock et al., 2016; Kilcullen et al., 2022; S. T. M. Peek et al., 2014; Pirzada et al., 2022; Tural et al., 2021)	Lack of understanding of computers (Davenport et al., 2012; Le et al., 2016)
	Lack of perceived need (Davenport et al., 2012; Ghorayeb et al., 2021; Tsertsidis et al., 2019)	Need confidence it will improve quality of life (Kilcullen et al., 2022; Liu et al., 2016)
	Trust (Arthanat et al., 2019; Ghorayeb et al., 2021; Pirzada et al., 2022)	Embarrassment of the need for support (Kilcullen et al., 2022; S. T. M. Peek et al., 2014)
	Increased problems or stress perceived as being caused by technology (Dermody et al., 2021)	Anxiety over loss of privacy (Liu et al., 2016)
		Fear of dependency (Dermody et al., 2021; S. T. M. Peek et al., 2014)
		Prefer personal assistance/human contact (Ghorayeb et al., 2021; Kilcullen et al., 2022)
Technology
	False alarms (S. T. M. Peek et al., 2014; Tsertsidis et al., 2019)	Level of false alerts (Tsertsidis et al., 2019)
	Esthetics/obtrusiveness (Ghorayeb et al., 2021; Kilcullen et al., 2022; S. T. M. Peek et al., 2014; Pirzada et al., 2022; Tsertsidis et al., 2019)	Obtrusively of some technology (Courtney et al., 2008; Liu et al., 2016)
	Cost/Affordability (Arthanat et al., 2019; Choi et al., 2021; Davenport et al., 2012; Dermody et al., 2021, 2024; Ghorayeb et al., 2021; S. T. M. Peek et al., 2014; Tsertsidis et al., 2019)	Cost ($ and time; return on investment; Arthanat et al., 2019; Choi et al., 2021; Dermody et al., 2021; Moyle et al., 2021; Tural et al., 2021)
	Accuracy of data (i.e., if there is a visitor; Choi et al., 2021; Tsertsidis et al., 2019)	System instability and malfunctions (Moyle et al., 2021; Tsertsidis et al., 2019)
	Reliability (Arthanat et al., 2019; Choi et al., 2021; Ghorayeb et al., 2021; S. T. Peek et al., 2016; Pirzada et al., 2022)	System being turned off (Moyle et al., 2021; S. T. M. Peek et al., 2014)
	Usability/Accessibility (Arthanat et al., 2019; Ghorayeb et al., 2021; S. T. M. Peek et al., 2014)	Home not accommodating technology/poor wifi (Liu et al., 2016; Moyle et al., 2021)
	Lack of familiarity with technology (Ghorayeb et al., 2021; Pirzada et al., 2022)	Data on screen too small (Liu et al., 2016)
		Technology rapidly becoming obsolete (Tural et al., 2021)
Social context
	Security (e.g. who accesses data; Ghorayeb et al., 2021; Pirzada et al., 2022)	Risk of data getting into the wrong hands (Liu et al., 2016)
	Privacy/intrusiveness (Arthanat et al., 2019; Choi et al., 2021; Courtney et al., 2008; Dermody et al., 2021, 2024; Ghorayeb et al., 2021; S. T. M. Peek et al., 2014; Tsertsidis et al., 2019)	Technology might show they can’t stay in their homes (Liu et al., 2016)
	Stigma (Davenport et al., 2012; Ghorayeb et al., 2021; Kilcullen et al., 2022; S. T. M. Peek et al., 2014; Tsertsidis et al., 2019)
	Burden to others (technology assistance; Ghorayeb et al., 2021; S. T. M. Peek et al., 2014; Tsertsidis et al., 2019)
	Lack of human response (Davenport et al., 2012; Ghorayeb et al., 2021; Kilcullen et al., 2022; Pirzada et al., 2022)
	Fear of loneliness (Ghorayeb et al., 2021)

Note: Only the first author and year are included in the citations in this table; full references are in the Reference list.

Past studies have found that when OAs consider SHT use, they may be accepting of some loss of privacy and their concerns about being a burden on others by using SHT may be unfounded. In the absence of cameras, the sensors often become unobtrusive and OAs may forget that the sensors are there (Demiris et al., 2008; Ghorayeb et al., 2021; Oliveira et al., 2020; Pirzada et al., 2022). When it comes to OAs reporting “burden” as a rationale for not wanting to be monitored (Dermody et al., 2024; Ghorayeb et al., 2021; Le et al., 2016), the evidence suggests that use of SHT may actually reduce the burden on caregivers (Dermody, 2024; S. T. M. Peek et al., 2014). Given that these concerns may slow or interfere with SHT adoption, it is important to be aware of the evidence when communicating about SHT with OAs.

Socially-relevant contextual factors have also been discussed within the literature by those who have developed models aimed at describing successful SHT use. For example, Golant (2017) suggests, as a part of the Elderadopt model, that OAs are more likely to adopt SHT if external information from others is credible, useful, and powerful. Additionally, Pirzada et al. (2022), discuss the Technology Acceptance Model (TAM2) adding that a person’s perceptions of SHT are based on the influence of family, friends, and social status (Pirzada et al., 2022). These models were helpful in understanding the many factors that influence adoption, or not, of SHT. While these models include a social component, they don’t explicitly guide health practitioners’ approach with OAs’ family members.

While most of the evidence surrounding SHT addresses the OAs perceptions and experiences around SHT adoption and use, little is known about family members’ experiences. Given that family members are likely to be the ones entrusted with getting alerts or viewing data reports from SHT monitoring, it is important to understand how they perceive the OAs’ experiences with SHT adoption. To fill a gap in knowledge, investigators engaged in a qualitative study eliciting OAs’ and their family members’ perceptions with the aim of understanding the essence of the older adults’ experience receiving SHT and the contextual factors that influence that experience.

Methods

This phenomenological study was part of a larger study which included in-depth interviews prior to and shortly after (2-months) SHT installation. For this manuscript, the authors describe the essence of the OAs’ SHT adoption experiences by reporting their perspectives 8-months post-installation and their family members at 2-months post-installation. Investigators chose to interview family members only once at the 2-months post installation, to identify any concerns that could be resolved early on in the adoption process. The Consolidated Criteria for Reporting Qualitative Research (COREQ) 32-item checklist, described by Tong et al. (2007), was used to guide this study’s reporting.

Participant Recruitment and Inclusion/Exclusion Criteria

Recruitment for this study began after receiving institutional review board approval. Participants were recruited by word-of-mouth and through flyers posted within a senior-living community in the Midwestern United States. Residents could attend an information session given by a SHT retailer to learn about the technology. Consent took place after the information session, in a separate room where study investigators led the consent process. OAs were included if they were 55 years or older (the requirement for living in that community), living in independent or assisted living, and agreed to SHT installation and excluded if unable to pass a cognitive pre-screening. Family member participants were included once identified by the OA as the designated family member to receive SHT updates/alerts. They underwent consent in advance of their scheduled interview.

Smart Home Technology Installation and Education

Participants received select SHT at no cost for 1 year, with the option of continuing their subscription post-study. Package-options included receiving general-purpose technologies such as a smart lightbulb (voice-activated) and Amazon Alexa^® (2018 Edition) as well as sensors. The sensors included bed and chair occupancy sensors; front, bathroom, and refrigerator door sensors; and a software application with a dashboard to record activity and alert designated family members of atypical activity-patterns. All but one OA opted to include Alexa^® in their package. OAs received training from the SHT retailer before use. Family members had the option of attending the training. Both were given the retailer’s contact information to request additional training, if needed.

Study Procedures, Data Collection, and Analysis

To ensure rigor, investigators applied data and investigator triangulation which involved using multiple data sources: OA in-depth interview, family member in-depth interview and fieldnotes. Additionally, a minimum of two investigators presided over interviews and analysis (coding transcripts, participating in consensus-sessions deriving and charting final themes). Investigators also conducted member checking with OAs and family members to verify the accuracy of the transcripts and themes.

For each hour-long interview (8-months for OA and 2-months post-installation for family member interviews), investigators used an interview guide containing grand-tour and mini-tour questions like those conceptualized by Spradley (1979 and a pre-designed fieldnote template. The Elderadopt and TAM2 models helped shape the two overarching interview questions about the essence of the OA’s experience with adopting SHT and the contextual influences on their experience: 1) What have you experienced using SHT? and 2) What contexts (social, physical, temporal, virtual, personal, cultural) or situations influenced how you experienced that technology? The family interview guide contained prompts for respondents to describe any changes they perceived the OA having had since SHT installation and the potential supports afforded by having SHT in the home. Each investigator had a role as either the primary interviewer or notetaker. Interviews were audio-recorded and transcribed. Transcripts were provided to the OAs and their family members to verify their accuracy.

The transcribed interviews were analyzed using open, axial, and selective coding. Investigators independently coded each transcript using NVivo^®, labeling participant statements and matching those labels to corresponding quotes. Then, investigators analyzed across participants as a team, reviewing, sorting, discussing and revising codes until consensus was achieved and the overarching themes were identified, named, and charted. Themes and corresponding quotes were organized using framework analysis (Glaser, 1978; Miles et al., 2014).

Results

In total, 14 enrolled in the larger study (10 OAs, four family members). Nine OAs completed pre-SHT-installation in-depth interviews with five finishing the study, completing the in-depth post SHT-installation interviews. Four family members enrolled, participating in an in-depth post SHT-installation interview.

Participant Demographics/Description

Those OAs completing the project were White females aged 75 to 90 who lived alone (n = 4) or with a spouse (n = 1) in independent apartments within the same senior living community. All reported leaving their apartments three or more times per day, never being concerned about their own safety and being regularly checked-in on by staff for wellbeing/safety. They reported family members checked up on them in-person either occasionally, one, or two-times per week. Family members were White and either a daughter (n = 3) or a sister (n = 1) of the OA and had regular contact with the OA prior to the study.

In-Depth Post-Installation Interview Findings

A total of five major themes emerged from the data, revealing the OAs’ experiences with SHT. Three were identified by the OAs and two by the family members. Older adult themes included: don’t need it here/not worth it; it changed/didn’t change anything, and could be helpful for someone living alone. Additional themes identified by family member included: she loves Alexa and [It] gave her peace of mind. The perspectives of the OAs and their family members aligned closely with one another and ultimately the OAs chose to not adopt the SHT. This choice was primarily due to social contextual factors as well as the OAs current levels of functioning. The following section describes the themes and corresponding quotes.

Older Adult Theme – Don’t Need It Here/Not Worth It

The theme don’t need it here/not worth it reveals that the OAs were living in an environment where they had effective systems in place, such that the technology was not needed. For example, they either had routines of checking-in with family or senior-living community staff or they had predictable daily activity patterns of interacting (e.g., community meal times) so that others would know if activity patterns were atypical. Even though most lived alone in an apartment, they had social networks within the senior-living community that decreased the need for or perceived value of having SHT to monitor their activity levels.

S6: “I feel that here, there’s no real need for it. I do have my own activity here. . .I’m not real sure on how useful it would be in this building.”

S1: “Oh, I really don’t need it.”; “It hasn’t made a difference to me.”

Additionally, for at least one OA, the perceived family member’s time commitment of having to set-up and use the monitoring software was reason to not adopt SHT:

S09: “For us, as I’ve said before, we have checks here. And our children and grandchildren are working full time and our great-grands, of course, take up their time. And so, it didn’t seem worth it. I thought it would be too intrusive to their lives to try to set this up with them.

Older Adult Theme – It Did or Didn’t Change Anything

The theme it did or didn’t change anything reflects the degree to which the OAs believed SHT affected their behavior patterns. While most described that the technology didn’t change them or their interactions with family, they did identify making minor changes to their actions, so that sensors wouldn’t unnecessarily alert their family member. They also discussed that while they didn’t feel changed by the technology, it did add convenience.

S06: “Maybe, I might [have left] the door open a little bit more often. My sister’s gotten notification of the door being open a couple times, so I’ve been trying to make a point [of closing the door]”

S19: “Well, except for using Alexa for questions, because I’ll ask her a question, and the alarm. . . I don’t really think so. . .I don’t think it’s had a lot of impact. It’s been a convenience and more of a safety net for me to know that it was there if I needed it.”

Older Adult Theme – Could Be Helpful for Someone Living Alone

The theme could be helpful for someone living alone reveals participants beliefs that those living alone either without others close by or pre-existing supports could benefit from having SHT sensors that measured activity and notified others of changes in activity patterns. The OAs in this study did not feel they had significant enough health or safety issues to warrant the use of the SHT, but could see how it would benefit others.

S19: “Well, mostly the single people. . .As long as there’s two of you, you know, you have that to fall back on. But when you’re single and no matter how attentive your children and family are, you’re still alone. . .I would just think it would be so comforting . . .[for someone whose health is] failing, people living alone. . .people who don’t have anybody there.”

Their statements also revealed that the participants living alone in their apartment did not identify themselves as being alone.

S09: “. . .But I can see where it would be helpful for people living alone or people living in a home, say where they didn’t have a close neighbor. . .So, I can see the benefit of it but it wasn’t a benefit to us.”

S18: “I can see it if I lived alone in some place and if I didn’t have all these other things to fall back on, I can see where it would be just wonderful.”

Family Member Triangulation

Family member themes corroborated the OA themes of don’t need it here/not worth it and could be helpful for someone living alone. They reported that the OAs were well-supported in their current living environment and if changes were to occur (e.g., fall, memory decline) the technology might be more useful. The family members had similar ideas about SHT being good for someone living alone.

S06-F: “So basically, with her situation now, I probably would check it out once a week or something rather than having it on all day long. . .[I’d want to know] if she falls, that would be a big one for me. She’s pretty known around this building, so I think there would be enough people wondering, "Where’s [name]?”

S19-F: “This would be a very valuable technology piece for maybe somebody living at home alone. . .I’m sure it’s going to be useful technology in the future for all. I can imagine so many situations of people living with disabilities and limitations where this would just be so useful.”

Family Member Themes – She Loves Alexa and [It] Gave Her Peace of Mind

Two additional themes arose from family member interviews that differed somewhat from OA themes: she loves Alexa and it gave her peace of mind. These themes revealed that the family members may have thought the OAs valued the SHT more so than the OAs reported. Family members believed the OA was really excited about Alexa for the first 2-months of use and thought they even considered Alexa as a friend.

S01-F: “Oh, yes. She has a ball with Alexa. . .She thinks Alexa’s the bee’s knees. . .”

S19-F: “Her best friend is now Alexa. . .Alexa is all I heard about for the two months when I was gone. . . because that is her best friend.

Some family members perceived the sensors and atypical-pattern alerting software as adding to the OAs existing sense of security and having value by giving the OA peace of mind:

S18-F: “I think she likes this. She likes these sensors because they’re helping her feel . . . a little more secure. . ., that if something would happen, somebody would know right away.”

S19-F: “That would be a reason why it would be worth continuing, because it gives her this peace of mind. . .It’s kind of nice just to have that extra little safety . . .”

Other family members identified the SHT as having value to themselves and providing them with reassurance that the OA is maintaining their typical routine:

S01-F: “It’s kind of reassuring to see what she’s up to. I mean, I can’t tell what she’s doing, but I kind of know what she’s doing. Only because she’s a creature of habit for the most part.”

Discussion

Family members in this study appreciated having a non-intrusive way of attending to their loved one as did those in previous studies who also reported that monitoring gave OAs and families peace of mind and was thought to be less intrusive than phone calls (Aggar et al., 2023; Choi et al., 2021; Davenport et al., 2012; Dermody et al., 2024; Maswadi et al., 2022). Despite reports that SHT provides reassurance, it appears that for OAs to adopt SHT and consider its use “worth it,” they would need to be in failing health or be alone and without a well-developed social network. These findings are consistent with the Elderadopt Model (Golant, 2017) and the TAM2 Model (Pirzada et al., 2021) with respect to reasons why OAs will or will not adopt SHT.

All of this study’s participants felt the SHT would be helpful for other people in other circumstances, but it was not currently needed. This sentiment parallels previous findings that many OAs think technology would be good for someone else who was in worse health, had more disability, but not for themselves because they considered their health as “good right now” (Courtney et al., 2008; Dermody et al., 2021; Kilcullen et al., 2022; Wei et al., 2023). These findings suggest that practitioners would be wise to assess their client’s health-related status or perceptions of prior to making recommendations.

At the end of this study, all participants opted to discontinue SHT use. While the previously identified factors of living situation and health status appeared to play a role in their decision, so might their feelings of safety. In past studies, personal safety has often been cited as the primary reason for getting SHT (Choi et al., 2021; Davenport et al., 2012; Dermody et al., 2024; Maswadi et al., 2022; S. T. M. Peek et al., 2014). At the outset of this study, OAs reported that they didn’t have concerns about their own safety, thus they may not have had cause to keep using SHT after the study ended.

Some of the differences in themes between the OAs and their family members may have been due to time, given that final OA interviews took place at 8-months and family interviews at 2-months post SHT-installation. In hindsight, it might have been better to also interview family members at 8 months post installation. Tsertsidis et al. (2019) found that the longer the OA used the technology the stronger their perceptions of usefulness of the technology became. While most of the OAs in the current study expressed feeling less excited over time. Future researchers should evaluate SHT use over the long-term to fully understand SHT outcomes. Additionally, future investigators might consider establishing criteria for including participants who are in poor health, have safety concerns, and live alone with minimal social supports to see how SHT-adoption experiences differ from those in this study.

Limitations

This study describes experiences active OAs living independently in a highly supportive senior living community. There was little diversity in terms of race, ethnicity, disability status, or gender. A greater breadth of understanding about SHT adoption-related experiences could be achieved by having a more heterogenous group of OAs coming from varied communities. A greater understanding about why the participants in this study chose to return the SHT might have been achieved by collecting data about their decisions at the end of this study. That the older adult and family interviews occurred at different time intervals may have also impacted the results.

Conclusion

This study examined the SHT adoption experiences of OAs and their family members. While the OAs did not feel they needed the SHT, they (as well as their family members) felt it had some value in providing peace of mind for themselves or family members and that SHT would be particularly valuable for people who were ill or living alone without well-established social supports. Patterns of interaction between OAs and their designated family member did not change, nor did the OA’s patterns of activity participation.

Supplemental Material

sj-docx-1-ggm-10.1177_30495334251326263 – Supplemental material for Adoption of Smart Home Technologies: A Qualitative Exploration of Older Adults’ and Their Family Members’ Experiences

Supplemental material, sj-docx-1-ggm-10.1177_30495334251326263 for Adoption of Smart Home Technologies: A Qualitative Exploration of Older Adults’ and Their Family Members’ Experiences by Karen M. Sames and Jennifer A. Hutson in Sage Open Aging

Footnotes

Acknowledgements

We would like to thank the faculty, staff, and students of St. Catherine University who assisted in the data collection and analysis, in particular, Penny Moyers Cleveland who initiated the study and Skye Thompson who worked with us through the entire study. We would also like to thank Pennie Viggiano of Benedictine Health System for their collaboration on this project

ORCID iDs

Karen M. Sames

Jennifer A. Hutson

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was approved by the Institutional Review Board of St. Catherine University. It was partially funded through St. Catherine University’s GHR Grant. Smart home devices and dashboard were provided and installed by Best Buy^TM.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Supplemental Material

Supplemental material for this article is available online.

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