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

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.

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.

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.

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.