Ethical and Quality of Care-Related Challenges of Digital Health Twins in Care Settings for Older Adults: Scoping Review.

Background: Digital health twins (DHTs) have been evolving with their diverse applications in medicine, particularly in care settings for older adults, in response to the increasing demands of older adults. Despite its numerous benefits, the optimal implementation of DHTs has faced several challenges, particularly in terms of ethics and quality of care. Given the continuous rise in the need for such care and the evident potential for DHTs to meet these needs, this review seeks to identify and address the gaps in research knowledge to enhance DHT implementation. Objective: The review aims to compile and synthesize the best available evidence regarding the issues associated with quality of care, the ethical implications of DHTs, and the strategies undertaken to overcome those challenges in care settings for older adults. Methods: The review followed the Joanna Briggs Institute (JBI) methodology as a guide. The published studies were searched through CINAHL, MEDLINE, JBI, and Web of Science. The unpublished studies were searched through Mednar, Trove, OCLC WorldCat, and Dissertations and Theses. Studies published in English from 2016 were considered. This review included studies of older individuals (aged 60 years and older) undergoing care delivery associated with DHTs and respective care providers. The concept involved the application of technology, and the context included studies based on care settings for older adults. A broad scope of evidence, including quantitative, qualitative, text, and opinion studies, was considered. In addition, 2 independent reviewers screened the titles and abstracts and reviewed the full text. Results: The results will be presented in a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram. A total of 2 draft charting tables were developed and presented. A summary of the characteristics of the included studies was then described in terms of location, study sites, timing, participants, and outcomes measured or phenomena of interest. A result-based convergent (integrated) synthesis design was used to identify 5 key challenges. Those challenges included (1) data security and privacy concerns, (2) equity and accessibility of health care, (3) effectiveness concerning context, timing, and location, (4) ethical implications regarding autonomy, consent, and overdiagnosis, and (5) the impact of DHTs on health care workflows and provider workload. Conclusions: The studies reviewed reveal several critical characteristics regarding the implementation of DHT technologies and their associated ethical considerations, particularly in terms of safety, equity, timing, location, participant characteristics, and workflow impact. The implications of these challenges emphasize the necessity for more practical ethical guidelines and policy frameworks to mitigate the potential risks associated with DHT application in older care. Further research should be conducted to examine other dimensions of the quality of care, such as access, timeliness, acceptability, and appropriateness.