# A Review of Blockchain Technology Applications in Ambient Assisted Living
## 4 Discussion  
As the population of the world is aging, societal challenges will need to be faced, especially about the delivery of care, which needs to be improved, and new care system paths need to be designed. At the same time, the development of IoT sensors and technology such as blockchain can ease this process by the implementation of ambient assisted living services which aim at moving the care from hospitals and care centers to home. The integration of sensors in older adults or patients' homes to enable remote follow-up and care is seen as key in delaying. The ambient assisted living systems address many of the concerns of patients in this transition towards remote care and personalized interventions, such as (1) time-consuming process for healthcare professionals caused by the lack of accurate monitoring and follow-up support, (2) patient data-sharing gaps across the care continuum, (3) not having a proper care support network in place to reduce patient anxiety or worries; (4) patients and family caregivers lacking sufficient knowledge and skills to optimize self-care; (5) patient difficulties in adherence to postdischarge instructions, e.g., medication usage or behavioral changes. Despite advantages brought to the care process, the ambient assisted living solutions have a rather limited adoption mostly because of the problems related to IoT sensors integration, data sharing, trust, ethical considerations, data confidentiality, privacy, etc. (see Table 6). As shown by the qualitative review conducted, blockchain technology can play a significant role in addressing some of the concerns related to the ambient assisted living services adoption, but at the same time, several technological barriers require further investigation. Blockchain scalability is important for integrating the technology into ambient assisted living systems. The monitoring data related to the patient's state and well-being, captured \begin{table}
\begin{tabular}{c c c c} \hline \hline
**Ambient Assisted Living Open Issues** & **Blockchain Solutions** & **Future Research Directions** \\ \hline \multirow{6}{*}{Monitoring and Interoperability} & \multirow{3}{*}{\begin{tabular}{c} IoT sensors \\ integration scalability \\ \end{tabular} } & Smart contracts for a device to & \multirow{3}{*}{\begin{tabular}{c} Improve scalability and decrease \\ transactional costs \\ \end{tabular} } \\ \cline{3-3}  & & & \begin{tabular}{c} Edge off-chain data vs. \\ on-chain transactions \\ \end{tabular} \\ \cline{2-3}  & \multicolumn{2}{c}{Interoperability} & \multicolumn{2}{c}{single source of truth} & \multicolumn{2}{c}{Blockchain networks integration, care} \\ \cline{2-3}  & & \multicolumn{2}{c}{No data segregation} & \multicolumn{2}{c}{system legacy application integration} \\ \hline \multirow{6}{*}{Data Management} & \multirow{3}{*}{Data Storage} & Decentralized & \multirow{3}{*}{\begin{tabular}{c} Decrease storage costs \\ \end{tabular} } \\ \cline{3-3}  & & Encrypted data & & \\ \cline{3-3}  & & Replicated blocks & & \\ \cline{3-3}  & & Tamper proof & & \\ \cline{3-3}  & Data sharing & \begin{tabular}{c} Sharding based on healthcare \\ rules and care paths \\ \end{tabular} & \begin{tabular}{c} Create new care and data-sharing paths \\ for the transition from hospital to home \\ \end{tabular} \\ \hline \multirow{6}{*}{Security and privacy} & Privacy and & safe environment for & \multirow{3}{*}{\
\begin{tabular}{c} Common concept of the data \\ confidentiality, personalization of data \\ disclosure paths \\ \end{tabular} } \\ \cline{3-3}  & &
\begin{tabular}{c} Theorem of a patient’s \\ digital identity \\ \end{tabular} \\ \hline \hline \end{tabular}
\end{table} 
Table 6: Assisted living issues and blockchain solutions. using IoT sensors, must be disseminated through the blockchain network. However, nowadays, the scalability of blockchain networks is low for handling an increasing number of transactions as more people will utilize the platform.