Solitary death and new lifestyles during and after COVID-19: wearable devices and public health ethics

Abstract

Background Solitary death (kodokushi) has recently become recognized as a social issue in Japan. The social isolation of older people leads to death without dignity. With the outbreak of COVID-19, efforts to eliminate solitary death need to be adjusted in line with changes in lifestyle and accompanying changes in social structure. Health monitoring services that utilize wearable devices may contribute to this end. Our goals are to outline how wearable devices might be used to (1) detect emergency situations involving solitary older people and swiftly connect them with medical treatment, to (2) reduce the frequency of deaths that remain undiscovered and (3) to reduce social isolation by promoting social interaction. Methods Theoretical and philosophical approaches were adopted to examine ethical issues surrounding the application of wearable devices and cloud-based information processing systems to prevent solitary death in the world with/after COVID-19. Main body (1) Technology cannot replace social connections; without social support necessary to foster understanding of the benefits of health management through wearable devices among older adults, such devices may remain unused, or not used properly. (2) Maturity of the technology; systems face the difficult task of detecting and responding to a wide range of health conditions and life-threatening events in time to avert avoidable morbidity and mortality. (3) Autonomy and personhood; promoting the voluntary use of wearable devices that are a part of larger efforts to connect isolated individuals to a community or social services might be effective. Legal force should be avoided if possible. There is some concern that landlords may require an older person to sign a contract agreeing to wear a device. The autonomy of solitary older people should be respected. (4) Governance: policies must be developed to limit access to data from wearables and the purposes for which data can be used. Conclusion If thoughtfully deployed under proper policy constraints, wearable devices offer a way to connect solitary older people to health services and could reduce cases of solitary death while respecting the personhood of the user.

A retrospective study on solitary deaths (kodoku-shi) from the aspects of forensic and social medicine

“…Since the 1990s, the relationship with poverty has become a problem, and in the latter half of the 2000s, solitary death became a social problem as a result of social exclusion 13 . In addition, solitary deaths associated with social isolation have a negative impact on public health and increase the economic burden 14 . And social isolation and loneliness have been reported to increase the risk of coronary heart disease (CHD) 15 , dementia 16 , etc.…”

Perceived Risk of Solitary Death and Depressive Symptoms Among Older Adults Living Alone in Seoul: Can Structural and Functional Social Support Buffer the Impact?

“…Solitary deaths frequently involve the older population (Nakazawa et al, 2021). Life-course transitions in older adulthood, such as retirement and bereavement, may restrict one’s social networks and increase social isolation in this population (Weiss, 2005; Weldrick & Grenier, 2018).…”

“…Life-course transitions in older adulthood, such as retirement and bereavement, may restrict one’s social networks and increase social isolation in this population (Weiss, 2005; Weldrick & Grenier, 2018). Additionally, social isolation is associated with an increased likelihood of mortality and a longer period of undiscovered after death (Holt-Lunstad et al, 2015; Nakazawa et al, 2021). Older adults living alone are more likely to experience social isolation than those not living alone (Park et al, 2017; Victor et al, 2000), and are therefore, at a greater risk of solitary death (Kakiuchi et al, 2019; Nomura et al, 2016).…”

COVID-19 Pandemic Control Measures and Their Impact on University Students and Family Members in a Central Region of Spain

“…Anxiety and stress alter the quality of life of those who suffer from them [24]. Studies show that university students were the main group affected by these mental illnesses during the COVID-19 pandemic [25][26][27].…”