A systematic review of gerontechnologies to support aging in place among community-dwelling older adults and their family caregivers

Objective Paucity of information concerning the efficacy of gerontechnologies to support aging in place among community-dwelling older adults prevents potential users, healthcare professionals, and policymakers from making informed decisions on their use. The goal of this study was to identify gerontechnologies tested for home support in dyads of community-dwelling older adults with unimpaired cognition and their family caregivers, including their benefits and challenges. We also provide the level of evidence of the studies and recommendations to address the specific challenges preventing their use, dissemination, and implementation. Methods We conducted a systematic review of the literature published between 2016 and 2021 on gerontechnologies tested for home support in dyads. Two independent reviewers screened the abstracts according to the inclusion/exclusion criteria. A third reviewer resolved eligibility discrepancies. Data extraction was conducted by two independent reviewers. Results Of 1,441 articles screened, only 13 studies met the inclusion criteria with studies of moderate quality. Mostly, these gerontechnologies were used to monitor the older adult or the environment, to increase communication with family caregivers, to assist in daily living activities, and to provide health information. Benefits included facilitating communication, increasing safety, and reducing stress. Common challenges included difficulties using the technologies, technical problems, privacy issues, increased stress and dissatisfaction, and a mismatch between values and needs. Conclusion Only a few gerontechnologies have proven efficacy in supporting community-dwelling older adults and their family caregivers. The inclusion of values and preferences, co-creation with end users, designing easy-to-use technologies, and assuring training are strongly recommended to increase acceptability and dissemination. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=310803, identifier CRD42022310803.


Introduction
In the past decades, the world population has shown a steady increase in the proportion of individuals aged 65 years and older.

Objective and research questions
The objective of this study was to evaluate and synthetize information via a systematic review of literature published between 2016 and 2021 concerning gerontechnologies used for home support among Community-Dwelling Older Adults (CDOA) without cognitive impairment and their Family Caregivers.The systematic review was designed to answer four main questions: 1 What gerontechnologies have been tested for home support by both CDOA and their family caregivers? 2 What are the benefits, challenges, and opportunities provided by these gerontechnologies for CDOA and their family caregivers? 3 What is the evidence level of the studies conducted with dyads comprised of CDOA and their family caregivers? 4 What recommendations, if any, address the specific challenges preventing the use and dissemination of these gerontechnologies?

Methods
Search strategy and information sources We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).A systematic review of literature published between 2016 and 2021 was conducted by the principal investigator (AM) in collaboration with two librarians with a background in Psychology and Geriatrics.The two librarians participated in different iterations and validations of the search strategy.Databases searched included: CINAHL, Medline, PsycINFO, Web of Science, and AgeLine.The search terms included « home support », « older adults », « family caregivers », and « technology ».Table 1 presents the search strategy, as well as truncation symbols (denoted by *) and Boolean operators (AND, OR).The systematic review was registered in PROSPERO (registration number: CRD42022310803).

Study selection
Studies were included based on the following criteria: (a) studies reporting results on the efficacy or the feasibility of gerontechnologies tested at home; (b) gerontechnologies tested with dyads of CDOA and family caregivers; (c) tested with older adults without neurocognitive impairment; (d) studies using quantitative, qualitative or mixed data analysis methods; (e) studies available in Chinese, Spanish, French, or English.Studies were excluded if: (a) the sample included older adults with a diagnosis of cognitive impairment; (b) the gerontechnology was not tested with dyads of CDOA and family caregivers; (c) the gerontechnology did not

Data extraction and synthesis
Titles and abstracts were screened by two independent reviewers (students in psychology and a student with a background in engineering) according to the inclusion/exclusion criteria.Interrater reliability was assessed as moderate for the title and abstract screening (Cohen's kappa coefficient of 0.48).Studies matching the inclusion criteria and those being unclear regarding their eligibility were retained for a full-text review.
Interrater reliability was assessed as moderate for the full-text review (Cohen's kappa coefficient of 0.51).A third reviewer (AM) resolved eligibility discrepancies where the first two reviewers did not reach a consensus.Data extraction was conducted by two independent reviewers, and included the sociodemographic characteristics of the participants, the characteristics of the gerontechnology tested at home, the duration of the intervention with the gerontechnology, the cost, and the benefits and challenges of using each specific gerontechnology.

Quality assessment
Three independent reviewers (HS, KA, M-CS) evaluated the quality of the empirical studies included in the present systematic review with the Mixed Methods Appraisal Tool (MMAT - Hong et al., 2018).This tool is designed for quality assessment of empirical studies included in systematic reviews.The scores range from 0 to 5, where scores near 5 indicate an excellent methodological quality.A mean score was calculated using the ratings of the three independent reviewers.

Level of evidence of the studies
The results of the Mixed Methods Appraisal Tool (MMAT) revealed that studies had on average a moderate quality of evidence (Table 2).The mean score obtained by the three independent reviewers was 3.7 (SD = 1).Common factors limiting the quality of the studies were linked to the sample sizes.Notably, all samples were small, a few had a high rate of attrition and a potential selection bias.For example, in Bradford et al. (2018), participants selected themselves (self-selection), thus it was mentioned that it is possible that they were already prone to positively appreciate the technology.In another study, most caregivers earned more than 100,000 US$ per year, which is considerably higher than the mean American salary (Quinn et al., 2019).Also, for the studies using a mixed methods design, divergences between qualitative and quantitative results were often not addressed (e.g., Grgurić et al., 2019).

Description of gerontechnologies for home-support tested simultaneously with community-dwelling older adults and their family caregivers
Each of the 13 studies evaluated a different technology.The mean duration of the intervention was 11.3 months (SD = 20.3)for a total of 135.5 months of intervention combining the 13 studies.Interventions varied in terms of their duration between 1 week and 6 years.A review of these technologies and their functionalities is presented in Tables 3 and 4.
In terms of functionalities, the technologies tested with CDOA and their family caregivers can be summarized as: (a) monitoring technologies, (b) communication technologies, (c) daily life assistance technologies, and (d) health information technologies.

Monitoring technologies
Monitoring technologies are developed for supervision and to allow rapid detection of anomalies or dangers at home to ensure the safety of older adults.Most technologies (10/13) included a system to monitor individuals or the environment (Bock et al., 2016;Cohen et al., 2016;Galambos et al., 2017;Åkerlind et al., 2018;Bradford et al., 2018;Suzuki and Hasegawa, 2018;Berridge et al., 2019;Grgurić et al., 2019;Tseng and Hsu, 2019;Pais et al., 2020).Cameras and sensors were the most widely used monitoring technologies in these studies.Cameras were used to monitor older adults in bed during nighttime (Åkerlind et al., 2018) and to detect falls while older adults were walking in their homes (Galambos et al., 2017).Sensors were used to detect motion and record usual activity patterns (Bock et al., 2016;Cohen et al., 2016;Bradford et al., 2018;Berridge et al., 2019;Grgurić et al., 2019;Pais et al., 2020).For example, the Intelligent Wireless Sensor System (IWSS) consists of a set of sensors that record older adults' movements in different rooms of their homes.Messages are sent to family caregivers when there is a behavioral pattern modification (Cohen et al., 2016).Four technologies used a system of alerts to signal anomalies (e.g., fall detection or change in walking pattern) (Galambos et al., 2017;Berridge et al., 2019;Grgurić et al., 2019;Tseng and Hsu, 2019) or to confirm that an activity has been performed by the older adult (e.g., self-administration of medication) (Suzuki and Hasegawa, 2018).Alerts were sent by the system and received by the family caregivers through text messaging and phone calls.

Communication technologies
A few technologies are designed to enhance the communication between the older adult living at home and their family caregivers.Five studies presented technologies serving this goal (Åkerlind et al., 2018;Bradford et al., 2018;Gutierrez et al., 2019;Quinn et al., 2019;Corbett et al., 2021).Smarter Safer Homes (Bradford et al., 2018) and the ICMed technology (Quinn et al., 2019) allowed the sharing of information about the health and daily activities between the older adult and the family caregiver via a platform.Finally, four technologies included a system of communication via phone calls, videoconferencing and/or text messages to connect older adults with their social circle (Åkerlind et al., 2018;Bradford et al., 2018;Gutierrez et al., 2019;Corbett et al., 2021).This allowed family caregivers to communicate in real time, do check-ups, and provide reminders when needed.

Daily life assistive technologies
A few technologies are designed to assist older adults in their daily life.These technologies include any electronic tool or equipment designed to help a person perform their regular daily activities, such as cooking, cleaning, entertaining, or planning.Two technologies served this purpose, namely the Virtual Home Assistant and the One-dose package medication support system.The Virtual Home Assistant is an electronic tablet used for entertainment, information search, planning (e.g., access to the calendar), and communication (Corbett et al., 2021).The One-dose package medication support system was used to help with medication compliance (Suzuki and Hasegawa, 2018).

Health information
Some technologies or applications are developed to increase access to evidence-based information that can help both older adults and their family caregivers manage their health and well-being.ICMed is a mobile application serving this goal.It uses the information collected on the older adult and their families to generate personal health advice (Quinn et al., 2019).

Benefits using gerontechnologies
Gerontechnologies have the potential to help CDOA maintain their autonomy and age in place when they are developed to respond to the specific needs of dyads.A review of the benefits found in the studies included: (a) increased communication and family participation, (b) increased sense of safety, (c) reduced stress of family members and CDOA, and (d) other perceived benefits.

Increased communication and family participation
Several studies revealed that the use of technology improved the communication between older adults, their family caregivers, and health care professionals (Åkerlind et al., 2018;Bradford et al., 2018;Quinn et al., 2019;Tseng and Hsu, 2019;Corbett et al., 2021).For instance, during an interview, a family caregiver who used the system Smarter Safer Homes shared the benefits of videoconferencing to assess the mood and state of the older adult (Bradford et al., 2018).Gutierrez et al. (2019) also showed that the Social Connector system can facilitate the interaction of family members and that video-calls were a highly appreciated activity by older adults.Tseng and Hsu (2019) found that the use of the Smart Care Interactive Systems (SCIS) with a chair significantly improved the quality of parent-child interactions.Hence, these technologies have the potential to decrease loneliness, by connecting older adults to their social network and improve the quality of relationships.

Increased sense of safety
Four studies revealed that in-home monitoring had a positive influence on feelings of safety (Cohen et al., 2016;Galambos et al., 2017;Åkerlind et al., 2018;Pais et al., 2020).For instance, older adults viewed the eHomecare system as a valuable resource to ensure safety.Family caregivers felt relief knowing that the technology was in place, because it provided information that the older adult was out of danger.It made it easier to keep balance with other responsibilities and social life (Åkerlind et al., 2018).Galambos et al. (2017) found that both family caregivers and older adults perceived an increased sense of safety using the Fall risk assessment sensor system.The Intelligent Wireless Sensor system was perceived as useful to ensure safety at home in case of falls by 34.8% of older adults and by 76.5% of family caregivers (Cohen et al., 2016).A higher proportion of older adults (74.5%) and a similar rate of family caregivers (70%) viewed the technology Domocare as useful to prevent falls and increase quality of life (Pais et al., 2020).

Reduced stress of family members and community-dwelling older adults
Improvements in communication and monitoring of potential threat is associated with stress reduction in older adults and the perception that gerontechnologies are useful to reduce family stress (Åkerlind et al., 2018;Bradford et al., 2018;Pais et al., 2020).For instance, family caregivers who used the eHomecare system noticed a decrease of concerns regarding the safety of the older adult.A total of 83% of older adults who used the Smarter Safer Homes system experienced peace of mind during the intervention (Bradford et al., 2018).Finally, older adults and family caregivers perceived that the use of Domocare could help reduce family stress by increasing the supervision of the older adult (Pais et al., 2020).

Other perceived benefits
In two studies, CDOA felt motivated to take better care of their health, after using technologies, such as the Fall Risk Assessment System (Galambos et al., 2017) and the ICMed Application (Quinn et al., 2019).Furthermore, the study on ICMed application showed that communication technologies have the potential to increase the participation of the older adult and their family caregivers in decisions regarding health (Quinn et al., 2019).Finally, the One-dose package medication support system was reported to be useful to compensate for forgetfulness and increase medication adherence (Suzuki and Hasegawa, 2018).All these benefits promote aging in place.However, several challenges need to be addressed to optimize the implementation of these technologies.

Challenges using gerontechnologies
Challenges and negative opinions have also been expressed by CDOA and their family caregivers.Their feedback is crucial for the development of gerontechnologies to be used at home that suit the profile, the preferences, and the needs of the dyads.Challenges included: (a) difficulties using the technologies, (b) technical problems, (c) privacy issues, (d) increased stress and dissatisfaction, and (d) a mismatch between values and needs.

Difficulties using the technologies
The use of technological devices often requires learning new skills.CDOA reported that learning how to correctly use technologies is a challenge (Bock et al., 2016;Bradford et al., 2018;Corbett et al., 2021).For example, older adults reported having difficulties learning how to use the technology and to identify its purpose (Bock et al., 2016).Participants reported that explaining how the data collected can be helpful to family caregivers and physicians would help them better understand their utility.It was also suggested that simplifying the visualization provided by the sensor system and demonstrations with case examples could increase its usability.In another study, older adults reported that it was challenging to adapt to a new device, especially when it served the same purpose as another technology already available in their homes (Corbett et al., 2021).Therefore, training was identified as an important need for technological implementation in older adults.Another study showed that the use of an iPad was perceived as difficult for a few older adults because of the visual and motor skills required, as well as lack of familiarity with the technology and its capabilities (Bradford et al., 2018).This is   ( The Fall risk assessment sensor system includes a pulse-Doppler radar, a Microsoft Kinect, and two Web cameras.The system works to detect motion and falls using a machine learning approach.compatible with other studies with smartphones and tablet use in older adults (Barnard et al., 2013;Wilson et al., 2022).

Technical problems
Three studies reported technical problems during the intervention phase (Cohen et al., 2016;Grgurić et al., 2019;Quinn et al., 2019).First, some connectivity problems with mobile phone network occurred in rural areas while using Intelligent Wireless Sensor System (IWSS) (Cohen et al., 2016).Hence, some family caregivers did not receive the alarm messages.Connectivity issues were also found using the ICMed Application, along with log in problems (Quinn et al., 2019).Variability in the Internet connectivity caused family caregivers to receive system-offline notifications (Grgurić et al., 2019).The prolonged use of technologies like the SmartHabits system requires a change of batteries for the sensors.Battery replacement needs planning to make sure that the technology will be constantly operating at home.

Privacy issues
The perception of intrusiveness and the discomfort regarding loss of privacy is part of the downsides of environmental or personal monitoring reported by older adults (Cohen et al., 2016;Åkerlind et al., 2018;Gutierrez et al., 2019).Privacy concerns have been reported by participants in two studies (Åkerlind et al., 2018;Gutierrez et al., 2019).Feelings of being watched were experienced by older adults using the Intelligent Wireless Sensor System and triggered conflicts in some families (Cohen et al., 2016).

Increased stress and dissatisfaction
The use of gerontechnologies has a different impact on the level of stress and satisfaction.For instance, frequent false alarms can increase stress in family caregivers (Berridge et al., 2019).A few family caregivers felt annoyed by the number of alarms and calls needing to be answered (Cohen et al., 2016;Suzuki and Hasegawa, 2018).For older adults in an emergency situation, language barriers in communication while interacting with an employee of the Telecare Center can be a stressful experience for non-English speakers (Cohen et al., 2016).

Mismatch between values and needs
Studies showed that the use of technology can sometimes create a mismatch between values and needs (Suzuki and Hasegawa, 2018;Berridge et al., 2019).For instance, technologies might not match the expectation of how the older adult wished to be cared for by family members and sometimes led to conflict with family caregivers.Devices like the ODP-MSS did not allow enough flexibility in the medication administration (e.g., the older adult could not take their medication if they were away from home).As a consequence, a few older adults felt obligated to remain at home.Furthermore, four out of nine older adults perceived the technology as not useful because they could take medicine without relying on the ODP MSSS (Suzuki and Hasegawa, 2018).

Discussion
The goal of this systematic review was to summarize the research findings on in-home interventions using gerontechnologies tested simultaneously with CDOA with unimpaired cognition and their family caregivers.More specifically, we aimed to describe the technologies, their benefits and challenges, and the evidence level of the studies about them published between 2016 and 2021.We also aimed to provide recommendations for technological development, implementation, and research.To our knowledge, this is the first study synthesizing the evidence concerning the efficacy of technologies designed to support CDOA-family caregiver dyads.The review was conducted to inform older        adults, family caregivers, healthcare professionals, scientists, and policymakers about the gerontechnologies available to enable them to make well-informed decisions on their use and development.Surprisingly, we found only 13 studies meeting our eligibility criteria.The technologies were usually tested on a small sample of participants and were designed to monitor older adults, promote communication between older adults and family caregivers, help with daily tasks, and provide useful information that can be used to optimally manage their health.Most studies were conducted in the United States.Only four studies were conducted in Europe and two in Asia, even though these continents represent most of the world's oldest population (United Nations, 2021).The majority of studies did not specify the price of the technology used, preventing people from making decisions based on the cost/efficacy.Large differences were found related to the intervention duration, ranging from 1 week (Tseng and Hsu, 2019) to 6 years (Berridge et al., 2019).The quality of studies also varied greatly, with mixed and quantitative studies receiving lower scores due to their small sample size and risk of non-response bias.Given their position in the development process, it is common for these studies to have small sample sizes.They are often the first step before conducting large implementation studies.In general, pilot studies allow for iterations to refine the technologies being tested.To our knowledge, none of these 13 studies has moved to a wider implementation phase.
Several benefits have been reported by dyads of CDOA and family caregivers, such as an increase in communication and feelings of safety.However, some gerontechnologies elicited different reactions in older adults and family caregivers, including reports of technical difficulties, learning challenges, emotional reactions (e.g., increased stress), and interpersonal difficulties (e.g., family conflicts).These differences in reaction can perhaps be addressed via co-designing technologies to facilitate their development, increase confidence levels in their use and efficacy.
The results of a systematic review of assistive technologies in dementia care showed similar results with good acceptance to facilitate daily living (Pappadà et al., 2021).Although they included intervention studies (e.g., telemedicine) and a different population (i.e., people with dementia), the potential of technology is clearly to provide monitoring and security of older adults, support in activities of daily living, and psychosocial support.The use of these technologies seems to be increasing and they can be very useful during future pandemics.Taken together, gerontechnologies provide concrete support to older adults and family caregivers when they respond to specific needs and the different problems that can be experienced in the continuum ranging from normal aging to dementia.
Currently, education about gerontechnologies and their efficacy is needed to inform the general population, clinicians, and policymakers about the options available to promote independent living in the older adult population.Innovative solutions to quickly test, implement, and commercialize these technologies remains a challenge as there is a gap between their development and community implementation.Initiatives to educate the public in the availability of these technologies and promote research are currently underway (Aboujaoudé et al., 2023; envisAGE, https://www.envis-age.ca/en/).Still, the lack of evidence on their efficacy impedes informed decision-making.We provide the following recommendations based on the current systematic review to address some specific challenges preventing the use and dissemination of these gerontechnologies.

Recommendations for technological development, implementation, research, and public policies
Technology development 1.To develop gerontechnologies that are sensitive to the need for privacy of older adults.Privacy is an important ethical issue that must be considered during the development of gerontechnologies (Sundgren et al., 2020).For example, studies reported that cameras are less accepted because they are perceived as more intrusive (Boström et al., 2013;Claes et al., 2015).Alternative methods seem to be more appreciated by older adults (e.g., sensors for movement detection or wearable technologies for fall detection instead of cameras or microphones).2. To develop technologies that are easy-to-use.Technologies that are easy-to-use can increase their acceptability.Also, considering potential physical, sensorial, and physical barriers in the development of gerontechnologies is a crucial step to make them more inclusive.3. To develop technologies that respond to unmet needs at home.It is important that the functionalities respond to unmet needs identified through a co-construction process as it influences the perceived usefulness of gerontechnologies, which has been linked to positive attitudes towards their use (Chen and Chan, 2014).It is understandable that older adults would prefer using older technologies already in place instead of replacing them with new ones, since it does not require any adaptation or financial outlay.
Implementation 1.To provide training and guided practice to CDOA to help them learn new skills.Training was identified as a need in a few studies (Bock et al., 2016;Bradford et al., 2018;Corbett et al., 2021) as lack of it is a barrier to technology adoption.Training facilitates learning new skills and helps overcoming barriers to utilization of new technologies and devices (Chen and Chan, 2014).Strategies recommended include training by healthcare professionals, providing video or written instructions as well as providing access to continuous technical support.Also, providing a test period without penalty could allow older adults to explore the technologies before purchasing them to make sure that they really respond to their needs.2. To evaluate the needs, the values, and the preferences of family caregivers and older adults simultaneously and explore the options available to the dyads.It is important that clinicians provide information about the interventions currently available and listen to the preferences of families.It is important to explore different alternatives to solve problems, such as forgetfulness, isolation, or mobility issues.Needs exploration can help families make informed choices and increase their feeling of selfdetermination, which is important to promote psychosocial health (Ntoumanis et al., 2021).Also, personalizing the interventions can ensure optimal results in CDOA and their family caregivers in their unique social, economic, and environmental context (Ebrahimi et al., 2021).3. To ensure that the intervention proposed matches the current physical and cognitive autonomy level of the older adult.It has FIGURE 1 PRISMA flow diagram.
things (LoT)  is an open-source platform that manages smart home system deployment and integration.The platform runs on a laptop in the kitchen of the older adult and connects to the cloud-side component of LoT for data storage and central management.The LoT transforms the data created by sensors (one multi-sensor and two door/window sensors at home) into sensor firing data (e.g., when a door is opened) or environmental parameters such as temperature and humidity (in the case of the multi-sensor).Monitoring 500$ 3Bradford et al. (2018) Smarter Safer Homes platform is a system using roughly 30 in-home sensors, different electronic medical devices (weight scales, a thermometer, and a combined blood pressure monitor and glucometer unit) connected to an iPad for selfmonitoring.Sensor and medical device data are uploaded to a website (family portal) where authorized relatives can remotely monitor health and daily activities of their family member.Communication with family caregivers is also facilitated using a Sensor system allows recording the movements and activity/ inactivity of the home-dwelling older adults in strategic places of their living space (e.g., living room, bedroom, bathroom, time spent in bed, and time at which the fridge was opened).The system detects changes in movements and contacts caregivers depending on the participants' changing behavior patterns represented on a dashboard (by short message service, email, or smartphone application).is a second-generation Echo Show that had a 10.1-inch smart video screen and a third-generation Echo Dot smart speaker that was 3.9 inches in diameter and 1.7 inches high.Support persons received an Echo Spot that was 4.1 inches in diameter, 3.8 inches tall, and had a small video screen and smart speaker.The technology allows the older adult to have a voice-activated connection to the internet and receive vocal answers.It also allows videoconference communication with the primary caregiver, who received an Echo Spot.
monitoring system using sensors to detect usual daily activity patterns.The system also contacts family members or caregivers when an unusual situation is detected.Data is stored in the Cloud Platform and used for a PC tablet application created to facilitate family communication.The tablet is fixed on a wall or furniture inside the older adult's house.The older adult can interact with his surroundings using voice, video, or text messaging that can be controlled using voice commands or the touch-based screen (i.e., synchronous and asynchronous voice messaging, synchronous video messaging, text messaging, and multimedia messaging).Family members receive messages from the application to invite them to engage in conversations.
photos sent to the older adults

TABLE 1
Search terms and results from each database.(home adj2 care) or own home or (living adj2 independent*) or (aging adj2 independent*) or (base adj2 home) or community dwelling or living alone or aging in place).mpor Home Care/or Living alone/or Home Environment/or Aging in place/) AND ((techno* or gerontotechnology or gerontechnolog* or digital or tablet or intelligen* or touchscreen or computer or smart or machine or numeric or virtual or monitor* or sensor* or robot*).mpor Technology/or Digital technology/ or Mobile technology or Information and communication technology/or Assistive technology/or Wireless technology/or Monitoring/or Self-Monitoring/) AND ((Aging or ageing or senior* or old* adult* or old* person* or old* people* or elder* or late life or geriatric* or gerontolog*).mpor dwelling or living alone or aging in place).mpor Independent living/or Home care services/) AND ((techno* or gerontotechnology or gerontechnolog* or digital or tablet or intelligen* or touchscreen or computer or smart or machine or numeric or virtual or monitor* or sensor* or robot*).mpor exp.technology/ or wearable electronic devices/ or hearing aids/or exp.Video Recording or Reminder Systems/or Mobile Applications/or user-computer interface/or Geographic Information Systems/or self-help devices/ or communication aids for disabled/or Robotics/or exp.Monitoring, Ambulatory/ or exp.Signal Processing, Computer-Assisted/) AND ((Aging or ageing or senior* or old* adult* or old* person* or old* people* or elder* or late life or geriatric* or gerontolog*).mpor exp.Aged/ or exp.Aging/) AND (relative* or informal carer* or caregiver* or dyad* or spouse* or famil* or support person*).mpor exp.Family/or exp.Caregivers/ Limite: 2016-2021 603 CINAHL TIAB((home N2 care) OR "own home" OR (independent* N2 living) OR (independent* N2 aging) OR (home N2 base*) OR "community dwelling" OR "living alone" OR "aging in place") or (MH "Home Care Equipment and Supplies") or (MH "Home Health Care+") AND TIAB(techno* or gerontotechnology or gerontechnolog* or digital or tablet or intelligen* or touchscreen or computer or smart or machine or numeric or virtual or monitor* or sensor* or robot*) or (MH "Technology+") or (MH "Assistive Technology Devices+") or (MH "Assistive Technology Services") or (MH "Robotics") AND TIAB (Aging or ageing or senior* or "old* adult*" or "old* person*" or old* people* or elder* or "late life" or geriatric* or gerontolog*) or (MH "Aged+") or (MH "Aging+") or (MH "Gerontologic Care") or (MH "Gerontologic Nursing") or (MH "Geriatrics") AND TIAB(relative or "informal care*" or caregiver* or dyad* or spouse* or famil* or "support person*") or (MH "Caregiver Support") or (MH "Caregivers") or (MH "Dependent families") or (MH "Patient-Family Relations") or (MH "Family relations") AND Topic(Aging or ageing or senior* or "old* adult*" or "old* person*" or old* people* or elder* or "late life" or geriatric* or gerontolog*) AND Topic(relative* or "informal care*" or caregiver* or dyad* or spouse* or famil* or "support person*")

TABLE 1 (
Continued) "Daughters" OR DE "Extended Family" OR DE "Grandchildren" OR DE "Grandparents" OR DE "Great Grandparents" OR DE "In Laws" OR DE "Parents" OR DE "Siblings" OR DE "Sons" OR DE "Spouses" OR DE "Step Relatives" OR DE "Husbands" OR DE "Wives" OR DE "Couples") AND TI (technolog$ or smart$ or monitor$ or device$ or computer$ or artificial intelligence or gerontechnology) OR (DE "Technology" OR DE "Information Technology" OR DE "Information Technology" OR DE "Automation" OR DE "Computers" OR DE "Distance Education" OR DE "Assistive Devices" OR DE "Corrective Lenses" OR DE "Durable Medical Equipment" OR DE "Hearing Aids" OR DE "Orthopedic Equipment" OR DE "Pacemakers" OR DE "Prosthetic Devices" OR DE "Monitoring Devices" OR DE "Alarm Systems" OR DE "Computers" OR DE "Artificial Intelligence" OR DE "Automation" OR DE "Computer Aided Instruction" OR DE "Computer Software" OR DE "Information Technology" OR DE "Older Computer Users" OR DE "Technology") AND TI home or hous$ or smart house or design or living alone or aging in place OR (DE "Home Care" OR DE "Home Health Care" OR DE "Home Health Care" OR DE "Home Maintenance" OR DE "Repairs" OR DE "Home Modification") OR (DE "Living Alone") OR (DE "Housing Design" OR DE "Housing Improvement" OR DE "Housing Security" OR DE "Housing Characteristics" OR DE "Housing" OR DE "Housing" OR DE "Affordable Housing" OR DE "Housing Types" AND DE "Housing Characteristics" OR DE "Housing Conditions" OR DE "Housing Design" OR DE "Housing Improvement" OR DE "Housing Needs" OR DE "Housing Preferences" OR DE "Housing Security" OR DE "Residential Mobility") 10provide in-home support; (d) the article was a research protocol; (e) the studies were available in languages other than Chinese, English, Spanish, or French.As shown in Figure1, 2,120 references were identified.Two independent reviewers separately screened titles and abstracts based on inclusion/exclusion criteria (HS and KA) using COVIDENCE software (Veritas Health Innovation, 2014).Disagreements about inclusion were resolved by the supervisor (AM).A full-text review was then conducted for the remaining 109 references (HS and KA), with a total of 13 records compatible with the inclusion criteria.

TABLE 2
Average scores of the Mixed Methods Appraisal Tool for the studies included in the systematic review.

TABLE 3
Description of gerontechnologies for home-support tested simultaneously in community-dwelling older adults and their Family Caregivers.Åkerlind et al. (2018)eHomecare is a Swedish technology offered by the municipality that replaces home care visits including a camera for supervision at night, a videophone, and an electronic mailbox.The videophone is used for social interactions and to send reminders.The mailbox is used for reminders and to receive information.

TABLE 3 (
Continued) Characteristics and main findings of the studies included in the systematic review.