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Like other developed countries, New Zealand is experiencing an ageing population (OECD.Stat, 2019; Ministry of Social Development, 2019), and more people are spending longer in poor health (Ministry of Health, 2016), often with multiple health problems (Ministry of Health, 2016), challenging health systems to find ways to provide sustainable and affordable services (Ministry of Health, 2016a). The New Zealand Ministry of Health has strongly directed a move to new models of care, away from the traditional models based around hospital or residential care, to a more patient-focused integrated system within an expanded primary care where the person is supported to remain in their community (Ministry of Health, 2001; Ministry of Health, 2016; Ministry of Health, 2016a), otherwise known as ‘ageing in place’ (where ‘place’ is that which the older adults calls home) (Labour, Greens and Grey Power, 2017; Boldy et al., 2011; Wiles et al., 2012). For the older person, this would usually be either in their own home, with family, or in supported community accommodation, which is often preferred by older people and their families (Labour, Greens and Grey Power, 2017; Boldy et al., 2011; Wiles et al., 2012). The use of enhanced information and communication technology (ICT) is often seen as a key enabler of these new models of care (Ministry of Social Development, 2019; Ministry of Health, 2016; MWNZ, 2011).
Smart home technologies, such as infra-red motion detectors, sensors built into beds and chairs and recording devices, can be used to create an intelligent environment that can monitor and control the environment, track activities of daily living (ADL) (Blackman et al., 2016; Peek et al., 2017), and recognise significant departures from normal behaviour by the occupants (Guesgen and Marsland, 2017; Loane et al., 2012; Rantz et al., 2015), an approach sometimes referred to as ambient assisted living (AAL). Common wearable technologies such as fitness trackers and watches as well as more specialist devices incorporated into clothing are increasingly used to monitor the health and activity of people by measuring activity and heart rate etc. (Lewis & Neider, 2017; Li et al., 2019). Smart home appliances such as televisions, fridges and cooking appliances can also monitor people’s activities and ensure that they seem to be eating and looking after themselves and following their daily routines. Usually, these sensor technologies use wireless communications technologies to connect to a central hub where the data is stored and processed, and alerts are raised with caregivers when falls or anomalous behaviours are detected. An excellent summary of the various devices in use and issues relating to their deployment can be found in the paper by Booth et al. (2019).
Combinations of these various technologies have been the subject of much research and development for several years, but have not yet been adopted into new models of care (Ienca et al, 2018). This lack of uptake has been attributed to a range of causes by various studies. Some authors have suggested that it is caused by the lack of clear user-requirements of the various stakeholder groups (Ienca et al., 2018; Wang et al., 2019) and a poor fit between technologies and people’s needs (Greenhalgh et al. 2015; Gutierrez et al. 2017). Poor interface design which does not take into account the physical and sensory limitation of older is also seen as a cause for concern (Pietrzak et al., 2014; Yusif et al., 2016). Furthermore, adoption has been impeded by uncertainty around many societal and economic issues surrounding their utilisation, such as privacy and confidentiality of information and concerns about the reimbursement for services (Loane et al, 2012; Ienca et al, 2018; Kapadia et al, 2015; Yusif et al, 2016).
Many existing telemonitoring systems for transferring data from patients to clinicians tend to support a one-to-one relationship, such as transferring blood pressure readings to a clinic nurse (Day & Johnson, 2016; Ruland et al., 2013) and use common communications techniques such as sending text messages from mobile phones (Hammett, Sasangohar, & Lawley, 2018). This dyadic approach does not cater for the complex nature of aged care, where older people frequently have co-morbidities, multiple health practitioners and informal carers (Carretero et al., 2012). We argue that the use of social media types of technologies would offer the option of many-to-many relationships between the older person, their informal support network of family and friends, as well as their formal support network of health providers, thus widening and individualising the support network of the older person.