Older Adults’ Views of Passive Smartphone Monitoring for Dementia Risk: A Multi-Method Analysis

Abstract Background and Objectives Functional difficulties are hallmark signs of incident cognitive decline and progression to dementia but are challenging to measure in clinics. Passive smartphone monitoring enables continuous tracking of everyday behaviors and may improve the status quo of dementia risk assessment, but acceptability is understudied. This study evaluated older adults’ attitudes toward personal smartphone monitoring for dementia risk and identified barriers and facilitators to acceptability. Research Design and Methods Seventeen older adults completed a semi-structured interview followed by a Likert-scale rating to measure acceptability. Transcripts were analyzed using hybrid inductive-deductive thematic analysis. Exploratory correlations examined associations between acceptability ratings and participant features. Results Participants identified unique benefits of smartphone monitoring, including enhanced scope of measurement, greater ecological validity and personalization, and improved accessibility. Potential disadvantages were confounding variables that threaten validity and concerns about privacy/data security. Preferences for clinical implementation that may improve acceptability included extended monitoring options, assurances of privacy safeguards, control over data, and continued face-to-face interactions with one’s medical team. Most participants (13/17) were likely or extremely likely to participate in future smartphone monitoring research; higher likelihood was associated with lower depression (r=-.49, p=.046) and White vs. non-White race (U=57.50, n1=10, n2=7 p=.025, r=.57). Discussion and Implications Findings offer insights to enhance the acceptability of smartphone monitoring, including transparent review of procedures, privacy safeguards, and existing evidence. Outstanding requirements for clinical implementation include streamlining results to minimize physician burden and accounting for confounders that threaten data integrity. Our small, research-savvy cohort necessitates follow-up in other settings.