Lessons Learned From the Integration of Ambient Assisted Living Technologies in Older Adults' Care: Longitudinal Mixed Methods Study.

Background: COVID-19 has given impetus to an already growing trend around the use of ambient assisted living (AAL) technologies to support frail older adults who live alone. However, the challenge is that systematic research on the long-term use of AAL technologies remains in its nascent stages, leaving gaps in the understanding of the predictors that contribute to the routine embedding of AAL technologies in older adults' care.

Objective: This paper aims to share key lessons from a longitudinal study on the routine embedding of AAL technologies in older adults' care within a hitherto under-studied Southeast Asian context. Our objective was to design and deploy an AAL system termed Ubiquitous Service Management and Reasoning Architecture (Ubismart), evaluate its impact on older adults' quality of life (QOL), and distill lessons to inform the sustainable and culturally sensitive adoption of AAL technologies in similar settings.

Methods: We conducted an in-depth case study using a mixed methods design. First, we designed and deployed Ubismart to unobtrusively monitor and visualize older adults' activities of daily living. To assess changes in QOL, we administered a simplified, gamified version of the validated Older People's Quality of Life Questionnaire. Finally, we conducted semistructured interviews with older adults and their caregivers to triangulate the quantitative findings and explore evolving perceptions of the technology and its integration into daily routines.

Results: Quantitative analysis revealed significant improvements in (1) psychological and emotional well-being (P=.01) and (2) leisure and social activities (P=.03) following the AAL intervention. Other QOL dimensions showed no statistically significant change. Qualitative findings reinforced the improvement in psychological and emotional well-being, with many participants describing a heightened sense of safety and peace of mind, often likening the technology to "insurance" or a silent companion. However, the impact on social relationships was paradoxical; some older adults felt more cared for, while others perceived a decline in in-person visits. This paradox highlighted the complexities of technology's role in caregiving, as it might simultaneously enhance feelings of safety while unintentionally diminishing social connection for some older adults.

Conclusions: AAL technologies such as Ubismart enhance older adults' psychological and emotional well-being and sense of safety but may inadvertently reduce social interaction. Sustainable integration requires balancing these benefits with efforts to maintain meaningful caregiver connections, supporting both safety and social engagement for older adults.

Trial registration: ClinicalTrials.gov NCT06486935; https://clinicaltrials.gov/study/NCT06486935.