Emerging technologies and vulnerabilities in older adults with cognitive impairments: a systematic review of qualitative evidence

BACKGROUND: Recently, a vast amount of both theoretical and empirical literature has appeared, exploring the ethical implications of emerging technologies (ET) in the context of daily management and care of (frail) older adults. However, to the best of our knowledge, no comprehensive research has been carried out over the impact of ET on older adults’ vulnerability, focusing on older adults with cognitive impairments, who are the main beneficiaries of ET. RESEARCH AIM: This work aims to investigate the ethically-related impact of ET, in particular exploring the impact of ET on cognitively-impaired older adults’ vulnerabilities. METHODS: Using the PRISMA procedure, we conducted a systematic review of empirical (qualitative) evidence exploring the relationship between ET and older adults’ vulnerabilities as perceived by older adults with cognitive impairments. Five major databases (Pubmed, Embase, Web of Science, CINAHL and Philosopher’s Index) were queried, covering biomedical, philosophical, bioethical, and anthropological literature. 11.631 results were obtained. After duplicates were eliminated, titles, abstracts, and full texts of identified papers were screened for relevance. Eventually, 51 articles were included. Data analysis and synthesis followed the preparatory steps of the coding process detailed in the QUAGOL methodology. RESULTS: ET seem to act in a twofold manner, taming some already existing vulnerabilities, and, at the same time, worsening already existing – or creating new – vulnerabilities. As an example, some Unconventional Monitoring Techniques (e.g., wearables) tame “physical vulnerability”, by providing a sense of safety and constant monitoring, but threat “psychological vulnerability”, causing frustration related to inherent technology’s limitations and to a lack of familiarity with the technology itself. CONCLUSIONS: This systematic study significantly contributes to enriching the ethical debate on the use of technology for the care and assistance of older adults. It shows that, if properly implemented and used, ET can be helpful in taming some dimensions of older adults’ vulnerability, thus contributing to active ageing and/or the containment of physical and psychological deterioration. However, technologies alone cannot mitigate vulnerability in all its dimensions. Indeed, some of these dimensions involve more complex and multi-layered phenomena, thus requiring authentic human intervention and, in some cases, socio-political measures.