Reply to: From Measuring to Protecting “Days at Home”: Toward Frailty‐Informed Monitoring After Serious Health Events

In our report [1], we suggested that future studies are needed to determine whether days at home, a patient-centered outcome that meaningfully integrates days not in a health care facility and survival, are increased by six evidence-based strategies, including those that reduce preventable illnesses and injuries leading to hospitalization, decrease adverse consequences of these hospitalizations, bolster restorative therapies after hospitalization, substitute hospital-at-home for traditional inpatient care, and strengthen hospital-to-home transitional care interventions. The letter by Bignami et al. thoughtfully proposes an additional multi-modal home-based strategy that includes continuous monitoring, wearable technologies, and machine learning–enabled early detection [2]. This vision is compelling. However, it also highlights a critical gap: the need for rigorous evidence demonstrating that such strategies improve clinically meaningful outcomes, including days at home. At present, much of the support for digital monitoring rests on observational studies, feasibility work, and proof-of-concept analyses demonstrating the ability to detect physiologic or behavioral changes preceding clinical deterioration. While these findings are encouraging, they do not establish that acting on these signals—whether through clinician alerts, telemedicine interventions, or augmented home supports—actually reduces hospitalizations, delays institutionalization, or increases time spent at home. Nor do they clarify potential unintended consequences, such as alert fatigue, overdiagnosis, increased healthcare utilization, or exacerbation of disparities related to technology access and digital literacy. Randomized controlled trials are therefore essential. Such trials should evaluate not only the accuracy of digital biomarkers in predicting decline, but also whether integrated monitoring-and-response systems improve outcomes that matter to patients, including functional status, quality of life, caregiver burden, and, importantly, days at home. Equally important are pragmatic trials embedded within real-world care systems to assess scalability, cost-effectiveness, and implementation challenges across diverse populations and settings. Methodological clarity is also needed. As noted [1, 2], “days at home” itself remains heterogeneous in definition and interpretation. If it is to serve as both an outcome and a target for intervention, standardization becomes even more critical to ensure comparability across studies and to support regulatory and policy applications. Finally, the proposed shift from reactive to anticipatory care raises important questions about clinical workflow, accountability, and the balance between technological input and clinical judgment. These issues, too, warrant prospective evaluation rather than assumption. In summary, the aspiration to move from measuring to preserving days at home is both timely and important. Realizing this goal, however, will require a robust evidentiary foundation—ideally grounded in well-designed clinical trials—that demonstrates not only technological capability but tangible benefit for older persons. Dr. Gill meets the criteria for authorship stated in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals. Preparation of manuscript: Gill. The author has nothing to report. The work for this report was funded by a grant from the National Institute on Aging (R01AG017560). The study was conducted at the Yale Claude D. Pepper Older Americans Independence Center (P30AG021342). The organization funding this work had no role in the preparation, review, or approval of the manuscript. The author declares no conflicts of interest. This publication is linked to a Letter by Bignami et al. To view this article, visit https://doi.org/10.1111/jgs.70510.