Ethical considerations in home monitoring technologies for persons living with cognitive impairment: a scoping review.

Journal: The Gerontologist
Published Date: Feb 12, 2026

Abstract

BACKGROUND AND OBJECTIVES: As the global population of people living with cognitive impairment grows, Home Monitoring Technologies (HMTs), such as cameras, motion sensors, wearable trackers, and artificial intelligence enabled ones are increasingly used to enhance safety and support aging in place. However, these technologies raise ethical concerns, particularly regarding privacy, autonomy, trust, and transparency. This scoping review explores these ethical implications and identifies key themes to inform future research, practice, and policy development. RESEARCH DESIGN AND METHODS: Following Arksey and O'Malley's scoping review framework, systematic searches were conducted in PubMed, EMBASE, CINAHL, and PsycINFO (Arksey & O'Malley (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8, 19-32). Studies were included if they examined HMTs for people living with cognitive impairment and addressed ethical concerns. Our eight central themes were derived inductively during data synthesis, and the Rubeis' 4D Risks Framework offered a valuable conceptual scaffold to organize and interpret the broader patterns of ethical risk. RESULTS: A total of 110 publications from 30 countries were reviewed. Ethical concerns were identified in each of the 4 areas of the framework, including privacy violations, loss of autonomy, erosion of trust, and unintended consequences such as social isolation and reduced human interaction. Person-centered design approaches, which engage both people with cognitive impairment and caregivers, were identified as crucial for mitigating risks and fostering ethical implementation. DISCUSSION AND IMPLICATIONS: Findings underscore the need for evidence-informed guidelines that explicitly incorporate ethical frameworks to ensure consideration of the balance of health and safety with autonomy and dignity.

Authors

  • Jing Wang
    Endoscopy Center, Peking University Cancer Hospital and Institute, Beijing, China.
  • Sajay Arthanat
    Department of Occupational Therapy, University of New Hampshire, Durham, NC, USA.
  • Eugenia Opuda
    College of Health and Human Services, University of New Hampshire, Durham, NH, USA.
  • Dain LaRoche
    College of Health and Human Services, University of New Hampshire, Durham, NH, USA.
  • Samantha Hamilton
    College of Health and Human Services, University of New Hampshire, Durham, NH, USA.
  • Amber Li
    College of Health and Human Services, University of New Hampshire, Durham, NH, USA.
  • Chloe Mitchell
    College of Health and Human Services, University of New Hampshire, Durham, NH, USA.
  • Aubrie Woodward
    College of Health and Human Services, University of New Hampshire, Durham, NH, USA.
  • Guowei Li
    Center for Clinical Epidemiology and Methodology, Guangdong Second Provincial General Hospital, Guangzhou, China.
  • Momotaz Begum
    Department of Computer Science,University of New Hampshire,Kingsbury Hall,N215A,Durham,New Hampshire 03824,USA.
  • Giovanni Rubeis
    Institute of Ethics and History of Medicine, Greifswald University, Greifswald, Germany.
  • Charlene Chu
  • Kirsten Corazzini
    College of Health and Human Services, University of New Hampshire, Durham, NH, USA.

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