Smart Systems for Loneliness Monitoring in Older Adults: User-Centered Evaluation and Experience-based Co-Design for System Improvement (Preprint)

BACKGROUND Loneliness is a critical issue among older adults and constitutes a significant risk factor for a range of physical and mental health conditions. However, current assessment methods primarily rely on self-report questionnaires and clinical evaluations, which are susceptible to recall bias and social desirability bias, highlighting the need for more objective and continuous assessment approaches. Recent studies have explored the use of sensor technologies for detecting behavioral and physiological patterns associated with loneliness. While these technologies have demonstrated correlations between physiological and behavioral sensor data and the experience of loneliness, their implementation has been limited. Most systems rely on fixed-location sensors or smartphone applications, with little attention given to the integration of these tools into users’ daily routines. To date, no published studies have applied smart textile technology which integrate sensing capabilities directly into garments or furniture, as a medium for loneliness detection. This study addresses that gap by exploring the usability, experiential acceptability and ethical considerations of smart textile-based monitoring systems. OBJECTIVE This research aims to develop and evaluate a smart loneliness monitoring system that integrates sensing garments, furniture and a companion mobile application, aiming to detect behavioral and physiological signals potentially associated with loneliness. METHODS Building on earlier conceptual research, a functional prototype system was developed and evaluated through two immersive in-person workshops with older adults (N=10). A mixed-methods approach was applied, combining structured questionnaires, sensory ethnographic observations, focus group discussions and experience-based co-design. Quantitative data were analyzed descriptively, and qualitative data were analyzed thematically to explore user perceptions related to system usability, emotional response, lifestyle compatibility and ethical considerations. RESULTS Quantitative data indicated high user satisfaction in dimensions such as comfort, ease of use and feedback clarity. However, trust in long-term monitoring and willingness to use the system regularly varied. Thematic analysis revealed four main areas influencing acceptance, including wearability, usability, and daily integration; trust, privacy, and data control; perceptions of loneliness and the limits of detection; and adoption, applicability, and ethical futures. Participants emphasized the need for discretion, personalization and human oversight in system feedback and data-sharing mechanisms. CONCLUSIONS The resulting prototype was positively received, demonstrating the potential of smart systems for passive and personalized loneliness monitoring among older adults. However, adoption is influenced by perceptions of autonomy, emotional sensitivity and contextual integration. Future development should focus on modularity, transparency and integration within care infrastructures to ensure ethical and sustainable deployment.