A Review of IoT System

Internet of Things 21 (2023) 100653
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Internet of Things
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A review of IoT systems to enable independence for the elderly

and disabled individuals
Alfredo J. Perez a, *, Farhan Siddiqui b, Sherali Zeadally c, Derek Lane c
a
University of Nebraska Omaha, 6001 Dodge St, Omaha, NE 68182, United States
b
Dickinson College, 28N College St, Carlisle, PA 17013, United States
c
University of Kentucky, USA, Little Library Building, Lexington, KY 40506, United States
A R T I C L E I N F O A B S T R A C T
Keywords: Recent years have witnessed an increase in human life expectancy fueled by significant im
Actuators provements in infrastructure, healthcare, and economies across the globe. Longer life spans have
Disabled altered the world demographics resulting in a larger senior population compared with previous
Elderly
years. This trend has created the need for providing additional care and assistive services to
Wearables
IoT
support the aging individuals. Innovative assistance techniques are especially necessary for
Sensors elderly people who live on their own in their homes. Simultaneously, an explosive growth in IoT
Smart home gadgets such as sensors and actuators have accelerated the development of smart homes which
comprise various types of IoT systems that provide increased convenience to people with
degenerating physical and cognitive abilities. Common examples of IoT systems that are being
integrated into smart homes include home automation systems, home activity detectors, wearable
sensor technologies for remote health management and so on. We identify the common needs of
aging and impaired individuals and then we review several IoT applications that can provide the
required support. We further discuss some of the challenges that must be addressed to make these
IoT systems more practical and reliable for everyday use.
1. Introduction
The Internet of Things (IoT) is comprised of everyday objects equipped with computational power, sensing and networking ca
pabilities for data collection and transmission. The main enablers of IoT include low-cost processors and easy-to-install wireless
networks. IoT devices such as sensors are capable of automatically collecting and transmitting data in real-time to servers with minimal
or no human intervention [1]. Developments in Artificial Intelligence (AI), data communications, and cloud computing, have further
fueled IoT developments. AI robots can respond to data received from sensors. Data can be easily shared amongst devices using
networks such as WiFi, Bluetooth, Bluetooth Low Energy (BLE), Zigbee, LoRa, and so forth. Cloud computing further provides huge
storage and computing power by providing access to an array of servers in the cloud [1].
The fast proliferation of IoT-enabled smart connected devices, communicating via mobile networks enables ubiquitous connectivity
which provide many opportunities for a better quality of life for individuals and societies. IoT connectivity has the potential to provide
enhancements to living conditions in various ways. Fig. 1 shows some of the IoT domains that have gained increased popularity in
recent years. Within homes, the combination of smart connected objects and cloud-based services can enhance home security (through
* Corresponding author.
E-mail address: [email protected] (A.J. Perez).
https://doi.org/10.1016/j.iot.2022.100653
Available online 1 December 2022

2542-6605/© 2022 Elsevier B.V. All rights reserved.
A.J. Perez et al. Internet of Things 21 (2023) 100653
remote monitoring) as well as improve energy efficiency and lower energy bills. Smart cities will be able to deliver innovative energy
management through smart grid technologies, provide intelligent traffic management to autonomous vehicles and integrate security
[2]. IoT can promote improved education and healthcare services. With the growing demand of healthcare needs, IoT devices can
address this challenge by supporting a variety of e-health services that provide cost-effective healthcare access and allow remote
monitoring of chronic diseases and health conditions within the patient’s home environment [3]. This can improve the quality of life
for patients while reducing the costs for healthcare organizations. In the education sector, virtual classrooms and mobile applications
can provide enhanced flexibility and allow the design of solutions tailored to meet the learning abilities and needs of each student and
improve their learning experiences. Mobile education models have already shown to promote learning outcomes and lower dropout
rates [4]. For companies, sensor data combined with data analytics can improve productivity by refining the quality of decision making
and incorporating value-added production techniques.
The concept of the Internet of Things (IoT) relates to Mark Weiser’s vision of devices interconnected operating under diminishing
visibility [5]. However, the term IoT was first coined and implemented in a system by Kevin Ashton in 1999 through the development
of Radio Frequency Identification (RFID) chips that could be used to track goods in supply chains [6]. In 2005, the International
Telecommunication Union (ITU) developed the “ITU Internet Reports 2005: The Internet of Things” [7] that highlighted opportunities as
well as challenges and concerns related to the development of this technology. This report helped to increase the visibility of IoT
systems. IoT widespread adoption saw a turning point after 2010 when the ratio of connected Internet devices to people jumped to 6.25
[8].
As of 2022, the number of IoT devices has reached around 40 billion connected devices, and their numbers are expected to rise to
and exceed 70 billion by the end of 2022 [9]. The widespread adoption of IoT has not only contributed to new applications, but also to
improvements in communication networks and architectures. For example, improvements by 2024 in cellular network technology
provided by 5 G will be able to accommodate services based on IoT systems and devices [9]. All these improvements have also fueled
research in IoT systems and applications. Table 1 presents a summary of related works in IoT systems for the past decade.
Most of the works cited in Table 1 addressed IoT and wearable systems (including smartphone-based applications) and use cases in
multiple areas (including healthcare in general). While many of these works have a focus on computational, networking and infra
structure aspects to support m-Health systems (in general), in this work, we describe current advances in IoT and wearable tech
nologies to support the elderly and the disabled specifically. To the best of our knowledge our work is the first review to address the
specific requirements and solutions on using IoT/wearables to support the elderly/disabled population.
Fig. 1. Internet of Things (IoT) domains.
2
Table 1
Summary of survey works in IoT Systems (2010 – 2022).
Refs. Year Title Remarks
[10] 2010 The Internet of Things: A survey Reviews general applications and status of IoT systems and devices as of
2010
[11] 2010 A survey of mobile phone sensing Reviews architectures and applications of smartphone sensing
[12] 2011 A survey of middleware for Internet of things Review middleware architectures in support of IoT systems as of 2011
[13] 2011 A survey on facilities for experimental Internet of things research Reviews testbeds to conduct research on IoT systems as of 2011
[14] 2012 A proposal for using the Internet of things concept to increase children’s Discusses the use of IoT in health awareness for children. Among the first
health awareness works highlighting the use of IoT in healthcare
[15] 2012 Privacy and security issues in IoT healthcare applications for the This work describes security and privacy requirements when using IoT in
disabled users: a survey healthcare for the disabled
[16] 2013 Survey of Internet of things technologies for clinical environments Reviews communication technologies supporting IoT systems in hospital-
centric applications
[17] 2013 U-Healthcare System: State-of-the-Art Review and Challenges Reviews communication technologies that can support m-Health systems.
It includes communication technologies in support of Wireless Body Area
Networks (WBANs)
[18] 2014 Wearables: Fundamentals, advancements, and a roadmap for the future Reviews wearable sensor technology and applications as of 2014. Review
does not address security or privacy issues
[19] 2015 The Internet of Things for Health Care: A Comprehensive Survey Reviews the use of IoT in the context of healthcare, including clinical (in-
hospital) applications and remote monitoring
[20] 2015 Feasibility of popular m-health technologies for activity tracking among Reviews consumer wearable sensors/connected mobile applications and
individuals with serious mental illness their feasibility in people with mental illness
[21] 2015 Internet of things: A survey on enabling technologies, protocols, and Presents a review of sensor, communication, and applications of IoT
applications systems. Provides a use case of IoT in a nursing scenario
[22] 2016 Mobile health (m-health) system in the context of IoT Describes requirements for IoT systems in the context of IoT. This work
highlights security as one of the important aspects in IoT healthcare
[23] 2016 Effective ways to use Internet of Things in the field of medical and smart Evaluates architectures as of 2016 for IoT m-Health and proposes and
health care evaluates a m-Health IoT architecture based on 4 layers
[24] 2016 An IoT-based mobile gateway for intelligent personal assistants on Highlights the use of Intelligent Personal Assistants (IPA) to learn about
mobile health environments patients’ health condition and alert healthcare/caretakers in case of an
emergency
[25] 2017 A review on IoT based m-Health systems for diabetes Reviews the use of IoT systems in the context of diabetes management
[26] 2017 Semantic interoperability in the Internet of Things: An overview from the Presents an overview of the interoperability requirements in IoT systems
INTER-IoT perspective particularly for healthcare and transportation/logistics
[27] 2017 Internet of medical things (IoMT): Applications, benefits, and future Reviews requirements for IoT in the healthcare domain in general.
challenges in healthcare domain. Presents applications of IoT systems in healthcare as of 2017, and present
future challenges
[28] 2017 Future of IoT networks: A survey Provides an overview of IoT communication networks rather than devices
and applications
[29] 2018 m-Health 2.0: new perspectives on mobile health, machine learning and Reviews IoT, cloud, machine learning and analytics in the context of m-
big data analytics Health systems
[30] 2018 Recommender systems for IoT enabled m-health applications Describes requirements and applications of recommender systems in the
context of IoT m-Health applications
[31] 2018 Internet of medical things: Architectural model, motivational factors, Provides an overview of IoT in m-Health realm, and describes an
and impediments architectural model for m-Health services
[32] 2018 Privacy issues and solutions for consumer wearables Provides a review of privacy issues in wearable IoT systems
[33] 2018 A critical review of consumer wearables, mobile applications, and Addresses the use of wearables for stress and sleep monitoring. No
equipment for providing biofeedback, monitoring stress, and sleep in privacy or security issues mentioned in the paper
physically active populations
[34] 2018 Internet of Things (IoT): Research, Simulators, and Testbeds Reviews testbeds and simulators to conduct IoT experiments
[35] 2019 Demystifying IoT security: An exhaustive survey on IoT vulnerabilities Review of security issues and solutions in Internet of Things (IoT) systems
and a first empirical look on Internet-scale IoT exploitations. in general
[36] 2019 Survey on machine learning and deep learning algorithms used in Describes the use of deep learning and machine learning for IoT systems.
internet of things (IoT) healthcare Covers traditional machine learning and deep learning approaches
[37] 2019 Internet of Things: A survey of enabling technologies in healthcare and its Addresses and reviews the utilization of WBAN and other communication
applications technologies in support of IoT healthcare
[38] 2019 A survey on Internet of things and cloud computing for healthcare Reviews IoT and cloud technology in healthcare from 2015 to 2019, with
a focus on cloud, fog and IoT applications in healthcare settings
[39] 2019 Edge computing for Internet of Things: A survey, e-healthcare case study Discusses protocols, communication technologies and applications of IoT
and future direction and edge computing in the context of healthcare
[40] 2019 A survey of healthcare Internet of Things (HIoT): A clinical perspective Reviews the usage of sensors and IoT systems from a clinical perspective
[41] 2019 Internet of things for healthcare using effects of mobile computing: a Conducts a systematic bibliographic review on the topic of IoT in
systematic literature review healthcare. Shows trends in research in the area
[42] 2019 The impact of the hybrid platform of Internet of things and cloud Reviews IoT and cloud with a focus on cloud, protocols, big data with IoT
computing on healthcare systems: opportunities, challenges, and open applications in healthcare settings
problems
[43] 2020 A comprehensive overview of smart wearables: The state-of-the-art Bibliographic review of wearable IoT works published between 2010 and
literature, recent advances, and future challenges 2019 (before the COVID-19 pandemic)
[44] 2020 Wearables and the Internet of Things (IoT), applications, opportunities, Presents the use of sensors and applications of wearables before the
and challenges: A Survey COVID-19 pandemic. This work does not review security, privacy, or ML
(continued on next page)
3
Table 1 (continued )
Refs. Year Title Remarks
[45] 2020 A survey of COVID-19 contact tracing apps Discusses the development of contact tracing apps during the COVID-19
pandemic
[46] 2020 Industry 4.0 and health: Internet of things, big data, and cloud Reviews IoT, cloud and big data technologies in support of healthcare.
computing for healthcare 4.0 This works focuses on communication and storage support
[47] 2021 Internet of Things in Health Care: A Survey Presents IoT technology in healthcare with a focus on security, privacy,
and applications
[48] 2021 A Survey on IoT Applications in Health Care and Challenges Discusses services, applications, and challenges of IoT in healthcare
[49] 2021 Integrating M-health with IoMT to counter COVID-19 Describes the use of IoT technologies in support of the COVID-19
emergency
[50] 2021 Recent Advances in Wearable Sensing Technologies Reviews recent advances in wearable IoT devices. Presents a summary on
the use of wearables during the COVID-19 pandemic
2. Contributions of this research
The main research contributions of this work are as follows:
• We identify current requirements and challenges and impediments faced by the aging and disabled population.
• We discuss how the Internet of Things (IoT) technologies can address the challenges identified and help to improve the living
conditions of elderly or disabled people in their homes.
• We discuss challenges that still need to be addressed before an IoT-enabled smart home can be fully deployed in practice and
simplify the lives of people who are aging or have disabilities.
We organize the rest of the paper as follows. Section 3 presents the requirements of the elderly or disabled population for inde
pendent living and summarizes some conventional assistive technologies used to support the aging and disabled population. In Section
4 we describe various IoT solutions that have been proposed in recent years to meet the requirements of the elderly population and
needs of individuals with physical or mental impairments. Section 5 identifies some future challenges that must be addressed to
develop actual smart and reliable IoT solutions for the elderly and disabled’s home environments. Finally, in Section 6 we make some
concluding remarks.
3. Challenges for ageing and impaired people
The population trends, as reported by the United Nations [51], indicates that the world population aged over 80 years is estimated
to grow from 125 million in 2015 to 202 million by 2030, reaching 434 million by 2050. In the United States, the population age 65 and
older increased from 39.9 million in 2008 to 54.1 million in 2019, and it is projected to reach 94.7 million by 2060 [52]. Approxi
mately 29 percent of the 52.4 million senior adults (65 and older) live alone [52] in the United States and face several types of unique
challenges and potential hazards. Some of these risks [53] include the absence of assistance in a severe emergency such as an episode of
falling and experiencing a traumatic injury, unintentional overdoses of prescription pills, or sometimes even undernourishment due to
inappropriate dietary selections, the incapacity to maintain sanitary home conditions, or the inability to identify an illness or a disease
in a timely manner.
Prolonged, unhealthy conditions tend to occur more often among elderly people thereby decreasing the capability of their inner
body parts to work efficiently in comparison with their health in earlier years. It is estimated that approximately 80 percent of the
elderly people suffer from at least one chronic disease [54]. Seniors’ health is also a social issue in many countries where people have
Fig. 2. The ICF disability model [59].
4
an inactive routine. Most of the seniors throughout the world prefer the autonomy of living alone and find it especially difficult to cope
with challenges and health issues of old age. People with disabilities can also face additional struggles while living alone. For instance,
a person with limited mobility (example a paraplegic individual) may find it difficult to carry out simple tasks such as dimming the
lights, locking and un-locking doors, closing and opening curtains, altering the thermostat settings, etc. [55]. People who are visually
impaired find it difficult to navigate their environment and may struggle in performing even a simple task such as reading the label on a
prescribed medication. Similarly, individuals with speech and hearing issues might not be able to communicate clearly with others
when answering the telephone or engaging in face-to-face conversations.
According to the World Health Organization (WHO), old age is defined as the stage of life starting at age 65. Similarly, the
Organisation for Economic Co-operation and Development (OECD) defines the elderly population as people aged 65 and older [56]. The
OECD also defines incapacity as the partial inability for a citizen to participate gainfully in the labor market due to a disability which
may be caused by congenital, accident or illness causes [57]. As of 2021, more than 46% of older persons in the world have disabilities
[58] which impact their living standards while also taking a toll on the economy of a country [57].
According to the WHO, there are two major conceptual models to describe disabilities which are the medical model and the social
model [59]. In the medical model, a disability is described as a feature of the individual requiring a medical intervention. In the social
model, a disability is seen as an issue affecting the inclusion of the individual with a disability, thus it requires a political/social
response to accommodate the individual in a social environment [59]. Based on these two models, in 2002, the WHO proposed a model
integrating both the medical and the social models, called the biopsychological model. This biopsychological model (as Fig. 2 shows)
serves as a basis for the WHO’s The International Classification of Functioning (ICF) Disability and Health [59].
In the ICF model, any kind of health condition (including any disability) can have three dimensions, namely impairment, activity
limitation, and participation restriction. The first dimension (impairment) describes an issue in a body function or structure with a
significant loss (e.g., loss of limb). The second dimension (activity limitation) describes the difficulties an individual may face in
performing a task. The last dimension (participation restriction) are issues that an individual may face when involved in life/social
situations. Table 2 presents a relationship between health conditions dimensions and intervention levels.
Traditionally, adaptive assistive technology has been developed to improve the autonomy and increase the independence of both
the elderly and disabled individuals. Assistive technology includes devices that can be used by individuals with sensory, cognitive,
and/or visual impairments to live more comfortably and with improved independence. Assistive technology devices enable powered
mobility, augmentative communication, and enhanced audio/visual reception. These devices are used in various ways depending on
the needs and challenges faced by a disabled or elderly individual to allow him or her to live a life comparable to that of a healthy
individual [60]. Thus, the IoT can benefit the elderly and impaired populations to provide more inclusion through the utilization of
assistive devices, the provision of rehabilitation, prevention, and monitoring of conditions that may hinder the participation in
common life activities. Conditions that the elderly and the impaired population can benefit from the utilization of IoT include the
management of chronic diseases, cognitive challenges and mental health, communication challenges, mobility impairments, emerging
infectious diseases, safety, and wellness/entertainment. Next, we describe these dimensions conditions.
3.1. Chronic diseases
Based on studies from the U.S. Center for Disease Control and Prevention (CDC), in the U.S. approximately 85% of older adults have
at least one chronic health condition, and at least 60% have two chronic conditions [61]. These diseases include heart disease, cancer,
and diabetes, and many are caused by a group of behaviors that include tobacco use (and second-hand smoking), poor nutrition, lack of
physical activity and excessive alcohol use. The annual cost in the U.S. economy of these chronic diseases is about $3.7 trillion USD
[62] and these costs continue to rise annually as the at-risk adult population increases and grows older. Table 3 presents a summary of
chronic health conditions for older adults in the U.S. It worth noting that chronic conditions are not mutually exclusive, and some
conditions may simultaneously affect a person.
Table 2
Relationship between health conditions and intervention levels [59].
Health condition dimension Intervention Prevention
Impairment Medical treatment/care Prevention of the development of further activity limitations

Issue with a body function or structure with significant loss Medication
Surgery
Activity limitation Assistive devices Preventive rehabilitation
Difficulties an individual may face in performing/executing a task Personal assistance Prevention of the
Rehabilitation therapy development of participation restrictions
Participation restriction Accommodations Environmental change
Issues that an individual may face to be involved in life/social situations Public education Employment strategies
Anti-discrimination law Accessible services
Universal design Universal design
Lobbying for change
5
Table 3
Chronic diseases in the elderly in the U.S., based on data published by the U.S. National Council on Aging [63], the American Cancer Society [64], and
WebMD [65].
Chronic condition Definition Population
impact
Hypertension Blood pressure above 130/90. Normal pressure is considered below 120/80 (systolic/ 58% of older
diastolic) adults
High cholesterol Cholesterol levels above 240 mg/dL 47% of older
adults
Heart disease (including coronary/ischemic heart Heart conditions that include diseased vessels, muscular/structural problems, and blot 43% of older
disease and heart failure) clots adults
Arthritis Swelling/tenderness of one or more joints 31% of older
adults
Diabetes Abnormal levels of glucose in the blood as result of the body’s ability to manage insulin 27% of older
levels adults
Cancer Abnormal and uncontrolled cellular growth 21% of older
adults
Chronic kidney disease Damage to kidneys that results in the inability to filter waste out of the blood 18% of older
adults
Depression Persistent feelings of sadness, pessimism, hopelessness, and fatigue 14% of older
adults
Alzheimer’s disease/dementia A specific type of dementia that causes memory loss and difficulty thinking/problem 11% of older
solving that interferes with everyday activities adults
Chronic Obstructive Pulmonary Disease (COPD) Difficulty breathing due to emphysema and chronic bronchitis. Caused by smoking, 11% of older
second-hand smoke, fumes and dust adults
3.2. Mobility impairments
While the elderly and the impaired population may be challenged in their mobility due to longstanding conditions (e.g., traumatic
injuries, birth defects), the progression of some of the chronic diseases previously described may impact adults in their mobility.
According to the CDC, in the U.S. 14.2% (1 out of 7 adults) of the adult population less than 65 years old had a mobility disability, with
this number increasing to 40% (2 out of 5) in the elderly population [66]. Mobility impairments [67] can range from gross motor skills
(e.g., walking) to fine movement, such as the manipulation of objects by hand (e.g., eating with a spoon). Table 3 summarizes the major
mobility impairments in the U.S. for the elderly as of 2018. It worth noting that the recent COronaVIrus Disease – 19 (COVID-19)
caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) may have significantly affected Table’s 4 statistics as
this disease has had a terrible impact on the elderly population.
3.3. Cognitive challenges and mental health
The U.S. National Health Institute defines cognitive health as the ability to clearly think, learn, and remember [69]. Cognitive
challenges may arise as a result of chronic health issues, side effects from medication, emerging diseases, or by traumatic injuries. In
the U.S. as of 2019, 30% of the elderly population self-reported subjective cognitive decline or memory loss that interferes with their
Table 4
Mobility impairments in older adults. Based on data from the U.S. CDC [68].
Mobility impairment Impact
Any physical difficulty 48.6% of adults aged 75+

30% of adults aged 65–74
Very difficult to or cannot stand for 2 h 32.6% of adults aged 75+
18.1% of adults aged 65–74
Very difficult to or cannot stoop, bend, or kneel 29.4% of adults aged 75+
Very difficult or cannot walk a quarter of a mile 27.7% of adults aged 75+
Very difficult to or cannot push or pull large objects 21.8 of adults aged 75+
Very difficult or cannot climb up 10 steps 20.1% of adults aged 75+
Very difficult or cannot lift or carry 10 pounds 16.6% of adults aged 75+
Very difficult or cannot reach over head 8.6 of adults aged 75+
Very difficult or cannot grasp or handle small objects 6.2% of adults aged 75+
Very difficult to or cannot sit for 2 h 2.7% of adults aged 65–74
5.0 of adults aged 75+
6
ability to engage in social activities or household chores [70]. Around 25% of the elderly self-reported that they needed assistance with
daily activities [70], and around 11.3% of the elderly population has Alzheimer’s disease (the most common form of dementia) in the
U.S. [71]. The prevalence of dementia increases with age in the U.S: approximately 2% of the elderly aged 65–69 live with dementia,
increasing to 33% among those elderly aged 90 and older [72].
Mental health also negatively affects the well-being of the elderly with 7% of the global elderly population affected with depression
as of 2017 [73]. Mental health affects physical health as people with mental health issues usually engage in unhealthy physical habits.
We summarize these statistics for the U.S. in Table 5.
3.4. Sensory and communication/voice challenges
Sensory challenges are a decline/difficulty that people have in their sensory functions which affect their quality of life. These
declines include decline in vision, hearing loss, smell, and taste (chemosensory function), and sense of touch. In the past research has
found correlations between sensory loss function and chronic and cognitive challenges with serious impact on elderly lifespan, even
correlated with death [74]. Table 6 summarizes U.S. statistics on sensory challenges/decline in the elderly along with their impact. The
statistics in the table for tactile sensitivity correspond to poor/fair sensitivity on community-living dwelling older adults who rated
their sensitivity either poor or fair [74].
3.5. Emerging infectious diseases/pathogens
Emerging infectious diseases are defined by the U.S. National Institute of Allergy and Infectious Diseases (NIAID) either as out
breaks of previously unknown diseases, known diseases that are rapidly increasing in incidence or geographic range in the last two
decades, or persistent infectious diseases that cannot be controlled [77]. Examples of emerging infectious diseases include Ebola, Zika
virus, Lyme disease, SARS, SARS-CoV-2, among others. These diseases tend to affect the elderly in a much worse way. For example,
according to a study done by Yanez et al. [78] in 16 countries, the outbreak of the newly emerging SARS-CoV-2 virus that has caused
the COVID-19 pandemic has affected the elderly disproportionally a mortality rate of 62.5 times higher among 65+ compared to
people younger than 54 years.
3.6. Safety, wellness, and entertainment
According to the U.S. Administration for Community Living (ACL) [52], as of 2018, around 28% of the elderly population 65+ lived
alone in the community, 57% lived with their spouse, around 2.29% lived in nursing homes, and the rest have a different living
arrangement (~10%). While living alone (or with a partner), the elderly may face sudden safety issues such as falls or fires, or abuse
which may be deadly (e.g., physical abuse, sexual abuse, neglect).
CDC’s statistic shows that 25% of the elderly suffer falls, with around 800,000 individuals requiring hospitalizations due to head or
hip fracture. Falls is the most common cause of traumatic brain injuries, which has an impact in cognitive, mental, and physical health
[79]. CDC data shows that, in the U.S., elderly abuse is common with 10% of the elderly 60+ living at home experiencing abuse, which
may have a physical, emotional, economic and sometimes fatal impact on the elderly. CDC data shows that between 2002 and 2016,
there were more than 643,000 older adults treated in emergency departments for non-fatal assaults and there were over 19,000
homicides among the elderly population [80].
Wellness and entertainment may delay, or even prevent the onset of many chronic conditions that affect the elderly. While there are
many programs globally available that support wellness activities for the elderly, the participation of the elderly in them remain low,
with many old persons not meeting guidelines for physical activities, especially women. For example, globally 25% of adults aged
60–69, 33.3% aged 70–79, and 50% of the elderly aged 80 or more do not get the recommended levels of physical activity [56].
Table 5
Cognitive challenges and mental health in older adults. Based on data from the U.S. CDC [68,70], the Alzheimer’s Association [71] and the U.S.
Assistant Secretary for Planning and Evaluation [72].
Cognitive/mental health Definition Population impact
condition
Dementia Group of symptoms that affect memory, thinking and social 2% of the elderly aged 65–69, 33% among those elderly
(including dementia caused by abilities severely enough to interfere daily life activities aged 90 or older (including Alzheimer’s)
Alzheimer’s disease)
Alzheimer’s disease A degenerative disease in which brain cell connections and cells 11.3% of the elderly population aged 65 or older
die, causing dementia. Alzheimer’s disease is not
Anxiety, worry or nervousness Excessive feeling of fear/stress that interferes with daily living 13.2% of the elderly aged 65+ take prescription
medication for anxiety, worry or nervousness
Depression Sad moods lasting for a long time that interferes with normal day 11.5% of the elderly aged 65+ take prescription
activities/everyday functioning medication for depression
7
Table 6
Sensory and communication challenges in the U.S elderly population. Based on data from the U.S. CDC [68] and Correia et al. [74].
Sensory challenge Impact Population impact
Vision impairments Correlation with depression, poor quality of life, cognitive decline, and mortality 25.2% elderly aged 75 and
older
19.8% of the elderly aged
65–74
Hearing impairments Correlation with slower gait speed, poor cognition, and mortality 39.4% elderly aged 75 and
older
65–74
Smell/taste impairments Correlation with nutritional compromise and mortality 39.4% elderly aged 75 and
older
65–74
Tactile sensitivity Associated with cognitive decline and has been linked to impairment in manual control, balance, ~77% elderly aged 75 –
walking ability, and risks of falls [75] 85
~68% elderly aged 65–74
Communication/voice Voice problems associated with depression [76] 12.1% elderly 75 and
challenges older
65–74
3.7. The need for IoT systems to enable independence for the elderly and disabled populations
The statistics reported in the previous sections showed that, as the population grows older, the elderly become sicker, limiting not
only their health, but their independence, thus making these populations mentally and physically challenged in many aspects of
modern life. In addition, developed economies can suffer from a demographic crisis in which the birth rate falls rapidly while their
population continues to have longer life expectancies [81,82]. This situation has been exacerbated by the COVID-19 pandemic, as
demographics research has shown that in Germany, Italy and the United Kingdom, the young population (aged between 14 – 34) has
modified their fertility plans, with many either planning or delaying their decision to have children [83].
The effect of the changes in demographics limits in the future the availability of a younger population not only to be part of the
professional healthcare workforce, but also to be caretakers. Without technology, the healthcare costs could increase for the general
population not only because of more elderly and disabled people in need of healthcare services, but also because of the lack of
healthcare professionals, infrastructure, and accessibility to services. For example, recently, the COVID-19 pandemic demonstrated the
limits of worldwide healthcare infrastructure in times of crisis [84], with the elderly and disabled population hit harder by the
pandemic [85].
The utilization of IoT-supported services can provide a scalable, cheaper, and proactive approach for healthcare and other services
(e.g., transportation, security, entertainment) for the elderly and disabled to counter the shifts in population worldwide and the
availability of caretakers. Table 7 summarizes how IoT can provide support to the elderly and the disabled, with examples of
commercially available products/services.
Table 7
IoT systems’ support for the elderly and people with disabilities.
Condition IoT support for the elderly and disabled population Examples of publicly available systems/services
Chronic diseases Remote monitoring of vital signs and automated delivery of Abbott’s CardioMEMS HF ™ system [86]
medications
Mobility impairments Use of self-driving vehicles and/or systems to ride public Self-driving trolleys for the elderly in rural areas of Japan
transportations based on wearables and smart phones [87] Ride hailing paratransit services for the elderly and
senior citizens [88]
Cognitive challenges and Treatment of certain types of mental health conditions (e.g., VitaVita VR Kit for the elderly [89]
mental health depression) via augmented and/or virtual realityTracking of AngelSense GPS for Alzheimer’s [90]
conditions and individuals (e.g., Alzheimer)
Sensory and Speech aid Sonantic AI voice platform [91]
communication/voice Hearing aids Oticon Opn™ and others [92]
challenges
HandTalk [93] Mobile/wearable devices and apps to translate sign language in real-
time
Emerging infectious Contact tracing and remote monitoring of vital signs Covid Shield mobile app [45]
diseases/pathogens
Safety, wellness, and Gait monitoring and automatic fall detection/recognition Lifeline ™ fall detection system and service [94]
entertainment
8
4. IoT solutions for elderly and disabled individuals
The term IoT is used to describe Cyber-Physical Systems (CPS) that collect, share data, and can perform actions on some type of
physical process while connected to the Internet [95]. As we have mentioned earlier, applications areas of IoT systems include smart
cities, transportation, security, agriculture, and healthcare (among others). IoT systems can be classified into two broad categories,
namely special purpose and consumer IoT systems. In the first group (special purpose), IoT systems are developed to satisfy re
quirements of special applications and are not easily bought by the public (e.g., law enforcement IoT devices, certain types of drones,
military IoT). In the second group, (consumer IoT), devices and systems are easily acquired by the public. IoT systems can also be
classified based on their mobility. Thus, we can classify IoT systems as follows:
• Wearables: these are computers with embedded sensors and actuators/output devices developed as a garment, accessory, or device
that is worn (or carried around) by consumers [50]. We can include smartphones and applications using smartphones sensors
(either included in a smartphone or connected via Bluetooth to a smartphone) in this category. Mobile applications that do not use
sensors but collect data for remote monitoring via the user typing on the mobile app (e.g., to collect physiological data) could be
included in this category, as without their use the elderly or disabled person could not be monitored for certain conditions using
self-reported health forms.
• Smart infrastructures: these devices are statically deployed in buildings/dwellings with the goal of simplifying a consumers’ life from
the perspective of safety, security, comfort, and entertainment. This category may include Internet-connected toys and robotic
systems deployed at homes, nursing homes, museums, or hospitals.
• Mobile IoT: this category encompasses bicycles, smart cars, drones, and others that people use either for transportation, comfort, or
leisure.
We present a general architecture of IoT systems in Fig. 3. In this architecture, IoT devices collect data, and depending on their
programming and hardware support, they can execute data analysis or recognize contexts/patterns based on pre-trained Machine
Learning (ML) algorithms. In addition, some IoT devices can execute actions on the environment or people without connecting to a
remote service (data collection). After data is collected, IoT systems may connect to other devices (which may be other IoTs) in a local
area or connect to the Internet by using wired/Wireless Local Area Networks (such as Wireless Fidelity (WiFi) technology) or mobile
cellular networks. Some IoT systems may use instead satellite networks or military-type networks (data transport). The Internet makes
it possible for IoT devices to connect to remote services (which can be implemented in the cloud, as private servers, or as blockchain
systems based on smart contracts [37] which can collect data from various devices, conduct analysis and provide feedback to the user
or to third parties (data analysis). Feedback to the user may be an intrusive action (e.g., delivering a medication, opening a door,
moving to a location), or may be a notification. Feedback to third parties may be a summary of statistics, or an alert about safety or
security concerns to an appropriate service (e.g., emergency services).
Mobile applications developed for smartphones or other wearables (e.g., smartwatches) could be included as part of IoT systems for
Fig. 3. An architecture for IoT systems for the elderly and disabled.
9
the elderly/disabled in this section even if they do not collect data automatically, but require a manual input by the user, as without
these apps the elderly or disabled would not access a health service to track a condition or alert a caregiver/healthcare professional.
While some researchers may not agree that certain mobile apps are part of IoT, it worth mentioning that in the 2005 report developed
by the International Telecommunication Union, the definition, and numbers of IoT devices provided (as of 2005) in this report
included smartphones as IoT devices [6]. Moreover, some types of monitoring applications do not require physical sensors to infer
health state (e.g., monitoring of depression using smartphone metadata [96]). However, some connectivity to the Internet (either
continuously, or event-based/delay-tolerant) is needed for any mobile app that collects data to be considered as an IoT system.
In the U.S., before any IoT device/system is considered as a medical device, it must be certified by the U.S. Food and Drug
Administration (USFDA/FDA) and satisfy the definition of a medical device [97]. If it is not certified, then the device or system cannot
claim that it treats (or that even serves to diagnose) any kind of illness. For example, any IoT device sold to the public that collects heart
rate data (e.g., a wearable such as a wristband), unless certified by the FDA, it would be classified as a non-medical (fitness/leisure)
device.
For a device to become FDA-certified, the process can take up to approximately eight months, and the process depends on the
intrusiveness and risks to the human (or animal). If a device is not FDA certified, it could still be used as a medical device if it is an
experimental device used to conduct research with humans for the purpose of diagnosing, treating or preventing an illness/disease. In
this case, the device would be part of an approved research protocol overseen by an ethics board, which in the U.S. is called Insti
tutional Review Board (IRB). In this section we describe technologies and IoT systems/solutions aimed at helping the elderly/disabled
address the challenges we have discussed in the previous section.
4.1. IoT solutions for chronic diseases
The majority of IoT systems for chronic diseases are wearable IoT devices and smart phone mobile applications that can help the
elderly to track their health conditions. Some of these devices can also provide/alleviate symptoms or help manage these chronic
diseases. In this section we describe some of these technologies and the principles/sensors behind them.
4.1.1. IoT solutions for hypertension monitoring

Hypertension occurs when the human blood pressure in the body rises above 130/90. IoT solutions for hypertension control focus
on the monitoring/detection of hypertension. Non-intrusive hypertension monitoring devices monitor blood pressure using a cuff that
inflates on the left arm and presses the brachial artery, fully occluding it, then the cuff begins to deflate in a controlled manner. The cuff
is connected to a sphygmomanometer which shows the blood pressure measurements.
Manual sphygmomanometers measurements require the utilization of a stethoscope which is placed also on the arm to listen for
specific sounds called the Korotkow sounds. This method is called the auscultatory method and requires a third-party (person) who is
trained to inflate, deflate, and listen for the Korotkow sounds. IoT systems using this manual method need somebody (either the user or
the third-party) who takes the measurement and input it in an application running on the smartphone [98].
Digital sphygmomanometers are usually based on the oscillometric method which may still use a cuff that inflates and deflates in a
controlled manner, but now the digital device measures the pressure by using deformable membranes inside the device that change
their capacitance while the cuff deflates, or by using a piezoresistance while the cuff deflates. These capacitances/resistances are then
used by the device’s microprocessor to calculate a pressure value [99]. There is no need of an external person to take the measurement.
Most of the automatic digital sphygmomanometers publicly available use the cuff-based oscillometric method. Oscillometric blood
pressure measurement devices can also a Photoplethysmography (PPG) sensor instead of a cuff to estimate blood pressure. PPG
oscillometric blood pressure devices are usually used in the user’s finger which is pressed using a clamp (like a pulse oximeter),
however other positions such as the wrist, forehead or toe may be used [100]. Recently, Chandraskhar et al. proposed an oscillatory
method using an iPhone to measure the blood pressure using only the smartphone’s screen pressure sensor and the Charged-Coupled
Device (CCD) camera sensor [101] without the need of any other external sensor.
Oscillatory digital sphygmomanometers may be connected to a smart phone via Bluetooth or to a remote service using WiFi or
cellular networks. However, if the digital sphygmomanometers do not have connectivity, they still can be used by having the user
register the measured values in a smart phone app such as the SmartBP app and similar [98]. While other methods exist to take blood
pressure measurements (e.g., Continuous Noninvasive Arterial Pressure (CNAP™) and pulse wave velocity), these products are more
expensive and require prescriptions [102,103].
4.1.2. IoT for high cholesterol monitoring

Commercial self-monitoring high-cholesterol IoT systems are portable devices (size of a human palm) that analyze drops of blood
taken by having a patient pinching a finger using lancets. Once a lancet is used and a drop of blood is placed on a test strip, the strip is
placed that analyses blood composition and tells current cholesterol levels. Depending on its characteristics, the portable device may
connect to a printer, or connect via Bluetooth to a smart phone which then forwards or store the data to a remote service. Example of
such devices include the FORA Total Cholesterol Test Kit [104,105] and the LipidPlus Total Cholesterol measuring system [106]. Some
of these devices may require a prescription or are accessible to educational institutions or medical practices. Other non-invasive
techniques for cholesterol measurements for IoT/wearables use Near-InfraRed (NIR) light which can be coupled with Charged
Coupled Devices (CCD) sensors [107,108].
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4.1.3. IoT for heart disease monitoring and management

IoT devices for heart disease monitoring are based on devices that can measure different features of the cardiovascular system. For
example, devices and systems for hypertension monitoring can also measure physiological variables (e.g., heart rate). In addition to
heart rate, some wearable IoT devices can take ElectroCardioGraphy (ECG) measurements. Wearables of this kind can be found in
fitness services (non-medical) as well as in medical applications to treat and manage heart diseases such as arrythmias, congestive
heart disease, sudden cardiac arrest (among others). Heart rate monitoring using wearable sensors and smart phones supporting IoT
systems is usually done using three approaches:
• ElectroCardioGraphy (ECG): By placing electrodes on the skin (or directly in the heart muscle), this method measures the bio-
potential generated by electrical signals that control the expansion and contraption of the heart chambers over a period to
obtain a measurement of the heart rate. This method is commonly used in chest straps. However, a disadvantage of this method is
that it may be uncomfortable for users [109].
• PhotoPlethysoGraphy (PPG): Uses optical-based technology to measure the volume of blood flow which is controlled by the heart’s
pumping action. Commonly, a PPG measurement is obtained by using a sensor that illuminates the skin and then measures the
changes in the light absorbed. Even though PPG can be used at diverse body locations, this method is commonly used in fitness
bands and smartwatches [110]. The drawbacks of this method include motion/movement, adequate placement of the sensors (they
may be worn loosely) and pulse deficit which may induce errors in the measurements [111,112]. PPG can be combined with ECG
using independent sensors to provide a more accurate reading and detect errors in measurements [113].
• Eulerian Video Magnification (EVM): Uses cameras to track the variation of face pixels over time. As the heart pumps, the color of the
skin changes slightly because of the oxygenated blood in the arteries swell with bright red blood. EVM detects the slightly redder
pixels that change as result of blood pump and exaggerates them to estimate heart rate [114]. A disadvantage of this technology is
that environmental factors (e.g., illumination) can affect the measurements.
In addition to these external sensors, implantable sensors and connected IoT systems can proactively prevent heart failure hos
pitalizations remotely. This is the case of the Abbott’s CardioMEMS HF™ system which monitors the pulmonary artery. The Car
dioMEMS sensor device is implanted in the pulmonary artery via a catheter. Depending on the blood pressure on the artery, the sensor
can generate magnetic fields that can be detected using a special pillow that connects to a network interface which then sends
measurements back to a medical practitioner/hospital. The system can then alert the practitioner/patient of changes in the pressure
which may be used to detect the onset of congestive heart failure up to a week before it can happen [86], thus allowing the practitioner
to make timely changes to a patient’s therapy and preventing a possible heart failure.
Sensing technologies for heart rate can also be combined with actuators to perform intrusive actions in the cardiovascular system.
This is the case of pacemaker devices and automatic (implantable) cardioverter defibrillators, which, upon detecting a problem with
the heart, can deliver an electrical current directly to the cardiac muscle [115], and be remotely connected to a health service for
monitoring, and download software (firmware) updates [116,117].
4.1.4. IoT for arthritis

There are five common types of arthritis [118] which are osteoarthritis (caused by the fatigue of joints), rheumatoid arthritis
(caused by autoimmune conditions), psoriatic arthritis (caused by psoriasis which is a type of skin inflammation), gout (caused by the
build-up of uric acid crystals in a joint), and lupus (an autoimmune disease). All these types can produce pain and stiffness in the joints
that can be disabling for a patient. To diagnose arthritis a physician can measure different variables such as Range Of Motion (ROM),
pain, swelling, stiffness, grip, and strength.
Since arthritis can be present at different joints, IoT and wearable systems have been developed with the goals to help diagnose and
ease the pain associated with the condition. Examples of IoT systems to help diagnose arthritis include smart gloves [119], smart phone
applications [120], inertial sensors such as accelerometers [121,122], and wearable cameras combined with accelerometers [123]. IoT
pain management systems for arthritis include wearable pain relief systems such as the Quell 2.0 wearable pain relief technology [124]
and the iTENS wearable pain relief systems based on electrical stimulation [125], devices based on infrared Light Emitting Diodes
(LEDs)/laser systems [126] and connected and vibration-based wearable therapy systems [127].
4.1.5. IoT for diabetes

Connected devices for diabetes are available for both diabetes tracking and medication delivery. In the area of diabetes tracking,
wearable IoT devices have been developed to track glucose levels continuously as well as sporadically. Some glucose monitors are
based on electrochemical sensors like those used for high cholesterol monitoring by which patients pinch their finger and take a blood
sample which then the device uses to measure glucose levels [104]. Non-intrusive glucose wearable monitors include wearables with
PPG sensors [128] and trans-dermal monitoring devices [129]. For automated medication delivery for diabetes (i.e., insulin delivering
systems) IoT wearable systems include microneedles [120,130,131] as well as connected cannula-based insulin pumps [132]. It worth
noting that an artificial pancreas is a system that combines both a glucose monitoring system and an insulin infusion pump [133].
4.1.6. IoT for cancer

IoT wearables such as pulse oximeters, smart phones, activity trackers (i.e., accelerometers [134]), heart rate trackers have been
used in research studies that observed if the utilization of these devices improves physical activity, stress, and overall health state
during chemotherapy [135–137].
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Some studies have explored the adoption of wearable IoT technology and smart phone applications, and they found that while
devices and apps were accepted by the elderly [138], some sensors may cause discomfort (depending on the type of cancer). For
example, Yong Chung et al. [139], in a study of wearables and smart phone apps in women patients with breast cancer found that
activity bands (wrist bands) can be discomforting for elderly women.
For connected IoT systems to help cancer patients (including the elderly) with their treatments (for chemotherapy in form of pills),
the MedMinder system [140] is a commercial product currently available that provides reminder and medication intake. In the past,
devices such as the MedMinder have been researched to investigate their feasibility in use in cancer patients. In this direction, Song
[141] investigated the utilization of electronic pillboxes in cancer patients and found that pillboxes facilitated adherence to treatment
medication after allogenic hematopoietic cell transplants, even though some of features of the boxes could be modified.
4.1.7. IoT for chronic kidney disease

Chronic Kidney Disease (CKD) is found usually together with other conditions that affect the elderly such as type 2 diabetes,
hypertension, and cardiovascular diseases such as arrhythmias [142]. For patients with diabetes and CKD, research has found that the
adherence to exercise, and medication results in a better quality of life [143]. Thus, non-implantable activity trackers, wearables for
diabetes monitoring (i.e., glucose monitoring), hypertension monitoring and cardiac diseases monitoring devices combined with other
medical health records, and AI/Machine Learning (ML) and Deep Learning (DL) techniques can help track progress of CKD [144–146].
When there is renal failure (the final stage of CKD) the treatment for the patient is kidney transplantation or the use of dialysis by
which waste is removed from the human blood by a machine. While portable dialysis machines exist in currently in the market to
provide dialysis at home, as of 2021, there are no Internet-connected dialysis machines in the market.
4.1.8. IoT for depression and mental health

Systems to monitor depression (and other mental health issues) can track three types of signals, namely behavioral signals,
physiological signals, and social signals [147]. Data associated with these signals can be collected using wearable sensors (e.g., location
sensors, accelerometers, microphones, heart rate monitors, galvanic skin response sensors), cameras in smart phones and/or external
IoT devices (to track facial and eye tracking features that can be used to detect depression such as microexpressions), cellphone data
and web search/navigation data/metadata (e.g., text messages, duration, and frequency of phone calls, visited websites). These
sensors, when combined with intelligent algorithms, can then detect mood states. To help treat depression (and in addition to elec
tronic dispensers), exergames (video games that combine exercise with games) have been used in the past to treat depression in both
immersive (e.g., virtual and augmented reality devices [148–150]) and non-immersive environments [151].
4.1.9. IoT Alzheimer’s disease/dementia

IoT solutions for Alzheimer’s disease can be used to prevent a patient from wandering or to help locate a patient. Given the
cognitive decline of people suffering from this disease, location-based services developed over the last decade can help to track/find a
patient who may be lost. In addition, the continuous monitoring of the environment can help to track the current physical and
emotional state of a patient. For example, Enshaeifar et al. [152] proposed an integrated health management system composed of
wearable and environmental sensors to track patients. Virtual Reality (VR) devices and systems have been proposed to help in the
diagnostics of both elderly and people with cognitive impairments [153], and for treatment in the early stages of dementia (e.g., to
calm patients, for cognitive stimulation, and to help patients remember [154]).
Chronic obstructive pulmonary disease (COPD). Wearable and portable sensors have been used in the past to track the health state of
people with COPD. Example of sensors used to track include PPG sensors to measure oxygen saturation [155,156], accelerometers to
recognize activities and activity levels [156,157], heart rate [157], elastic sensors and smart fabrics (to measure the depth of the
respiration) [155] and microphones/ultrasound (through smart stethoscopes [50]). Sensors such as air quality sensors [158] can also
help to improve the quality of life of elderly patients with COPD because they can monitor air pollutants that could trigger dangerous
situations for patients.
Increasing the physical activity level for COPD patients through low and high-intensity exercise training can improve the health
state of COPD patients [159]. Thus, exergames based on IoT and virtual/augmented reality devices have been proposed and evaluated
in the past to help elderly COPD patients [160,161].
4.2. IoT solutions for mobility impairments
As we have previously described, 40% of the elderly population in the U.S. have mobility impairments including gross motor skills
impairments such as moving/walking and fine motor skills such as manipulating objects with hands (and other mobility impairments
in between). Supporting independent living includes IoT mobility technology to help the elderly and people with disabilities. In this
context, we can classify IoT mobility solutions into three groups: (1) outdoor/long-distance mobility solutions; (2) indoor/short-
distance mobility solutions; (3) accessibility devices for hand/arm-based activities.
IoT solutions for long distance mobility allow the elderly and people with disabilities to move or travel longer than walking dis
tances. Here we include connected devices or systems that help elderly/people with disabilities to move around in a city. IoT solutions
in this category includes self-driving cars [162], transportation systems such as self-driving trolleys [87,163], ride hailing mobility
services developed specifically for the elderly (similar to Uber and Lyft [88,164–165]), and systems to help the elderly and disabled
12
A.J. Perez et al.
Table 8
Examples of IoT systems for smart homes to support the elderly and disabled.
IoT system Services Technologies Implementation Evaluation of efficiency
details
Watch-Over Tracks the safety of elderly at home Motion, temperature, and humidity sensors, Raspberry Prototype system Model evaluated for efficiency
system [208] Pi, Bluetooth Low Energy (BLE), BLE beacons, Twitter implementation
described
IOT cares for Tracks actions and movements of the elderly Intel Edison platform, temperature, pulse sensor and Prototype system Model evaluated using real hardware and found to be 98.90%,
elderly (ICE) at home, provides secure entrance door accelerometer sensors, WiFi implementation 98.49% and
[209] access to guests described 90.0% accurate for the measurement of body temperature,
pulse rateand fall detection respectively.
We-Care prototype Tracks physical movements and vital signs Sensors, CC2650 MCU SensorTag, Bluetooth Low Energy Prototype system Model evaluated using real hardware
[210] 4.0, 6LoWPAN over the IEEE 802.15.4, Contiki-OS implementation
described
13
IoT Android Monitors safety and well-being of home Raspberry Pi, sensors, servo motors, Firebase Cloud Prototype system Model not evaluated for efficiency
application residents, provides front door access using Messaging (FCM) server, open source computer vision, implementation
[211] facial recognition, tracks sanitation and Node.js web server, Android application described
conditions in the home
Robotic Support for navigation, companionship, and Assistive robots with sensors and actuator. Sensors Prototype system Model evaluated for efficiency and concluded that active
environments various forms of interaction with human include a camera, touch sensors, infrared and stereo implementation communication with a robot using a human face instead of
[213] beings sound. Actuators include four legs, a moveable tail, and described devices (e.g., keyboard) improves the learning ability of the
a moveable head robot and enables better response to human users
IoT based home Home automation system for controlling Arduino Mega board, rain sensor, temperature sensor, a Prototype system Model not evaluated for efficiency
automation home appliances Light Dependent Resistor (LDR), WiFi module, relays, implementation
[212] LCD display, buzzer, servo motor, L293D motor driver described
IC, MAX 232 and light bulb
Automated curtain Home automation system easy and Microcontroller MSP-430, light and motion sensors, Prototype system Model evaluated using real hardware and shows suitable
system [214] independent living Universal Asynchronous Receiver Transmitter (UART), implementation mechanical performance and minimal energy consumption
IEEE 802.15.4, IPv4, IPv6 described
Internet of Things 21 (2023) 100653

(and the general population) to ride public transportation [166]. While these technologies are relatively new (many developed in the
last 15 years) and some are still relatively expensive (e.g., self-driving cars), a recent project in Japan [87] has demonstrated the use
and positive adoption/feedback of self-driving trolleys by the elderly in rural areas near Tokyo.
For short-distance mobility solutions, IoT devices include connected wheelchairs, walkers, prosthetics, and orthotic devices [167].
Connected IoT wheelchair solutions range from systems that capture the health (physiological) state of the individual sitting on a
wheelchair [168] to connected systems that control wheelchairs using gloves with accelerometers [169], wheelchair with joysticks and
notification capabilities [170]), EEG-controlled wheelchairs [171], and eye tracking (blinking) controlled wheelchairs [172]. Walker
solutions include robotic walkers that guide the patient to a destination and are controlled by a cell phone [173], walkers with
navigational aids [174], walkers for rehabilitation [175], among others. IoT prosthetics solutions integrate environmental information
for control using sensor fusion in prosthetic hands (and other prosthetics [176]), smart canes [177,178], smart lower limbs (e.g., leg)
prosthetics [179] and wearable robots (i.e., exoskeletons [180]).
Accessibility IoT devices for the hand/arm are devices that help the elderly and disabled who, because of hand tremors caused by
neurological or muscular diseases (such as Parkinson’s or arthritis) are unable to perform hand-based activities such as eating. One
example of a solution in this category is Liftware’ smart spoon [181].
4.3. IoT solutions for sensory and communication/voice challenges
IoT for sensory and communication/voice challenges attempt to improve the sensory and communication skills of the elderly and
the disabled. In this category, we include hearable devices to help listen [182], devices to help people to see via retinal implants [183,
184], electrolarynxes augmented with neural networks for people with voice challenges [185,186], mobile devices/wearables to
translate in real time sign language (using deep neural networks [187] and other machine learning algorithms [188]). In addition to
IoT for communication, some other IoT such as smart gloves and wearable accelerometers connected to games [189,190] have been
developed to stimulate the proprioceptive system which is a system in the human body (and other vertebrates/invertebrates) that
provides awareness of self-movement and body position It worth noting that research has shown that the proprioceptive system is used
by the elderly more than visual and vestibular cues for posture control [191].
4.4. IoT solutions for emerging infectious diseases/pathogens
Recently the Coronavirus Disease (COVID-19) pandemic (caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-
2)) has been devastating for the elderly population [192]. In addition to the physical issues experienced by the elderly (which un
fortunately included death for many) who contracted the virus and the disease, social isolation has taken a serious public health
concern due to the chronic and mental health problems that the elderly may experience when in self-isolation [193,194]. A similar
situation has been experienced by people with disabilities [195,196].
In the context of emerging diseases such as the COVID-19 pandemic, IoT has been used to mitigate the pandemic effects through
patient tracking, contact tracing, and remote patient monitoring and treatment [45,197–199]. IoT devices have also been used to
diagnose possible COVID-19 cases remotely [200,201], and to keep diagnosed patients’ communication with healthcare providers and
family members/friends. For communication specifically, while tablets and smartphones have proved useful for the elderly [202–204],
the elderly population has also suffered from digital isolation/digital divide because of the rate of adoption of IoT devices by the elderly
[205,206], which is, especially for newer devices, much smaller with respect of the rest of the population. Recent research in IoT
devices for emerging diseases has also included the development of masks and facial wearables that can self-sterilize and detect viruses
such as the SARS-CoV-2 virus [207].
4.5. IoT solutions for home safety
Advances in IoT devices for smart homes have facilitated the automation of home processes benefiting not only the population in
general, but also the elderly. Popular home automation IoT systems such as thermostats, TV sets, radios, vacuum machines, and alarm
systems (among others) can be connected to the Internet and be controlled through voice using intelligent voice assistants and mobile
phones. In addition to these commercially available systems, other systems currently in research specifically for the elderly use cheap
computers and other devices (e.g., Raspberry-Pi, Arduino, among others). We provide a review of such smart home systems for hone
safety in this section and Table 8 presents a summary of the IoT systems developed by various researchers.
Suzuki et al. [208] proposed a “watch-over” system based on IoT devices which can be used to observe the safety of elderly people
who live alone. This system employs external motion which are installed in various rooms of the house. Additional sensors exist that
can collect temperature and humidity information from the environment. The system is intentionally designed to restrict the capture of
audio, video, or static images to ensure the privacy of individuals using the system. In addition to the sensors, the “watch-over” system
utilizes Bluetooth Low Energy (BLE) wireless technology, BLE beacons and a Raspberry Pi. The system delivers both emergency as well
as non-emergency messages via twitter to family members. If, for instance, the temperature exceeds thirty degrees in any room, or if a
bathroom visit exceeded the expected average time by more than fifteen minutes, the system automatically delivers an emergency
message to family members via Twitter. The system is also designed to work only when a senior resident is alone and shifts into an “idle
mode” when the resident is accompanied by a caregiver or other able-bodied adults.
Hua et al. [209] proposed a monitoring system that intelligently tracks the actions and movements of the elderly person at home.
The system is based on the Intel Edison platform and consists of three sensors (temperature, pulse sensor, and accelerometer) to
14
measure the body temperature, pulse rate, and acceleration values which are then designed to detect different types of movements as
well as any falls. The system handles emergency situations by transmitting messages to paramedics as well as to immediate family
members. The main tasks carried out include data gathering, data communication, back-end evaluation, and result demonstration. A
GY521 sensor and a pulse sensor are placed on the individual’s wrist to collect heart beats and body temperature information. A 6-axis
accelerometer, MPU6050 with frequency of 100 Hz is positioned on the user’s wrist to detect falls. The system enables secure door
access. A button on a wristband sends a Wi-Fi signal to a nearby server which transmits a special Short Message Service (SMS) code to
relatives to allow them to get access through the home’s entrance door. The system was experimentally evaluated and showed an
accuracy of above 90 percent for measuring the body temperature as well as the pulse rate
Pinto et al. [210] developed an IoT-based health care system called “We-Care” that collects data and monitors older people in their
homes. The model is constructed by using various types of hardware as well as software modules. The core framework comprises three
components: a We-Watch wristband, the system’s services, and the cloud platform. We-Watch includes a miniature wristband that is
designed for providing support to the senior population. The wristband obtains data such as temperature (body and environmental),
pressure, light, humidity, and acceleration from on-board sensors, and transmits the information to the We- Care board, which stores it
in a SD-card connected to the board and can also upload the information to the cloud. The We-Care board receives data from the
We-Watch and responds quickly in emergency situations by alerting the appropriate medical personnel. The wristband utilizes a
SensorTag from Texas Instruments which incorporates a low-power development platform which comprises a CC2650 Microcontroller
Unit (MCU) and multiple on-board sensors. This multi-standard MCU uses Bluetooth Low Energy (BLE) 4.0 and 6LoWPAN over the
IEEE 802.15.4 standard (2.4 GHz) and runs the Contiki-OS (an operating system for IoT). The platform’s small size facilitates its
implementation as a wristband. It worth noting that its low-power consumption allows the We-Care wristband to work for long periods
of time using a single, coin-sized cell battery. The Contiki-OS provides the full IoT support for the 6LoWPAN protocol.
Lee et al. [211] have demonstrated how the IoT technology can be integrated in the residences of elderly people with the help of
simple hardware and open-source software. Using technologies such as Raspberry Pi, Open-Source Computer Vision, and a Node.js web
server, an unaccompanied senior’s health status can be safely monitored. The system enables five different services: facial recognition
for providing entry through front door, alerting family members when movement is detected, recording the internal home temper
ature, turning lights on and off, and keeping track of garbage levels in a trash bin. The system employs an Android application which
can be customized to meet the requirements of its users. Sensors gather data and transmit it to a server. Upon analyzing the data
received from the sensors, the server sends signals to the actuator to enable it to take an action. The system utilizes the Hypertext
Transfer Protocol (HTTP) protocol. The devices transmit a POST request for storing data in the MongoDB database. When the Android
application transmits a GET request, the server responds with the required data, which is retrieved from the database. The system also
uses a Firebase Cloud Messaging (FCM) server that can transmit data reliably. The FCM connection server issues an identifier called an
App token to the client application (Android) to enable it to receive messages. The Android application can display the
sensor-accumulated data as well as providing controls for the actuators.
Reddy et al. [212] developed a home automation system using IoT. The system uses an Arduino Mega, rain sensor, temperature
sensor, a Light Dependent Resistor (LDR), Wi-Fi module, relays, an LCD display, buzzer, servo motor, L293D motor driver IC, MAX 232-
a dual transmitter-receiver for the transmit (RX), receive (TX), Clear to Send (CTS), and Request to Send (RTS) signals and a light bulb.
The Arduino board interfaces with the temperature sensor, LDR and rain sensor to manage home appliances such as the speed of the
fan, brightness of the light, and to detect rainfall. Temperature measurement is done by the LM35 sensor. Likewise, the intensity of
light is varied by using the LDR depending on need. Rain can be detected using the rain sensor and the status of the rainfall, light, and
fan are displayed on the LCD display and android mobile device. A Wi-Fi module and the Arduino board are joined via the MAX232.
Light and fans are connected to the Arduino board through a relay (a piece of hardware that is used for opening and closing a circuit)
which acts as switch. All these appliances are managed by an Android application running on the mobile device. The application uses
the Wi-Fi connection to transmit characters to the Arduino board. Specific characters are assigned as a code to each appliance. These
codes are used by the Android application to alter the light brightness, fan speed, and to detect rain.
Broekens et al. [213] developed a range of robotic services in the homes that act as social buddies for lonely elderly individuals. The
robots are also utilized for interacting with a sick person (in the absence of human and animal companions) and help in the recovery
process. Smart robotic environments are also very advantageous for individuals suffering from dementia by acting as friends thereby
causing mood improvements and decreasing loneliness. However, the research studies related to the usefulness of robotic support for
the elderly are very limited and confined to certain communities only.
Souza et al. [214] proposed an automated curtain system that aims to provide comfort, ease of living, and independence to people
living by themselves. The system is characterized by low energy consumption, via the use of off-the-shelf smartphones, sensors, and
actuators. The microcontroller selected for this system is an MSP-430 G2553 which is energy-efficient. It controls a high-accuracy step
motor. A software driver (ULN2003A) is used to start the motor. The system also includes a position switch, Light Dependent Resistor
(LDR), which is a light sensor and a motion sensor. The commands, or data, are sent to a border router by the user through an
application on a smartphone, or computer, via the Internet, using IPv4 or IPv6. The border router sends data to the radio controller via
the low-power IEEE 802.15.4 protocol. From the radio controller, data is sent to the microcontroller via a Universal Asynchronous
Receiver Transmitter (UART), which is a serial data transmission protocol primarily utilized for microcontrollers.
5. Challenges in using IoT for elderly and disabled
We have reviewed IoT solutions that will improve the lives of elderly and disabled individuals, especially those living indepen
dently with no assistance from other caregivers. As we have described, research in the last decade has developed IoT systems in various
15
areas including remote healthcare, home assistance, mental or physical impairments, and timely medicine consumption. These IoT
solutions rely on sensors, wearable devices, robotic assistants, and voice commands. The Internet of Things and their applications can
play a vital role in assisting senior and disabled individuals in their daily lives and routines and act as a substitute for caregivers. While
these IoT models and prototypes are innovative and a step toward leveraging different types of IoT technologies to help the elderly and
disabled people, they also have several shortcomings and challenges that must be addressed before IoT systems can simplify the lives of
people who are aging or have disabilities. We discuss some of these challenges below:
• Difficulty in accessing and learning to operate a user interface: many IoT solutions utilize Graphical User Interfaces (GUIs) to offer
menus to the elderly to use various automated tasks. For example, a home automation system may utilize a smartphone (or a tablet)
to present a menu that allows users to dim lights or change thermostat settings. Similarly, many wearable IoT systems also provide
smartphone-based GUIs to control settings. However, many elderly find it difficult to understand such interfaces and due to
cognitive decline, they have a difficult time remembering the steps needed to use and access device settings through its interface.
This is also an issue with individuals with cognitive challenges and disabilities. Furthermore, individuals suffering from arthritis
could make errors in their selections while using a GUI, thereby lowering the usefulness of an IoT product. Voice interfaces are a
good alternative to GUIs and text-based interfaces. However, voice commands cannot always be easily memorized and recalled by
elderly people. Smart voice assistants (e.g., Google Home, Amazon Echo) can remind individuals when to take medications, how to
contact their health care professionals, and can even assist with calling an ambulance in the event of a life-threatening emergency.
Speech impairments (as we have previously discussed) may create additional complications when members of the elderly/disabled
communities attempt to incorporate voice commands. In this direction we include also issues related to the accessibility of privacy
and security policies for the elderly and disabled. More research is needed to develop intelligent, friendly user interfaces that can
adapt to different user requirements of the elderly and the disabled while imposing the least burden on them to learn and use the
user interface.
• Dependency on power sources: many IoT devices (and in particular wearable IoT devices) are powered by batteries. Therefore, a
continuous source of power supply is essential to ensure that many battery-powered IoT devices can accomplish their tasks (either
to collect data or to control other IoT devices). Moreover, in third-world countries where power outages are common, the use of
battery-powered IoT systems can limit the usefulness of IoT devices for the elderly and the disabled because of the inability to
recharge such devices. More research is needed on power management and reliable power sources to use in IoT systems.
• Security and privacy issues: Only few IoT systems incorporate security as part of their design. Authentication, authorization, and
encryption are significant to any IoT systems. While several security and privacy concerns exist in IoT technologies and systems
[215–219] and have been demonstrated throughout the years, still many IoT devices are developed and released to consumers
ignoring security and privacy issues. For example, even though Bluetooth standards provide security assurances, there are still IoT
devices that are manufactured and sold without implementing Bluetooth security [220]. The consequence is that unauthorised
access can harm the well-being of the elderly/disabled and provide access to sensitive information. Some systems may violate the
elderly/disabled privacy without users’ knowledge (an issue like the issue of bystanders’ privacy [221]). Unauthorised access can
also cause user privacy violations, financial losses, interruption of IoT-based services, eavesdropping, home break-ins, and so on
[222]. For example, in September 2016, hackers were able to take control of over thousands video security cameras and other
consumer IoT devices manufactured by a small group of companies [223]. This hack received a tremendous attention across the
world and made it very difficult to persuade people originally enthusiastic about IoT systems to accept that the gadgets they use are
secure.
• Interoperability of devices: due to the lack of complete standards in the IoT domain, it may be challenging for an IoT device from one
vendor to communicate with other IoT systems from different vendors. Despite many IoT devices having similar networking ca
pabilities, the lack of interoperability protocols and standards [224] may prevent different devices from collaborating which may
affect not only the implementation of services, but also human-computer interaction issues related to cognitive loads for the
elderly/disabled due to the myriad of GUI interfaces and features that are needed to successfully use multiple IoT systems at the
same time. Samsung has attempted to overcome such compatibility and interoperability issues by proposing more open protocols
and architectures (such as the Samsung ARTIK architecture [225]), but due to the competition among many technological com
panies to position themselves as leaders in the IoT market, these efforts have not produced a widely adopted open IoT architecture.
• Context awareness: context awareness allows IoT systems to recognize activities, emotional, and physical states to provide proactive
services. An IoT system can be made intelligent by allowing it to make decisions by combining sensor data with additional
knowledge and Artificial Intelligence (AI). However, many IoT applications and services cannot dynamically adapt to changes in an
environment or respond to changes in a person’s context (and psychological/personal factors). For example, a remote health
monitoring system may not be able to distinguish whether an increase in pulse rate is due to increased physical activity such as a
work-out or due to a serious medical condition. The development of context aware IoT solutions can decrease the quantity of data
that is transferred to services, which may provide more privacy while minimizing communication overheads. The use of AI
techniques with IoT can help implement decision making locally without the need to transmit huge amounts of data to remote cloud
servers. Moreover, context-awareness can provide better services to the elderly and disabled by recognizing the differences be
tween individuals and better adapt to the needs of each one.
• Long-term support of IoT devices for healthcare: Many IoT devices in healthcare have been developed by start-up companies. As a
result, due to the limited time for development that start-ups need to place a product in the market (due to their business models),
and the relatively long time for safety approval of IoT healthcare, early adopters and/or patients in clinical trials can end without
long-term support if the start-up companies fail. While for some IoT devices this may not be an issue (because there may be
16
equivalent devices in the market, or are easy to be replaced), for some other IoT devices (especially implantable devices) this may
not be the case. To illustrate this issue, Argus II is a system that combines an external wearable with a retinal implant [183] and
enables people without certain types of blindness to see again. The company that developed Argus II was launched in 1998 but the
device was approved in the United States in 2013 (2011 in the European Union), this company has been in financial stress (up to the
point of being bankrupt and ceasing operations), leaving its users and adopters without support, which would make them even
tually be blind again [226].
Finally, we have also observed that most IoT systems proposed for the elderly and disabled that have been published so far only
describe the implementation and operation of the model, but many lack extensive evaluation tests to demonstrate the strengths and
shortcomings of the prototypes when used in an actual environment. This issue may improve safety wherein an IoT system claims that
it works in a specific way when tested in a controlled (lab), but when actually deployed, the IoT system behaves differently and cause
unexpected issues that may be problematic (or even life-threatening) to the users. We must evaluate the efficiency and performance of
these systems extensively to better understand their impact, usefulness and effectiveness. These evaluations can generate data to
provide a strong insight into the strengths and shortcomings of each system and can therefore help in improving the IoT systems to
better adapt to the needs of the users and accommodate different societies and cultures.
6. Conclusion
In this work, we reviewed several IoT solutions that have been proposed in recent years for providing convenience and support to
elderly and disabled individuals in their home environments. These proposed IoT-based architectures create a smart home and
leverage a combination of sensors, actuators, computing devices, cloud services, wireless technologies, and protocols, and various
types of IoT technologies. While some of these IoT systems have been tested in experimental environments, we argue that additional
long-term field testing can generate critical information about the advantages and shortcomings of the proposed IoT systems -
especially among older adults who may require audio enhancement devices, mobility devices, cognitive or speech impairment aids.
These concerns along with the challenges associated with accessing and learning a user interface, dependency on power sources,
security and privacy issues, interoperability of devices, intelligence based on context awareness, and long-term support of IoT devices
for healthcare must be addressed to make these smart IoT products more reliable, ready for practical deployments, and easy to use by
older and disabled populations.
CRediT authorship contribution statement
Alfredo J. Perez: Conceptualization, Investigation, Writing – original draft. Farhan Siddiqui: Conceptualization, Investigation,
Writing – original draft. Sherali Zeadally: Conceptualization, Writing – review & editing. Derek Lane: Writing – review & editing.
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to
influence the work reported in this paper.
Data availability
The data presented in this research is publicly available through the U.S. Government agencies, the United Nations and the OECD.
References have been cited in their corresponding places.
Acknowledgments
We thank the anonymous reviewers for their valuable comments which helped us improve the organization, content, and quality of
this article.
References
[1] R. Gupta, R. Gupta, ABC of internet of things: advancements, benefits, challenges, enablers and facilities of IoT, in: Proceedings of the Symposium on Colossal
Data Analysis and Networking, CDAN 2016, 2016.
[2] B. Hammi, R. Khatoun, S. Zeadally, A. Fayad, L. Khoukhi, Internet of things (IoT) technologies for smart cities, IET Netw. 7 (2018).
[3] S. Zeadally, F. Siddiqui, Z. Baig, A. Ibrahim, Smart healthcare: challenges and potential solutions using internet of things (IoT) and big data analytics, PSU Res.
Rev. 4 (2020).
[4] I. García-Martínez, J.M. Fernández-Batanero, D.C. Sanchiz, AntonioLuque de la Rosa, Using mobile devices for improving learning outcomes and teachers’
professionalization, Sustainability 11 (2019) (Switzerland).
[5] M. Weiser, The computer for the 21st century, Sci. Am. 265 (1991).
[6] K. Ashton, That internet of things thing, RFID J. (2009) 4986.
[7] ITU Internet Reports, The Internet of Things, November 2005.
[8] D. Evans, How the Next Evolution of the Internet Is Changing Everything, CISCO white paper, 2011.
17
[9] Ericsson, Ericsson Mobility Report, (2021).

[10] L. Atzori, A. Iera, G. Morabito, The internet of things: a survey, Comput.Netw. 54 (2010).
[11] N.D. Lane, E. Miluzzo, H. Lu, D. Peebles, T. Choudhury, A.T. Campbell, A survey of mobile phone sensing, IEEE Commun. Mag. 48 (2010).
[12] S. Bandyopadhyay, M. Sengupta, S. Maiti, S. Dutta, A survey of middleware for internet of things, in: Proceedings of the Communications in Computer and
Information Science 162, CCIS, 2011.
[13] A. Gluhak, S. Krco, M. Nati, D. Pfisterer, N. Mitton, T. Razafindralambo, A survey on facilities for experimental internet of things research, IEEE Commun. Mag.
49 (2011).
[14] M. Vazquez-Briseno, C. Navarro-Cota, J.I. Nieto-Hipolito, E. Jimenez-Garcia, J.D. Sanchez-Lopez, A proposal for using the internet of things concept to increase
children’s health awareness, in: Proceedings of the CONIELECOMP 2012 - 22nd International Conference on Electronics Communications and Computing,
2012.
[15] W. AL-mawee, Privacy and Security Issues in IoT Healthcare Applications For the Disabled Users a Survey, 49008, Western Michigan University, 1903 W
Michigan Ave, Kalamazoo, MIUSA, 2012. Master’s thesis.
[16] P. Lopez, D. Fernandez, A.J. Jara, A.F. Skarmeta, Survey of internet of things technologies for clinical environments, in: Proceedings of the 27th International
Conference on Advanced Information Networking and Applications Workshops, WAINA, 2013, 2013.
[17] F. Touati, R. Tabish, U-healthcare system: state-of-the-art review and challenges, J. Med. Syst. 37 (2013).
[18] S. Park, K. Chung, S. Jayaraman, Wearables: fundamentals, advancements, and a roadmap for the future, Wearable Sensors: Fundamentals, Implementation
and Applications, 2014,.
[19] S.M.R. Islam, D. Kwak, M.H. Kabir, M. Hossain, K.S. Kwak, The internet of things for health care: a comprehensive survey, IEEE Access 3 (2015).
[20] J.A. Naslund, K.A. Aschbrenner, L.K. Barre, S.J. Bartels, Feasibility of popular m-health technologies for activity tracking among individuals with serious
mental Illness, Telemed. e-Health 21 (2015).
[21] A. Al-Fuqaha, M. Guizani, M. Mohammadi, M. Aledhari, M. Ayyash, Internet of things: a survey on enabling technologies, protocols, and applications, IEEE
Commun. Surv. Tutor. 17 (2015).
[22] S.H. Almotiri, M.A. Khan, M.A. Alghamdi, Mobile health (m-health) system in the context of IoT, (2016) 39–42.
[23] K. Ullah, M.A. Shah, S. Zhang, Effective ways to use Internet of Things in the field of medical and smart health care, in: Proceedings of the International
Conference on Intelligent Systems Engineering, ICISE, 2016, 2016.
[24] J. Santos, J.J.P.C. Rodrigues, B.M.C. Silva, J. Casal, K. Saleem, V. Denisov, An IoT-based mobile gateway for intelligent personal assistants on mobile health
environments, J. Netw. Comput. Appl. 71 (2016).
[25] S. Deshkar, V.G. Menon, A review on IoT based m-health systems for diabetes, Int. J. Comput. Sci. Telecommun. 8 (2016).
[26] M. Ganzha, M. Paprzycki, W. Pawłowski, P. Szmeja, K. Wasielewska, Semantic interoperability in the internet of things: an overview from the INTER-IoT
perspective, J. Netw. Comput. Appl. 81 (2017).
[27] G.J. Joyia, R.M. Liaqat, A. Farooq, S. Rehman, Internet of medical things (IOMT): applications, benefits and future challenges in healthcare domain,
J. Commun. 12 (2017).
[28] S.K. Lee, M. Bae, H. Kim, Future of IoT networks: a survey, Appl. Sci. 7 (2017) (Switzerland).
[29] R.S.H. Istepanian, T. Al-Anzi, m-Health 2.0: new perspectives on mobile health, machine learning and big data analytics, Methods (2018) 151.
[30] S.P. Erdeniz, I. Maglogiannis, A. Menychtas, A. Felfernig, T.N.T. Tran, Recommender systems for iot enabled m-health applications, IFIP Adv. Inf. Commun.
Technol. 520 (2018).
[31] M. Irfan, N. Ahmad, Internet of medical things: architectural model, motivational factors and impediments, in: Proceedings of the15th Learning and
Technology Conference, L and T, 2018.
[32] A.J. Perez, S. Zeadally, Privacy Issues and Solutions for Consumer Wearables, 20, IT Professional, 2018.
[33] J.M. Peake, G. Kerr, J.P. Sullivan, A critical review of consumer wearables, mobile applications, and equipment for providing biofeedback, monitoring stress,
and sleep in physically active populations, Front. Physiol. 9 (2018).
[34] M. Chernyshev, Z. Baig, O. Bello, S. Zeadally, Internet of things (IoT): research, simulators, and testbeds, IEEE Internet Things J. 5 (2018).
[35] N. Neshenko, E. Bou-Harb, J. Crichigno, G. Kaddoum, N. Ghani, Demystifying IoT security: an exhaustive survey on IoT vulnerabilities and a first empirical
look on internet-scale IoT exploitations, IEEE Commun. Surv. Tutor. 21 (2019).
[36] S. Durga, R. Nag, E. Daniel, Survey on machine learning and deep learning algorithms used in internet of things (IoT) healthcare, in: Proceedings of the 3rd
International Conference on Computing Methodologies and Communication, ICCMC, 2019, 2019.
[37] M.M. Dhanvijay, S.C. Patil, Internet of things: a survey of enabling technologies in healthcare and its applications, Comput. Netw. 153 (2019).
[38] L. Minh Dang, M.J. Piran, D. Han, K. Min, H. Moon, A survey on internet of things and cloud computing for healthcare, Electronics 8 (2019) (Switzerland).
[39] P.P. Ray, D. Dash, D. De, Edge computing for internet of things: a survey, e-healthcare case study and future direction, J. Netw. Comput. Appl. 140 (2019).
[40] H. Habibzadeh, K. Dinesh, O. Rajabi Shishvan, A. Boggio-Dandry, G. Sharma, T. Soyata, A survey of healthcare internet of things (HIoT): a clinical perspective,
IEEE Internet Things J. 7 (2020).
[41] S. Nazir, Y. Ali, N. Ullah, I. García-Magariño, Internet of things for healthcare using effects of mobile computing: a systematic literature review, Wirel.
Commun. Mob. Comput. (2019), 2019.
[42] A. Darwish, A.E. Hassanien, M. Elhoseny, A.K. Sangaiah, K. Muhammad, The impact of the hybrid platform of internet of things and cloud computing on
healthcare systems: opportunities, challenges, and open problems, J. Ambient Intell. Humaniz Comput. 10 (2019).
[43] N. Niknejad, W.B. Ismail, A. Mardani, H. Liao, I. Ghani, A comprehensive overview of iter wearables: iteratur of the art iteratura, recent advances, and future
challenges, Eng. Appl. Artif. Intell. 90 (2020).
[44] F.J. Dian, R. Vahidnia, A. Rahmati, Wearables and the Internet of Things (IoT), Applications, Opportunities, and Challenges: A Survey, 8, IEEE Access, 2020.
[45] N. Ahmed, R.A. Michelin, W. Xue, S. Ruj, R. Malaney, S.S. Kanhere, et al., A survey of COVID-19 contact tracing apps, IEEE Access 8 (2020).
[46] G. Aceto, V. Persico, A. Pescapé, Industry 4.0 and health: internet of things, big data, and cloud computing for healthcare 4.0, J. Ind. Inf. Integr. 18 (2020).
[47] A.I. Alsalibi, M.K.Y. Shambour, M.A. Abu-Hashem, M. Shehab, Q. Shambour, Internet of things in health care: a survey, in: Proceedings of the Intelligent
Systems Reference Library, 2021.
[48] S.M. Yassin, D. Batran, A. Al Harbi, M.Z. Khan, A survey on IoT applications in health care and challenges, in: Proceedings of the International Conference on
Communication and Computational Technologies, 2021.
[49] D. Sharma, A.Z.B. Nawab, M. Alam, Integrating M-health with IoMT to Counter COVID-19, Stud. Comput. Intell. (2021).
[50] A.J. Perez, S. Zeadally, Recent advances in wearable sensing technologies, Sensors 21 (2021).
[51] ONU, World Population Ageing 2019, United Nations, Department of Economic and Social Affairs, 2019. Population Division (2019).
[52] ACL, Profile of Older Americans, U.S. Department of Health and Human Services, 2020 (2021).
[53] D. Gupta, U. Kelekar, D. Rice, Associations between living alone, depression, and falls among community-dwelling older adults in the US, Prev. Med. Rep. 20
(2020).
[54] NCO, Get the facts on healthy aging, (2021).
[55] M. Antonić, IoT technologies offer new potentials for people with disabilities, 2021 29th International Conference on Software, Telecommunications and
Computer Networks, SoftCOM 2021. (2021).
[56] OECD, Population (indicator), (2022).
[57] OECD, Public spending on incapacity (indicator), (2022).
[58] United Nations, Ageing and disability, (2022).
[59] WH Organization, Towards a Common Language For Functioning, disability and health: ICF. International Classification, 2002, p. 1149.
[60] J. Soar, Reinventing health, ageing and aged care through smart homes and intelligent technologies, in: Proceedings of the 4th International Conference on
Cooperation and Promotion of Information Resources in Science and Technology, COINFO, 2009, 2009.
18
[61] CDC, About chronic diseases (2019).

[62] H. Waters, M. Graf, The costs of chronic disease in the US, (2020).
[63] NCOA, The Top 10 Most Common Chronic Conditions, Older Adults, 2021.
[64] American Cancer Society, Cancer facts & statistics, (2018).
[65] K. Morgan, Cancer incidence rates by age, (2020).
[66] C.A. Okoro, N.D. Hollis, A.C. Cyrus, S. Griffin-Blake. Prevalence of Disabilities and Health Care Access by Disability Status and Type Among Adults — United
States, 2016, MMWR. Morbidity and Mortality Weekly Report. 67 (2018).
[67] A.J. Ko, R.E. Ladner, Access computing promotes teaching accessibility, ACM Inroads 7 (2016).
[68] National Center for Health Statistics, Interactive summary health statistics for adults — 2019-2021 (2022).
[69] NIH National Institute on Aging (NIA), Cognitive Health and Older Adults, (2020).
[70] Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Alzheimer’s Disease and Healthy Aging Data Portal,
2019.
[71] 2021 Alzheimer’s disease facts and figures, Alzheimer’s and Dementia. 17 (2021).
[72] W. Chi, E. Graf, L. Hughes, J. Hastie, G. Khatutsky, S.B. Shuman, et al., Older adults with dementia and their caregivers: key indicators from the national health
and aging trends study, (2019).
[73] WH Organization, Mental health of older adults (2017).
[74] C. Correia, K.J. Lopez, K.E. Wroblewski, M. Huisingh-Scheetz, D.W. Kern, R.C. Chen, et al., Global sensory impairment in older adults in the United States,
J. Am. Geriatr. Soc. 64 (2016).
[75] J.M. Aimonetti, C. Deshayes, M. Crest, P.H. Cornuault, B. Weiland, E. Ribot-Ciscar, Long term cosmetic application improves tactile discrimination in the
elderly; a new psychophysical approach, Front. Aging Neurosci. 11 (2019).
[76] S. Marmor, K.J. Horvath, K.O. Lim, S. Misono, Voice problems and depression among adults in the United States, Laryngoscope 126 (2016).
[77] NIAID, NIAID emerging infectious diseases/pathogens | NIH: national institute of allergy and infectious diseases, (2018).
[78] N.D. Yanez, N.S. Weiss, J.A. Romand, M.M. Treggiari, COVID-19 mortality risk for older men and women, BMC Public Health 20 (2020).
[79] CDC, Important facts about falls | home and recreational safety | CDC injury center, (2015).
[80] M. Jeffrey Hall PhD, P. Debra L Karch, M. Alex Crosby, Elder abuse surveillance: uniform definitions and recommended core data elements, Natl. Center Injury
Prev. Control 1 (2016).
[81] J. Song, The political dynamics of japan’s immigration policies during the abe government, Pacific Focus 35 (2020).
[82] C. Reynaud, S. Miccoli, Population ageing in Italy after the 2008 economic crisis: a demographic approach, Futures (2019) 105.
[83] F. Luppi, B. Arpino, A. Rosina, The impact of COVID-19 on fertility plans in Italy, Germany, France, Spain, and the United Kingdom, Demogr Res. 43 (2020).
[84] N. Kokudo, H. Sugiyama, Hospital capacity during the COVID-19 pandemic, Glob. Health Med. 3 (2021).
[85] T. Shakespeare, F. Ndagire, Q.E. Seketi, Triple jeopardy: disabled people and the COVID-19 pandemic, Lancet North Am. Ed. 397 (2021).
[86] C.E. Angermann, B. Assmus, S.D. Anker, F.W. Asselbergs, J. Brachmann, M.E. Brett, et al., Pulmonary artery pressure-guided therapy in ambulatory patients
with symptomatic heart failure: the CardioMEMS European Monitoring Study for Heart Failure (MEMS-HF), Eur. J. Heart Fail. 22 (2020).
[87] N. Tajitsu, Japan trials driverless cars in bid to keep rural elderly on the move, Reuters (2017).
[88] D.L. Leistner, R.L. Steiner, Uber for seniors?: exploring transportation options for the future, Transp. Res. Rec. (2017) 2660.
[89] VitaVita VR Kit for the elderly (2022).
[90] J.M. Wigg, Recent developments in technological support for wanderers, Curr. Geriatr. Rep. 9 (2020).
[91] D. Napolitano, Reuniting speech-impaired people with their voices: sound technologies for disability and why they matter for organization studies, puntOorg
Int. J. (2021).
[92] P.N. Plyler, M. Easterday, T. Behrens, The effects of extended input dynamic range on laboratory and field-trial evaluations in adult hearing aid users, J. Am.
Acad. Audiol. 30 (2019).
[93] D.K. Sarji, HandTalk: assistive technology for the deaf, Computer (2008) 41 (Long Beach Calif).
[94] J.R. Burwinkel, B. Xu, J. Crukley, Preliminary examination of the accuracy of a fall detection device embedded into hearing instruments, J. Am. Acad. Audiol.
31 (2020).
[95] A.J. Perez, S. Zeadally, J. Cochran, A review and an empirical analysis of privacy policy and notices for consumer Internet of things, Secur. Priv. 1 (2018).
[96] R. Razavi, A. Gharipour, M. Gharipour, Depression screening using mobile phone usage metadata: a machine learning approach, J. Am. Med. Inform. Assoc. 27
(4) (2020) 522–530.
[97] J.J. Darrow, J. Avorn, A.S. Kesselheim, FDA regulation and approval of medical devices: 1976-2020, JAMA J. Am. Med. Assoc. 326 (2021).
[98] J. Hsu, Personalized digital health beyond the pandemic, J. Nurse Pract. 18 (2022).
[99] B. Shahbabu, A. Dasgupta, K. Sarkar, S.K. Sahoo, Which is more accurate in measuring the blood pressure? A digital or an aneroid sphygmomanometer, J. Clin.
Diagn. Res. 10 (2016).
[100] M. Hosanee, G. Chan, K. Welykholowa, R. Cooper, P.A. Kyriacou, D. Zheng, et al., Cuffless single-site photoplethysmography for blood pressure monitoring,
J. Clin. Med. 9 (2020).
[101] A. Chandrasekhar, K. Natarajan, M. Yavarimanesh, R. Mukkamala, An iPhone application for blood pressure monitoring via the oscillometric finger pressing
method, Sci. Rep. 8 (2018).
[102] E. Gayat, N. Mongardon, O. Tui, K. Sievert, T. Chazot, N. Liu, et al., CNAP® does not reliably detect minimal or maximal arterial blood pressures during
induction of anaesthesia and tracheal intubation, Acta Anaesthesiol. Scand. 57 (2013).
[103] N. Bausek, K. Longoria, S. Aldarondo, Impact of RMT on pulmonary function and vascular compliance - a case report, J. Biomed. Res. Rev. 3 (2020) 22–25.
[104] FORA 6 Connect Total Cholesterol Kit (2022).
[105] S.Y.Y. Tun, S. Madanian, D. Parry, Clinical perspective on internet of things applications for care of the elderly, Electronics 9 (2020) (Switzerland).
[106] M. Hoffler, S. Thompson, M. Honeywell, E. Campbell, A.J. Gaffney, E. Allen, et al., LipidPlus: a device to monitor lipid profile and blood glucose, U.S. Pharm.
(2015) 40.
[107] S. Shimawaki, Y. Kobayashi, M. Nakabayashi, N. Sakai, Non-invasive serum cholesterol detection using near-infrared light transmission, Biomed. Eng. Res. 3
(2014).
[108] I.M.M. Yusoff, R. Yahya, W.R.W. Omar, L.C. Ku, Non invasive cholesterol meter using near infrared sensor, in: Proceedings of the Innovation and
Commercialization of Medical Electronic Technology Conference, ICMET, 2016, 2015.
[109] P. Athilingam, B. Jenkins, M. Johansson, M. Labrador, A mobile health intervention to improve self-care in patients with heart failure: pilot randomized control
trial, JMIR Cardio 1 (2017).
[110] T. Tamura, Y. Maeda, M. Sekine, M. Yoshida, Wearable photoplethysmographic sensors—Past and present, Electronics. 3 (2014).
[111] H. Fukushima, H. Kawanaka, M.S. Bhuiyan, K. Oguri, Estimating heart rate using wrist-type Photoplethysmography and acceleration sensor while running, in:
Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS, 2012.
[112] R.R. Kroll, J.G. Boyd, D.M. Maslove, Accuracy of a wrist-Worn wearable device for monitoring heart rates in hospital inpatients:a prospective observational
study, J. Med. Internet Res. 18 (2016).
[113] A.J. Perez, K.G. Rivera-Morales, M.A. Labrador, I. Vergara-Laurens, HR-auth: heart rate data authentication using consumer wearables, in: Proceedings of the
International Conference on Software Engineering, 2018.
[114] K. Alghoul, S. Alharthi, H. Al Osman, A. El Saddik, Heart rate variability extraction from videos signals: ICA vs. EVM comparison, IEEE Access 5 (2017).
[115] R.E. Eckart, K.G. Kinney, C.M. Belnap, T.D. Le, Ventricular fibrillation refractory to automatic internal cardiac defibrillator in Fabry’s disease: review of
cardiovascular manifestations, Cardiology 94 (2000).
[116] H. Burri, D. Senouf, Remote monitoring and follow-up of pacemakers and implantable cardioverter defibrillators, Europace (2009) 11.
19
[117] L.A. Saxon, N. Varma, L.M. Epstein, L.I. Ganz, A.E. Epstein, Factors influencing the decision to proceed to firmware upgrades to implanted pacemakers for
cybersecurity risk mitigation, Circulation 138 (2018).
[118] D. Fulghum Bruce, 5 Common Types of Arthritis, WebMD, 2022.
[119] J. Henderson, J. Condell, J. Connolly, D. Kelly, K. Curran, Review of wearable sensor-based health monitoring glove devices for rheumatoid arthritis, Sensors
21 (2021).
[120] M. Crouthamel, E. Quattrocchi, S. Watts, S. Wang, P. Berry, L. Garcia-Gancedo, et al., Using a researchkit smartphone app to collect rheumatoid arthritis
symptoms from real-world participants: feasibility study, JMIR Mhealth Uhealth 6 (2018).
[121] C. Vallati, A. Virdis, M. Gesi, N. Carbonaro, A. Tognetti, ePhysio: a wearables-enabled platform for the remote management of musculoskeletal diseases,
Sensors 19 (2019) (Switzerland).
[122] S.I. Lee, M.Y. Ozsecen, L. Della Toffola, J.F. Daneault, A. Puiatti, S. Patel, et al., Activity detection in uncontrolled free-living conditions using a single
accelerometer, in: Proceedings of the IEEE 12th International Conference on Wearable and Implantable Body Sensor Networks, BSN, 2015, 2015.
[123] G. Bottoni, Knee range of motion monitoring system for personalized rehabilitation, in: Proceedings of the Osteoarthritis Patients, Politecnico di Torino, Corso
Castelfidardo, Torino TO, Italy, 2018, 39, 10129Master’s thesis.
[124] L.V. Sundararaman, R.R. Edwards, E.L. Ross, R.N. Jamison, Integration of mobile health technology in the treatment of chronic pain: a critical review, Reg.
Anesth. Pain Med. 42 (2017).
[125] iTens wearable Pain Relief (2022).
[126] H. Yu, X. Yang, Y. Lian, M. Wang, Y. Liu, Z. Li, et al., An integrated flexible multifunctional wearable electronic device for personal health monitoring and
thermal management, Sens. Actuators A 318 (2021).
[127] D.J. Cochrane, Effectiveness of using wearable vibration therapy to alleviate muscle soreness, Eur. J. Appl. Physiol. 117 (2017).
[128] E. Monte-Moreno, Non-invasive estimate of blood glucose and blood pressure from a photoplethysmograph by means of machine learning techniques, Artif.
Intell. Med. 53 (2011).
[129] E. Oppel, S. Kamann, F.X. Reichl, C. Högg, The Dexcom glucose monitoring system—an isobornyl acrylate-free alternative for diabetic patients, Contact Derm.
81 (2019).
[130] T.T. Ly, J.E. Layne, L.M. Huyett, D. Nazzaro, J.B. O’Connor, Novel bluetooth-enabled tubeless insulin pump: innovating pump therapy for patients in the
digital age, J. Diabetes Sci. Technol. 13 (2019).
[131] H.C. Zisser, The omnipod insulin management system: the latest innovation in insulin pump therapy, Diabetes Ther. 1 (2010).
[132] M. Burnside, M. De Bock, J. Williman, D. Lewis, C. Jefferies, H. Crocket, et al., Create (community derived automated insulin delivery): randomised trial
comparing automated insulin delivery (Anydana-Loop) using open-source algorithm, with sensor augmented pump therapy in type 1 diabetes, Diabetes
Technol. Ther. 22 (2020).
[133] S. Deshpande, J.E. Pinsker, S. Zavitsanou, D. Shi, R. Tompot, M.M. Church, et al., Design and clinical evaluation of the interoperable artificial pancreas system
(iAPS) smartphone app: interoperable components with modular design for progressive artificial pancreas research and development, Diabetes Technol. Ther.
21 (2019).
[134] S. Dadhania, M. Williams, Wearable Accelerometers in Cancer Patients, Intelligent Systems Reference Library, 2022.
[135] D. Albino de Queiroz, C. André da Costa, E. Aparecida Isquierdo Fonseca de Queiroz, E. Folchini da Silveira, R. da Rosa Righi, Internet of things in active cancer
treatment: a systematic review, J. Biomed. Inform. 118 (2021).
[136] C. Holländer-Mieritz, I.R. Vogelius, C.A. Kristensen, A. Green, J.L. Rindum, H. Pappot, Using biometric sensor data to monitor cancer patients during
radiotherapy: protocol for the OncoWatch feasibility study, JMIR Res. Protoc. 10 (2021).
[137] U.L. Beauchamp, H. Pappot, C. Holländer-Mieritz, The use of wearables in clinical trials during cancer treatment: systematic review, JMIR Mhealth Uhealth 8
(2020).
[138] K.J. Lafaro, D.J. Raz, J.Y. Kim, S. Hite, N. Ruel, G. Varatkar, et al., Pilot study of a telehealth perioperative physical activity intervention for older adults with
cancer and their caregivers, 28, Supportive Care in Cancer, 2020.
[139] I.Y. Chung, M. Jung, S.B. Lee, J.W. Lee, Y.R. Park, D. Cho, et al., An assessment of physical activity data collected via a smartphone app and a smart band in
breast cancer survivors: observational study, J. Med. Internet Res. 21 (2019).
[140] A. Pande, R. Kumar, V. Yadav, V.N. Dhawas, Medminder:a medicine intake scheduler and reminder, Int. J. Adv. Eng. Res. Dev. 3 (2016).
[141] Y. Song, Psycho-Social Determinants and Strategies for Facilitating Adherence to a Complex Medication Regimen in Cancer Treatment, Columbia University,
61 Claremont Avenue, New York, NY 10115, USA, 2019. Doctoral Dissertation.
[142] F.P. Wieringa, N.J.H. Broers, J.P. Kooman, F.M. Van Der Sande, C. Van Hoof, Wearable sensors: can they benefit patients with chronic kidney disease? Expert
Rev. Med. Devices 14 (2017).
[143] P.S. Tucker, A.T. Scanlan, V.J. Dalbo, Chronic kidney disease influences multiple systems: describing the relationship between oxidative stress, inflammation,
kidney damage, and concomitant disease, Oxid. Med. Cell Longev (2015), 2015.
[144] M. Hosseinzadeh, J. Koohpayehzadeh, A.O. Bali, P. Asghari, A. Souri, A. Mazaherinezhad, et al. A diagnostic prediction model for chronic kidney disease in
internet of things platform, Multimedia Tools and Applications. 80 (2021).
[145] A. Abdelaziz, A.S. Salama, A.M. Riad, A.N. Mahmoud, A machine learning model for predicting of chronic kidney disease based internet of things and cloud
computing in smart cities, (2019).
[146] A.A. Imran, M.N. Amin, F.T. Johora, Classification of chronic kidney disease using logistic regression, feedforward neural network and wide deep learning, in:
Proceedings of the International Conference on Innovation in Engineering and Technology, ICIET, 2018, 2018.
[147] S. Abdullah, T. Choudhury, Sensing technologies for monitoring serious mental illnesses, IEEE. Multimedia 25 (2018).
[148] J.E. Yang, T.Y. Lee, J.K. Kim, The effect of a VR exercise program on falls and depression in the elderly with mild depression in the local community, J. Phys.
Ther. Sci. 29 (2017).
[149] P. Lindner, W. Hamilton, A. Miloff, P. Carlbring, How to treat depression with low-intensity virtual reality interventions: perspectives on translating cognitive
behavioral techniques into the virtual reality modality and how to make anti-depressive use of virtual reality–unique experiences, Front. Psychiatry 10 (2019).
[150] J.L. Maples-Keller, B.E. Bunnell, S.J. Kim, B.O. Rothbaum, The use of virtual reality technology in the treatment of anxiety and other psychiatric disorders,
Harv. Rev. Psychiatry 25 (2017).
[151] J. De Conti Pelanda, A.M. Cabal Herrera, I. de Torres Garcia, K. Burken Burgess, F. Engel Aduan, A.P. Koo, et al., The WIRED trial - Wii Sports™ as a virtual
reality exercise experience to improve depression in healthcare workers during the COVID-19 pandemic: a multicenter, prospective, randomized, controlled,
superiority phase II trial. Principles and practice of, Clin. Res. J. 7 (2021).
[152] S. Enshaeifar, P. Barnaghi, S. Skillman, A. Markides, T. Elsaleh, S.T. Acton, et al., The internet of things for dementia care, IEEE Internet Comput. 22 (2018).
[153] C.J. Duffy, L.A. Cushman, K. Stein, Detecting navigational deficits in cognitive aging and Alzheimer disease using virtual reality, Neurology (2008) 71.
[154] J. Hayhurst, How augmented reality and virtual reality is being used to support people living with dementia—design challenges and future directions, (2018).
[155] H.J. Davies, P. Bachtiger, I. Williams, P.L. Molyneaux, N.S. Peters, D.P. Mandic, Wearable in-ear PPG: detailed respiratory variations enable classification of
COPD, IEEE Trans. Biomed. Eng. 69 (2022).
[156] N. Moraveji, P. Golz, J. Hollenbach, M. Holt, R. Murray, Long-term, ambulatory respiratory monitoring of COPD patients using garment-adhered sensors, in:
Proceedings of the Medical Measurements and Applications, MeMeA 2019 - Symposium Proceedings, 2019.
[157] A. Tiwari, S. Liaqat, D. Liaqat, M. Gabel, E. De Lara, T.H. Falk, Remote COPD severity and exacerbation detection using heart rate and activity data measured
from a wearable device, in: Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS, 2021.
[158] D. Mendez, A.J. Pérez, M.A. Labrador, J.J. Marron, P-Sense: a participatory sensing system for air pollution monitoring and control, in: Proceedings of the IEEE
International Conference on Pervasive Computing and Communications Workshops, PERCOM Workshops, 2011.
[159] G. Xiang, X. Zhu, L. Ma, H. Huang, X. Wu, W. Zhang, et al., Clinical guidelines on the application of Internet of Things (IOT) medical technology in the
rehabilitation of chronic obstructive pulmonary disease, J. Thorac. Dis. 13 (2021).
20
[160] E.R. Hoeg, J.R. Bruun-Pedersen, S. Serafin, Virtual reality-based high-intensity interval training for pulmonary rehabilitation: a feasibility and acceptability
study, in: Proceedings of the IEEE Conference on Virtual Reality and 3D User Interfaces Abstracts and Workshops, VRW 2021, 2021.
[161] N. Skjæret, A. Nawaz, T. Morat, D. Schoene, J.L. Helbostad, B. Vereijken, Exercise and rehabilitation delivered through exergames in older adults: an
integrative review of technologies, safety and efficacy, Int. J.Med. Inform 85 (2016).
[162] C. Adams, Smart sustainable urban mobility behaviors: public attitudes and adoption intentions concerning self-driving cars, Contemp. Read. Law Soc. Just. 12
(2020).
[163] M. Mahmoodi Nesheli, L. Li, M. Palm, A. Shalaby, Driverless shuttle pilots: lessons for automated transit technology deployment, Case Stud. Transp. Policy 9
(2021).
[164] S.K. Mitra, Y. Bae, S.G. Ritchie, Use of ride-hailing services among older adults in the United States, Transp. Res. Rec. (2019) 2673.
[165] L.F. Blanar, N. Larco, R. Best, AARP, Rand Corporation. Older adults, New mobility, and Automated Vehicles, RAND Coorporation, 2021.
[166] S.J. Barbeau, P.L. Winters, N.L. Georggi, M.A. Labrador, R. Perez, Travel assistance device: utilising global positioning system-enabled mobile phones to aid
transit riders with special needs, IET Intel. Transport Syst. 4 (2010).
[167] What are some types of assistive devices and how are they used? | NICHD - eunice kennedy shriver national institute of child health and human development,
(2018).
[168] L. Yang, Y. Ge, W. Li, W. Rao, W. Shen, A home mobile healthcare system for wheelchair users, in: Proceedings of the IEEE 18th International Conference on
Computer Supported Cooperative Work in Design, CSCWD, 2014, 2014.
[169] U. Garg, K.K. Ghanshala, R.C. Joshi, R. Chauhan, Design and Implementation of Smart Wheelchair for Quadriplegia patients using IOT, in: Proceedings of the
ICSCCC 1st International Conference on Secure Cyber Computing and Communications, 2018.
[170] P. Upender, P.A. Harsha Vardhini, A hand gesture based wheelchair for physically handicapped person with emergency alert system, in: Proceedings of the 5th
IEEE International Conference on Recent Trends in Electronics, Information and Communication Technology 2020, RTEICT, 2020.
[171] A. Carrasquilla-Batista, K. Quiros-Espinoza, C. Gomez-Carrasquilla, An Internet of Things (IoT) application to control a wheelchair through EEG signal
processing, in: Proceedings of the International Symposium on Wearable Robotics and Rehabilitation (WeRob), 2017.
[172] C. Gomez-Carrasquilla, K. Quiros-Espinoza, A. Carrasquilla-Batista, Wheelchair control through eye blinking and IoT platform, in: Proceedings of the IEEE 11th
Latin American Symposium on Circuits and Systems 2020, LASCAS, 2020.
[173] M. Aljahdali, R. Abokhamees, A. Bensenouci, T. Brahimi, M.A. Bensenouci, IoT based assistive walker device for frail &visually impaired people, in:
Proceedings of the 15th Learning and Technology Conference, L and T 2018, 2018.
[174] S. Zehtabian, S. Khodadadeh, R. Pearlman, B. Willenberg, B. Kim, D. Turgut, et al., Supporting rehabilitation prescription compliance with an IoT-augmented
four-legged walker, in: Proceedings of the 2nd Workshop on AI for Aging, Rehabilitation and Independent Assisted Living (ARIAL’18), 2018.
[175] C. Nave, O. Postolache, Smart Walker based IoT Physical Rehabilitation System, in: Proceedings of the International Symposium in Sensing and
Instrumentation in IoT Era, ISSI, 2018, 2018.
[176] O. Fukuda, Y. Takahashi, N. Bu, H. Okumura, K. Arai, Development of an IoT-based prosthetic control system, J. Robot. Mechatron. 29 (2017).
[177] P. Di, J. Huang, K. Sekiyama, T. Fukuda, A novel fall prevention scheme for intelligent cane robot by using a motor driven universal joint, in: Proceedings of the
International Symposium on Micro-NanoMechatronics and Human Science, Symposium on "COE for Education and Research of Micro-Nano Mechatronics",
Symposium on "Hyper Bio Assembler for 3D Cellular System Innovation, 2011.
[178] Y.S. Delahoz, M.A. Labrador, Survey on fall detection and fall prevention using wearable and external sensors, Sensors 14 (2014) (Switzerland).
[179] Z. Jelačić, H. Velijević, Application of big data analysis and internet of things to the intelligent active robotic prosthesis for transfemoral amputees, Int. J. Artif.
Intell. Appl. 10 (2019).
[180] A. Kapsalyamov, P.K. Jamwal, S. Hussain, M.H. Ghayesh, State of the art lower limb robotic exoskeletons for elderly assistance, IEEE Access 7 (2019).
[181] S. Miocinovic, A. Shoeb, S. Wang, N. Swann, A. Pathak, J. Ostrem, Tremor severity estimation using Liftware instrumented eating utensil (P4.295), Neurology
86 (2016).
[182] A.S. Dhanjal, W. Singh, Tools and techniques of assistive technology for hearing impaired people, in: Proceedings of the International Conference on Machine
Learning, Big Data, Cloud and Parallel Computing: Trends, Prespectives and Prospects, COMITCon 2019, 2019.
[183] L. da Cruz, J.D. Dorn, M.S. Humayun, G. Dagnelie, J. Handa, P.O. Barale, et al., Five-year safety and performance results from the argus II retinal prosthesis
system clinical trial, Ophthalmology 123 (2016).
[184] R. Hornig, M. Dapper, E. Le Joliff, R. Hill, K. Ishaque, C. Posch, et al., Pixium Vision: First Clinical Results and Innovative Developments, Artificial Vision, 2017.
[185] E. Urabe, R. Hirakawa, H. Kawano, K. Nakashi, Y. Nakatoh, Electrolarynx system using voice conversion based on WaveRNN, in: Proceedings of the Digest of
Technical Papers - IEEE International Conference on Consumer Electronics, 2020, 2020-January.
[186] S. Raman, X. Sarasola, E. Navas, I. Hernaez, Enrichment of oesophageal speech: voice conversion with duration–matched synthetic speech as target, Appl. Sci.
11 (2021) (Switzerland).
[187] C.K.M. Lee, K.K.H. Ng, C.H. Chen, H.C.W. Lau, S.Y. Chung, T. Tsoi, American sign language recognition and training method with recurrent neural network,
Expert Syst. Appl. 167 (2021).
[188] R. Elakkiya, Machine learning based sign language recognition: a review and its research frontier, J. Ambient Intell. Humaniz Comput. (2020).
[189] C.E. Seim, S.L. Wolf, T.E. Starner, Wearable vibrotactile stimulation for upper extremity rehabilitation in chronic stroke: clinical feasibility trial using the VTS
Glove, J. Neuroeng. Rehabil. 18 (2021).
[190] M. Lapresa, C. Tamantini, F. Scotto Di Luzio, F. Cordella, M. Bravi, S. Miccinilli, et al., A Smart Solution for Proprioceptive Rehabilitation through M-IMU
Sensors, in: Proceedings of the IEEE International Workshop on Metrology for Industry 4.0 and IoT, MetroInd 4.0 and IoT, 2020.
[191] I.K. Wiesmeier, D. Dalin, C. Maurer, Elderly use proprioception rather than visual and vestibular cues for postural motor control, Front. Aging Neurosci. 7
(2015).
[192] K. Liu, Y. Chen, R. Lin, K. Han, Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients, J. Infect. 80 (2020).
[193] R. Armitage, L.B. Nellums, COVID-19 and the Consequences of Isolating the Elderly, 5, The Lancet Public Health, 2020.
[194] K. Lee, G.C. Jeong, J. Yim, Consideration of the psychological and mental health of the elderly during COVID-19: a theoretical review, Int. J. Environ. Res.
Public Health 17 (2020).
[195] T.G. Tseng, H.L. Wu, H.C. Ku, C.J. Tai, The impact of the COVID-19 pandemic on disabled and hospice home care patients, J. Gerontol. Ser. Biol. Sci. Med. Sci.
75 (2020).
[196] E.M. Lund, A.J. Forber-Pratt, C. Wilson, L.R. Mona, The COVID-19 Pandemic, Stress, and Trauma in the Disability Community: A call to Action, Rehabilitation
Psychology, 2020.
[197] J.H. Wright, R. Caudill, Remote treatment delivery in response to the COVID-19 pandemic, Psychother. Psychosom. 89 (2020).
[198] D.A. Drew, L.H. Nguyen, C.J. Steves, C. Menni, M. Freydin, T. Varsavsky, et al., Rapid implementation of mobile technology for real-time epidemiology of
COVID-19, Science 368 (2020).
[199] H. Cho, D. Ippolito, Y.W. Yu. Contact tracing mobile apps for COVID-19: privacy considerations and related trade-offs, (2020).
[200] H. Lukas, C. Xu, Y. Yu, W. Gao, Emerging telemedicine tools for remote COVID-19 diagnosis, monitoring, and management, ACS Nano 14 (2020).
[201] S. Mirjalali, S. Peng, Z. Fang, C.H. Wang, S. Wu, Wearable sensors for remote health monitoring: potential applications for early diagnosis of COVID-19, Adv.
Mater. Technol. 7 (2022).
[202] S. von Humboldt, N.M. Mendoza-Ruvalcaba, E.D. Arias-Merino, A. Costa, E. Cabras, G. Low, et al., Smart technology and the meaning in life of older adults
during the Covid-19 public health emergency period: a cross-cultural qualitative study, Int. Rev. Psychiatry 32 (2020).
[203] Z. Sun, B. Yang, R. Zhang, X. Cheng, Influencing factors of understanding COVID-19 risks and coping behaviors among the elderly population, Int. J. Environ.
Res. Public Health 17 (2020).
[204] G. Sacco, S. Lléonart, R. Simon, F. Noublanche, C. Annweiler, Communication technology preferences of hospitalized and institutionalized frail older adults
during COVID-19 confinement: cross-sectional survey study, JMIR Mhealth Uhealth 8 (2020).
21
[205] A. Seifert, The digital exclusion of older adults during the COVID-19 pandemic, J. Gerontol. Soc. Work 63 (2020).
[206] J. Wang, I. Katz, J. Li, Q. Wu, C. Dai, Mobile digital divide and older people’s access to ‘Internet plus social work’: implications from the COVID-19 help-
seeking cases, Asia Pac. J. Soc. Work Dev. (2021) 31.
[207] P.Q. Nguyen, L.R. Soenksen, N.M. Donghia, N.M. Angenent-Mari, H. de Puig, A. Huang, et al., Wearable materials with embedded synthetic biology sensors for
biomolecule detection, Nat. Biotechnol. 39 (2021).
[208] H. Suzuki, Y. Kiyonobu, T. Mogi, K. Matsushita, M. Hanada, R. Suzuki, et al., An updated watch-over system using an IoT device, for elderly people living by
themselves, in: Proceedings of the 3rd International Conference on System Reliability and Safety, ICSRS 2018, 2019.
[209] B.D. Chung Hua, H. Fahmi, L. Yuhao, C.C. Kiong, A. Harun, Internet of things (IOT) monitoring system for elderly, in: Proceedings of the International
Conference on Intelligent and Advanced System, ICIAS 2018, 2018.
[210] S. Pinto, J. Cabral, T. Gomes, We-care: an IoT-based health care system for elderly people, in: Proceedings of the IEEE International Conference on Industrial
Technology, 2017.
[211] C. Lee, S. Park, Y. Jung, Y. Lee, M.J. Mathews, Internet of things: technology to enable the elderly, in: Proceedings of the 2nd IEEE International Conference on
Robotic Computing, IRC 2018, 2018, 2018-January.
[212] P.S. Nagendra Reddy, K.T. Kumar Reddy, P.A. Kumar Reddy, G.N. Kodanda Ramaiah, S.N. Kishor, An IoT based home automation using android application,
in: Proceedings of the International Conference on Signal Processing, Communication, Power and Embedded System, SCOPES, 2017.
[213] MHeerink Broekens, H. Rosendal, Assistive social robots in elderly care: a review, Gerontechnology 8 (2009).
[214] L.C. Souza, J.J.P.C. Rodrigues, G.D. Scarpioni, D.A.A. Santos, V.H.C. De Albuquerque, S.K. Dhurandher, An IoT automated curtain system for smart homes, in:
Proceedings of the International Conference on Advances in Computing, Communications and Informatics, ICACCI 2018, 2018.
[215] M.K. Kuyucu, S. Bahtiyar, G. Ince, Security and privacy in the smart home: a survey of issues and mitigation strategies, in: Proceedings of the UBMK 2019 4th
International Conference on Computer Science and Engineering, 2019.
[216] H. Liu, T. Spink, P. Patras, Uncovering security vulnerabilities in the Belkin WeMo home automation ecosystem, in: Proceedings of the IEEE International
Conference on Pervasive Computing and Communications Workshops, PerCom Workshops 2019, 2019.
[217] B. Hammi, S. Zeadally, R. Khatoun, J. Nebhen, Survey on Smart Homes: Vulnerabilities, Risks, and Countermeasures, 117, Computers and Security, 2022.
[218] W. Ali, G. Dustgeer, M. Awais, M.A. Shah, IoT based smart home: security challenges, security requirements and solutions, in: Proceedings of the ICAC 23rd
IEEE International Conference on Automation and Computing: Addressing Global Challenges through Automation and Computing, 2017.
[219] A.J. Perez, S. Zeadally, N. Jabeur, Security and privacy in ubiquitous sensor networks, J. Inf. Process. Syst. 14 (2018).
[220] Y. Kurt Peker, G. Bello, A.J. Perez, On the security of bluetooth low energy in two consumer wearable heart rate monitors/sensing devices, Sensors 22 (2022).
[221] A.J. Perez, S. Zeadally, S. Griffith, L.Y.M. Garcia, J.A. Mouloud, A user study of a wearable system to enhance bystanders’ facial privacy, IoT 1 (2020).
[222] B. Ali, A.I. Awad, Cyber and physical security vulnerability assessment for IoT-based smart homes, Sensors 18 (2018) (Switzerland).
[223] M. Antonakakis, T. April, M. Bailey, M. Bernhard, E. Bursztein, J. Cochran, et al., Understanding the mirai botnet, in: Proceedings of the 26th USENIX Security
Symposium, 2017.
[224] S. Zeadally, A.K. Das, N. Sklavos, Cryptographic technologies and protocol standards for Internet of Things, Internet Things 14 (2021) (Netherlands).
[225] C. Wootton, Beginning samsung ARTIK, (2016).
[226] O.C. Van Stuijvenberg, A.L. Bredenoord, M.L.D. Broekman, K.R. Jongsma, Leaving users in the dark: a call to define responsibilities toward users of neural
implanted devices, AJOB Neurosci. 13 (2022) 233.
Alfredo J. Perez is an Associate Professor of Computer Science at the University of Nebraska – Omaha. His-research interests include
ubiquitous computing/sensing, privacy/cybersecurity, and computer science education. His-projects have been sponsored by NSF/DoD, DoE
and Google. He is an IEEE Senior Member and a member of the National Academy of Inventors.
Farhan Siddiqui is an Assistant Professor of Computer Science at Dickinson College, PA. Her teaching encompasses courses across the
undergraduate Computer Science curriculum. Her research interests are primarily in computer networking, with a focus on wireless
networking, mobile and ubiquitous computing, and the Internet of Things. She has also recently become interested in Computer Science
education research with a focus on broadening participation in Computer Science through Humanitarian Free and Open-Source projects.
22
Sherali Zeadally is a Professor in the College of Communication and Information at the University of Kentucky. His-research interests
include Cybersecurity, privacy, Internet of Things, computer networks, and energy-efficient networking. He has received numerous awards
and honors for his research and teaching. He is a Fellow of the British Computer Society and the Institution of Engineering Technology,
England.
Derek R. Lane is a Professor in the Department of Communication at the University of Kentucky. His-research focuses on understanding how
message characteristics interact with individual differences and technologies to improve sustained attitude and behavior change in
instructional, risk, organizational, health, and other applied contexts. Over the past decade his work has been used to explain how
instructional messages can be used as catalysts to mitigate personal risk in crisis situations.
23

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Internet of Things 21 (2023) 100653

Contents lists available at ScienceDirect

A review of IoT systems to enable independence for the elderly

Available online 1 December 2022

Fig. 1. Internet of Things (IoT) domains.

2. Contributions of this research

The main research contributions of this work are as follows:

3. Challenges for ageing and impaired people

Fig. 2. The ICF disability model [59].

3.1. Chronic diseases

Impairment Medical treatment/care Prevention of the development of further activity limitations

3.2. Mobility impairments

3.3. Cognitive challenges and mental health

Any physical difficulty 48.6% of adults aged 75+

3.4. Sensory and communication/voice challenges

3.5. Emerging infectious diseases/pathogens

3.6. Safety, wellness, and entertainment

4. IoT solutions for elderly and disabled individuals

4.1. IoT solutions for chronic diseases

4.1.1. IoT solutions for hypertension monitoring

4.1.2. IoT for high cholesterol monitoring

4.1.3. IoT for heart disease monitoring and management

4.1.4. IoT for arthritis

4.1.5. IoT for diabetes

4.1.6. IoT for cancer

4.1.7. IoT for chronic kidney disease

4.1.8. IoT for depression and mental health

4.1.9. IoT Alzheimer’s disease/dementia

4.2. IoT solutions for mobility impairments

Internet of Things 21 (2023) 100653

4.3. IoT solutions for sensory and communication/voice challenges

4.4. IoT solutions for emerging infectious diseases/pathogens

4.5. IoT solutions for home safety

5. Challenges in using IoT for elderly and disabled

CRediT authorship contribution statement

Declaration of Competing Interest

[9] Ericsson, Ericsson Mobility Report, (2021).

[61] CDC, About chronic diseases (2019).

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