The effectiveness and costeffectiveness of remotely monitored assistive technology in community-dwelling older people

By 2050, the population of those aged 65 years and over is expected to double, increasing demand for care in hospitals and residential care facilities. Current Government policy aims to support older people to live independently at home for as long as possible. Assistive technology (AT) particularly with remote patient monitoring capabilities can promote independent living by helping providers monitor a person’s health and alert healthcare professionals if support is needed.

This systematic review examined the effectiveness and cost-effectiveness of remotely monitored AT for older people living in the community in Organisation for Economic Co-operation and Development (OECD) member countries.

Twenty studies investigated 17 different AT (products or systems) and their impact on healthcare utilisation while 5 investigated the cost-effectiveness of 5 AT. A range of different products were used across the studies, from products aimed at a single metric (e.g. blood pressure) to more complex packages or systems that monitor several different metrics (e.g. the e-GEROPASS software, a hub with seven external biometric sensors). We did not identify any Irish studies.

In relation to healthcare utilisation outcomes, most outcomes were graded as very low certainty, meaning that our confidence that future studies would report similar findings is limited or very low. This was the case for: the effect of remotely monitored AT on emergency department (ED) visits; hospitalisations and length of stay; admissions to long-term care facilities; outpatient visits; days at home and home care episodes; and access to diagnosis. One outcome demonstrated low-certainty evidence, that remotely monitored AT results in an increase in urgent care visits (incidence rate ratio: 1.6). Two outcomes, days at home and primary care encounters, demonstrated moderate-certainty evidence that remotely monitored AT results in a small increase in the number of days at home (mean difference: 3.4 more days at home) and fewer primary care encounters (mean difference: 0.4 fewer visits) among a general population of older people. One study found that AT may reduce post-fall admissions to the ED. Moderate certainty evidence means that future studies would probably report similar findings.

Most cost-effectiveness studies projected that remotely monitored AT had a positive impact on costs without decreasing effectiveness, although three studies found that the benefits sometimes varied across levels of risk among patients. One Dutch study projected that nursing telephone support resulted in increased quality-adjusted life years and lower costs for most patients with heart failure, making it the dominant choice over home telemonitoring; only in the most severe cases was home telemonitoring a potentially cost-effective choice. Another study from the United States of America projected that a home-based visual-field monitoring system was more cost-effective for high-risk patients than for low-risk patients. One Norwegian study projected that smart home technology for older adults was cost-saving compared with older adults living at home without smart home technology, with cost-savings increasing with greater functional impairment. When compared with older adults living in a nursing home, smart home technology at home was still projected to be cost-saving, but the savings decreased with greater functional impairment. However, the generalisability of these findings to the Irish context was limited due to differences in healthcare systems examined and study design choices.

Although our review was comprehensive, it also highlighted a weak evidence base, research gaps, and challenges in the evaluation of complex personalised AT for remote patient monitoring. There is a need for more robust research into how AT affects the health outcomes of community-dwelling older adults. Expanding this evidence base, as well as investigating the acceptability, experience, and clinical outcomes of remotely monitored AT, will help better integrate it into the lives of older adults.