“We must cultivate a culture of digital awareness, wherein we deliberately select our engagement with technology instead of allowing it to govern our lives.”
1. Can you briefly introduce yourself and your current role at the School of Nursing, IHM Learning and Teaching?
Dr Israel Gabriel’s expertise is clearly demonstrated by his more than twenty-six years of experience in both academic and clinical settings. He currently serves as a senior lecturer at the Institute of Health and Management, Brisbane, Australia, where he teaches and supervises postgraduate students. He is a researcher, educator, and clinical specialist in psycho- oncology, perioperative care, anaesthesia, and public health. He holds a Doctor of Philosophy (PhD) in nursing and a research-based master’s degree in nursing from Griffith University, Queensland, Australia, and the University of Cape Town, South Africa, respectively. His PhD was funded by Griffith International postgraduate scholarships. He won multiple awards throughout his PhD, including a publication prize for two consecutive years, was recognised as the best tutor in evidence-based practice, and his article in a Q1 journal was awarded the top-cited article for the year 2020- 2021. His master’s dissertation received a distinction. He possesses a bachelor’s degree in nursing from Obafemi Awolowo University, Nigeria, along with specialised professional diplomas in anaesthesia, perioperative care, public health, and education. He holds a professional licence as a registered nurse in English-speaking developed countries, including the USA, Canada, the UK, Australia, New Zealand, and Nigeria.
2. What has been your academic or professional involvement in the fields of nursing, gerontology, or technology integration in healthcare?
Older individuals are found in various nursing environments and possess distinct care needs. With over twenty years of experience as a nurse, including all aspects of medical-surgical nursing, I have delivered focused health screenings, counselling, crisis intervention, and comprehensive care to the elderly population. Additionally, I acted as an advocate in guiding the effective use of resources and facilitating referrals that enhance continuity of care tailored to the needs of older individuals. Moreover, I have provided essential educational services to elderly patients, their families, and the nursing and medical personnel engaged in their care. Lastly, I am also conducting research on e-Health technologies aimed at enhancing the health-related quality of life for persons with cancer and their family carers in developing countries.
3. How do you perceive the evolving role of digital technologies in nursing education and practice, particularly concerning older adults?
Kraus et al. (2021), highlight that the growing use of digital technology impacts every aspect of society and presents new opportunities to address diverse needs and challenges. In nursing, digital technologies are becoming increasingly essential for providing evidence-based care to patients. It presents an opportunity to advance nursing education, improve patient care, and empower older persons, particularly through telehealth and remote monitoring, while also requiring careful consideration of accessibility, equity, and potential challenges (David-Olawade et al., 2024). The transformative impact of digital technology on nursing education and practice renders learning and practice almost impossible without its incorporation (Bertolazzi et al., 2024).
According to Liu et al. (2023), online learning platforms, virtual reality, and simulations have greatly enhanced the nursing education process by creating more engaging and participatory environments for students. Similarly, according to Glauberman et al. (2023), nurses can easily access the latest research and best practices through educational applications, online databases, and e-books, which helps with their continued professional progress. In addition, Haleem et al. (2022) argued that nurses can receive training and education regardless of their location through online courses and webinars, creating a more accessible and flexible educational environment.
Anawade et al. (2024) notes that digital technology makes nursing practice better by allowing for remote care, which includes regular check-ins, medication administration, and vital sign monitoring. This is especially helpful for older people who have trouble moving around or who live in remote areas. The use of digital devices in healthcare allows for the gathering and evaluation of patient information, which in turn permits nurses to adapt treatment programs in response to specific needs and preferences, thus promoting a more all-encompassing strategy for personalised care (Vrančić et al., 2024). Healthcare providers are able to more effectively communicate and collaborate with one another and plan patient treatment when they use electronic health records (EHRs) and encrypted messaging platforms (Huter et al., 2020). The integration of analytics with real-time data can also facilitate data-driven decision-making. The ability to recognise patterns, predict potential problems, and make informed decisions would greatly benefit patients. Another way in which digital technologies are helping the elderly is by making it easier for them to keep track of their health, their medications, and their interactions with healthcare providers. This, in turn, promotes autonomy and self-sufficiency. The same holds true for the ways in which technology facilitates interaction between people; it helps the elderly keep in touch with loved ones and reduces feelings of loneliness.
4. Could you share any specific research, teaching initiatives, or collaborations you’ve led or participated in related to aging populations and technology?
With the emergence of AI and its influence on nursing education and practice, I have been engaged with telehealth within the nursing field. I am presently undertaking a systematic review on e-health and its effects on the health-related quality of life of adults living with cancer and their family caregivers. This review protocol has been registered with PROSPERO under registration number CRD42024622302 (https://www. crd.york.ac.uk/PROSPERO/recorddashboard). Similarly, I have taught modules relating to ageing populations at both the undergraduate and postgraduate levels for several years. This experience has established me as an authority in this subject matter.
5. In your opinion, what are the most pressing ethical concerns when implementing AI-driven technologies for older populations?
Concerns regarding data privacy, algorithmic bias leading to discrimination, the possibility of dehumanisation, and loss of autonomy rank high among the most pressing ethical issues surrounding AI in relation to older populations.
According to research by Alagood et al. (2023), older persons, particularly those with cognitive impairments or decreased computer literacy, are more likely to be victims of data breaches and the misuse of personal information. Declining cognitive function could impair one’s capacity to make rational choices regarding one’s privacy settings and data sharing habits. Unintentional data sharing can occur because older persons may have difficulty understanding privacy settings and regulations. Protecting the privacy of sensitive patient information is not only a legal requirement but also an ethical imperative, respecting the autonomy and dignity of older patients (Alodhialah et al., 2024). The elderly and their caregivers need support and instruction on how to utilise technology securely while maintaining personal information.
The data used to train AI algorithms can contain existing cultural or societal biases, which means that the AI system could reinforce or even worsen such biases. This could lead to biassed outcomes in fields like healthcare that use AI to assess the health of the elderly. To ensure fairness and minimise bias in AI systems, meticulous planning of data collection, algorithm development, and ongoing monitoring is required. While there are certainly advantages to using monitoring technology and robotics, there is also a risk that they may reduce the amount of time that older persons receive in-person care, which could make them feel abandoned or neglected. Human connection, empathy, and personal touch are essential to health, but technology has the potential to eclipse them. Rather of offering comprehensive care, healthcare providers risk becoming overly reliant on technology and seeing themselves merely as machine monitors. It is important to regularly evaluate how technology impact the well-being and quality of life of the elderly and to make necessary adjustments based on that assessment.
Additionally, a loss of autonomy and dignity may occur if AI systems made care decisions without considering the individual’s preferences and values. It is of the utmost importance to keep elderly people’s autonomy and control over their own lives intact while using AI technology; these should augment human care, not replace it.
6. How can healthcare professionals ensure that data security protocols are both robust and understandable for older users of digital health tools?
According to a systematic review by Maqbool and Herold (2024) Healthcare providers should emphasise the significance of strong encryption and secure storage solutions; prioritise clear and succinct communication; use accessible language; offer tailored education; and guarantee user-friendly interfaces to develop effective and understandable data security protocols for older users of digital health tools.
Use simple, direct language when briefing senior users on data security policies and processes. Avoid using overly technical terms and convoluted jargon. Infographics, icons, and diagrams are also useful visual aids for explaining security processes and ideas. Written materials, one-on-one consultations, and group conversations are all great ways to disseminate information and accommodate diverse learning styles. To ensure the safety of sensitive information, it is essential to condense and emphasise the most crucial points.
Training courses must be culturally sensitive and tailored to the specific needs of elder users to be effective. Individuals should have the chance to rehearse utilising digital health tools and security features in a supportive and risk-free setting. Users should continue to receive regular support and have their questions answered as they acquire confidence in using digital health solutions. Caregivers and family members should also feel encouraged to attend training sessions and be there for their loved ones.
When creating digital health technologies, it is essential to keep the user experience in mind. To make things easier to read and use, you can add things like big fonts, easily identifiable icons, and simple layouts. Users can interact with the tools without touching a touchscreen or typing by using voice-activated features. People who have trouble seeing or hearing could benefit from these kinds of aids. Protecting sensitive information during storage and transmission requires the use of strong encryption methods. Protect sensitive information from prying eyes by storing it in a safe and reliable location. One way to find and fix security flaws is to conduct audits on a regular basis. Prevent unauthorised access to digital health tools and data by implementing strong user authentication measures, such as multi-factor authentication. Clearly define the procedures for collecting, using, and protecting user data in your data privacy policy, and then put it into action. Make sure that all data security procedures are in line with applicable regulations, such as HIPAA, to protect the privacy of patients.
7. User autonomy is critical in aging-focused technologies. How can developers and clinicians strike a balance between assistance and independence for older users?
Emphasising patient autonomy in aging-focused tech development and implementation is crucial for people to keep their dignity and quality of life intact while making decisions about their own care. Autonomy in healthcare refers to the freedom of a patient to make choices about their own treatment without interference from other parties. A fundamental ethical concept in healthcare is the preservation of autonomy, and it is critical to ensure that technology used to care for the elderly does not infringe upon this right. To ensure patient autonomy in technology focused on ageing, among the various options available are:
The principle of “informed consent” states that patients should not make treatment decisions without first receiving complete information regarding the procedures, tools, and risks associated with those procedures (Pugh, 2020). Another significant component is shared decision- making, which promotes open communication and collaboration among healthcare practitioners, patients, and their families (Roodbeen et al., 2020).
Be mindful of people’s beliefs and preferences when introducing new technology into their lives and be ready to make changes or remove them entirely if they aren’t working for them (Roberts et al., 2021).
Healthcare providers and other caregivers should have sufficient training and education on how to respect patients’ rights to make informed decisions about their care and how to use technology in an ethical and effective manner (Mennella et al., 2024).
Lastly, there needs to be legislation in place to safeguard patients’ rights and guarantee the ethical use of technology while respecting their autonomy.
8. Do you see any existing gaps in how informed consent is obtained from older adults in digital healthcare settings? How can these be addressed?
It can be difficult to gain older people’s informed consent in digital healthcare owing to technology limits, cognitive impairments, and an absence of adequate support for digital literacy. For instance, understanding and managing digital consent processes can be challenging for older individuals with limited technological abilities. In a similar vein, elderly people may be hesitant to give personal information or give their consent for digital healthcare interventions due to increased concerns about privacy and security in online settings.
Simplifying digital operations, providing tailored teaching, and ensuring accessibility through various forms and support networks are crucial to solve these challenges. Digital consent procedures should be easily navigable, simple, and accessible to older adults with varying levels of technological literacy. Similarly, this population would do well to get targeted assistance in developing their digital literacy skills so that they can make more effective use of online healthcare resources. Providing information in several formats (e.g., text, audio, video, visual aids) and offering support systems (e.g., translators, family members, trained staff) are further techniques to promote accessibility and comprehension. To better support and connect with older adults, health care personnel who work with this group should receive training on digital engagement tactics, including informed consent.
9. What strategies can be employed to build trust in AI and smart technologies among older individuals, especially those with limited digital literacy?
Emphasising accessibility and security, personalised education, and clear communication can help elderly patients with limited digital literacy trust smart technologies. These approaches also highlight practical applications that show immediate advantages.
For example, start with the basics of digital literacy, such turning on and off a device, recognising icons, and using a basic interface. To accommodate different learning styles and rates, consider offering lessons in small groups or one-on-one. Prove that technology may enhance everyday life by showing how a smart watch can remind you to take your medication, gaining access to medical records, keeping track of prescriptions, or how a tablet can make video chats to loved ones. Also, instead of only explaining features and apps, show how to use them. Devices and applications should be intuitive and easy to use. Help people overcome obstacles by offering continuing support and troubleshooting assistance.
To further facilitate trust and understanding, describe concepts using everyday English rather than technical jargon. Make sure everything is legible by using big fonts and clear images. Give presentations, handouts, and demonstrations in person, among other forms of media. Highlight how technology has enhanced their life in positive ways, such making them healthier, more connected to others, and more self-reliant. Get to the bottom of people’s fears and worries over technology, privacy, and security. Incorporate older adults who are comfortable with technology as mentors or facilitators to help others.
To build trust and rapport with older folks, it is important to treat them with respect and empathy, considering their individual experiences and viewpoints. Get to know your patients on a personal level by being kind, patient, and responsive to their needs. Make technology a source of strength, not fear, for the elderly. Collaborate with neighbourhood groups and local resources to reach out to elders and earn their trust. Outline responsible and secure ways to use technology, stressing the significance of data protection and privacy.
10. How should interdisciplinary teams (nurses, IT professionals, ethicists) collaborate to create ethically sound aging-focused technologies?
To ensure that technologies are patient-centred, transparent, and accountable, interdisciplinary teams consisting of nurses, IT professionals, and ethicists must work together by defining clear roles, encouraging open communication, and incorporating ethical considerations at every stage of development.
The key to successful teamwork is delineating each member’s precise function. For example, nurses offer a wealth of knowledge about clinical practice, patient perspectives, and ethical concerns. They should be a part of the team that builds, deploys, and monitors AI systems. The IT professionals are highly competent in creating and deploying various forms of technology, including algorithms that use artificial intelligence. Making sure the technology works, is secure, and is easy to use should be their top priorities. To ensure the technology is in line with ethical ideas and values, ethicists offer advice on how to act ethically. They can be of assistance in recognising possible ethical concerns and creating ethical guidelines for the advancement of AI.
Regular meetings and forums for members of interdisciplinary teams to talk about successes, failures, and ethical considerations are a great way for these experts to encourage open communication and teamwork. Promote a common vision for the technology and make sure that everyone in the team is on the same page regarding the project’s aims. Recognising the value of each team member’s area of expertise, promote an environment where everyone feels comfortable speaking out and working together.
Concerns about privacy, algorithmic bias, and patient should be considered at every stage of development and discussed with stakeholders. To find and fix possible ethical issues, ethical audits should be done often. Emphasise patient-centred design to make sure that older people’ needs and preferences are included throughout the development of the technology. Before deploying the technology, ensure patients have enough information and can give their informed consent. Strong precautions should be taken to ensure the privacy and security of patient data.
11. From a policy and practice perspective, what guidelines or frameworks do you think are essential to protect older adults from privacy breaches or algorithmic bias?
Data security measures, ethical AI development, and explicit transparency in data collection and utilisation are critical principles and frameworks that should be in place to safeguard older individuals from algorithmic prejudice and privacy breaches. Additionally, there should be strong governmental supervision and public awareness campaigns to further ensure compliance.
Privacy and data security: encrypt any sensitive information using strong algorithms to prevent its disclosure or alteration. Do not gather more data than is absolutely required for the task at hand. Limit the ability to view and edit personal data by implementing stringent access controls. Make sure everyone knows what to do if a data breach occurs. To make sure data security safeguards are working, run audits often.
Also, develop and adhere to a code of ethics for artificial intelligence that prioritises openness, accountability, and justice. To detect and reduce algorithmic bias, employ stringent testing, monitoring, and design processes. Aim for AI models that can be explained, so we can learn how decisions are made and hold people accountable. Particularly in domains where decisions can significantly affect persons, human supervision of AI decision-making systems is essential. In healthcare settings, it is imperative to have people’s informed consent before collecting or using any personal information.
Similarly, to safeguard individual information and combat algorithmic bias, there must be regulatory monitoring and enforcement in the form of robust laws. Establish regulatory agencies that can investigate cases of algorithmic bias and privacy breaches and act if necessary. For better adherence to privacy rules and regulations, we need data protection agencies that are stronger.
Raising public awareness: Launch public awareness campaigns to inform the elderly of their right to privacy and provide them with tools to safeguard their own data. Healthcare providers and other interested parties should participate in data privacy and ethical AI training programs. Help the elderly understand data privacy and artificial intelligence by providing them with straightforward information.
12. Looking ahead, how can we better integrate ethical considerations into the design, deployment, and regulation of technologies aimed at aging populations?
The need of integrating ethical standards is more important than ever before as technologies transform healthcare and impact important decisions. Fairness, transparency, privacy, and security are just a few of the many complex and varied ethical issues raised by healthcare technology. Achieving AI fairness requires constant evaluation of results to ensure equitable treatment of all individuals and the identification and elimination of biases in data and algorithms. It is critical to set clear lines of accountability for decisions made by AI systems since these judgements have the potential to impact people’s lives.
Designers, developers, firms deploying the AI, data scientists, and other stakeholders are all part of the AI practitioner community, and accountability means holding them to account when AI makes mistakes or causes harm. By establishing channels for recourse in the event of misconduct, accountability frameworks guarantee the ethical application of AI. Preventing malfunctions or hostile actors from taking advantage of unforeseen outcomes requires robust safety measures. By making safety and security top priorities, we can lessen the likelihood of harm and make AI systems reliable.