Renegotiating autonomy and safety: disentangling tensions emerging for older adults living with smart monitoring systems

Abstract Smart monitoring systems (SMS) are increasingly deployed in community-based care to empower older adults to live safely and independently. However, existing research largely treats monitoring as a process in which continuous data collection and real-time alerts are intended to translate into improved outcomes. What remains underexplored is how older adults experience monitoring and how it shapes their behavior over time. In this qualitative longitudinal study, 21 older adults are accompanied from SMS installation for more than one year, with individual semi-structured interviews conducted across four data collection phases. Findings reveal that older adults actively anticipate how the system interprets their behavior, producing three responses: reactance, that is, disengaging from devices to reclaim autonomy over safety; preemptive behavior, for instance, restructuring daily routines to avoid triggering alerts constraining their autonomy and safety; and performative compliance, that is, managing behavior to satisfy caregivers rather than personal needs, leading to a loss of autonomy. These constitute autonomy-safety value tensions: a technology designed to advance both values instead produces conditions under which protecting one systematically undermines the other. To this end, this study provides empirical insights into unintended consequences and a conceptual model explaining how value tensions emerge, with implications for practitioners and caregivers.