Session 1C: Works in Progress
The Adoption, Issues, and Challenges of Wearable Healthcare
Technology for the Elderly
Chi Zhang
Department of Information Technology
Kennesaw State University
Marietta, Georgia, USA
chizhang@kennesaw.edu
ABSTRACT
Wearable healthcare technology allows consumers to track their
healthcare data for either personal or clinical use. As
advancements in this technology continue to rise, the use of these
wearable devices has become more widespread. This paper
summarizes the factors that influence elderly consumers’ adoption
of wearable healthcare devices and perceived risks. This paper also
reviews advancements for the wearable healthcare devices and
examines the associated ethical questions. The use, issues, and
future of wearable technology in healthcare need to be critically
analyzed to best serve the interest of the elderly population. The
suggestions for future studies may help companies interested in
increasing the adoption of wearable devices.
KEYWORDS
Wearable technology in healthcare; Elderly Population; Internet of
Things; Artificial Intelligence; Perceived Usefulness; Privacy; Data
Security; Personalization; Electronic Health Records
ACM Reference format:
Chi Zhang and Hossain Shahriar. 2020. The Adoption, Issues, and
Challenges of Wearable Healthcare Technology for the Elderly. In
Proceedings of 21st Annual Conference on Information Technology
Education (SIGITE’20), October 7-9, 2020 Virtual Event, USA. ACM, New
York, NY, USA. 4 pages. https://doi.org/10.1145/3368308.3415454
1 INTRODUCTION
As the Internet of Things (IoT) technology becomes more
ubiquitous, wearable devices play a significant role in the
maintenance of health, prevention of disease, patient management,
and disease management [13, 28]. These devices can work from
simple tasks such as counting footsteps to relieving pain through
electrical impulses [1, 10].
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https://doi.org/10.1145/3368308.3415454
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SIGITE ’20, October 7–9, 2020, Virtual Event, USA
Hossain Shahriar
Department of Information Technology
Kennesaw State University
Marietta, Georgia, USA
hshahria@kennesaw.edu
Wearable devices such as the Fitbit, Apple Watch, and Android
can track information related to health and fitness, including
monitoring heart rate, glucose, heartbeat, etc. [6]. Smart devices
can extend their operational parameters with downloaded
applications and be personalized for specific situations. For the
older population specifically, wearables offer the opportunity to
help monitor care and contribute to their feelings of safety at
home [17, 29]
According to the Census Bureau, all baby boomers will be age 65
or older by 2030 [3]. As the gap between the older people and the
number of professionals caring for them grow, there is a greater
need for automated systems to lighten the load on these caregivers
[18]. While wearable devices continue to gain popularity, the
perceived risks point to concerns over data privacy and whether or
not the devices are truly accomplishing what they promise to
achieve. To best serve the interest of the elderly, the use, issues,
and challenges in healthcare should be critically analyzed to
determine their benefits and maximize their potential. This paper
is organized as follows: Section 2 reviews prior studies of adoption
and perceived issues, Section 3 proposes directions of future
studies in wearable healthcare technology, and Section 4 concludes
the paper.
2 LITERATURE REVIEW
2.1 ADOPTION OF WEARABLE HEALTHCARE
TECHNOLOGY
While wearable healthcare devices allow patients autonomy over
monitoring their health and symptoms, they have not yet been as
widely adopted as other portable technology, such as smartphones
[4]. A research team led by Cheung found that perceived
usefulness was the greatest factor in determining the purchase of
the devices, and it has a greater impact on consumers than
influence from their peers. They also found that an individual’s
personal beliefs about health impacted theirs as well. Tran et al. in
France [23] found that the patients’ hesitation stemmed from the
fear of the overuse of technology removing the human touch in
healthcare.
The adoption of this technology for the elderly has been reviewed
specifically. Several studies noted that wearable healthcare could
be beneficial to this population but found that those over 65 may
own the technology but were less likely to use them [14, 20, 26,
27]. Although considering the survey collection method used in
Session 1C: Works in Progress
the studies also required the use of technology, there is a
possibility that the adoption among the elderly is lower.
2.2 MHEALTH TECHNOLOGY ADOPTION FOR
CARDIOVASCULAR MANAGEMENT
Using a mobile app with wearable technology to improve the
quality of life is considered groundbreaking in modern healthcare.
World Health Organization [30] defines mobile health (mHealth)
technology as a medical and public health practice supported by
mobile devices, such as mobile phones, patient monitoring devices,
personal digital assistants, and other wireless devices. A mobile
application is a promising tool to promote a sustained and
successful healthy behavioral lifestyle. Research has investigated
the use of mHealth for Cardiovascular disease management.
Honeyman et al. [12] explained the usage of mHealth for cardiac
arrest, arrhythmias, myocardial infarction, heart failure, and
interventional cardiology. mHealth helps improve cardiac care
from both a patient and a clinical perspective. They highlighted
some of the key cardiac interventions where mobile health has
been applied or studied in both acute and longer-term care
settings. Treskes et al. [24] discussed uses of mHealth for remote
monitoring of cardiovascular patients, and the untrustworthiness
of mobile technology, insufficient regulation, and poor
compensation for mHealth implementation. Tundjungsari et al.
[25] compared several mHealth applications with the ability to
calculate cardiovascular risk factors. They conducted usability
testing toward three different mHealth applications by involving
different participants (physicians, IT developers, and patients). The
result indicates that knowing the target user's need is central in
the design process.
2.3. PERCEIVED ISSUES OF WEARABLE
HEALTHCARE TECHNOLOGY
As mentioned in the study done by Tran’s team, a key concern is
information privacy. Stephen Robinson [21] reviewed the privacy
policies and disclosure practices of five wearable devices for pain
management. The article identifies scenarios and recommends that
manufacturers need to make an effort to clearly and concisely
state how data is used and allow users to be able to opt-out.
Another study by Cilliers [5] surveyed a sample of 106 consumers
using wearable healthcare technology on their knowledge of the
privacy policies and data storage. Over half of them did not know
the details of their devices’ privacy policies or how their health
data were stored. Murky privacy policies are just one of the ethical
questions raised by wearable healthcare device technology [9].
Lucivero and Jongsma [16] critically analyzed the ethics of these
devices on efficiency and prevention but it was inconclusive.
Finally, accessibility only goes so far when many of the devices
require the use of a smartphone, which limits and possibly
prevents the use of this technology due to limited financial means.
Another ethical question regarding wearable healthcare
technology is the use of the data collected by such devices.
Montgomery et al. [19] noted the technology’s potential for
“discriminatory profiling, manipulative marketing, and data
breaches.” By using analytical models, these companies can use
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the collected data to target advertising for additional medical
expenditures, such as certain pharmaceutical products. It was
found that certain populations are more likely to use their
smartphones to research health conditions. Therefore, these
populations are more susceptible to their data being used for
profiling. All of these studies note data privacy as an outstanding
issue of wearables. Overall, using these devices to shift the
responsibility of healthcare from the industry to the individual is
an ethical question society must consider.
2.3. THE FUTURE OF WEARABLE
TECHNOLOGY IN HEALTHCARE
With data security at the forefront of the wearable healthcare
device industry, advancements continue to be explored. Dwivedi
[8] propose their model for using blockchain technology to secure
data transactions in these devices [8]. Another research used a
variety of experimental tests to determine the performance of
various sensors [11]. By maximizing the accuracy of sensors, it is
believed that future wearable devices will be able to better
personalize results.
One of the main benefits of wearable healthcare technology is how
it allows the consumer to collect and review their health data
outside of the doctor’s office. However, there would also be
benefits to bringing this data back into the healthcare setting; for
example, allowing trained medical professionals to identify trends
that could indicate a potential issue. A study [7] reviewed the
trend of integrating data from these devices into patient electronic
health records (EHRs). Best practices and workflows still need to
be further explored and finalized. These studies focused on
improving the technical aspects of wearable healthcare devices.
Further studies would need to be conducted on a specific
technology to ensure that it can accomplish the goals put forward.
3 PROPOSAL FOR FUTURE STUDIES
3.1 INCREASING ELDERLY CONSUMER
ADOPTION
The previously mentioned study by Cheung’s team [4] noted the
perceived usefulness of wearable healthcare technology as the top
reason for consumer adoption. However, the question remains as
to what quality of the technology is seen as most useful. Options
range from early detection of medical conditions, individualization
and personal ownership of healthcare, management of symptoms,
and more. A future study to delve into what aspect of the
technology is perceived as most useful could help companies
better market their products (and therefore further increase
adoption). Cheung’s [4], Tran’s [23], and Kekade’s [14] teams all
used a specific population for their studies. Therefore, further
studies in other regions and elderly populations could better assess
whether or not their results scale globally.
3.2 PRIVACY CONCERNS
Concern over the security and use of the data collected by
wearable healthcare devices is widespread. As these devices
continue to shift the responsibility of healthcare from the industry
to the consumer, the burden of data privacy education must be
considered. Ideally, manufacturers would make an effort to clearly
Session 1C: Works in Progress
and concisely state how data is used and allow users to ability to
opt-out of providing it. However, it would be beneficial to study
the most impactful way to educate the general population on how
their data should be handled.
The technology used to secure data in other industries can be
expanded onto the wearable healthcare industry as well. The
blockchain model proposed by Dwivedi’s team [8] could be
groundbreaking in securing the healthcare data handled by these
devices. Further studies should be conducted to test the data
security capacities of that specific technology. Tests should include
a variety of potential data breaches and cyberattacks.
3.3 POTENTIAL DISCRIMINATION
Older population and individuals within lower-income populations
are often at great risk for health-related issues. Wearable
healthcare devices provide multiple benefits in managing current
symptoms and monitoring health data for early detection.
However, device costs (or associated device costs, such as
smartphones) can often be prohibitive to consumer adoption. To
better serve all members of society, a future study could be
conducted on ways to effectively reduce the costs of wearable
technology and provide budget-friendly alternatives to what is
currently on the market.
To prevent potential discrimination and/or exploitative marketing,
wearable healthcare device data regulations should be considered.
Expanding upon healthcare data privacy policies could help
prevent companies from taking advantage of certain populations.
However, if new or updated legislation is put into place to regulate
wearable healthcare technology data, there will be costs and effort
associated with bringing current products up to code. Therefore, a
future study on the impact of regulation in this industry would be
beneficial.
3.4 OTHER BARRIER TO ADOPTION
Devices that require little or no user interaction would be
preferable. The idea is not to overwhelm people with extra
features when a specific use case is required. For some users
having extra features and tracking will make them use the devices
more, for others it will be a hindrance and cause them to forsake
their use.
Under current regulations by the United States Food and Drug
Administration (FDA), there is no single standardization of
medical smartphone application. The FDA has issued guidelines
st
for the creation and use of applications as part of the 21 Century
Cures Act, but as of this time exerts no true power on the matter.
The FDA is currently using a pilot program to determine the
effectiveness of a new product review system for smartphone
rd
applications using 3 party firms rather than its traditional in-
house testing [22]. While there is no single official government
standardization there are several other non-governmental and
professional standards that exist, which pertain to different
technologies that a mobile health application would use, including
HL7 CDA Rel.2, HL7 v2.x, FHIR, Auto Blue Button (ABBI) – S&I
Framework, Digital Imaging and Communications in Medicine
(DICOM), Body Area Network, Certificate Interoperability,
ISO/IEEE 11073 [15].
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For security concerns, it should be noted that health applications
will contain and transmit Personal Health Information (PHI) data,
this makes them subject to HIPAA. If the application is just
tracking specific non-identifiable information such as calorie
counts to the amount of time exercised it is exempt for HIPAA. For
example, for an anomalous heartbeat detection system that will
automatically send out an alert for medical help, the application
must have certain information such as name and location for
alerts. While these in-themselves are not PHI, if an application
does anything else or requires more information then it may no
longer be exempt. Tracking an individual location may be allowed
by a user, but more information collected such as age, sex, home
address, existing health issues could bring complicacy in storing
and sharing of data among providers without permission.
Some wearable devices rely on smartphone applications to record
and report information. They allow patients or care providers to
view the collected information. Most consumer smartwatches have
an application available on either Android, IOS, or both. Stanley
Healthcare has apps available for care providers, but these are not
usable by the patients.
In the case of health monitoring devices, there are major concerns
regarding security and privacy. The over-collection and misuse of
data have been a substantial issue over the last few years and these
devices are no exception. Questions have to be asked about the
ownership and use of such data, for instance, is collected
information the property of the individual, the application
provider, the government (in instances involving service members
or Medicaid/Medicare recipients), the insurance company, or the
medical facility that requested the monitoring. It should also be
discussed if any of the collected information will be used by the
government or third-party companies, and if so if it would be
scrubbed first.
Unreliable connections may also create an unneeded barrier for
the use of monitoring devices. The elderly are less likely to have
in-home Wi-Fi installed compared to most other demographics.
Depending on the type of devices used, Wi-Fi could be more
reliable than a cellular signal or even required due to cost and the
amount of data being transferred. In rural America, there are still
issues with communications either having gaps in the service area
or in the speed in which they operate. This is part of a larger
problem called the “digital divide” which is that some areas have
better access to technology than others. Without a reliable high-
speed communication to and from a patient's home, a fall
detection system will simply not be effective. The situation has
gotten better over the years with the majority of homes having
access to the internet, but just basic access itself is not enough.
Data from the Federal Communications Commission reports
research shows there are still massive tracts of the United States
with internet connections slower than 10Mbs [2].
Technology, especially related to healthcare, can be incredibly
expensive. Most elderly persons in the United States rely on a
fixed income coming from retirement savings, Social Security
payments, help from others, or a combination of these. The price
of a monitoring system should be paid at least partially by
Medicare as monitored individuals will all be over the age of 65. If
a monitoring system is not paid for by Medicare or private
Session 1C: Works in Progress
insurance, then it has little chance of success. Integrating existing
technologies with newer systems allows for the cost of these
systems to be reduced. Life alert for instance uses cellular
technology to call for help, but it is only used to call for help rather
than constantly communicating patient information to care
providers. Stanley Healthcare uses a combination of WiFi and LoFi
communications to send patient data.
3.5 SUMMARY
Wearable devices and associated technologies are important topics
of interest to the community. We continue to see an increasing
number of research work examining different aspects of wearables
including the design, development, implementation, and
evaluation from the hardware, software, and usability
perspectives. Discussion of the related issues such as device
characteristics as drivers for wearable adoption and productivity,
sustainable use, user interaction, among others. This paper intends
to explore the issues that are particularly of interest among elderly
people – privacy concerns, potential discrimination in terms of
cost and adoption, personalization, and integration with EHR for
the elderly’s documented health issues, data sharing, and HIPAA
and other regulatory compliance. More studies are needed to
explore further how the issues identified in this paper affect the
positive role that the wearable technology provides to the
population at large and elderly in particular.
4 CONCLUSION
Wearable healthcare technology allows consumers to record their
healthcare data for either personal or clinical use via portable
devices. As advancements in this technology continue to rise, the
use of these devices has become more widespread. Increasing the
security of wearable healthcare devices will decrease the
associated risks while allowing for increased personalization will
increase the associated benefits. If the industry continues to
innovate in these directions, the issues noted for these devices will
be mitigated and consumer adoption will rise. Increasing the use
of wearable healthcare devices will allow both individual patients
and healthcare professionals to use the generated data to make
more informed decisions for care and prevention. Although
additional research is warranted, wearable healthcare devices
present a great opportunity for accessing data on patients’ out of
office experiences.
REFERENCES
[1] 8 products that can relieve pain without medicine: 2019.
https://www.cnet.com/health/chronic-pain-relief-without-drugs-8-products-to-try/.
Accessed: 2020-06-02.
[2] 2018 Broadband Deployment Report: 2018. https://www.fcc.gov/reports-
research/reports/broadband-progress-reports/2018-broadband-deployment-report.
Accessed: 2020-06-02.
[3] By 2030, All Baby Boomers Will Be Age 65 or Older: 2019.
https://www.census.gov/library/stories/2019/12/by-2030-all-baby-boomers-will-be-
age-65-or-older.html. Accessed: 2020-06-02.
[4] Cheung, M.L. et al. 2019. Examining Consumers’ Adoption of Wearable
Healthcare Technology: The Role of Health Attributes. International Journal of
Environmental Research and Public Health. 16, 13 (Jan. 2019), 2257.
DOI:https://doi.org/10.3390/ijerph16132257.
[5] Cilliers, L. 2019. Wearable devices in healthcare: Privacy and information
security issues. Health Information Management: Journal of the Health
Information Management Association of Australia. (May 2019), 1833358319851684.
DOI:https://doi.org/10.1177/1833358319851684.
53
SIGITE ’20, October 7–9, 2020, Virtual Event, USA
[6] Dias, D. and Paulo Silva Cunha, J. 2018. Wearable Health Devices—Vital Sign
Monitoring, Systems and Technologies. Sensors (Basel, Switzerland). 18, 8 (Jul.
2018). DOI:https://doi.org/10.3390/s18082414.
[7] Dinh-Le, C. et al. 2019. Wearable Health Technology and Electronic Health
Record Integration: Scoping Review and Future Directions. JMIR mHealth and
uHealth. 7, 9 (Sep. 2019), e12861. DOI:https://doi.org/10.2196/12861.
[8] Dwivedi, A.D. et al. 2019. A Decentralized Privacy-Preserving Healthcare
Blockchain for IoT. Sensors (Basel, Switzerland). 19, 2 (Jan. 2019).
DOI:https://doi.org/10.3390/s19020326.
[9] Eckenwiler, L. 2018. The Murky Ethics of Wearables. Privia Health.
[10] FDA OK of mHealth Wearable Puts Pain Management in the Spotlight: 2019.
https://mhealthintelligence.com/news/fda-ok-of-mhealth-wearable-puts-pain-
management-in-the-spotlight. Accessed: 2020-06-02.
[11] Guk, K. et al. 2019. Evolution of Wearable Devices with Real-Time Disease
Monitoring for Personalized Healthcare. Nanomaterials (Basel, Switzerland). 9, 6
(May 2019). DOI:https://doi.org/10.3390/nano9060813.
[12] Honeyman, E. et al. 2014. Mobile health applications in cardiac care.
Interventional Cardiology. 6, 2 (2014), 227–242.
[13] How Wearables Help Healthcare: 2019. https://www.mdtechreview.com/news/how-
wearables-help-healthcare-nwid-179.html. Accessed: 2020-06-02.
[14] Kekade, S. et al. 2018. The usefulness and actual use of wearable devices among
the elderly population. Computer Methods and Programs in Biomedicine. 153, (Jan.
2018), 137–159. DOI:https://doi.org/10.1016/j.cmpb.2017.10.008.
[15] Lee, S. and Do, H. 2018. Comparison and Analysis of ISO/IEEE 11073, IHE PCD-
01, and HL7 FHIR Messages for Personal Health Devices. Healthcare Informatics
Research. 24, 1 (Jan. 2018), 46–52. DOI:https://doi.org/10.4258/hir.2018.24.1.46.
[16] Lucivero, F. and Jongsma, K.R. 2018. A mobile revolution for healthcare? Setting
the agenda for bioethics. Journal of Medical Ethics. 44, 10 (Oct. 2018), 685–689.
DOI:https://doi.org/10.1136/medethics-2017-104741.
[17] Martin, R. 2018. Wearables Gain Traction in Elder Population - Today’s Geriatric
Medicine. Today’s Geriatric Medicine.
[18] Mathews, T.J. and Hamilton, B.E. 2019. National Vital Statistics Reports Volume
68, Number 1 January 10, 2019, Total Fertility Rates by State and Race and
Hispanic Origin: United States, 2017. 68, 1 (Jan. 2019), 11.
[19] Montgomery, K. et al. 2018. Health Wearables: Ensuring Fairness, Preventing
Discrimination, and Promoting Equity in an Emerging Internet-of-Things
Environment. Journal of Information Policy. 8, (2018), 34–77.
DOI:https://doi.org/10.5325/jinfopoli.8.2018.0034.
[20] More Seniors Are Embracing Technology. But Can They Use It? UCSD
Researchers Suggest Asking Them.: 2019.
https://www.forbes.com/sites/robinseatonjefferson/2019/06/28/more-seniors-are-
embracing-technology-but-can-they-use-it-ucsd-researchers-suggest-asking-them/.
Accessed: 2020-06-02.
[21] Robinson, S.C. 2019. No exchange, same pain, no gain: Risk–reward of wearable
healthcare disclosure of health personally identifiable information for enhanced
pain treatment. Health Informatics Journal. 25, 4 (Dec. 2019), 1675–1691.
DOI:https://doi.org/10.1177/1460458218796634.
[22] Statement from FDA Commissioner Scott Gottlieb, M.D. and Jeff Shuren, M.D.,
Director of the Center for Devices and Radiological Health, on FDA’s updates to
Medical Device Safety Action Plan to enhance post-market safety: 2018.
https://www.fda.gov/news-events/press-announcements/statement-fda-
commissioner-scott-gottlieb-md-and-jeff-shuren-md-director-center-devices-and-2.
Accessed: 2020-06-03.
[23] Tran, V.-T. et al. 2019. Patients’ views of wearable devices and AI in healthcare:
findings from the ComPaRe e-cohort. npj Digital Medicine. 2, 1 (Jun. 2019), 1–8.
DOI:https://doi.org/10.1038/s41746-019-0132-y.
[24] Treskes, R.W. et al. 2016. Mobile health in cardiology: a review of currently
available medical apps and equipment for remote monitoring. Expert Review of
Medical Devices. 13, 9 (Sep. 2016), 823–830.
DOI:https://doi.org/10.1080/17434440.2016.1218277.
[25] Tundjungsari, V. et al. 2018. Development of Mobile Health Application for
Cardiovascular Disease Prevention. International Journal of Advanced Computer
Science and Applications. 9, 11 (2018).
DOI:https://doi.org/10.14569/IJACSA.2018.091175.
[26] Vaportzis, E. et al. 2017. Older Adults Perceptions of Technology and Barriers to
Interacting with Tablet Computers: A Focus Group Study. Frontiers in
Psychology. 8, (Oct. 2017). DOI:https://doi.org/10.3389/fpsyg.2017.01687.
[27] Wang, S. et al. 2019. Technology to Support Aging in Place: Older Adults’
Perspectives. Healthcare. 7, 2 (Jun. 2019), 60.
DOI:https://doi.org/10.3390/healthcare7020060.
[28] Wearable Technology Applications in Healthcare: A Literature Review: 2019.
https://www.himss.org/resources/wearable-technology-applications-healthcare-
literature-review. Accessed: 2020-06-02.
[29] Wearable technology for the elderly automatically calls for help in time of need:
2019. https://www.news-medical.net/news/20190923/Wearable-technology-for-the-
elderly-automatically-calls-for-help-in-time-of-need.aspx. Accessed: 2020-06-02.
[30] WHO Global Observatory for eHealth and World Health Organization 2011.
MHealth: new horizons for health through mobile technologies. World Health
Organization.