# Older Adults’ Views of Smartphone-Based Monitoring for Dementia Risk

## TL;DR

Older adults generally find smartphone-based monitoring for dementia risk acceptable, though privacy concerns remain a key barrier.

## Contribution

The study provides insights into the acceptability of passive smartphone monitoring for dementia risk among older adults.

## Key findings

- 76% of participants were likely to join a future digital monitoring study.
- Privacy concerns varied depending on the type of data collected.
- Transparency about privacy protections and clinical integration can improve acceptability.

## Abstract

Clinical assessment of function in dementia risk evaluations is challenging and may benefit from passive smartphone monitoring, which enables low-burden, continuous tracking of everyday behaviors outside the clinic. However, acceptability of passive monitoring in older adults is required for such technologies to be useful. To assess acceptability, 17 cognitively normal older adults (mean age=76.9, SD = 8.7; mean education=15.8, SD = 3.4; 59% White, 41% Hispanic) from the Mount Sinai Alzheimer’s Disease Research Center completed a 1-hour semi-structured interview in English or Spanish assessing attitudes toward smartphone monitoring, followed by a 5-point acceptability rating (likelihood of future study participation). Our interview guide drew from the Technology Acceptance Model and preliminary passive smartphone studies to explore a priori themes. Transcripts were analyzed using a hybrid inductive-deductive approach and content analysis. Emergent themes included perceived utility, privacy/ethical concerns, personal characteristics, logistical considerations, and overall comfort level. Key barriers to acceptability included privacy concerns (e.g., unease with monitoring, risk of data breach) which varied by data type (GPS versus call/text meta-data). Some participants questioned the clinical utility and identified potential confounding variables. Factors contributing to acceptability included recognized scope (i.e., perceived value in tracking behaviors not routinely assessed in clinic), altruistic attitudes toward research, clear understanding of privacy protections, and interest in early detection of dementia. Post-interview, 76% were likely to participate in a future digital monitoring study and 94% agreed to recruitment contact. These findings offer insights to enhance acceptability in future clinical implementation, including transparent review of privacy safeguards, existing evidence, and clinical integration logistics.