Emerging Technologies and Vulnerabilities in Older Adults Without Cognitive Impairments: Systematic Review of Qualitative Evidence.

Background: Aged care has recently undergone major transformations due to demographic aging and the concomitant need to manage health care costs. New emerging technologies (ETs) have started to play central roles in the daily management of older adults. For these transformations to effectively promote successful and active aging, it is essential to understand the opinions of older adults on the impact that technology can have on their vulnerabilities and aging process. Objective: This work aims to study the ethically related impact of ETs on cognitively healthy older adults' vulnerabilities. Methods: Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a systematic review of empirical (qualitative) evidence exploring the relationship between ETs and older adults' vulnerabilities as perceived by older adults (older than 65 years) without cognitive impairments. Five major databases (PubMed, Web of Science, Embase, CINAHL, and Philosopher's Index) were queried on March 1, 2022. After eliminating duplicates, titles, abstracts, and full texts were screened for relevance. Data analysis and synthesis followed the preparatory steps of the coding process detailed in the Qualitative Analysis Guide of Leuven methodology, which involved carefully reading the publications included, identifying significant themes, and constructing conceptual schemes for each paper. The quality of the publications was evaluated by using the Critical Appraisal Skills Program. Results: A total of 11,631 results were obtained. Eventually, 70 articles were included, and of these, 46 articles had a high level of methodological quality. The remaining 24 articles had moderate quality. ETs appeared to have an ambivalent effect, mitigating some already existing vulnerabilities, and at the same time, worsening already existing vulnerabilities or creating new vulnerabilities. For example, unconventional monitoring techniques (eg, wearables) often mitigated relational vulnerability, helping to maintain independence and remain at home and in one's community. Conversely, these same devices may negatively affect moral vulnerability, threatening older adults' privacy linked to data confidentiality. Conclusions: This systematic review, which focused on the perceptions of older adults without cognitive impairments, enriches the vast literature about the everyday management and care of seniors by exploring the ethical implications of ETs. This research is complementary to another systematic review of qualitative evidence, which analyzed the views of older people with cognitive disorders on the same topic. Although a certain ambivalence in the use of ETs was identified by both population groups, it is interesting how cognitively healthy older adults give more importance to some dimensions of vulnerability, such as the moral and relational ones, which, in the case of cognitively impaired older adults, are not as significant. Two important aspects identified were the respect of privacy and data security, and the perceived risk of control and surveillance linked to the use of monitoring technologies.