Unaddressed Privacy Implications for Non-Enrolled Household Members in the REAACH-IT Remote Monitoring Protocol (Preprint)

UNSTRUCTURED The increasing deployment of multisensor remote monitoring systems to support aging-in-place among persons living with Alzheimer disease and related dementias (ADRD) has introduced complex ethical challenges. The REAACH-IT protocol (JMIR Research Protocols 2025;14:e78623) proposes long-term installation of ambient sensors—including motion and door sensors—in the homes of rural, low-income African American individuals with ADRD and their care partners. While the protocol addresses dyadic consent procedures and participant confidentiality, it does not explicitly consider the privacy implications for non-enrolled household members who may reside in or regularly occupy the monitored environment. Ambient environmental sensors capture behavioral and movement data generated by all individuals physically present within the home, regardless of enrollment status. In multi-person or multigenerational households, this results in the systematic collection of longitudinal behavioral data from individuals who have neither consented to participation nor been identified as secondary data subjects. The absence of an articulated framework addressing notification, consent, opt-out mechanisms, or data governance for co-residents represents a structural ethical gap. Given documented disparities in multigenerational living arrangements and longstanding concerns regarding surveillance, mistrust, and equity in marginalized communities, this omission has broader implications for digital health research ethics. This commentary argues that home-based remote monitoring protocols should explicitly incorporate co-resident privacy protections within institutional review board review processes and study design. Addressing bystander data capture is essential for maintaining ethical integrity as aging-in-place technologies scale within community settings.