Impact of the Smarter Safer Homes Solution on Quality of Life and Health Outcomes in Older People Living in Their Own Homes: Randomized Controlled Trial
Authors: Lu Wei , Silvera-Tawil David , Yoon Hwan-Jin , Higgins Liesel , Zhang Qing , Karunanithi Mohanraj , Bomke Julia , Byrnes Joshua , Hewitt Jennifer , Smallbon Vanessa , Freyne Jill , Prabhu Deepa , Varnfield Marlien 
Published: November 2024

Background
An increasingly aging population, accompanied by a shortage of residential aged care homes and workforce and consumer feedback, has driven a growing interest in enabling older people to age in place through home-based care. In this context, smart home technologies for remote health monitoring have gained popularity for supporting older people to live in their own homes.

Objective
This study aims to investigate the impact of smart home monitoring on multiple outcomes, including quality of life, activities of daily living, and depressive symptoms among older people living in their own homes over a 12-month period.

Methods
We conducted an open-label, parallel-group randomized controlled trial. The control group continued to receive their existing care from aged care service providers. Meanwhile, the intervention group, in addition to receiving their usual aged care services, had their activities of daily living monitored using a smart home platform. Surveys including the Adult Social Care Outcomes Toolkit (ASCOT), EuroQol-5 Dimensions-5 Levels (EQ-5D-5L), Katz Index of Independence in Activities of Daily Living (Katz ADL), Lawton Instrumental Activities of Daily Living Scale (IADL), and Geriatric Depression Scale (GDS) were conducted at baseline and 6 and 12 months from baseline. Linear mixed-effects models were used to compare the difference between the intervention and control groups, with the ASCOT as the primary outcome measure.

Results
Data from 130 participants were used in the analysis, with no significant differences in baseline characteristics between the control group (n=61) and the intervention group (n=69). In comparison to the control group, the intervention group had a higher ASCOT score at the 6-month assessment (mean difference 0.045, 95% CI 0.001 to 0.089; Cohen d=0.377). However, this difference did not persist at the 12-month assessment (mean difference 0.031, 95% CI –0.014 to 0.076; Cohen d=0.259). There were no significant differences in EQ-5D-5L, Katz ADL, IADL, and GDS observed between the intervention and control groups at the 6-month and 12-month assessments.

Conclusions
The study demonstrates that smart home monitoring can improve social care–related quality of life for older people living in their own homes. However, the improvement was not sustained over the long term. The lack of statistically significant findings and diminished long-term improvements may be attributed to the influence of the COVID-19 pandemic during the later stage of the trial. Further research with a larger sample size is needed to evaluate the effect of smart home monitoring on broader quality-of-life measures.

Trial Registration
Australian New Zealand Clinical Trials Registry ACTRN12618000829213; https://tinyurl.com/2n6a75em

International Registered Report Identifier (IRRID)
RR2-10.2196/31970