The future of healthy ageing: Wearables in public health, disease prevention and healthcare

Wearables have evolved into accessible tools for sports, research, and interventions. Their use has expanded to real-time monitoring of behavioural parameters related to ageing and health. This paper provides an overview of the literature on wearables in disease prevention and healthcare over the life course (not only in the older population), based on insights from the Future of Diagnostics Workshop (Leiden, January 2024). Wearable-generated parameters include blood glucose, heart rate, step count, energy expenditure, and oxygen saturation. Integrating wearables in healthcare is protracted and far from mainstream implementation, but promises better diagnosis, biomonitoring, and assessment of medical interventions. The main lifestyle factors monitored directly with wearables or through smartphone applications for disease prevention include physical activity, energy expenditure, gait, sleep, and sedentary behaviour. Insights on dietary consumption and nutrition have resulted from continuous glucose monitors. These factors are important for healthy ageing due to their effect on underlying disease pathways. Inclusivity and engagement, data quality and ease of interpretation, privacy and ethics, user autonomy in decision making, and efficacy present challenges to but also opportunities for their use, especially by older people. These need to be addressed before wearables can be integrated into mainstream medical and public health strategies. Furthermore, six key considerations need to be tackled: 1) engagement, health literacy, and compliance with personalised feedback, 2) technical and standardisation requirements for scalability, 3) accountability, data safety/security, and ethical concerns, 4) technological considerations, access, and capacity building, 5) clinical relevance and risk of overdiagnosis/overmedicalisation, and 6) the clinician's perspective in implementation.