Digital assistive technologies to support community-dwelling older adults: an interpretative synthesis of experienced benefits and harms

Digital assistive technology (DigAT) holds promise for reducing healthcare costs, improving access to care, and supporting independent living for older adults. However, realizing these benefits remains challenging as seemingly effective and cost-efficient forms of DigAT often fail in real-world settings due to misalignment with users’ needs, values and practices. With the ultimate aim of contributing to more effective DigAT use among community-dwelling older adults, we explored the benefits and harms they experienced using DigAT. We systematically searched PubMed, CINAHL, Philosopher’s Index, and PsycINFO for qualitative studies on community-dwelling older adults’ experiences with DigAT, and conducted an interpretative synthesis of thirty-one studies. As intended, DigAT resulted in experienced benefits related to health, safety, self-reliance, wellbeing, motivation, empowerment, and access to care. Autonomy and independence were mostly framed as aspirational benefits, dependent on maintaining health and safety to age-in-place. Unexpected benefits of DigAT included self-confidence, feeling cared for, and social inclusion. However, users also reported various harms, including perceived unsafety, burdening others or being burdened, privacy concerns, feeling controlled and judged, alienation, powerlessness, loneliness, stigma, and emotional distress. When DigAT did not align with users' needs, values, or practices, it resulted in misuse, non-use, or adapted use. Our synthesis highlights the need for an intentional and person-centered approach to DigAT design and implementation, ensuring alignment with older adults' needs, values, and practices. Such an approach could enhance DigAT's perceived value, and thereby support the realization of its promise to increase healthcare accessibility and support independent living. • We synthesized experienced benefits and harms of digital assistive technology for older users • Misalignment between assistive technology and older users prevents the realization of benefits • Potential harms and shifts in responsibility should be transparently discussed with users • Our findings support the tailored implementation of digital assistive technology