The Role of Smart Homes in Providing Care for Older Adults: A Systematic Literature Review from 2010 to 2023

Abstract

This study undertakes a systematic literature review, framed by eight research questions, and an exploration into the state-of-the-art concerning smart home innovations for care of older adults, ethical, security, and privacy considerations in smart home deployment, integration of technology, user interaction and experience, and smart home design and accessibility. The review evaluates the role of smart home technologies (SHTs) in enhancing the lives of older adults, focusing on their cost-effectiveness, ease of use, and overall utility. The inquiry aims to outline both the advantages these technologies offer in supporting care for older adults and the obstacles that impede their widespread adoption. Throughout the investigation, 58 studies were analyzed, selected for their relevance to the discourse on smart home applications in care for older adults. This selection came from a search of literature published between 2010 and 2023, ensuring an up-to-date understanding of the field. The findings highlight the potential of SHTs to improve various aspects of daily living for older adults, including safety, health monitoring, and social interaction. However, the research also identifies several challenges, including the high costs associated with these technologies, their complex nature, and ethical concerns surrounding privacy and autonomy. To address these challenges, the study presents recommendations to increase the accessibility and user-friendliness of SHTs for older adults. Among these, educational initiatives for older adults are emphasized as a strategy to improve technology acceptance, along with suggestions for design optimizations in wearable devices to enhance comfort and adaptability. The implications of this study are significant, offering insights for researchers, practitioners, developers, and policymakers engaged in creating and implementing smart home solutions for care of older adults. By offering an understanding of both the opportunities and barriers associated with SHTs, this research supports future efforts to create more inclusive, practical, and supportive environments for aging populations.

1. Introduction

The aging of the population is a global phenomenon that presents challenges for societies, particularly in developed countries. According to UN predictions, by 2050, the proportion of people aged 60 and older will surpass the number of children under 14 years old [1]. This demographic shift will impact various societal sectors, including the economy, social welfare, and healthcare. It is, therefore, crucial to explore innovative solutions to enhance the quality of life for older adults and meet the increasing demand for long-term care. Older adults, typically those close to retirement age, vary in designation from as early as age 60 to as late as age 65, depending on the nation and culture.

One significant aspect of aging is the growing desire among older adults to age in place. This concept refers to the ability of older adults to live independently in their homes and communities, maintaining their lifestyle despite age-related health challenges or the need for assistance with daily activities [2]. Factors influencing this preference include emotional attachment to one’s home, preservation of familiar surroundings and social ties, and the belief that institutional care may not provide the desired level of personalized care.

The potential for technology to support older adults in aging in place is increasingly recognized. Smart homes, with their transformative capabilities, emerge as a promising solution. These homes provide functionalities such as automated medication dispensing, medical monitoring, and personal assistance through features such as connectivity, automation, mobile device management, energy and resource efficiency, accessibility, and device integration [3]. By utilizing sensors, actuators, and intelligent systems, smart homes monitor the activities and health of older adults, detecting changes in patterns and providing timely assistance or notifications to caretakers or medical specialists [4]. This proactive approach can prevent accidents, detect early signs of health deterioration, and facilitate timely interventions, reducing the need for hospitalization or institutional care.

Furthermore, smart homes empower older adults by enhancing their independence and autonomy. User-friendly interfaces and voice-activated instructions simplify the control of various aspects of their living environment, such as lighting, temperature, and entertainment systems, thereby maintaining daily routines and enhancing convenience [5]. These features also help tackle social isolation by enabling older adults to maintain relationships through integrated communication technologies, such as video calls, social media, and online activity trackers, fostering a sense of belonging [6].

Additionally, smart homes are pivotal in managing chronic illnesses and promoting healthy aging. They monitor vital signs, medication adherence, and lifestyle trends, sharing these data with healthcare providers for remote monitoring and personalized interventions. This capability allows older adults to better manage their conditions, prevent complications, and improve their overall health [7]. Considering the significant challenges posed by population aging, smart homes offer a comprehensive solution that enhances the quality of life for older adults, enabling them to maintain independence, promote social connections, and manage health-related challenges effectively.

The aim of this study is to provide a comprehensive and interdisciplinary review of smart home technologies (SHTs) for older adults, covering the period from 2010 to 2023. Integrating technological, ethical, and practical perspectives, it captures broader trends and persistent challenges in the development and implementation of SHTs. Previous research has often been limited by narrower focuses or shorter timeframes, failing to encompass the full spectrum of advancements and obstacles in this field [8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24]. Our review not only offers a longitudinal perspective on the evolution of these technologies but also provides a detailed analysis of their impact on the lives of older adults, which is crucial for understanding both progress and enduring challenges.

The originality of our work is highlighted by its dual focus on the benefits and limitations of SHTs, a balance often overlooked in existing literature. While numerous studies document the technological advancements and potential health benefits of smart homes, few simultaneously address the significant ethical and practical challenges accompanying these innovations. Our systematic review goes beyond merely listing the advantages of SHTs, such as enhanced safety, independence, and well-being for older adults. It rigorously examines the high costs, technological complexities, and ethical concerns, particularly those related to privacy and autonomy, that hinder the widespread adoption of these technologies. By addressing both positive and negative aspects, our study provides a more balanced and realistic assessment of the potential of SHTs.

Furthermore, this study fills a critical knowledge gap by presenting targeted recommendations that are both practical and theoretically grounded. Derived from a thorough analysis of existing literature, these recommendations are designed to address the identified challenges directly. For instance, educational initiatives are proposed to improve older adults’ technological literacy, thereby enhancing their acceptance and effective use of SHTs. Design optimizations to make these technologies more user-friendly and adaptable to the specific needs of older adults are also suggested, with a focus on comfort and ease of use. Additionally, the development of ethical guidelines to address privacy and consent issues is advocated, ensuring that the deployment of SHTs respects the dignity and autonomy of older adults. These recommendations are not only innovative but also actionable, providing clear pathways for future research, development, and policy formulation.

Our research methodology is noteworthy for its integration of qualitative, quantitative, and mixed-method analyses. This methodological diversity allows for a more thorough understanding of user perceptions and the real-world applicability of SHTs. By synthesizing data from various research approaches, our study offers comprehensive insights into how these technologies are perceived and utilized by older adults. This multifaceted analysis enhances the robustness of our findings and underscores the importance of considering multiple perspectives when evaluating the impact of SHTs. Such a methodological approach distinguishes our study from previous research, which often relies on a single type of analysis, thus providing a less complete picture.

The remainder of the paper is structured as follows. An overview of current relevant and related studies is provided in Section 2. The employed research methodology is described in Section 3. Outcomes of the systematic literature review on the role of smart homes in the lives of older adults are reported in Section 4. Recommendations for enhancing SHTs for older adults are provided in Section 5. Implications for designers, developers, healthcare professionals, researchers, older adults, and the community are discussed in Section 6. Future work directions are proposed in Section 7. Limitations are explained in Section 8. Conclusions are drawn in Section 9.

2. Related Work

Numerous studies have explored the role of smart homes as caregivers. Lattika et al. [8] conducted a review examining technologies to alleviate loneliness and social isolation among older adults, including robots, wearable technology, and smart homes. They concluded that while robotic dogs and social robots can only partially address loneliness, smart homes can effectively identify and anticipate both loneliness and social isolation, thus improving older adults’ social well-being and offering guidance for future study and development in this field. Ghafurian et al. [9] evaluated the literature on smart home environments and equipment designed to support older adults, uncovering a range of devices, technical challenges, and their advantages for older adults.

In the context of assistive smart homes, Zulas et al. [10] evaluated the needs of caregivers of older adults, revealing a demand for technology that simplifies monitoring older adults’ safety, health, and activities, and facilitates access to and sharing of information with other healthcare professionals. This study underscores the significance of deploying innovative home technology to meet the needs and preferences of older adult caregivers and provide them with adequate support. Additionally, Zulas et al. [11] examined the needs of healthcare workers in smart homes for older adults, identifying essential requirements, such as monitoring vital signs, safety, communication, and medication management. The study emphasizes the importance of customizing each solution to the individual older adult, highlighting challenges, such as user interface difficulties, the need for training, and concerns about privacy and data security.

Ma et al. [12] focused on design strategies for smart homes to support aging in place, identifying numerous benefits and challenges. The benefits included improved safety, enhanced comfort, increased autonomy, and social connectedness, while the challenges encompassed high costs, compatibility issues, privacy and data security concerns, and technological literacy among older adults. Sumner et al. [13] conducted a systematic literature review to explore knowledge about the design of technology used in smart homes, concluding that their active involvement in the technology design process is crucial for ensuring relevance, acceptance, and effectiveness for older adults. Additionally, they emphasized the importance of adaptability of technology to the diverse needs and preferences of older adult users. Zielonka et al. [14] investigated current developments and trends in smart homes, with a focus on how these environments interact with older adults through software and artificial intelligence (AI). Their study concludes that an improvement in older adults’ quality of life will not be possible with the current infrastructure of smart homes.

Graybill et al. [15] examined the cost-effectiveness of aging in place, analyzing various studies on the costs associated with home-based care versus other forms of care for older adults. They concluded that aging in smart homes can be more cost-effective compared to options such as institutional care, also identifying factors that influence this cost-effectiveness, including home modification costs, availability of support and services, and social support. The research highlighted that aging in smart homes can positively impact older adults’ quality of life by enabling them to remain in a familiar environment and maintain their autonomy. Kachouie et al. [16] explored the role of socially assistive robots in enhancing the well-being of older adults by providing companionship, assistance, and engagement. Ollevier et al. [17] conducted a systematic literature review exploring how technology can support aging in place for older adults, identifying technologies such as sensors, telemedicine, smart home devices, and mobile applications that assist older adults in maintaining their independence, monitoring their health status, ensuring safety, and improving their quality of life. The study emphasizes challenges in using innovative home technology, including technological literacy, acceptance, financial factors, individual differences, and security and privacy concerns.

Solaimani et al. [18] examined the need for achieving a higher level of maturity to enable the mass commercialization of smart homes and increased connectivity, noting that the existing literature often overlooks social and economic aspects. Chadborn et al. [19] examined the advantages and drawbacks of smart homes and innovative health technologies, discovering varying perspectives and concerns among older adults regarding smart homes, including the importance of customizing technology to individual needs and the significance of emotional support and human interaction within technological systems. Privacy and data security emerged as additional significant concerns. The study emphasized the crucial role of involving older adults in the design of innovative home technologies.

Mashal et al. [20] conducted a systematic review of literature spanning ten years to explore the acceptance and adoption of smart homes, finding that psychological factors, such as user attitudes and perceptions, along with personalized applications and services that meet user needs and desires, are crucial for adoption. Wang et al. [21] focused on ethical issues concerning the implementation of smart homes for older adults. This research emphasized the importance of considering ethical aspects while developing innovative home technologies to ensure the safety, privacy, and well-being of aged individuals. It highlighted the significance of involving older adults in technology development to provide transparency and privacy protection, allowing them to participate and ensuring their needs and preferences are respected. Felber et al. [22] conducted a systematic review to map the ethical issues associated with smart home health technologies for the care of older adults. The review aimed to identify and analyze ethical concerns, such as privacy, autonomy, informed consent, data security, and the potential for social isolation, emphasizing the need for an ethical framework to guide the development, implementation, and use of these technologies, considering older adults’ values, rights, and well-being.

Zwijsen et al. [23] highlighted the absence of specific guidelines and ethical codes concerning the use of assistive care technologies for older adults, asserting that concepts such as privacy, autonomy, security, consent, dignity, and fairness should form the foundation of ethical deliberations. The research underscored the importance of understanding older adults’ perspectives on assistive care technology and their ethical concerns. It advocated for an interdisciplinary approach involving experts from fields such as ethics, law, medicine, and social work to develop appropriate guidelines and practices. Gochoo et al. [24] systematically reviewed the literature to explore privacy preservation in aging in place. The study emphasized the utilization of approaches and technologies, including data encryption, anonymization, identity protection techniques, and access controls, to safeguard the privacy of older adults in smart homes.

Analysis of the aforementioned studies has identified several areas for improvement and directions for future research. First, none of the studies provided detailed instructions on how to effectively communicate the advantages of innovative home technology to older adults. Additionally, while ethical issues related to technology were mentioned, there is a pressing need to develop better solutions for these problems, particularly concerning new legislative frameworks to regulate them. Further studies are needed to address the stigma surrounding older adults using innovative home technology and to develop strategies to encourage their acceptance. More investigation is also needed around socially assistive robots and their potential to alleviate loneliness in older adults, with a focus on developing innovative approaches for emotional support and social interaction. Although the importance of technology customization for each user was emphasized, few studies have explored specific methods to achieve this adaptation. Sensors are crucial in supporting older adults, but more research is needed to address the discomfort or unsuitability of wearing sensors and to develop more comfortable and practical alternatives for monitoring the health status of aging adults.

Building on these identified gaps and challenges, our research provides a detailed examination of the current state of SHTs and offers actionable insights and recommendations for future development and policy formulation. By addressing both the technological and ethical dimensions of SHTs, our study ensures that the findings are not only academically robust but also practically relevant. This dual approach advances the field of smart home technologies for older adults in a meaningful way, contributing to the creation of more inclusive, practical, and supportive environments for aging populations. Our study thus represents a significant step forward in understanding and enhancing the role of SHTs in the care of older adults.

The responsible research and innovation (RRI) [25] framework offers a robust guide for navigating the complex ethical landscape associated with integrating technology into the lives of older adults. Aligning with the principle of anticipation, this research endeavors to proactively identify and contemplate the potential long-term consequences and ethical implications of SHTs. This involves a thorough examination of privacy concerns, the autonomy of older adults, and the risk of social isolation that may arise from an over-reliance on technological solutions. By foreseeing these challenges, the study advocates for the development of technologies that prioritize the dignity and independence of older adults, ensuring that these innovations serve to enhance rather than diminish their quality of life. The principle of reflexivity urges researchers and technologists to critically examine their own assumptions, values, and potential biases in the design and implementation of SHTs. This research recognizes the importance of such introspection and advocates for a design philosophy that is empathetic to the unique needs and preferences of older adults. It calls for ongoing dialogue between technology developers, caregivers, and older adults themselves to ensure that the solutions developed are truly in alignment with the users’ desires and best interests. Inclusion is paramount in the responsible development and deployment of SHTs. This research emphasizes the need for a participatory approach, where older adults and their caregivers are actively involved in the co-creation of technological solutions. By fostering an environment of collaboration and open communication, the study aims to ensure that the voices of those most impacted by these technologies are heard and considered, leading to more equitable and acceptable outcomes. Finally, the principle of responsiveness highlights the necessity for flexible and adaptive research and innovation processes that can respond to new insights and societal concerns as they arise. This research underscores the need for continuous monitoring and evaluation of SHTs in real-world settings, allowing for iterative improvements that address unforeseen ethical challenges and user needs. It advocates for the establishment of ethical oversight mechanisms that can guide the responsible evolution of these technologies. By embedding RRI principles into the fabric of this research, the study aims to foster a more ethical, inclusive, and human-centered approach to the integration of SHTs in older adults’ care.

3. Research Methodology

This research paper presents a systematic literature review based on the guidelines proposed by Kitchenham et al. [26]. The central focus of our research is shaped by eight pivotal questions, outlined as follows: (1) How can we ensure the accessibility of innovative home technology for all levels of society, regardless of financial stability? (2) What level of support do health ministries provide for innovative home technology to improve people’s quality of life? (3) How actively do health ministries promote the use of smart home technology to reduce pressure on nursing homes? (4) To what extent do wearable sensors need to be redesigned to be unobtrusive and not interfere with the daily lives of users? (5) How can we create a smart home application that is equally adaptable to every user? (6) To what extent is it necessary to modify state laws and regulations to align with ethical issues? (7) How can smart home technology address the issue of loneliness among older adults while also facilitating their daily lives? (8) How can we overcome the stigma associated with older adults and introduce them to smart home technology? In addition to addressing these questions, this systematic literature review aims to identify the state-of-the-art in the subject area of our study, specifically pertaining to smart home innovations for older adults’ care, ethical, security, and privacy considerations in smart home deployment, integrating technology in smart homes, user interaction and experience in smart homes, and smart home design and accessibility.

To conduct the review, we used the following search string: “smart homes” AND “older adults” AND “quality of life” AND “health” AND “acceptance”. The review was performed between November 2022 and May 2023, covering articles from databases including ACM Digital Library, Elsevier ScienceDirect, Emerald Insight, Google Scholar, Hindawi, IEEE Xplore, Inderscience Publishers, MDPI, SAGE Journals, Scopus, SpringerLink, Taylor & Francis Online, Web of Science Core Collection, and Wiley Online Library.

The process of ascertaining the suitability of identified articles for our research topic entailed three steps. Initially, we selected articles based on the relevance of their titles to our study’s thematic scope, which encompasses smart home innovations, ethical considerations, technological integration, user experience, and design accessibility in older adults’ care. We then obtained all articles that met the criteria of the first phase. If it was not feasible to locate and obtain the complete version of a specific article, it was excluded from further consideration. In the second stage, every article that passed the initial screening underwent a review of its abstract. Articles that met the relevance criteria based on their abstracts, addressing either the specific research questions or the broader thematic focus, progressed to the third stage, where the entire body of each article was scrutinized. The final compilation of relevant studies included articles that fulfilled all the requirements set out by our research questions and thematic exploration. Throughout all three stages of selection, articles written in languages other than English and duplicate articles were excluded.

4. Results

4.1. Identification of Studies

Our search across academic databases yielded a total of 5721 records. However, only a small percentage of these were relevant to our study’s subject. Initially, 119 research papers with titles pertinent to our focus advanced to the screening stage. During this phase, we faced challenges with accessibility, leading to the exclusion of 18 papers due to the unavailability of their full texts. Consequently, 101 records proceeded to the next round of evaluation. Out of these, we identified and removed 8 duplicate records, 31 papers that were not relevant to our study, and 4 articles that were not written in English. This refining process left us with 58 studies that were directly related to the topic of our study and were, therefore, included in this research paper.

Table 1. The initial and final sets of studies found in relevant databases.

Database	Initial Set of Studies	Final Set of Studies
ACM Digital Library	68	1
Elsevier ScienceDirect	227	7
Emerald Insight	40	0
Google Scholar	3479	21
Hindawi	1	1
IEEE Xplore	14	11
Inderscience Publishers	0	0
MDPI	5	4
SAGE Journals	1	1
Scopus	212	0
SpringerLink	1620	7
Taylor & Francis Online	45	1
Web of Science Core Collection	5	0
Wiley Online Library	4	4

presents the breakdown of the initial and final sets of studies across different academic databases, while Figure 1 employs the PRISMA 2020 flow diagram [27] to graphically depict our study selection process, ensuring a standardized report of the methodology used.

4.2. Bibliometrics of Selected Studies

Of the total 58 studies selected for review, 77.59% were published in peer-reviewed journals, 18.97% appeared in conference proceedings, and 3.45% were master’s theses. The largest number of studies (15.52%) relevant to our research was published in 2020, while 10.35% of them were published in each of the years 2015, 2017, and 2019. On the other hand, the smallest number of papers (1.72%) related to the topic of our research was published in 2013. The distribution of papers selected for analysis by year of publication is shown in Figure 2.

Two papers each were published in the International Journal of Advanced Science and Technology, International Journal of Environmental Research and Public Health, and Sensors, while one paper was published in each of the remaining thirty-nine journals. This is summarized in

Table 2. The distribution of selected studies across journals.

Name of the Journal	Number of Studies	References
International Journal of Advanced Science and Technology	2	[28,29]
International Journal of Environmental Research and Public Health	2	[30,31]
Sensors	2	[32,33]
Advances in Experimental Medicine and Biology	1	[34]
Annual Review of Nursing Research	1	[35]
Asian Nursing Research	1	[36]
BMC Health Services Research	1	[37]
BMC Medical Informatics and Decision Making	1	[38]
British Journal of Community Nursing	1	[39]
Disability and Rehabilitation: Assistive Technology	1	[40]
Frontiers in Psychology	1	[41]
Future Internet	1	[42]
Geriatric Nursing	1	[43]
Gerontology and Geriatric Medicine	1	[44]
IEEE Access	1	[45]
IEEE Nanotechnology Magazine	1	[46]
IEEE Transactions on Information Technology in Biomedicine	1	[47]
IEEE Transactions on Systems, Man, and Cybernetics, Part C (Applications and Reviews)	1	[48]
Informatics in Primary Care	1	[49]
Innovations in Clinical Neuroscience	1	[50]
International Journal of Computer Networks and Applications	1	[51]
International Journal of Human–Computer Studies	1	[52]
International Journal of Medical Informatics	1	[53]
International Journal of Older People Nursing	1	[54]
International Journal of Technology Assessment in Health Care	1	[55]
International Journal of Wireless and Mobile Networks	1	[56]
Internet of Things	1	[57]
JMIR Aging	1	[58]
JMIR mHealth and uHealth	1	[59]
JMIR Research Protocols	1	[60]
Journal of Advanced Nursing	1	[61]
Journal of Electrical and Computer Engineering	1	[62]
Journal of Electrical Engineering and Technology	1	[63]
Journal of Intelligent and Robotic Systems	1	[64]
Journal of Nursing Management	1	[65]
Journal of Physics: Conference Series	1	[66]
Nature Reviews Materials	1	[67]
Personal and Ubiquitous Computing	1	[68]
Primary Health Care Research and Development	1	[69]
Review of Policy Research	1	[70]
Robotics and Autonomous Systems	1	[71]
Technological Forecasting and Social Change	1	[72]

.

Table 3. The distribution of selected studies across conference proceedings.

Name of the Conference	Number of Studies	References
Ambient Assisted Living	1	[73]
IEEE International Symposium on “A World of Wireless, Mobile, and Multimedia Networks”	1	[74]
IEEE International Symposium on Multimedia	1	[75]
IEEE International Symposium on Technology and Society	1	[76]
International Conference on Computer-Supported Cooperative Work in Design	1	[77]
International Conference on Green Engineering and Technologies	1	[78]
International Conference on Human Aspects of Information Security, Privacy, and Trust	1	[79]
International Conference on Intelligent Environments	1	[80]
International Conference on Pervasive Computing Technologies for Healthcare	1	[81]
International Conference on Software, Knowledge, Information Management, and Applications	1	[82]
International Conference on World Wide Web Companion	1	[83]

illustrates that for each conference, the proceedings included the publication of one paper.

As shown in

Table 4. The distribution of selected studies across master’s theses.

Name of the University	Number of Studies	References
Linnaeus University	1	[84]
Lund University	1	[85]

, both master’s theses included in our study were defended in Sweden, with one at Linnaeus University and the other at Lund University.

4.3. State-of-the-Art in Smart Home Technologies: Insights into Care Innovations and Challenges for Older Adults

This section examines the latest advancements in smart home technologies (SHTs) and their application in caring for older adults. It assesses how these technologies can improve safety, health monitoring, and daily living support, with a focus on their practical implementation. Through a review of current research and technologies, we explore both the opportunities these innovations present for enhancing the lives of older adults and the challenges, such as user acceptance and system integration, that must be overcome to maximize their effectiveness.

4.3.1. Smart Home Innovations for Older Adults’ Care: Enhancing Quality of Life and Independence

This section comprises research focused on the application of SHTs to improve the quality of life for older adults. The studies explore various innovations, such as health monitoring systems, emergency response solutions, and daily activity support, all tailored to meet the needs of older adults. The goal is to enhance independence, safety, and overall well-being through technology, making everyday life more manageable and healthcare more accessible in a home setting.

Doyle et al. [81] present findings from their investigation into older adults’ attitudes toward self-managing their health and wellness using data from SHTs. The study, conducted within the Great Northern Haven smart homes, involved interviews with seven older adults who had been living with integrated smart home systems for over four years. The research aimed to explore the residents’ long-term attitudes toward living with smart home sensors and assistive ambient living (AAL) technologies, their opinions on the utility of the data these technologies provide, and their preferences on data visualization techniques. Key findings revealed that older adults are generally interested in using sensor technology data to aid in self-managing their well-being. They expressed a particular interest in feedback on metrics such as time spent indoors and outdoors, walking times, sleep patterns, activity levels, blood pressure, and weight. However, the study also highlighted the need for data representation to be simple, intuitive, and accompanied by educational support and goal-setting to be genuinely useful. Residents showed a preference for visualizations that clearly and effectively communicate health and wellness data, suggesting that appropriate design and presentation of information can significantly enhance their engagement and the usability of smart home data. The reported findings underscore the potential benefits of SHTs in supporting older adults in managing their health and wellness independently. However, they also point to the necessity for careful consideration of how data are presented and the broader context of use, ensuring that these technologies meet the real needs of their older adult users.

Chernbumroong et al. [82] conducted a study to investigate perceptions, needs, and concerns related to SHTs aimed at assisting older adults. The research surveyed individuals in various settings, including a major hospital and nursing homes, to gather data on the acceptability and perceived usefulness of six specific SHTs. These technologies included systems for cooking safety, sleeping pattern monitoring, emergency alarms, automatic lighting, video monitoring, and activity monitoring. The study found that while there was general support for SHTs, significant concerns were also expressed. Participants appreciated the potential of these technologies to enhance their safety and well-being—particularly through features that prevent accidents (such as automatic stove shut-offs) and monitor health parameters (such as sleeping patterns and activity levels). However, there were notable apprehensions about privacy, the complexity of the technology, and the need for training on new devices. Moreover, the findings indicated a varied willingness to adopt these technologies. While some participants were open to integrating technologies such as automatic lighting systems into their homes, there was reluctance toward devices that might invade privacy or require extensive interaction, such as video monitoring systems. This highlights the importance of addressing user-friendliness and privacy concerns to increase the adoption rates of SHTs among older adults. The study emphasized that the successful implementation of SHTs in older adults’ care significantly depends on understanding and addressing the specific perceptions and concerns of the potential users, suggesting that user-centric design and comprehensive stakeholder engagement are crucial.

Ghorayeb et al.’s [52] study on older adults’ perspectives of smart home technology (SHT) revealed a complex relationship between user experience and technology acceptance. The findings indicated that familiarity with the technology through direct experience led to increased acceptance among older adults, who initially may harbor concerns about privacy, usability, and the intrusive nature of the technology. Those with experience tended to view these technologies more favorably over time, appreciating their potential to enhance safety and maintain independence. On the other hand, those without direct experience remained skeptical, perceiving these systems as potentially invasive and expressing heightened concerns regarding privacy. Both groups, however, emphasized the importance of customizable and non-intrusive technology solutions that can be adapted to individual needs and preferences. The study underscores the critical role of involving older adults in the design and development processes of SHTs, ensuring that these innovations align effectively with the end-users’ expectations and lifestyle requirements, thereby enhancing overall acceptance and utility.

Pal et al.’s [75] systematic review examined the impact of SHTs on the quality of life for older adults. The research assimilated findings from multiple studies, revealing a generally positive reception toward smart homes, particularly valued for health monitoring and assisted independent living. However, significant concerns about privacy, security, and potential social isolation due to increased technological reliance also prominently surfaced. Older adults appreciate smart homes for the autonomy and safety they confer, but simultaneously, they expressed apprehensions about being monitored and the impersonal nature of technology. This dichotomy underscores the need for designing smart home solutions that not only enhance physical safety and health monitoring but also consider the social and emotional well-being of older adults. The study highlighted the crucial balance between technological assistance and maintaining human interactions, pointing toward a future where SHTs are seamlessly integrated into the fabric of older adults’ care without compromising personal privacy or social engagement.

Majumder et al. [32] provided a review of recent advancements in SHTs tailored for older adult healthcare, addressing both significant progress and emerging challenges in the field. Their study emphasized the integration of environmental and wearable medical sensors within smart homes to facilitate continuous and remote health monitoring of older adults. This approach not only promises enhanced living standards for the aging population by allowing them to remain in their familiar home environments longer but also aims to alleviate the financial burdens on healthcare systems through cost-effective monitoring solutions. The research highlighted a variety of smart home applications, from basic health monitoring to sophisticated systems that can predict emergency situations, all enabled by the convergence of Internet of Things (IoT) technology, AI, and advanced sensor technology. However, despite these technological strides, the review also pointed out critical hurdles, such as the need for interoperability among different devices, privacy concerns, and the technical challenges in developing user-friendly systems that are both affordable and reliable. The study serves as a backbone for understanding the potential of smart homes in transforming older adults’ care, underscoring the importance of multidisciplinary approaches that merge healthcare, technology, and user-centered design to develop solutions that are not only technologically sound but also align with the real-world needs of older adults.

Dermody et al. [61] conducted an exploratory qualitative study to assess the readiness of community-dwelling older adults to adopt SHT. The study identified several key factors that influence this readiness, including knowledge, health and safety, independence, security, and cost. These factors manifested through qualitative themes, such as the level of familiarity with technology, concerns about privacy and data security, and perceived usefulness in enhancing independence and safety. The study underscored the mixed feelings among older adults regarding the adoption of smart homes: while recognizing the potential benefits for health monitoring and independent living, they also expressed apprehensions about privacy invasions and the intrusiveness of constant monitoring. Importantly, the research highlighted the need for increased awareness and information dissemination to enhance acceptance and reassure potential users about the benefits and safeguards of SHTs.

Marikyan et al. [72] conducted a systematic review that explored the burgeoning literature on SHTs from a user perspective, revealing how these innovations are reshaping residential living. Their review encapsulated a multitude of studies, illustrating that while users acknowledge the considerable benefits of smart homes, including enhanced convenience, increased safety, and potential health monitoring, there remain significant reservations, primarily about privacy, technology integration, and cost. The authors detailed that the adoption of SHTs is influenced by several factors, including the level of technology integration possible within existing infrastructures, the perceived ease of use, and the overall reliability of these systems. They argued that for broader adoption, smart home solutions must not only be technologically advanced but also user-friendly, affordable, and respectful of privacy and data security. This review sheds light on the crucial role of user-centric approaches in the design and implementation of SHTs, suggesting that future research should continue to address these user concerns to enhance acceptance and utility.

Bal et al. [77] provided an extensive review of collaborative SHTs aimed at supporting independent living of older adults. Their research synthesized findings from approximately 30 projects, underscoring the critical role these technologies play in enhancing safety, health, and social connectedness for older adults. The review highlighted how smart homes can significantly boost the quality of life by facilitating continuous health monitoring, emergency assistance, and social interaction, which are essential for older adults living independently. However, the authors also pinpointed several challenges that need to be addressed to maximize the benefits of these technologies. These included the integration of systems into existing infrastructures, the usability of the technology by older adults who may have varying levels of comfort and proficiency with digital tools, and the cost associated with implementing such technologies. Moreover, they emphasized the importance of privacy and data security, critical factors that influence the acceptance and success of smart home solutions among older adult users. The review provides a comprehensive perspective on how collaborative intelligence and smart environments can be leveraged to support the autonomy and well-being of older adults, suggesting a pathway toward more sustainable, efficient, and inclusive healthcare solutions.

Lee and Kim [41] critically evaluated the development and effectiveness of smart residential environments for older adults, with a particular focus on enhancing pleasurable experiences. Their review underscored that while smart technologies in residential settings significantly improve the physical and cognitive support for older adults, they often overlook the hedonic and emotional aspects that contribute to a pleasurable living experience. The study identified a prevalent focus on utilitarian benefits, such as safety, monitoring, and energy efficiency, which, while crucial, do not fully address the needs for emotional and social enrichment. The authors argued that smart environments should integrate features that not only ensure physical wellness and safety but also promote fun, social interaction, and emotional engagement. They suggest that a shift toward including hedonic factors would greatly enhance the quality of life for older adults, making the technology more appealing and acceptable. The study presented an evaluation framework consisting of wellness, independence, acceptance, and design, which aims to guide future research and development in creating more holistic smart residential environments that support not just the functional needs but also the psychological and emotional well-being of older adults.

Yusif et al. [53] conducted a systematic review to explore the barriers to the adoption of assistive technologies (ATs) by older individuals, focusing on empirical studies that identify these barriers from the perspective of older adults. Their research highlighted several critical issues influencing older adults’ willingness to embrace ATs. A primary concern among older adults was privacy, cited as a major barrier in 34% of the studies reviewed. Other significant barriers included trust in the technology and its added value, both of which impacted the perceived usefulness and efficacy of ATs. The cost of technologies and their ease of use also posed substantial challenges, each noted in 23% of the studies. Additionally, the perception of not needing assistance, stigma associated with using ATs, and the fear of becoming dependent on technology further hindered adoption rates. These factors were compounded by physical declines related to aging and generational differences in technology acceptance, which are often exacerbated by the design of ATs that may not appeal to older users due to their clinical appearance or perceived complexity. This review clearly demonstrated that while ATs have the potential to significantly improve quality of life for older adults, adoption rates will remain low unless these technologies are designed and marketed in a way that addresses these barriers, emphasizing privacy, trustworthiness, affordability, simplicity, and the preservation of independence and dignity.

Sokullu et al. [57] discussed the design and implementation of an IoT-supported smart home system aimed at improving the living standards of older adults, particularly those with partial memory loss, such as mild cognitive impairment (MCI) or dementia patients. Their study elaborated on the deployment of various sensors throughout a residence to monitor the activities of older adults unobtrusively. The system included an emergency wristband for urgent situations, offering a comprehensive, low-cost solution for enhancing safety and providing early warnings for routine issues faced by older adults. The results highlighted the system’s effectiveness in contextual activity detection using ambient sensors, which assess activities without invading privacy. The prototype is praised for its affordability and ease of integration, reflecting a significant advancement in assistive living technologies. By offering real-time monitoring and emergency alerts, the system not only ensures the safety of older adults but also facilitates their independence, aligning with the needs and preferences of its users. This study underscored the potential of IoT in transforming older adults’ care through SHTs, fostering a safer and more responsive living environment.

Existing research implies that SHTs significantly contribute to the enhancement of care for older adults by improving safety, health monitoring, and social interaction capabilities. These technologies are tailored to meet the unique needs of older adults, facilitating better management of their healthcare costs and supporting their independence. However, the adoption of smart home solutions faces challenges, including privacy concerns, the complexity of the technologies involved, and the substantial costs associated with implementation. Studies also emphasized the importance of intuitive design and accessible interfaces to ensure that these innovations are user-friendly for an aging population. There is a notable need for educational support to help older adults become more comfortable and proficient with these technologies. Furthermore, the research advocates for a holistic approach that not only focuses on physical wellness but also considers the emotional and psychological health of older adults, promoting a shift from technology-centric solutions to those that are human-centered and enrich the lives of users by integrating elements of fun and social connectivity.

Table 5. Enhancing senior care with smart home innovations: benefits, challenges, and recommendations.

Smart Home Innovations	Advantages	Challenges	Recommendations	References
Automatic stove shut-offs, health parameter monitoring systems (sleep patterns, activity levels).	Enhanced safety and well-being through health monitoring and accident prevention.	Privacy concerns and complexity of technology.	Address privacy and user-friendliness to increase adoption rates.	[75,77,81,82]
Customizable health metrics’ tracking (time spent indoors/outdoors, walking times, blood pressure).	Increased acceptance and independence with customizable, non-intrusive solutions.	Skepticism and apprehensions about constant monitoring and invasiveness.	Provide clear, simple data representation and educational support.	[32,41,52,53,61]
IoT-supported monitoring systems, emergency wristbands for urgent situations, wearable sensors.	Continuous health monitoring and real-time emergency alerts.	Cost and interoperability challenges, along with usability issues.	Focus on affordable, user-friendly solutions with strong privacy and data security measures.	[57,72]
Systems facilitating social interaction, entertainment and engagement tools, interactive devices.	Autonomy and safety with potential for enhanced social interaction and emotional engagement.	Potential social isolation and overlooking emotional aspects of living experience.	Integrate features promoting social interaction and emotional engagement, along with physical safety.	[41,75]

showcases various smart home innovations, detailing their main advantages, disadvantages, and specific recommendations for enhancing adoption and effectiveness in older adults’ care.

4.3.2. Ethical, Security, and Privacy Considerations in Smart Home Deployment: Navigating the Challenges

The works in this section explore the ethical challenges as well as security and privacy concerns associated with the deployment of SHTs. These studies discuss issues such as data protection, user autonomy, informed consent, and the balance between technological benefits and the potential for intrusion. The focus is on ensuring that smart home solutions are developed and used in ways that respect the dignity and rights of users, fostering trust and acceptance.

Zhu et al. [65] conducted a scoping review to address ethical issues in smart-home-based care for older adults, exploring the implications of incorporating advanced technologies, such as AI and information technologies, into care practices. Their study highlighted key ethical concerns revolving around privacy, autonomy, safety, fairness, and the potential reduction in human contact. The findings emphasized significant privacy issues, particularly how smart technologies collect and handle sensitive personal data, raising questions about information privacy and physical privacy. Autonomy is another critical focus, with discussions on the importance of informed consent and user-centered control, ensuring that older adults can make voluntary and well-informed decisions about the technologies that affect their lives. Safety guarantees provided by these technologies are acknowledged as beneficial, enhancing the quality of life by enabling more effective emergency responses and everyday activity monitoring. However, there are concerns about fairness, as access to these technologies is not uniformly available, often limited by economic or social barriers. The review also addressed the reduction in human contact, a significant ethical concern, as SHTs might lead to less human interaction, potentially increasing feelings of isolation among older adult users. The researchers advocate for the careful integration of technology that complements human care rather than replacing it, ensuring that care for older adults remains a deeply human-centric service.

Sanchez et al. [55] conducted a systematic literature review exploring the ethical implications of implementing smart house welfare technology for older adults. Their study highlighted several key ethical challenges, including issues related to privacy, autonomy, informed consent, dignity, safety, and trust. These challenges arise from the potential for smart houses to intrude on personal space and monitor private activities without adequate safeguards, raising concerns about the erosion of autonomy and privacy. Additionally, the need for informed consent is critical, ensuring that users are fully aware of the technology’s capabilities and limitations. The authors emphasized that while smart home technology offers substantial benefits, such as enhanced safety and extended independent living, it also presents significant ethical dilemmas that must be addressed through careful design and transparent policies. The review suggested that developers and policymakers need to prioritize these ethical considerations to foster trust and acceptance among users, thereby ensuring that the technology genuinely supports the dignity and quality of life of older adults. This examination of the ethical landscape serves as a crucial guide for advancing smart home technologies in a responsible and user-focused manner.

Chung et al.’s [35] systematic review explored the ethical implications and concerns associated with the use of SHTs to support older adults. Their study identified key ethical issues, including privacy, autonomy, obtrusiveness, equal access, reduction in human contact, and usability, which are crucial in the context of aging, technology, and home environment. The review underscored that while smart homes have the potential to enhance the quality of life, safety, and independence of older adults, they also raise significant ethical concerns. The privacy of users is highlighted as a particularly pressing issue, considering the invasive nature of continuous monitoring technologies that collect and transmit personal health information. The authors argued for the need to balance technological benefits with ethical considerations to ensure that SHTs serve as a supportive, rather than intrusive, solution for aging individuals. The review calls for ongoing research to address these ethical challenges and for the development of guidelines that safeguard the interests and rights of older adults.

Robles and Kim [28] provided a thorough examination of security challenges and technological advancements in smart home development. Their review outlined the significant progress in smart home automation systems, focusing on enhancing security measures to protect homeowners and their properties. They discussed the evolution from basic security systems to advanced smart home systems that offer a myriad of additional benefits, such as remote monitoring, automated alerts, and integration with various household devices through sophisticated network protocols. The study highlighted the critical aspect of security within smart homes, noting that the technological sophistication of these systems also introduces complex security vulnerabilities. These vulnerabilities include network security threats and privacy concerns due to the potential for unauthorized data access. The authors emphasized the necessity for robust security protocols and encryption methods to safeguard data transmitted across smart home networks. They advocated for continuous advancements in SHTs to address these security challenges effectively, ensuring the safety and privacy of users in the increasingly connected and automated home environment.

Current studies indicate that while SHTs offer substantial benefits for improving care for older adults, they also present significant ethical challenges that must be addressed to ensure their responsible implementation. Key concerns include ensuring privacy and data protection, maintaining autonomy and dignity, and providing safety and fairness in technology use. The potential for reduced human contact and increased social isolation also highlights the need for solutions that balance technological benefits with maintaining human connections. Furthermore, the ethical deployment of these technologies requires robust frameworks that include clear guidelines on informed consent, user-centered control, and transparency. It is essential to minimize data collection to what is strictly necessary and ensure that all collected data are securely protected. The role of trust and user perception in the adoption of SHTs is critical, emphasizing the need for developers and policymakers to work toward building and maintaining trust through ethical practices. This entails a multidisciplinary approach that integrates ethical considerations at every stage of technology development and deployment, ensuring that smart home innovations enhance the lives of older adults without compromising their privacy or autonomy.

Table 6. Overcoming ethical, security, and privacy challenges in smart home technology for older adults.

Considerations	Key Points	How to Address	References
Privacy Issues	Significant concerns about how smart technologies collect and handle sensitive personal data, raising questions about both information privacy and physical privacy.	Implement robust data privacy measures and transparent policies.	[28,35,55,65]
Autonomy and Informed Consent	Importance of ensuring that older adults can make voluntary and well-informed decisions about the technologies affecting their lives. Emphasizes the need for user-centered control and informed consent.	Ensure clear, comprehensive informed consent processes and user-centered control.	[35,55,65]
Safety Guarantees	Benefits of enhanced safety and quality of life through effective emergency responses and everyday activity monitoring.	Develop reliable safety protocols and integrate comprehensive emergency response systems.	[35,55,65]
Fairness and Equal Access	Concerns about the uneven availability of technologies, often limited by economic or social barriers. Highlights the need for equitable access to ensure fairness in the deployment of smart home technologies.	Promote equitable access through subsidies or community programs and ensure cost-effective solutions.	[35,65]
Reduction in Human Contact	Ethical concern that smart home technologies might lead to less human interaction, potentially increasing feelings of isolation among older adults. Advocates for technology that complements rather than replaces human care.	Design technology to complement human care, not replace it.	[35,65]
Dignity and Trust	Challenges related to the potential for smart homes to intrude on personal space and monitor private activities without adequate safeguards, raising concerns about the erosion of autonomy and dignity. Emphasizes building trust.	Prioritize transparency in data usage and implement strong data protection.	[55]
Obtrusiveness	Ethical issues related to the intrusive nature of continuous monitoring technologies, emphasizing the need for a balance between technological benefits and ethical considerations.	Ensure that technologies are non-intrusive and maintain a balance between monitoring and privacy.	[35]
Security Measures and Encryption	Critical need for robust security protocols and encryption methods to safeguard data transmitted across smart home networks, addressing complex security vulnerabilities and network security threats.	Implement advanced security protocols and continuous updates to mitigate vulnerabilities.	[28]

outlines various considerations in smart home technology for older adults, along with key points and strategies to address these challenges.

4.3.3. Integrating Technology in Smart Homes: Building Connected and Efficient Environments

This section explores the integration of various technologies within smart homes, highlighting the roles of sensors, data analytics, and networked devices in creating interconnected living environments. The studies examine how these technologies can improve the efficiency, functionality, and adaptability of home systems, from energy management to security and health monitoring, emphasizing the technical underpinnings that make homes smart.

Mohammed et al. [66] presented a review of the integration of Internet of Things (IoT) technologies in smart homes and healthcare systems. Their study detailed the transformative impact IoT has on enhancing healthcare management by facilitating remote monitoring and management of health data with minimal human intervention. The review elaborated on various IoT applications, such as real-time health monitoring, patient information management, and emergency management systems, that improve the efficacy of healthcare services and patient care. The authors highlighted the potential of IoT to alleviate the strain on healthcare systems by reducing costs, increasing the efficiency of medical services, and enhancing patient outcomes through continuous monitoring. However, they also acknowledged significant challenges, including data security, privacy concerns, and the need for robust network infrastructure to support the seamless integration of IoT devices. The review underscored the necessity of addressing these challenges to fully harness the benefits of IoT in smart healthcare environments, suggesting future research directions to overcome these barriers and enhance system implementations.

Robles and Kim [29] provided an analysis of SHTs, focusing on their applications, systems, and methods. Their review underscored the integration of technology and services through home networking as a means to enhance the quality of life. The study revealed that smart home systems facilitate improved convenience and safety for residents, particularly older adults and disabled individuals, through automated systems that can control various aspects of the home environment, such as lighting, security, and temperature. The authors discussed several technologies, such as X10, Z-Wave, and ZigBee, which are crucial for the operation of these smart homes. These technologies enable devices within the home to communicate over both electrical wiring and radio frequencies, creating a mesh network that ensures commands are received and executed, even in the presence of signal interference. The use of such advanced protocols enhances the reliability and efficiency of smart home systems. Furthermore, Robles and Kim highlighted the potential for these technologies to provide significant energy savings and enhanced security measures. They illustrated how smart homes can adapt to the residents’ habits and needs, providing not only operational efficiency but also a personalized living experience. The review pointed to a future where SHT plays a pivotal role in everyday living, offering greater comfort, security, and energy efficiency.

Maswadi et al. [45] conducted a systematic literature review to evaluate smart home monitoring technologies for older adults, emphasizing IoT integration. The review underscored the transformative potential of these technologies in enhancing older adults’ care by facilitating health monitoring, emergency responsiveness, and daily activity management, which are essential for maintaining independence and safety. However, the authors highlighted a critical need for standardized research methodologies to reliably assess and implement these technologies. This work not only maps the current landscape but also calls for future research to adopt rigorous approaches for validating smart home solutions, thereby ensuring their effectiveness and reliability in real-world applications.

Kim et al. [74] presented an examination of the U-Health Smart Home project, focused on enhancing older adults’ care through technology. Their work elaborated on the implementation of an autonomic system within smart homes, using semantic web technologies and wireless sensor networks (WSNs) to monitor and assist older adults in real time. The study highlighted the integration of a knowledge-based framework that uses semantic reasoning to understand and adapt to the needs of older adults based on continuous data collection from environmental and body sensors. This approach enables the smart home to autonomously manage various home devices and systems in response to the identified needs of its residents, promoting safety and independence. The autonomic system is designed to operate with minimal human intervention, providing a proactive health management solution that significantly reduces the need for traditional healthcare interventions. The project’s findings demonstrated the potential of integrating advanced technologies in smart homes to significantly enhance the quality of life for older adults, offering a promising direction for future innovations in older adult care technology.

Agoulmine et al. [46] presented a study on innovative solutions for managing older adults’ care and chronic diseases through the integration of nanotechnology, biotechnology, and information and communication technologies. Their research discussed the development of a U-Health Smart Home system designed to support older adults and people with chronic diseases within their own homes, thus reducing the necessity for hospitalization and specialized care facilities. This U-Health Smart Home system is engineered to allow autonomous monitoring and assistance using advanced sensor technologies, including wearable devices and environmental sensors that continuously track health metrics. The system is connected to a back-end medical institution, which enables real-time updates on the patient’s status to healthcare providers, potentially allowing for an immediate medical response in emergency situations. The research illustrated how such technological integrations could alleviate the financial burden on healthcare systems by enabling older adults’ independence and proactive health management. It emphasized the role of a layered architecture in the smart home system, including sensors and actuators, a home communication network, and an autonomic decision-making system. This approach aims to provide a sustainable, cost-effective solution for enhancing older adults’ care through technology-driven innovations.

Paolini et al. [33] developed an IoT-based digital platform for smart homes under the HABITAT project, aiming to integrate advanced technologies, such as Radio Frequency Identification (RFID), wearable electronics, wireless sensor networks, and AI, to support older adults’ independence both at home and in retirement settings. The platform’s novelty lies in its system-level flexibility, enabling the interoperability of various smart devices, which allows for the customization of home environments to better serve the needs of older adult users, thereby reducing healthcare costs by minimizing the need for personal assistance. The study emphasized the potential of such integrated systems to enhance the quality of life for older adults by embedding technology in everyday objects, making them part of an unobtrusive assistive environment. This approach not only promotes aging in place by enabling older adults to live independently for longer but also integrates health monitoring and emergency management seamlessly into the living space. The HABITAT project showcases a forward-thinking application of IoT in gerontechnology, focusing on user-centered design to ensure the technology is adaptable, practical, and acceptable to its end-users.

Obaid et al. [56] developed a ZigBee-based voice-controlled smart home system intended to enhance the autonomy of older adults and disabled individuals. Their system utilizes voice commands to operate home appliances, offering a user-friendly and adaptable home automation solution. The study showcased how voice recognition integrated with ZigBee technology allows for efficient command execution with low power consumption, significantly improving accessibility for users with limited mobility or disabilities. The proposed system demonstrated a high degree of reliability in recognizing and executing commands, overcoming common challenges, such as noise interference and speaker accent variation. This advancement in SHT not only improves the quality of life for its users by providing them with more control over their living environment but also paves the way for further innovations in assistive home technologies. The study emphasized the potential for scalable smart home solutions that prioritize user interface simplicity and efficient communication protocols to address the specific needs of vulnerable populations.

Brulin et al. [47] developed a computer vision-based posture recognition method for home monitoring of older adults, integrating a fuzzy logic approach to categorize four static postures: lying, sitting, squatting, and standing. Their system begins with human detection, focusing on human silhouettes to ensure robustness against environmental variations, such as lighting changes and object movements. The posture recognition process utilizes fuzzy logic to handle the ambiguity in human posture, enhancing the system’s reliability in real-world applications. The system achieved a satisfactory accuracy of 74.29% in recognizing the correct postures, proving its efficacy in identifying emergency situations, such as falls, within a smart home environment. This capability indicates significant potential for enhancing older adults’ care by promptly detecting and responding to falls, thereby improving safety and potentially reducing the need for constant human supervision. The approach underscores the importance of incorporating adaptive, context-aware technologies in developing assistive tools for the aging population.

Kim et al. [63] developed a vision-based Human Activity Recognition (HAR) system utilizing depth silhouettes to monitor the daily activities of older adult residents within smart homes. The system employs depth video cameras to capture human silhouettes, which are then processed to extract skeleton joint features. These features include centroid points, joint distances, and magnitudes, forming a robust dataset for training Hidden Markov Models (HMMs). The experimental results demonstrated a high mean recognition rate of 84.33% across nine routine activities, showcasing the system’s effectiveness in identifying a wide range of daily actions accurately. This innovative approach highlighted the potential of depth-based video surveillance in enhancing older adults’ care by providing continuous, real-time monitoring that supports independent living while ensuring safety and well-being in smart home environments.

Neßelrath et al. [73] introduced a novel gesture-based interaction system for smart homes that significantly enhances the interface for older adult users by utilizing contextual sensitivity. Their system employs the WiiMote to recognize gestures, which then translate into commands for home appliances through a middleware based on the ISO 24752 standard [86]. The study tested two interaction concepts: one that adapts the gesture’s function based on its contextual use and another that triggers predefined scenarios, such as “go to bed”, simplifying complex sequences of actions into single gestures. The research demonstrated that contextual interactions allow a single gesture to perform various functions depending on the active appliance, reducing the cognitive load and number of gestures users need to remember. For example, a lifting gesture might increase TV volume or a fan’s speed depending on the device being controlled at the time. The scenario-based approach further simplifies interaction by allowing a single gesture to execute multiple related commands across different devices. User testing shows that the context-sensitive model was preferred, with 85% of participants responding favorably, highlighting its effectiveness in simplifying the control of various home functionalities without overwhelming the user. This approach not only enhances user experience but also supports independent living for older adults by making technology more accessible and intuitive.

Existing research demonstrates that smart home technologies (SHTs) have significantly progressed in functionality, offering substantial benefits in terms of convenience, safety, and health monitoring, particularly tailored to meet the needs of older adults. These technologies each play a distinct role in creating an effective and supportive living environment for older adults, enabling them to maintain their independence while ensuring their safety and well-being. The foundation of modern smart homes is the Internet of Things (IoT), which connects various devices and appliances within the home to the internet. This integration allows for seamless interaction and automated control over the home environment, adapting to the occupants’ habits and preferences. For example, smart thermostats can automatically adjust the temperature based on the weather and the residents’ schedule, while smart locks can provide secure, keyless entry based on digital permissions.

One of the earliest home automation systems, X10, utilizes the home’s existing electrical wiring to transmit control signals to various connected devices. This technology enables older adults to easily control lighting, security cameras, and other appliances without the need for complex installations or setups, making it a cost-effective option for enhancing home automation. Both Z-Wave and ZigBee employ low-energy radio waves to establish a network of connected smart home devices. Z-Wave is particularly valued for its robust security features and the creation of a large mesh network, enhancing the system’s reliability across a larger area. Conversely, ZigBee operates at higher frequencies and can handle more data, making it ideal for tasks that require significant data throughput, such as advanced security systems or streaming high-definition audio and video content.

The U-Health Smart Home Project specifically targets health monitoring integration into living spaces for older adults. It employs sensors and smart medical devices to continuously track vital signs and other health metrics. For instance, bed sensors can monitor sleep quality and duration, while wearable devices can track heart rate and physical activity, providing alerts to caregivers or medical professionals if abnormalities are detected. In smart homes, RFID technology is often used for security and personal identification. Embedding RFID tags in wearable devices, such as bracelets or key cards, enables the system to recognize individuals and tailor environmental settings to their preferences. Additionally, RFID can enhance home security by restricting access to certain areas or making it easier for residents to interact with their environment without physical contact.

Wearable electronics, such as smartwatches and fitness trackers, are central to personal health monitoring in smart homes. These devices continuously collect data on vital signs and physical activity, which can be analyzed to monitor health trends and potentially detect early signs of medical issues. For example, a smartwatch might detect irregular heart rhythms and alert both the user and their healthcare provider. Wireless sensor networks (WSNs) involve multiple sensors distributed throughout the home to monitor various environmental and structural parameters, such as temperature, humidity, and motion. These sensors facilitate automated responses, such as activating the heating, ventilation, and air conditioning (HVAC) system when a room reaches a certain temperature or triggering security alarms if unexpected movement is detected at night.

Artificial intelligence (AI) technologies analyze the data collected from various sensors and devices within the smart home to learn about the residents’ behaviors and needs. This insight allows AI to automate routine tasks, such as adjusting lighting and temperature, suggesting meal plans based on dietary restrictions and available ingredients, or even managing medication schedules. Computer vision allows smart home systems to interpret visual information from cameras and sensors. It is particularly useful for security applications, enabling the system to recognize faces, detect unusual movements, and provide alerts about potential threats or emergencies, such as detecting a fall or unauthorized entry. Semantic web technologies improve the interoperability of smart devices by using common data formats and protocols, ensuring that devices from different manufacturers can communicate effectively. This integration facilitates a more user-friendly and cohesive operation of the smart home environment.

Nanotechnology and biotechnology are pushing the boundaries of health monitoring in smart homes by developing devices that can interact directly with biological systems. For instance, microscopic sensors embedded in wearable devices can continuously analyze blood samples to monitor glucose levels or detect pathogens, offering real-time health insights and preemptive care options. Depth video cameras add another dimension to home security and functionality by capturing not only images but also the spatial relationships within a scene. They can be particularly valuable for applications that require precise motion detection, such as advanced security surveillance or assisting older adults with mobility challenges to navigate their homes safely. Gesture-based interaction systems allow older adults to control various aspects of their home environment through simple hand gestures. This technology reduces reliance on physical controls or complex interfaces, making it easier for users with limited mobility to interact with their home environment effectively.

Integrating various SHTs can significantly enhance the quality of life for older adults by optimizing their living environment for comfort, security, and health. Beginning with IoT devices, AI, and wearables, a typical morning routine for an older adult might include waking up, taking medications, and having breakfast. IoT-enabled appliances, such as coffee makers, can automatically start brewing as the resident wakes up. Simultaneously, wearable devices monitor sleep patterns and vital signs, and AI interprets these data to adjust lighting, temperature, and even play soothing music if it detects any abnormalities, such as a significant change in heart rate. This integration ensures a smooth start to the day by automating routine tasks and monitoring health metrics. Next, the integration of RFID and computer vision enhances security. RFID-enabled key cards or bracelets can be assigned to family members and caregivers, allowing them access to the home. As someone approaches the door, RFID confirms the card’s validity, while computer vision analyzes the visitor’s face to verify their identity. If there is a mismatch or unauthorized attempt, the system alerts the homeowner and local security services. This dual-layer security ensures that only recognized and authorized individuals can enter, providing peace of mind to the resident. Environmental control is crucial for comfort and health, achieved through the integration of Z-Wave/ZigBee with WSNs. Sensors throughout the home monitor temperature, humidity, and air quality, communicating with the HVAC system via Z-Wave or ZigBee to adjust settings automatically. For example, if a room becomes too cold or overly humid, the system can modify the heating or air conditioning settings accordingly, maintaining optimal comfort without any manual intervention. For older adults with mobility limitations, depth video cameras and gesture-based interaction systems provide an invaluable service. These cameras detect specific gestures, allowing residents to control lighting, televisions, window blinds, and other home devices with simple hand movements. This system eliminates the need for physical reach and manual operation, enabling easy and accessible control of the home environment. Semantic web technologies integrated with IoT ensure that devices from different manufacturers can operate together seamlessly. This integration allows residents to control all connected devices through a single interface, enhancing the usability of the smart home system. For example, a resident could adjust a thermostat, check security cameras, and manage lighting through a unified app, regardless of the brand or model of the devices. Health monitoring and emergency response are addressed by integrating the U-Health Smart Home Project with wearables. Continuous monitoring of health metrics through wearable devices and embedded sensors in the home allows for an immediate response if a fall is detected or abnormal vitals are recorded. The system can automatically contact emergency services and inform family members, ensuring that timely medical help is provided. By weaving all these systems together, a smart home can provide a supportive, adaptive, and secure environment that caters specifically to the needs of older adults, enhancing independence and ensuring safety and health in daily living. This cohesive approach demonstrates the powerful potential of SHTs to transform living spaces into safe, comfortable, and health-conscious environments for older adults.

Table 7. Integration of technologies in smart homes: advantages and challenges.

Technology	Integration Methods	Advantages	Challenges	References
IoT for Healthcare Management and Older Adults’ Care	Remote monitoring and management of health data, health monitoring, emergency responsiveness, and daily activity management.	Enhances remote health monitoring, reduces strain on healthcare systems, improves patient outcomes, promotes independence and safety for older adults.	Data security, privacy concerns, robust network infrastructure needed, standardized research methodologies needed to ensure reliability and effectiveness.	[45,66]
Advanced Home Networking, Voice Control, and Gesture-Based Interaction (X10, Z-Wave, ZigBee)	Automated control of lighting, security, temperature, and home appliances using home networking protocols, voice commands, and context-sensitive gestures.	Improves convenience and safety, facilitates energy savings, ensures reliable communication even with interference, increases autonomy for older adults and disabled individuals, user-friendly automation, simplifies user interactions, and reduces cognitive load.	Signal interference, network reliability issues, noise interference, speaker accent variation, user learning curve, ensuring intuitive and accessible gestures.	[29,56,73]
Semantic Web Technologies, WSNs, Nanotechnology, RFID, Wearable Electronics, AI	Real-time assistance and health management through autonomic systems, continuous data collection, and customizable home environment integration.	Autonomic management of home devices, proactive health solutions with minimal human intervention, supports older adults and chronic disease management, and enhances quality of life through personalized assistive environments.	Continuous adaptation required, ensuring seamless integration of technologies, financial burden, layered architecture complexity, ensuring interoperability, and customizing technology to individual needs.	[33,46,74]
Computer Vision for Posture and Activity Recognition	Monitoring of static postures and daily activities using computer vision, depth video cameras, and Hidden Markov Models.	Enhances safety by identifying emergency situations, improves fall detection, high recognition rate of daily activities, and supports independent living through continuous monitoring.	Variations in environmental conditions, accuracy of posture recognition, ensuring accuracy across various activities.	[47,63]

presents an overview of various smart home technologies, their integration methods, benefits, and associated challenges, highlighting how these technologies can enhance healthcare management, improve convenience and safety, and support independent living for older adults.

4.3.4. User Interaction and Experience in Smart Homes: Understanding and Improving Engagement

Studies in this section focus on user interaction with SHTs and the overall user experience. These works assess how users perceive, interact with, and benefit from smart home systems, with an emphasis on usability, acceptance, and satisfaction. The research aims to identify factors that influence the adoption of smart technologies and how these systems can be designed to better meet the needs and preferences of users, particularly older adults.

Turjamaa et al. [54] conducted an integrative review analyzing how SHTs support older adults in their daily lives. They collated data from sixteen studies, emphasizing the benefits of smart homes in enhancing daily living and safety for older adults. The review revealed that smart homes facilitate everyday activities, promote healthier lifestyles, and provide a sense of security, which is crucial for older adults who wish to live independently. The technologies discussed include automated systems for routine tasks and emergency alerts, as well as devices for health monitoring and social communication. Despite these advancements, the review identified a critical lack of older adult involvement in the development of these technologies. The authors argued that the perspectives and experiences of older adults are essential for tailoring SHTs to better meet their needs. Furthermore, while these systems improve physical safety and support daily activities, they also need to be developed in a way that considers maintaining and enhancing the social relationships of older adults, thereby avoiding the risk of social isolation. The study underscored the potential of SHTs to transform living environments for older adults, but it also calls for more inclusive and participatory approaches in technology development to fully realize this potential. This includes continuous collaboration between technical developers, healthcare professionals, and older adults to ensure that smart home solutions are both effective and aligned with the users’ actual needs.

Liu et al.’s [43] systematic review and meta-analysis examined the impact of SHTs on older adults with chronic conditions. This study, which included fifteen randomized controlled trials (RCTs), assessed the effects of smart homes on hospital admissions, emergency department visits, days spent in hospitals, quality of life, and satisfaction with the technology. The meta-analysis revealed no significant reductions in hospital or emergency department admissions, nor in the days spent in hospital due to tele-monitoring. There was also no significant improvement in the quality of life associated with the use of these technologies. However, the study noted a positive effect of tele-monitoring on physical functioning and a reduction in depression among older adults, suggesting that while SHTs may not significantly alter healthcare usage or perceived quality of life, they could contribute positively to specific health outcomes. The majority of participants expressed satisfaction with the smart home setup, highlighting its acceptance among the older adult population. This suggests that despite the lack of significant findings in some health-related metrics, the perceived benefits and satisfaction could encourage continued use and further refinement of SHTs in older adults’ care.

Pietrezak et al. [49] conducted a literature review to assess the efficacy of SHT in preventing falls among community-dwelling older adults. Their systematic review included studies that explored the use of various SHTs, such as fall detectors and motion sensors, aimed at preventing falls or reducing the fear of falling. The results from these studies, however, provided limited evidence that SHTs are effective in reducing fall rates or the fear of falling among older adults. Despite the lack of significant reductions in falls, the review found that older adults generally had positive attitudes toward the technology, valuing the increased sense of security and independence it provided, which could contribute to prolonging independent living. Privacy concerns and the intrusiveness of technology were noted but were deemed less significant compared to the perceived benefits. The review also highlighted the importance of user-friendly designs and adequate technical support to facilitate the adoption and effectiveness of these technologies.

Suresh and Sruthi [78] provided a review of SHT, focusing on its applications, technological challenges, and future research directions. Their study examined the integration of various SHTs aimed at enhancing the quality of life for older adults and disabled individuals through automation and energy conservation. They explored the increasing use of home automation systems that facilitate independent living by managing everyday tasks and monitoring health and safety. The authors highlighted the critical role of these technologies in reducing energy consumption through intelligent management systems and discussed the broader implications for e-health and telemedicine within smart homes. However, they also pointed out significant barriers to adoption, such as high costs, technological complexities, and concerns about privacy and data security. The authors concluded that while SHTs hold significant promise for improving living conditions, particularly for vulnerable populations, there is a pressing need for continued research and development to address these challenges and ensure the widespread acceptance and effectiveness of these systems.

Peetoom et al. [40] conducted a literature review focusing on the use of monitoring technologies to assist older adults in living independently. Their review identified various technologies designed to monitor daily activities and significant events, such as falls, highlighting the promising role these technologies play in supporting older adults. Five main types of monitoring technologies were described: passive infrared motion sensors, body-worn sensors, pressure sensors, video monitoring, and sound recognition, with additional mentions of multicomponent and SHTs. While the potential of these technologies to prolong independent living and reduce hospital visits and healthcare costs is acknowledged, the review also pointed out that research in this area is still in its early stages, predominantly featuring small-scale and short-term studies. The effectiveness, user acceptance, and cost-efficiency of these technologies remain under-examined in long-term scenarios. The authors suggested that further research is required to validate these technologies’ effectiveness in real-world settings and over longer periods, which is crucial for their broader adoption and to realize their full potential in aiding older adults.

Elers et al. [59] conducted a qualitative study exploring user requirements for technology that supports aging in place for older adults and their informal support networks. The research revealed three main themes influencing technology adoption: social enablers, technology concerns, and information desired. The “social enablers” theme highlighted the positive role of informal support networks in encouraging technology use, which aids in maintaining older adults’ independence and safety. Timing was identified as crucial, with technology adoption seen as beneficial either currently or in the near future, depending on the individual’s needs. The “technology concerns” theme addressed significant issues, such as cost, usability, security, and privacy, noting that these factors can act as barriers to technology adoption. Concerns were also raised about technology potentially replacing face-to-face interactions, which are valued for their depth and emotional connection. Lastly, the “information desired” theme examined the types of information that should be collected and shared via technology, emphasizing the importance of respecting older adults’ privacy and autonomy in deciding what information is shared and with whom. This study not only underscored the potential of technology to enhance the well-being of older adults by supporting their ability to live independently but also highlighted the need for designs that address both practical and interpersonal aspects of technology use in aging populations.

Gudmundsson [84] carried out a qualitative analysis of older adult citizens’ perceptions and acceptance toward SHT aimed at supporting their independence and welfare. Conducted in a care housing setting, this study integrated the Unified Theory of Acceptance and Use of Technology (UTAUT2) [87] to frame the investigation, focusing on how the technology aligns with older adults’ desires to age in place. The findings revealed a complex relationship between older adults and the technology. While some participants saw potential benefits, especially in terms of safety and maintaining independence, there were notable hesitations concerning the usability and intrusion of technology into daily life. The study underscored that despite the promise of SHT in enhancing older adult living, the actual acceptance hinges significantly on individual attitudes toward technology, perceived complexity, and the tangible benefits it offers. Moreover, Gudmundsson [84] highlighted the influence of social enablers, such as health professionals and peers, in shaping older adults’ attitudes toward technology. Older adults expressed a conditional acceptance of smart technology—if it is easy to use and clearly beneficial without being intrusive. This nuanced view suggests that while technology can support aging in place, its design and implementation need careful consideration to meet the actual needs and preferences of older adult users. The study thus calls for a more user-centered approach in the development of SHTs for older adults, ensuring they enhance rather than complicate the lives of the intended users.

Tural et al. [44] examined adults’ attitudes and intentions toward adopting SHTs, which could contribute to safe and active aging in place. The study employed a sequential mixed-methods approach, combining online and in-person surveys with a focus group discussion to gather comprehensive insights from community-dwelling older adults aged 50 and above. The research revealed that perceived usefulness is a consistent predictor of positive attitudes and the willingness to use smart home products. While smart fire prevention devices received favorable views due to their potential safety benefits, the affordability of these devices significantly influenced the older adults’ intentions to incorporate them into their homes. The focus group discussions highlighted several key determinants impacting attitudes toward smart home products, including skepticism about technology, privacy concerns, and concerns about the return on investment. These factors contribute to a nuanced understanding of the barriers and facilitators to SHT adoption among older adults. This study provided vital insights into designing and marketing SHTs that are aligned with the needs and preferences of older adults, emphasizing the necessity of user-friendly designs that address privacy and affordability to enhance adoption rates.

Cao et al. [58] explored the factors influencing the decision-making process for the adoption of smart home sensors (SHS) by older adults in Singapore. The research identified both intrinsic and extrinsic factors that impact older adults’ decisions to adopt such technologies. Intrinsic factors included the users’ understanding of the technology, its perceived usefulness, and the benefits, while extrinsic factors included affordability and community care support. The findings revealed that 74% of the participants adopted SHS after an intervention period, which involved installing SHS in their homes. The main reasons for adoption were the perceived benefits of increased safety and the convenience of monitoring health and activity without intrusion. However, 26% of participants chose not to adopt SHS due to privacy concerns, lack of family support, and perceived complexity or irrelevance of the technology. The study highlighted the necessity of involving older adults in the design process of SHS to ensure these systems are user-friendly and meet the actual needs of the end-users. Furthermore, it suggested that providing clear and comprehensive training on how to use these technologies and demonstrating their direct benefits can enhance adoption rates. This research emphasized the complex interplay of personal understanding, perceived benefits, and socioeconomic factors in the adoption of SHTs by older adults, pointing toward the need for strategies that address these diverse aspects to improve technology uptake in this growing population segment.

In their qualitative study, Zhao et al. [36] explored the expectations and acceptability of smart nursing home models among older Chinese individuals and their families. The study identified key expectations, including the desire for quality care supported by both government and social systems, the integration of smart technology applications, the presence of skilled healthcare professionals, access to basic medical services, and comprehensive integration of these services. The participants saw smart nursing homes as potentially enhancing the quality of care and improving their quality of life through innovative technology applications, such as health monitoring and emergency management systems. They also expected these homes to provide a link between traditional healthcare facilities and at-home care through smart technologies, thereby enhancing the continuity and accessibility of care. Acceptability of the smart nursing home model was largely influenced by its perceived efficacy, usability, and the tangible benefits it could offer, such as improving care quality and personal independence. Factors such as age, economic status, health condition, and openness to technology among older adults also significantly influenced their acceptance of smart nursing homes. The study underscored the importance of considering these factors when planning and implementing smart nursing home models to ensure they meet the needs and expectations of older adults and their families effectively.

Current research emphasizes the critical role SHTs play in enhancing the daily lives of older adults, primarily through health monitoring, safety features, and enabling independent living. Studies consistently point to the need for smart home solutions to be user-centric, incorporating the direct input and preferences of older adults to ensure the technologies align with their unique needs. Furthermore, the emphasis on intuitive design, ease of use, and robust technical support highlights an essential requirement for smart homes to be widely accepted and effectively used by the older adult population. However, the outcomes from the integration of these technologies are mixed, with significant benefits in physical performance and safety contrasted against less clear impacts on overall quality of life and hospitalization rates. This suggests a nuanced interaction between user expectations and technology performance, underscoring the importance of personalization in smart home applications. The research advocates for continuous adaptation and refinement of these technologies, focusing on enhancing their accessibility, reliability, and relevance to older adults’ lifestyles. Moreover, the studies reveal that successful adoption of SHTs among older adults not only hinges on the functionality of the devices but also on the broader support systems that include family and community engagement. This integrated approach ensures that SHTs are not merely tools but part of a strategy to improve the quality of life for older adults, addressing both their physical and social needs. The exploration of these technologies, therefore, continues to evolve, pointing toward a future where smart homes could become integral to older adults’ care, provided they are developed with a deep understanding of the end-users’ preferences and everyday challenges.

Table 8. User interaction and experience in smart homes: key insights and recommendations for improvement.

Interaction Type	Advantages	Challenges	Recommendations	References
Smart Home Technologies (SHTs)	Enhances daily living, promotes healthier lifestyles, provides a sense of security.	Lack of older adult involvement, risk of social isolation.	Inclusive, participatory approaches, collaboration with stakeholders.	[54,78]
Tele-monitoring and Health Monitoring Technologies	Positive impact on physical functioning, reduction in depression, high user satisfaction.	No significant reduction in hospital admissions or quality of life.	Further refinement and assessment of specific health outcomes.	[40,43]
Fall Prevention Technologies	Increased sense of security and independence among older adults.	Limited evidence of effectiveness in reducing falls or fear of falling.	User-friendly designs, adequate technical support.	[40,49]
Home Automation and Energy Conservation	Facilitates independent living, reduces energy consumption, supports health and safety monitoring.	High costs, technological complexities, privacy and data security concerns.	Continued research and development to address barriers.	[44,78]
Aging in Place Support	Maintains independence and safety, informal support networks encourage technology use.	Cost, usability, security, privacy concerns, potential replacement of face-to-face interactions.	Design addressing both practical and interpersonal aspects.	[36,59,84]
Adoption of SHTs	Positive attitudes when perceived useful, importance of affordability.	Skepticism, privacy concerns, return on investment.	User-friendly designs addressing privacy and affordability.	[44,58]
Smart Nursing Homes	Enhances quality of care, improves quality of life, supports continuity of care.	Acceptance influenced by age, economic status, health condition, openness to technology.	Consideration of individual needs and expectations, government and social support, integration of skilled healthcare professionals, access to basic medical services.	[36]

provides an overview of different smart home technologies, their advantages and disadvantages, and recommendations for improving their adoption and effectiveness among older adults, with a focus on user interaction and experience.

4.3.5. Smart Home Design and Accessibility: Creating Inclusive and User-Friendly Solutions

This section addresses the design and accessibility aspects of smart homes, focusing on how architectural, ergonomic, and technological design can enhance the livability and functionality of smart environments for all users, with a particular focus on aging populations. The works discuss the need for homes that not only incorporate advanced technology but also prioritize user-friendly, inclusive, and adaptable designs that support the diverse needs of individuals, fostering independence and improving quality of life through thoughtful innovation.

Yu et al. [30] evaluated the diverse needs of older adults for SHTs in South Korea, categorizing them into five distinct lifestyle-based groups. Their study, based on a questionnaire that assessed aspects such as home activities, social events, and overall quality of life, revealed significant variations in the preferences and priorities for smart home functionalities across these groups. One group comprised older adults who are ‘Tired of Housework’ and seek technologies to alleviate the burden of daily chores and house maintenance. Another set, referred to as ‘Just Rest’, included individuals who favor technologies that enhance comfort and relaxation to aid leisure and rest. There was also an ‘Active at Home’ segment of older adults who appreciate technologies that support physical activity and engagement within their living space. Conversely, the group labeled ‘Poor Quality of Life’ benefit from functions that focus on health monitoring and emergency management to improve their living conditions. Lastly, older adults with a ‘High Quality of Life and Good Health’ still value technologies that help maintain their well-being and support efficient health management. The reported findings indicated that the need for 16 out of 26 smart home functions varied notably across these groups, with some prioritizing assistance for daily tasks and health monitoring while others valued enhancements in social connectivity or environmental management. This underscored the critical importance of adopting a user-centered design approach in the development of SHTs to cater effectively to the varied lifestyles and health needs of the aging population, ensuring that the solutions provided genuinely support their independence and enhance their quality of life.

Liu and Tamura’s research [80] investigated the integration of smart home technologies (SHTs) to support the aging population in maintaining independence and improving connectivity. Their study focused on the “New elders” in China, defined as older adults who remain active in society post-retirement. The central finding was that the essential need of these older adults is ‘connectivity’, which includes both physical and psychological aspects. The researchers argued that the primary goal of SHTs for older adults should be to enhance this connectivity, thereby improving their quality of life and enabling independence, safety, and happiness. They highlighted the potential of smart homes to meet the diverse needs of older adults, including basic needs of connectivity, health management, and social interaction, through technology. By integrating intelligent systems within the home, these technologies can streamline daily routines, offer health monitoring, and support social interactions that might otherwise decrease with age. The study emphasized the importance of designing smart home systems that are technologically advanced yet attuned to the specific needs and preferences of the older adult population, aiming to create a comprehensive living experience that promotes well-being and satisfaction.

Kon et al. [83] explored the effectiveness of SHTs in assisting older adults in six key areas: safety, health and nutrition, physical activity, personal hygiene and care, social engagement, and leisure. Their findings indicated that while smart homes are adept at enhancing safety and health management, including fall detection and vital signs’ monitoring, there are notable deficiencies in personal hygiene, care, and leisure activities. The researchers stressed that smart homes should not only address essential functions but also enhance the overall quality of life by fostering social engagement and leisure activities, which are often neglected. Despite technological advancements, the adoption of these systems by older adults largely depends on their ease of use, perceived benefits, and how well they address privacy concerns.

By juxtaposing Liu and Tamura’s [80] findings with those of Kon et al. [83], we gained a more comprehensive understanding of smart home technologies’ (SHTs) potential to enhance the lives of older adults. Both studies underscored the pivotal role of connectivity and social engagement in improving the elderly’s quality of life. Liu and Tamura [80] underscored a broad concept of connectivity that encompasses physical, psychological, and social dimensions. In contrast, Kon et al. [83] identified specific gaps in social engagement and leisure within current SHT implementations. Both sets of researchers converged on the necessity for SHTs to provide a holistic and inclusive approach, addressing all facets of elder care beyond mere safety and health monitoring. Integrating Liu and Tamura’s emphasis on holistic connectivity [80] with Kon et al.’s detailed examination of daily life assistance [83] offers a clear direction for the evolution of SHTs. Future designs should not only advance technological capabilities but also cater to the distinct needs and preferences of older adults, ensuring that these systems promote comprehensive connectivity. This approach will result in smart homes that support overall well-being, foster social interactions, and enhance contentment for the aging population.

Humphreys [39] critically examined the potential of SHT to support older adults living independently. The study evaluated various smart home components, such as health monitoring, fall detectors, and daily living activity monitors, that are integral to aiding older adults in their own homes. Despite the advanced technological integrations aimed at facilitating independent living and preventing hospitalizations, Humphreys highlighted a significant gap in the evidence concerning the effectiveness of these technologies on actual health outcomes, such as reducing falls or improving the overall quality of life. The review underscored the challenges in assessing the real-world impact of these technologies, noting a scarcity of rigorous implementation studies that go beyond the feasibility and functionality to actually measure the impact on health outcomes. Furthermore, it pointed out the psychological aspects, indicating that while some users find the technology reassuring, increasing their confidence and sense of security, others may feel heightened awareness and anxiety regarding their risks in daily activities. Thus, while SHTs hold potential benefits in supporting aging in place by monitoring health and ensuring safety, Humphreys calls for more high-quality research and large-scale demonstrative projects to thoroughly ascertain their effectiveness and impact. This approach will help in overcoming barriers to adoption and utilization, ensuring that SHTs can truly meet the needs of older adults in a practical, reassuring, and health-promoting manner.

In their systematic literature review, Facchinetti et al. [31] explored the impact of SHTs on managing chronic diseases in older adults. The study categorized these technologies into three groups: smart home systems with environmental sensors, external memory aids involving mobile apps, and hybrid technologies combining multiple devices with telemedicine capabilities. The review evaluated the efficacy of these technologies in maintaining or improving various health outcomes, such as vital signs, medication management, daily living activities, mobility, falls, and overall quality of life. The findings indicated that smart homes can significantly aid in monitoring and managing health, potentially reducing the exacerbation of chronic conditions and improving safety by enabling independence. However, the study highlighted a crucial need for more comprehensive and long-term research to fully understand and quantify these benefits. Despite the promising potential, gaps in effectiveness, user acceptance, and cost-efficiency remain, suggesting that further technological advancements and rigorous evaluations are necessary to ensure these systems meet the complex needs of older adults effectively.

Miller et al. [76] examined the intersection of aging and technology, specifically through the lens of aging in place within smart environments. Their study highlighted the crucial role of SHTs in supporting older adults’ desire to live independently in their familiar environments. They addressed how different living arrangements—such as personal homes, assisted living facilities, nursing homes, and family housing—present unique and overlapping challenges that can be mitigated through targeted technological solutions. The research discussed the development and application of various technologies aimed at enhancing the quality of life for older adults. These technologies include sensors to prevent accidents, robotic vacuums for automated cleaning, and digital assistants to support routine tasks. The study critically analyzed these technologies, pointing out that while they offer significant benefits, they must be designed to meet the specific needs and preferences of older adults across different living situations. This work emphasized the importance of integrating advanced technology with a deep understanding of the social and physical aspects of aging. This approach aims to ensure that aging in place not only becomes a feasible option but also supports a high quality of life. The findings suggested that while technology can provide critical support, it must be developed in close consultation with its end-users to truly address the diverse challenges faced by older adults.

Lê et al.’s [42] study provided a detailed examination of the potential of SHTs to facilitate positive aging for older individuals. Their research assessed how these advanced systems can enhance the quality of life for older adults by supporting their independence and health, integrating various functionalities, such as health monitoring, emergency management, and daily living assistance, within a home environment. The study highlighted the benefits of smart homes, such as increased safety, improved communication, and greater convenience, which are crucial for older adults who may face physical and cognitive challenges. However, the authors also discussed several significant challenges related to the adoption and use of SHTs by older adults, including issues with accessibility, technology acceptance, and ethical concerns, such as privacy and autonomy. Overall, the authors advocated for a user-centered approach in the development of SHTs. They stressed the importance of considering the needs and preferences of older adults in the design process to ensure these systems are both beneficial and acceptable to the end-users. The research underscored the need for ongoing dialogue between developers, users, and policymakers to address these challenges and fully realize the potential of smart homes in supporting the aging population.

In their study, Alam et al. [48] provided a review of SHTs, outlining their evolution from basic automated systems to advanced networks capable of enhancing healthcare, security, and energy management in residential settings. They explored the multifaceted applications of smart homes, particularly emphasizing their role in supporting older adults through enhanced monitoring and health management systems. The review discussed the integration of various technological components, such as sensors, communication protocols, and specialized algorithms, which collectively improve the functionality and efficiency of smart homes. The authors highlighted the significant benefits of smart homes in facilitating independent living for older adults, improving comfort through automation, and ensuring safety through advanced monitoring systems. However, the authors also addressed the challenges facing the widespread adoption of SHTs, including issues related to interoperability, privacy, and user acceptance. They suggested that future research should focus on developing user-centric designs, improving the robustness of communication systems, and ensuring the security of data to fully realize the potential of smart homes in enhancing the quality of life for their users.

Mallinson and Shafi [70] explored the interplay between SHT and collaborative governance in the context of public policy, underscoring both the potential benefits and challenges. They highlighted how SHT can improve the quality of life for aging populations by promoting independence and reducing long-term healthcare costs. However, the authors identified significant governance and policy challenges, particularly concerning the protection and use of vast amounts of sensitive data collected by smart home devices. The study proposed the use of a collaborative governance framework to better integrate public and private efforts in regulating and advancing SHT. This approach aims to address the multifaceted issues of data privacy, security, and ethical concerns while also promoting innovation and user-friendly technology development. By fostering greater engagement from policy scholars and stakeholders, Mallinson and Shafi argued that more effective strategies can be developed for governing this rapidly expanding sector, thus ensuring that SHTs are implemented in ways that are both beneficial and ethical.

Moraitou et al. [34] provided a systematic review of smart home care technologies designed for older adults and those with chronic diseases, emphasizing the technological, psychosocial, ethical, and economic challenges associated with their implementation. The authors explored various applications of these technologies, including physiological and functional monitoring, safety and security assistance, and social interaction enhancement. The study found that while SHTs have significant potential to improve the quality of life for these populations by enhancing health monitoring and daily living support, they also raise considerable challenges. Technologically, the integration of various devices and systems within a home environment requires advanced networking capabilities and standardization to ensure seamless functionality and user-friendly interaction. Psychosocially and ethically, the concerns about privacy, autonomy, and the potential reduction in human interaction highlight the need for careful consideration in technology design and policy formulation. Economically, the authors discussed the cost implications of SHTs, arguing that while they may reduce healthcare expenses by decreasing the need for in-person care services, the initial setup and maintenance costs can be significant. They advocated for a balance between cost and benefit, emphasizing the importance of designing systems that are both affordable and effective in meeting the health and social needs of older adults and chronic disease patients. The research underscored the complexity of implementing SHTs and the need for multidisciplinary approaches to address the diverse challenges they present.

Das et al. [51] presented a study on the design and implementation of a smart home system specifically tailored for older adults and disabled individuals, leveraging a network of sensors and IoT technology to enhance living conditions. Their research outlined how SHT not only supports daily activities through automation but also provides critical monitoring for health and safety. The system includes features such as environmental controls, security measures, and emergency responses, all controlled via a centralized software platform that ensures real-time monitoring and intervention when necessary. The study highlighted the integration of a variety of sensors, such as motion detectors and appliance usage monitors, which collectively help to maintain an environment that is both safe and responsive to the needs of its residents. The results showed potential for reducing the need for constant human supervision, thereby increasing independence for users and reducing overall care costs. However, the authors also discussed the challenges faced in implementing such systems, including technical barriers, the need for continuous updates, and the adaptation of the technology to individual homes. They emphasized the importance of user-friendly designs and the need for systems to be scalable and adaptable to different home environments. The research underscored the critical role of SHTs in improving the quality of life for older adults and disabled individuals, suggesting ongoing development and refinement are key to their broader adoption.

In the study by Deen [68], a comprehensive exploration of information and communications technologies (ICT) for ubiquitous healthcare within smart home environments for older adults was presented. The research highlighted the growing need for innovative healthcare solutions due to increasing life expectancy and the rising costs associated with traditional healthcare models, particularly in the context of an aging global population. Deen introduced several low-cost, non-invasive, and user-friendly sensor and actuator systems that are integrated into smart homes to address the pressing healthcare challenges faced by older populations. These technologies are designed to monitor health conditions in a non-intrusive manner, allowing older adults to continue living independently at home. Key functionalities included environmental sensing, health monitoring through wearable devices, and emergency management systems. The author discussed the potential of SHTs to significantly enhance the quality of life for older adults by improving safety, increasing independence, and reducing healthcare costs. These systems enable remote monitoring of vital signs and physical activity, potentially decreasing the need for frequent hospital visits. Additionally, the integration of intelligent computing and sensors facilitates the early detection of health deteriorations, allowing for prompt medical interventions. This research provided valuable insights into the integration of advanced ICT in smart homes, proposing a future where older individuals can receive comprehensive care within the comfort of their own homes, thereby addressing both economic and social challenges associated with aging populations.

Do et al. [71] presented a study on a Robot-Integrated Smart Home (RiSH) system, specifically designed to enhance care for older adults through advanced assistive technologies. This system integrates a home service robot with a home sensor network, body sensors, mobile devices, cloud servers, and remote caregivers, providing a multi-layered approach to support for older adults. Their research demonstrated the capability of RiSH to effectively recognize and track human body activity using inertial measurement units (IMU) and to perceive the environment through audio signal processing. The development of specific applications, such as human localization and tracking, as well as human activity recognition, extends the robot’s perception beyond its onboard sensors, utilizing particle filter-based and Dynamic Bayesian Network-based methods. These applications achieved notable accuracies in tracking and activity recognition in their testbed experiments. The functionalities of the RiSH system include human activity recognition, which helps in monitoring daily activities and ensuring the well-being of older residents. It is also equipped for emergency detection and response, particularly geared toward detecting falls, thereby ensuring timely medical attention or intervention. Sound event detection utilizes sound-recognition technologies to understand various household sounds, playing a crucial role in activity recognition and environmental understanding. The integration with a home service robot allows it to act as a mobile sensor and actuator, able to interact with residents, provide companionship, and perform simple tasks. Additionally, environmental sensing monitors conditions, such as temperature and light, ensure the environment is safe and comfortable for older adults, while cloud connectivity facilitates remote monitoring and data-driven insights into the health and activities of the residents. These functionalities combine to create a comprehensive support system within the home, focusing on safety, monitoring, and interactive assistance. The high-level application of the system is designed to detect and respond to human falls, showing promising results in managing care for older adults more effectively. The experiments conducted with twelve human subjects validated the system’s auditory perception services, human body activity recognition, position tracking, sound-based activity monitoring, and fall detection and rescue capabilities. The authors reported that the robot successfully recognized 37 human activities through sound events, with an average accuracy of 88% and detected falling sounds with an accuracy of 80% at the frame level, indicating robust operation of various components within the RiSH system.

In the study conducted by Torta et al. [64], the effectiveness of a small, socially assistive humanoid robot in smart home environments for care of older adults was evaluated. This research explored both short-term and long-term impacts of the robot on older adults’ acceptance and emotional engagement, offering insights into its utility as a proactive interface in a smart home setting. The robot was tested in real-world scenarios within smart homes, aiming to provide multimodal communication channels and generate positive emotional responses among older adults. The study demonstrated that the robot was trusted by participants, who might engage in an emotional relationship with the technology over time, although perceived enjoyment decreased. Notably, the robot effectively recognized and tracked human activities using inertial measurement units and environmental perception through audio signal processing, which included capabilities such as human localization, activity recognition, and fall detection. The findings suggested that while the robot was generally well-received and trusted, the novelty and enjoyment factors might diminish over time, indicating the need for continuous adaptation and enhancement in functionalities to sustain user interest and emotional engagement.

Norell Pejner et al. [60] presented a mixed-methods study protocol for developing a smart home system designed to support information sharing, health assessments, and medication self-management for older adults. This protocol outlines a participatory design approach involving various stakeholders, including older adults, caregivers, and industrial partners to ensure the system meets the actual needs of its users. The smart home system, referred to as the Intelligent Age-Friendly Home (IAFH), is intended to evolve and adapt to the changing needs, preferences, and behaviors of its users. It integrates various components, such as health behavior assessments, communication of health data, and personalized medication reminders. These functionalities are supported by advanced home sensors and digitalized systems that facilitate accurate health monitoring and effective communication between care receivers and providers. The study’s phased approach, from conceptualization to full-scale intervention, aims to iteratively develop and refine the system, with a strong focus on user participation and real-world applicability. This methodical progression ensures that the system not only supports medication management but also enhances overall healthcare decision-making through improved information accuracy and accessibility. The ultimate goal is to promote independence among older adults by allowing them to manage their medications more effectively and safely within their home environments.

Existing research underscores a significant focus on enhancing the quality of life for older adults through adaptive and user-friendly environments. Studies suggest a strong need to develop smart homes that are not only technologically advanced but also tailored to meet the diverse needs and preferences of older adults. These environments often integrate a variety of functionalities, from health monitoring and fall detection to medication management and emergency response, highlighting the versatility and potential of smart homes to support independent living. The research highlights several key areas of focus: the importance of designing interfaces that are easy to use and understand, the need for systems that can be customized to individual preferences, and the critical role of security and privacy in the adoption of SHTs. Additionally, the engagement of older adults in the design process is crucial for ensuring that these technologies are practical and relevant to their daily lives. Moreover, the studies reveal that while smart homes have the potential to significantly improve safety and autonomy for older adults, there are still challenges related to technology acceptance and integration. These challenges include overcoming technical complexities, ensuring adequate support and training for users, and addressing potential issues related to privacy and data security.

Table 9. Key focus areas and insights on smart home design and accessibility.

Key Focus	Findings	Challenges	Recommendations	References
Categorization of older adults’ needs	Identified five distinct groups with varying smart home functionality needs.	Variations in preferences and priorities among these groups.	Adopt a user-centered design approach to cater to diverse needs.	[30]
Enhancing connectivity and social engagement	Connectivity is crucial for quality of life, supporting social interaction and engagement.	Gaps in social engagement and leisure activities.	Design comprehensive living experiences that promote holistic connectivity.	[80,83]
Health monitoring, safety, and chronic disease management	SHTs improve safety and health monitoring, potentially reducing chronic condition exacerbations.	Lack of evidence on actual health outcomes, privacy, and security concerns.	Conduct large-scale studies, improve health monitoring systems, address ethical concerns.	[31,34,39,68]
User-friendly designs for aging in place	Enhances quality of life and independence, addresses specific needs and preferences.	Accessibility issues, technology acceptance, ethical concerns.	Engage users in the design process, ensure ongoing dialogue between stakeholders, create user-friendly designs.	[42,60,64,76]
Integration and evolution of smart home technologies	Advanced technologies support health management, safety, automation.	Interoperability, need for continuous updates, user adaptation.	Develop scalable, adaptable systems, improve communication and data security.	[48,51,71]
Policy and ethical considerations	Promotes independence, reduces healthcare costs, but raises data privacy and security issues.	Ethical concerns, lack of rigorous implementation studies, data governance challenges.	Implement collaborative governance framework, conduct high-quality research, balance costs and benefits.	[70]

provides an overview of key focus areas and insights on smart home design and accessibility, highlighting inclusive and user-friendly solutions for the aging population.

4.4. Answers to Research Questions

4.4.1. How Can We Ensure the Accessibility of Innovative Home Technology for All Levels of Society, Regardless of Financial Stability?

Innovative home technology should be accessible to people of all socioeconomic classes, regardless of their financial stability. Most older adults expressed concerns about financial hurdles in the study by Elers et al. [59]. However, to achieve this goal, concrete steps must be taken. First, innovative home technology manufacturers should prioritize the development of a wide range of products at different price points to provide consumers of all budgets with access to affordable options [62]. In addition, manufacturers should explore partnerships with local governments or nonprofit organizations to offer subsidized or sponsored programs to financially disadvantaged individuals who cannot afford this technology. Governments and regulators should also actively promote the accessibility of innovative technologies by taking initiatives that make technology more accessible to all citizens. In most countries, many older adults receive very low or even below-average pensions. Older adults expressed concern about paying additional rent for SHT due to their already meager pension and high rental costs [84]. Those efforts could include subsidies or tax incentives for smart device buyers and setting up financial assistance programs for low-income and vulnerable people. Another critical action is education and awareness of the potential benefits of innovative home technology, as education plays a crucial role in ensuring affordability. Information programs and resources should be developed to educate people about the benefits and possibilities of innovative home systems. One action could be to encourage the recycling and refurbishment of smart devices to reduce costs and make them accessible to people with limited resources. Refurbished devices can also be a sustainable solution for reducing electronic waste. Providing internet access to rural areas and less developed communities is vital for intelligent technologies to be available across the country. The expansion of infrastructure and the provision of low-cost or free internet access contribute to the introduction of new technologies.

4.4.2. What Level of Support do Health Ministries Provide for Innovative Home Technology to Improve People’s Quality of Life?

The level of support from health ministries for intelligent technologies, aimed at improving people’s quality of life, varies by country and the specific policies implemented. According to Cao et al. [58], some countries recognize the potential of innovative technologies to enhance healthcare, which is reflected in strong support from health ministries. These countries often provide financial support, resources, and guidance for implementing smart homes within the healthcare system to achieve measurable user benefits. In such cases, health ministries can initiate pilot projects, engage in research, and collaborate with smart device manufacturers to develop programs and solutions focused on health and well-being. Increasingly, countries worldwide are realizing the benefits of smart homes and are actively working to implement them. Support from health ministries may include research funding, project implementation, training of health professionals, and raising awareness about the benefits of smart technologies in healthcare [37].

It should be noted that the availability of Ministry of Health support for smart homes is country-specific and may depend on factors such as healthcare sector priorities, available financial resources, and political will to implement technological innovations. Obaid et al. [55] illustrated that the level of support can vary within a single country, influenced by regional or local initiatives and policies. Despite these variations, health ministries, in general, are increasingly supporting smart homes, raising hopes that this technology will be increasingly used to improve people’s quality of life, particularly in the context of healthcare.

4.4.3. How Actively do Health Ministries Promote the Use of Smart Home Technology to Reduce Pressure on Nursing Homes?

The degree to which ministries of health encourage the use of intelligent technologies to alleviate the burden on nursing homes and caregivers varies between countries, based on their specific circumstances. In some countries, health ministries actively support the use of intelligent technologies to enhance the quality of care for older adults and reduce the reliance on institutional care. The Netherlands, for example, has developed plans that include financial support, training on technology use, and fostering collaboration among stakeholders [38]. Health ministries promote the adoption of intelligent technologies through campaigns aimed at informing and educating the public, healthcare professionals, and older adults about the benefits and opportunities of smart homes. These campaigns utilize media channels, public events, and educational materials to raise awareness about how smart technologies can enhance the quality of life for older adults and facilitate operations in care homes.

In addition to promotional campaigns, health ministries may issue guidelines and recommendations for implementing smart technologies in care homes. These guidelines typically cover device selection, onboarding instructions, privacy, and system security [59]. They also provide information on training providers in the use of smart technologies and practices for successful healthcare implementation. Furthermore, health ministries can promote collaboration among healthcare sectors, technology companies, and suppliers, including financial support for purchasing smart devices.

It is important to note, however, that the extent to which ministries of health encourage the use of intelligent technologies can vary depending on each country’s political will, financial resources, and priorities. Some countries may lack the resources or political support to actively promote and implement smart technology in nursing homes. Therefore, it is essential to monitor and compare approaches from different countries to identify best practices and opportunities for improving older adults’ care through smart technologies.

4.4.4. To What Extent Do Wearable Sensors Need to Be Redesigned to Be Unobtrusive and Not Interfere with the Daily Lives of Users?

Integrating wearable sensors unobtrusively and seamlessly into users’ daily lives requires a major overhaul focused on comfort, aesthetics, and practicality. Wearable sensors are essential to intelligent medical technology, providing valuable data on vital signs, activity, and other health parameters. According to a study by Ates et al. [67], the design of wearable sensors is crucial for achieving high user adoption and sustained usage. The design strategy includes several approaches: reducing size and weight to make the sensors less visible and more comfortable, using flexible and soft materials that adapt to the body to ensure comfort and minimize skin irritation, and integrating sensors into existing clothing or accessories, such as bracelets or watches, to increase their discretion.

One of the critical aspects in the redesign of wearable sensors is to consider the user’s daily activities [77]. Sensors should be designed to not restrict the user’s mobility and allow for everyday activities to be carried out without interference. It is also important that the sensors are moisture and dust resistant to withstand a wide range of conditions and environments. According to findings from Kachouie et al. [16], an improved design of wearable sensors that emphasizes discretion and convenience could be the key to increasing the acceptance and integration of this technology into users’ daily lives. This approach allows users to receive helpful information about their health without experiencing any inconvenience or limitations. It also ensures that wearable sensors are acceptable to a wide range of users, including older adults and those with special needs.

One notable example that encapsulates the outlined design principles and addresses the user’s daily activities is the development of the ‘SmartFabric Sensor Shirt’ [88]. Designed for older adults in smart homes, this shirt incorporates lightweight, flexible sensors seamlessly woven into the fabric. These sensors monitor vital signs such as heart rate and body temperature and detect falls, sending alerts to caregivers when anomalies occur. The shirt is moisture and dust resistant, suitable for various conditions, but its reliance on technology might reduce personal interaction with healthcare providers and present maintenance challenges due to regular washing. Similarly, the ‘Flexi-Watch Health Monitor’ [89] combines traditional watch aesthetics with health monitoring functionalities. It tracks heart rate, activity levels, and sleep patterns, encouraging routine wear due to its familiar design and ease of use. However, it has limitations in the range of health metrics monitored and requires frequent charging, which can be inconvenient. The ‘VitaBand’ [90] is a discreet wristband that monitors vital signs and physical activity while serving as a digital carrier for emergency contact information and medical IDs. It promotes continuous wear due to its unobtrusive design but raises data security concerns and relies heavily on smartphone connectivity, which can be problematic in areas with poor connectivity. ‘Smart Socks’ [91] are designed for diabetic patients, monitoring foot temperature to detect early signs of ulcers. These socks offer targeted preventative care and integrate seamlessly into daily life. However, they require meticulous maintenance to prevent sensor damage and may be cost-prohibitive for some users. The ‘E-Textile Sleep Shirt’ [92] monitors respiratory and heart rates during sleep using sensors embedded in the fabric. It offers non-invasive monitoring with comfortable materials, but the sensors require special care during washing and might cause discomfort for sensitive individuals.

Comparing these wearables, the common thread is their integration of health monitoring into everyday items, promoting seamless use. The SmartFabric Sensor Shirt and E-Textile Sleep Shirt provide comprehensive health monitoring without compromising daily activities or sleep comfort. The Flexi-Watch and VitaBand blend functionality with familiarity, reducing stigma and encouraging routine use. Smart Socks offer targeted care for diabetic patients, transforming a daily necessity into a health tool. However, each device faces challenges: the need for durability and maintenance in the SmartFabric Sensor Shirt and E-Textile Sleep Shirt, data security concerns with VitaBand, and the high maintenance and cost of Smart Socks.

These examples illustrate how the careful consideration of wearable sensor design, focusing on user comfort, discretion, and functionality, can lead to high user adoption and long-term usage, particularly among older adults who value both the practicality and unobtrusiveness of health monitoring solutions. The challenges presented, however, highlight the need for continued innovation and consideration in the development of such technologies to ensure they meet the needs of all potential users without adding undue complexity or dependency.

4.4.5. How Can We Create a Smart Home Application That Is Equally Adaptable to Every User?

To create an innovative home application that works equally well for every user, a significant overhaul is necessary to ensure the unobtrusive and seamless integration of wearable sensors into users’ everyday lives, emphasizing convenience, aesthetics, and functionality [67]. As an essential component of intelligent medical technology, wearable sensors provide valuable data on vital signs, activity, and other health parameters. When developing such an application, the most crucial factor is an intuitive and user-friendly interface that allows easy management of smart home devices, regardless of the user’s technical level. Studies have highlighted that a well-organized layout of functions, icons, and intuitive controls is associated with a better user experience [45].

Flexibility within the application is essential so it can adapt to each user’s preferences. This adaptability should allow users to customize the layout, prioritize features, and adjust settings to meet their specific needs [29]. It can include personalizing controls, scenarios, and automation based on users’ daily activities and habits. Moreover, the application must include features that cater to various user needs, including accessibility options for people with disabilities. This could involve support for alternative controls, such as voice commands or custom interfaces for users with special needs.

Regular collection of user feedback is critical. This feedback helps identify gaps, areas for improvement, and the potential for new features that users would like to see in the app. The application can be developed according to users’ needs and preferences through the systematic analysis of these opinions. Engaging users in the smart home application development process is crucial for ensuring adaptability and user satisfaction [85].

By fostering continuous cooperation with users and actively involving them in the development process, a flexible, smart home application that suits every user can be created. This approach makes the app intuitive, personalized, and usable for a broad audience, thus enhancing the overall experience and acceptance of the smart home.

4.4.6. To What Extent Is It Necessary to Modify State Laws and Regulations to Align with Ethical Issues?

The ethical alignment of government laws and regulations is essential to ensure justice, protect individual rights, and promote social well-being. Depending on the complexity of the ethical issues involved, changes in laws and regulations may be necessary, especially in fields such as AI, biotechnology, and autonomous systems. Zhu et al. [65] highlighted the need to amend laws and regulations to ensure patient privacy, transparency in data collection and use, and fair distribution of benefits. As technology advances, it is crucial to adapt laws and regulations to meet new challenges.

According to Sánchez et al. [55], data protection reforms are needed to address ethical issues arising from the collection and processing of large amounts of data. This may include creating stricter rules on how data are collected, used, and shared, making data processing transparent, and strengthening individuals’ rights over their data. It is also vital to ensure that technological advances are applied with respect for human rights, avoiding discrimination, and considering the safety and well-being of users. Moreover, openness and public participation in the legislative and regulatory processes are critical to ensuring compliance with ethical principles.

Laws and regulations must evolve to reflect the ethical implications of new technologies before their widespread adoption [79]. Citizens, experts, and organizations should have opportunities to express their opinions, participate in discussions, and contribute to policymaking. Through dialogue and collaboration, balanced laws and regulations that consider different perspectives and values can be enacted. It is crucial to continuously monitor and review existing laws to ensure they adequately regulate technological advances and remain up-to-date with innovations, research, and societal developments. Furthermore, cooperation between state institutions, experts in various fields, and the public is essential to create a compelling and fair legal framework.

Balancing government laws and regulations with ethical considerations is crucial to protect the interests of individuals and society amid rapid technological change. Legislative changes must ensure fairness, transparency, and respect for human rights while maintaining a balance between technological advances and ethical principles. This requires constant dialogue, the adjustment of regulations, and the promotion of openness and social participation.

4.4.7. How Can Smart Home Technology Address the Issue of Loneliness among Older Adults While Also Facilitating Their Daily Lives?

Innovative technology can provide significant support in nursing homes through sensors and activity monitoring systems. For example, motion detectors can track the activities of older adults and alert caregivers or healthcare professionals to unusual or emergency situations. Additionally, smart devices, such as smart thermostats, lighting, and security systems, can enhance the comfort and security of older adults in their homes. Studies have demonstrated that older adults utilize technology to connect with others, maintain social relationships, and overcome feelings of loneliness [72]. It is important to note, however, that smart technology cannot replace human interaction and social support.

Properly designed and adapted smart home apps can be a valuable tool that provides additional support to older people and simplifies everyday life. The research by Cotten et al. [50] highlighted the benefits of innovative technology in addressing the issue of loneliness among older people. By integrating technology that promotes social contact and facilitates everyday activities, a smart home can help reduce loneliness and improve the quality of life for older individuals.

To achieve maximum adaptability of smart home applications, it is essential to develop such technology in cooperation with users, taking into consideration their needs and opinions. Continuous improvement and updating of the application based on user experiences and feedback are essential to ensure adaptability and satisfaction.

Smart technology in the home can be a crucial support in addressing the loneliness of older people and facilitating their daily lives. Assistive technology enables them to connect with others and access information and services that would otherwise be unavailable [75]. Adequately designed and customized smart home applications, developed in collaboration with users and in compliance with ethical guidelines, can provide effective tools to maintain social connections, improve safety and comfort, and facilitate the daily activities of older adults.

4.4.8. How Can We Overcome the Stigma Associated with Older Adults and Introduce Them to Smart Home Technology?

Overcoming the stigma associated with older adults adopting smart home technology (SHT) requires careful customization and a sensitive approach to counteract negative perceptions and ensure acceptance. It is essential to educate older adults about the benefits and potential of innovative technologies, providing concrete examples of how these can enhance their quality of life and simplify daily activities. Suresh et al. [78] emphasized the importance of education and support in familiarizing older adults with the advantages of SHT. Through specialized approaches, it is crucial that older adults understand how the system can be personalized and tailored to their needs, with a focus on intuitive user interfaces.

Older adults should be aware that smart technology complements, rather than replaces, human interaction and serves as a supportive tool for facilitating everyday activities. Emphasizing the importance of privacy and data security is crucial for building trust when using smart technology. Organizing informational events can be beneficial for enhancing the acceptance of smart technologies among older adults. At these events, the details of SHT can be discussed more thoroughly, and testimonials from people who already use this technology can be shared.

Addressing why older people might feel stigmatized for owning smart homes requires understanding societal perceptions and age-related biases. Often, there is a misconception that older adults may not be technologically savvy or that they are too dependent on traditional ways of living. This can lead to feelings of inadequacy or embarrassment among older individuals when they adopt new technologies. To combat these feelings, it is important to showcase how smart homes are not just about technology but about enhancing personal autonomy and safety. Public discussions and media representation that positively reflect the successful integration of older adults with smart technology can also help to change these negative perceptions.

Furthermore, it is essential to explore how the physical and emotional comfort provided by smart homes can significantly reduce the social isolation often experienced by older adults. Smart homes enable older adults to maintain their independence while staying connected with their community and loved ones through advanced communication tools. This aspect should be highlighted to mitigate any feelings of shame associated with their living environment.

Working with health professionals can also play a crucial role in promoting smart technologies to enhance the well-being of older adults and reduce the burden on the social protection system. Peek et al. [69] highlighted the importance of accessibility and the integration of smart technologies for older adults. Adapting user interfaces and application designs to meet the specific needs of older adult users can make it easier for them to interact with technology and help break down stigma barriers. By fostering a community that understands and supports the use of smart technologies by older individuals, we can help ensure that these tools are seen as beneficial and dignifying enhancements to their lives, rather than sources of embarrassment or shame.

Table 10. Summary of research questions and responses.

Research Question	Response Summary	References
How Can We Ensure the Accessibility of Innovative Home Technology for All Levels of Society, Regardless of Financial Stability?	To ensure accessibility, manufacturers should develop a range of affordable products, explore partnerships for subsidies, and governments should promote technology through subsidies, tax incentives, and financial assistance. Education on benefits, recycling, and providing internet access are also crucial steps.	[59,62,84]
What Level of Support do Health Ministries Provide for Innovative Home Technology to Improve People’s Quality of Life?	Support varies by country. Some health ministries provide financial support, resources, and initiate pilot projects, while others offer research funding and training. The level of support depends on healthcare priorities, financial resources, and political will.	[37,55,58]
How Actively do Health Ministries Promote the Use of Smart Home Technology to Reduce Pressure on Nursing Homes?	Promotion levels vary by country. Some health ministries actively support smart technology use through financial aid, training, public campaigns, and guidelines. The extent of promotion depends on political will, financial resources, and country-specific priorities.	[38,59]
To What Extent do Wearable Sensors Need to be Redesigned to be Unobtrusive and Not Interfere with the Daily Lives of Users?	Wearable sensors need redesigning for comfort, aesthetics, and practicality. They should be small, lightweight, flexible, moisture and dust resistant, and integrated into daily wearables, such as clothing or accessories, to ensure high adoption and usability.	[16,67,77]
How Can We Create a Smart Home Application that is Equally Adaptable to Every User?	An adaptable smart home application requires an intuitive, user-friendly interface, customizable features, accessibility options for disabilities, and continuous user feedback for improvements. Engagement with users in the development process is crucial for adaptability.	[29,45,67,85]
To What Extent is it Necessary to Modify State Laws and Regulations to Align with Ethical Issues?	Modifications are essential to address ethical issues in AI, biotechnology, and autonomous systems. This includes patient privacy, data transparency, and fair benefit distribution. Laws should evolve with technology, ensuring public participation and constant review to reflect ethical implications.	[55,65,79]
How Can Smart Home Technology Address the Issue of Loneliness Among Older Adults while also Facilitating Their Daily Lives?	Smart technology can support social connections and enhance daily life through sensors and smart devices. It should be designed in collaboration with users, regularly updated based on feedback, and comply with ethical guidelines to effectively reduce loneliness and improve quality of life.	[50,72,75]
How Can We Overcome the Stigma Associated with Older Adults and Introduce Them to Smart Home Technology?	Overcoming stigma requires education on benefits, focusing on personalization, emphasizing privacy and security, and involving health professionals. Public events, positive media representation, and community support are also essential to change negative perceptions and promote acceptance.	[69,78]

summarizes the key points and actions suggested to address each research question.

5. Recommendations for Enhancing Smart Home Technologies for Older Adults

This section presents a carefully curated series of strategic recommendations aimed at enhancing smart home technologies (SHTs) to precisely cater to the distinct needs of the aging population. As societies grapple with the increasing demands of supporting a growing number of older adults, SHTs emerge as vital tools to aid in their everyday living. However, achieving their full potential requires substantial advancements in design, accessibility, security, and seamless integration with current systems and policies. The objective of these recommendations is to cultivate an environment in which SHTs not only bolster the daily lives of older adults but also enrich their capacity to live independently and with dignity.

5.1. User-Centric Design and Customization

User-centric design in smart homes involves developing technologies that are accessible and intuitive for older adults. This requires understanding the physical and cognitive changes associated with aging, such as reduced mobility, vision impairment, and diminished hearing. Design features might include voice-activated controls, high-contrast visual interfaces, and tactile buttons for easier manipulation. Additionally, customization should allow users to tailor settings to their individual needs, such as adjusting the thermostat via voice commands or customizing alert sounds for better audibility. Furthermore, engaging older adults in the design process can significantly improve the end product. This can be achieved through participatory design workshops, where older adults can try out prototypes and provide feedback. Such involvement not only ensures the functionality of the technology aligns with their needs but also increases their comfort level and familiarity with the technology, thereby promoting greater acceptance and satisfaction.

5.2. Cost-Effectiveness and Accessibility

The high cost of SHTs can be a significant barrier to their adoption among older adults. Strategies to address this include developing subsidized pricing models through partnerships with government agencies or private organizations focused on senior welfare. Additionally, insurance companies could be encouraged to include SHTs in their coverage, especially those that contribute to preventive healthcare, which could ultimately reduce overall medical costs by enabling older adults to manage their health at home. Moreover, offering scalable solutions can provide basic access to SHTs with optional upgrades. This ensures that all older adults, regardless of income level, can access essential features, with the possibility to expand functionalities as their comfort with the technology grows or as their needs change. This approach not only makes SHT more accessible but also allows for greater flexibility in adapting to individual requirements over time.

5.3. Enhanced Privacy and Security Measures

Implementing robust privacy and security measures is crucial in smart home environments to protect sensitive personal data of older adults. This includes the use of advanced encryption methods to secure data transmission and storage, as well as regular updates to security protocols to guard against potential cyber threats. Privacy policies should be transparent and easily understandable, providing clear information on how data are collected, used, and shared. In addition to technical measures, it is important to foster a culture of privacy within organizations that handle personal data. This involves training employees on privacy practices and developing policies that prioritize user confidentiality. Users should have control over their data, including who can access them and how they are used, empowering them to manage their privacy settings according to their personal preferences and security needs.

5.4. Interoperability and Standards

Ensuring interoperability among smart home devices from different manufacturers can greatly enhance the user experience. This requires the adoption of universal standards and protocols that allow devices to communicate seamlessly, regardless of their brand or model. Standardization not only simplifies the setup and maintenance of smart home systems but also enhances their reliability and functionality. The development of open platforms where developers can create compatible applications and tools can further enrich the smart home ecosystem. Such platforms encourage innovation and competition, leading to the development of more advanced, user-friendly solutions. Promoting interoperability also helps in future-proofing investments in SHT, as newer devices can integrate smoothly with existing systems.

5.5. Education and Training

To mitigate fears and build confidence among older adults in using SHTs, comprehensive education and training programs are essential. These programs should include hands-on workshops that allow older adults to interact with the technologies in a guided setting, which can help demystify the technology and illustrate its practical benefits. Online tutorials and printed manuals designed for cognitive and visual clarity can also support learning at home. Furthermore, community centers and senior organizations can play a pivotal role in providing ongoing support and training. By offering regular courses and updates on new features and devices, these organizations can help older adults stay current with technology developments. Peer-led training sessions can also be particularly effective, as older adults may feel more comfortable learning from someone who understands their experiences and challenges.

5.6. Monitoring and Evaluation

Regular monitoring and evaluation are necessary to ensure that SHTs continue to meet the needs of older adults effectively. This involves not only technical assessments to ensure devices are functioning as intended but also user feedback mechanisms to gather insights on user satisfaction and areas for improvement. Continuous user feedback can be facilitated through digital surveys, direct interviews, and usability testing sessions. Evaluating the impact of these technologies on the quality of life for older adults is also crucial. This can be performed through longitudinal studies that assess changes in independence, health outcomes, and social engagement as a result of using SHTs. The findings from these studies can help in refining existing products and shaping future innovations in the field.

5.7. Ethical Considerations

Ethical considerations in the deployment of SHTs involve ensuring that these innovations enhance rather than undermine the autonomy of older adults. Technologies should be designed with the consent and input of the users, providing them with clear information about what the technology does and any associated risks. It is also vital to ensure that these technologies do not replace human care but rather supplement it, maintaining essential human contact. Ethical deployment also involves considering the inclusivity of technology. This means designing solutions that are accessible to all older adults, including those with disabilities or those who are not technologically savvy. Efforts should be made to ensure that no segment of the older adult population is left behind as SHTs become more prevalent.

5.8. Community and Social Integration

Integrating community and social functions into SHTs can help address issues of loneliness and social isolation among older adults. Technologies that facilitate easy communication with family and friends, community engagement platforms, and social media can help maintain strong social connections. Features such as simple video calling interfaces and social networking tools specifically designed for older users can enhance their social participation and engagement. Moreover, integrating technologies that enable participation in virtual community events or online classes can help older adults feel more connected to their communities. These technologies can open up new avenues for engagement and interaction, ensuring that older adults remain active participants in social life despite any physical limitations.

5.9. Legislative and Policy Advocacy

To effectively integrate SHTs into the lives of older adults, comprehensive legislative and policy frameworks are needed. These frameworks should support the development and deployment of these technologies by addressing issues such as funding, standards, and privacy regulations. Policymakers can influence the scalability and sustainability of smart home solutions through incentives for innovation and strict guidelines that protect end-users. It is essential for government bodies to play an active role in promoting SHTs as part of aging-in-place initiatives. This can include providing grants for research and development, offering tax incentives for companies and consumers, and creating pilot programs that test the efficacy and safety of these technologies in real-world settings. Developing clear policies that guide the collection, use, and management of data from smart home devices is crucial. Policies should also ensure that these technologies are accessible to all, regardless of socioeconomic status. This might involve setting price controls or providing these technologies through government-funded healthcare services. Establishing and enforcing standards can help ensure that SHTs are safe, reliable, and effective. Regulatory bodies can set requirements not just for the physical and software components of these technologies, but also for their ethical implications, such as ensuring they do not infringe on the rights or dignity of older adults. Raising awareness among legislators and the general public about the benefits and challenges of SHTs can foster a more supportive environment for their adoption. Advocacy groups can play a vital role in ensuring that the voices of older adults are heard in the policymaking process.

6. Implications

For technology developers and designers, this research emphasizes the imperative of integrating human-centered design principles specifically tailored to the capabilities and preferences of older adults. The nuanced understanding of older adults’ interaction with technology necessitates designs that prioritize ease of use, intuitive interfaces, and minimalistic aesthetics to mitigate cognitive overload. Developers are encouraged to engage in participatory design processes, involving older adults and their caregivers in the developmental stages to ensure that the end products resonate with their actual needs and usage patterns. Furthermore, the findings advocate for the incorporation of adaptive technologies that can be customized to suit varying levels of physical ability and technical proficiency, ensuring broader accessibility. This approach not only enhances the user experience but also fosters a sense of ownership and comfort with the technology, ultimately leading to higher adoption rates.

Healthcare professionals and caregivers stand to significantly benefit from the integration of SHTs into older adult care routines. The implications for this stakeholder group involve a paradigm shift toward more proactive and preventive care models. By leveraging real-time data from smart homes, healthcare providers can monitor patients’ health more continuously, allowing for timely interventions before acute episodes occur. However, this transition necessitates upskilling and continuous education to effectively interpret data from smart home devices and integrate this information into care plans. Moreover, caregivers must develop a nuanced understanding of the ethical considerations associated with surveillance and autonomy to navigate the delicate balance between oversight and intrusion, ensuring that the dignity and independence of older adults are upheld.

The research outlines a clear mandate for policymakers and regulatory bodies to create an enabling environment that fosters the widespread adoption of SHTs among older adults. This includes crafting policies that incentivize the development of affordable and accessible smart home solutions, ensuring that the benefits of such technologies are not confined to the economically affluent. Equally important is the establishment of stringent data protection and privacy regulations to safeguard the sensitive information collected by smart home devices. Policymakers must also consider the broader socioeconomic implications of this technological shift, including potential impacts on employment within the caregiving sector and the need for social programs that facilitate digital literacy among older adults.

For the academic and research community, this study underscores the rich interdisciplinary potential that the field of smart homes and older adult care presents. Researchers are encouraged to further investigate the socio-technical intersections of this domain, exploring the psychological, ethical, and social dimensions of technology adoption among older adults. There is a pressing need for longitudinal studies that assess the long-term impacts of smart home living on the well-being and autonomy of older adults, providing empirical evidence to guide future developments. Moreover, the academic community plays a crucial role in training the next generation of technologists, designers, and healthcare professionals, imbuing them with a holistic understanding of the aging process and the role technology can play in enhancing the quality of life in later years.

For older adult users and their families, the integration of SHTs promises a transformative impact on daily living and care. This research advocates for systems that empower older adults with greater independence and self-efficacy, reducing reliance on caregivers for routine tasks. Families can find solace in enhanced safety features and emergency response systems, ensuring that their loved ones are protected and supported, even in their absence. However, the adoption of such technologies also necessitates open dialogues within families about privacy, consent, and the boundaries of technological intervention, ensuring that the dignity and wishes of older adults are at the forefront of any technological integration.

Community and social services organizations play a pivotal role in bridging the gap between technological advancements and the everyday lives of older adults. The implications for these organizations include the development of educational programs and support services that facilitate older adults’ understanding and use of SHTs. Collaborative efforts with technology developers can lead to the creation of pilot programs that demonstrate the tangible benefits of smart homes, serving as models for broader adoption. Furthermore, these organizations can advocate for policy changes that address the socioeconomic barriers to technology access, ensuring that the most vulnerable among older adults are not left behind in the digital divide.

7. Future Work Directions

Smart homes as caregivers for older adults is still a relatively new topic and, as such, requires further development. To address the gaps in the current literature, this section outlines key directions for future exploration and development, focusing on broadening the capabilities and effectiveness of SHTs in older adults’ care.

7.1. Ethical Challenges

The current ethical challenges include cost-effectiveness, privacy, autonomy, informed consent, dignity, security, and trust [93]. Since these issues are not unique to SHT but prevalent in many other technologies available today, it is necessary to establish laws that appropriately address these ethical challenges. Future research could explore developing guidelines and regulations to protect older adults’ rights and the moral acceptability of using smart homes. Additionally, future studies should focus on finding innovative technological solutions that provide security, privacy, and autonomy to older adults in smart homes. It is also essential to further investigate older adults’ perceptions of ethical issues related to smart homes to better understand their perspectives and needs.

7.2. Knowledge and Acceptance

Several factors influence the readiness of older adults to embrace SHT, one of which is their general knowledge of the technology itself [94]. Future research should focus more on addressing the knowledge gap among older adults regarding SHT, as their lack of understanding hinders their everyday use of smart homes. It is necessary to devise various approaches to transfer this knowledge, such as personalized training, supporting materials, community engagement, and peer-to-peer learning. A training program evaluation should also be created to determine the extent of knowledge achieved by older adults through education.

7.3. Cost Barriers

Due to the high costs involved, only a small number of people have adopted automation that transforms their residences into smart homes [95]. Future research should focus on developing cost-effective solutions to make innovative home technology more accessible to older adults and gain wider acceptance. Considering how to obtain government support for launching financial schemes or subsidies is necessary. Additionally, exploring partnerships between technology companies and organizations for older adults should be investigated to offer more affordable packages and options, reducing user costs. Future research should also analyze the needs and preferences of older adults to develop targeted strategies for cost reduction in smart homes, including the development of adaptable systems that allow for the gradual adoption of technology according to users’ financial capabilities.

7.4. Cultural Considerations

Many technologies in the design process do not account for cultural limitations [96]. Therefore, in future research, it is essential to focus on understanding the influence of cultural and geographical factors on the adoption of smart homes among older adults. To achieve this goal, in-depth cross-cultural research must analyze how different cultures impact the perception, acceptance, and use of SHT. What needs to be achieved in the future is the collaboration between cultural organizations and technology companies to tailor the development of smart homes to different cultures in different countries. Furthermore, there is a need to adapt the design of user interfaces to align with the specific needs, values, and preferences of older adults in different countries and cultures.

7.5. Wearable Sensors

Wearable sensors are directly or indirectly attached to the human body and provide continuous information [97]. However, there are challenges related to the comfort and practicality of wearing these sensors. In future research, it is crucial to focus on developing user-friendly wearable sensors that do not cause discomfort or limitations to the users. This includes improving the sensor design to reduce size, weight, and pain during wear. Furthermore, careful consideration should be given to privacy issues regarding data collected through wearable sensors, ensuring secure and protected processing and storage. Additionally, future research should explore integrating wearable sensors with other SHTs to provide comprehensive and personalized support for older adults. It is essential to create wearable sensors that are useful, easy to use, comfortable to wear, and socially and ethically aligned.

7.6. Healthcare Professional and Caregiver Perspectives

While our analysis has thoroughly examined the benefits and challenges smart homes present to older adults, it is evident that the perspectives of healthcare professionals and caregivers have not been as prominently featured. This oversight is significant, as these stakeholders play a crucial role in the adoption and successful integration of SHTs into the lives of older adults. Their viewpoints, informed by direct caregiving experience and medical expertise, are essential for understanding the practicality, ethical considerations, and potential impacts of these technologies on older adults’ care. For instance, healthcare professionals can offer invaluable insights into how smart home features could be optimized for medical monitoring and emergency responses, potentially transforming the way older adults’ care is administered. Similarly, caregivers’ daily interactions with older adults place them in a unique position to assess the usability and effectiveness of smart homes from a practical standpoint. Their feedback can highlight areas for improvement, ensuring that smart homes are not only technologically advanced but also user-friendly and supportive of older adults’ independence. To address the identified gap in our understanding of smart homes for older adults, future research should aim to investigate the perceptions of healthcare professionals and caregivers. It is recommended that subsequent studies undertake qualitative methodologies, such as interviews and focus groups, to capture the nuanced opinions of these key stakeholders regarding SHTs. The focus should be on elucidating the perceived benefits and concerns, as well as garnering suggestions for making SHTs more compatible with professional caregiving practices. The insights obtained from such studies are anticipated to be instrumental in refining smart home designs to better meet the needs of both older adults and their caregivers, ultimately fostering a more holistic approach to aging in place.

7.7. Theoretical Frameworks

To enrich the analysis within this systematic review, it is pertinent to incorporate an analytical lens provided by key theoretical frameworks, such as the Technology Acceptance Model (TAM), Innovation Diffusion Theory (IDT), and the Socio-Technical Systems (STS) perspective. These frameworks offer a multifaceted understanding of the adoption and impact of SHTs in older adults’ care, thus enhancing the depth and comprehensiveness of the review. The TAM, as proposed by Davis [98], posits that the perceived usefulness and perceived ease of use are significant determinants of an individual’s intention to use technology. In the context of smart homes for older adults, perceived usefulness might relate to the technologies’ potential to enhance safety, health monitoring, and overall quality of life, while perceived ease of use underscores the importance of user-friendly interfaces and systems designed to accommodate the unique needs of older adults. This framework suggests future research directions aimed at understanding how these perceptions influence older adults’ willingness to adopt SHTs and identifying design modifications that could improve usability and acceptance. Rogers’ IDT [99] provides further insights into how new technologies are adopted within a community, focusing on attributes such as relative advantage, compatibility, complexity, trialability, and observability. Applying IDT to SHTs for older adults could elucidate factors such as the perceived benefits versus traditional older adult care methods, the compatibility of these technologies with older adults’ lifestyles and values, and the role of observable benefits in promoting wider adoption among the older adult population. Lastly, the STS [100] perspective emphasizes the interplay between technology, individuals, and the societal context, highlighting the need to consider not only the technical features of smart homes but also the social environment in which they are implemented. This includes the support systems available to older adults, such as family, caregivers, and healthcare providers, and the importance of designing technologies that facilitate not only physical well-being but also social connectedness and psychological health. Incorporating these theoretical perspectives into the discussion on smart homes for older adults not only addresses the multifaceted nature of technology adoption but also aligns with the goal of creating inclusive, practical, and supportive environments for aging populations. Further exploration of these frameworks in future research could lead to more effective design, implementation, and utilization of SHTs, ultimately enhancing the lives of older adults.

7.8. Collaboration with Healthcare Agencies and Technology Companies

Healthcare organizations enable the exchange of knowledge and experiences and will be able to identify the critical needs of older adult patients living in smart homes. It is imperative to align protocols between healthcare systems and technology companies to enable rapid data exchange and system integration, ultimately establishing clear communication channels between healthcare workers and smart home users for timely decision-making when needed. Additionally, it is crucial to ensure secure data sharing among various systems and prioritize the needs of older adults.

8. Limitations

This study is subject to several limitations that merit consideration. First, the systematic literature review was inherently limited by the articles available for analysis. Studies not published in the searched databases or published outside the timeframe of 2010 to 2023 were not included, potentially omitting relevant innovations or findings. Secondly, the review predominantly relied on published academic literature, which may reflect publication bias favoring studies with positive results. This could skew the overall depiction of SHTs’ effectiveness. Thirdly, while this research spans a significant temporal range, the rapid evolution of technology means that newer innovations may not be fully represented in the literature reviewed. Additionally, the scope of this review was restricted to articles written in English, which excludes potentially valuable research published in other languages. Finally, the study’s focus on older adults may not capture the nuances of technology use among diverse subgroups within this demographic, such as varying levels of technology literacy or socioeconomic differences that could influence technology adoption and utilization.

9. Conclusions

This systematic literature review, covering a wide array of sources from 2010 to 2023, identified crucial advancements as well as substantial barriers that these technologies face in the context of older adults’ care.

The potential of smart home technologies to improve safety, health monitoring, and the overall independence of older adults is evident. Innovations in IoT and integrated smart systems have demonstrated significant benefits, including enhanced ability to age in place, reduced need for institutional care, and better management of health conditions through continuous monitoring. These technologies not only support the physical health of older adults but also address psychological and social well-being by enabling connections with caregivers and loved ones, thus reducing feelings of isolation.

However, the review also highlighted several persistent challenges that need to be addressed to realize the full potential of these technologies. High costs and technical complexities make these solutions less accessible to a broader segment of the aging population. Privacy and ethical concerns, particularly related to data security and user autonomy, continue to pose significant hurdles. Moreover, the rapid pace of technological change means that findings related to the effectiveness and user acceptance of older systems may quickly become outdated, necessitating ongoing research and adaptation of recommendations.

The findings from this review also indicated a need for a more inclusive approach to technology development. Current smart home solutions often fail to fully consider the varied capabilities and preferences of older adult users, suggesting a gap in design practices that could be addressed by involving end-users more directly in the development process. Additionally, policy and regulation have not kept pace with technological advancements, indicating an urgent need for frameworks that better protect users while promoting innovation.

Educational initiatives aimed at both users and caregivers could enhance technology acceptance and utilization, ensuring that more older adults can benefit from these innovations. Future research should focus on longitudinal studies to assess the long-term impacts of smart home technologies on aging in place, and on developing scalable, cost-effective solutions that can be widely implemented.

While the adoption of smart home technologies in older adults’ care presents notable advantages, the full integration of these systems into everyday use will require concerted efforts from researchers, developers, and policymakers. Only through sustained collaboration and commitment to addressing the outlined challenges can we ensure that smart home technologies effectively contribute to the care and well-being of the aging global population. This study sets a foundation for further exploration and development in the field, aiming to bridge the gap between technological potential and practical, everyday application for older adults.