6 IEEE JOURNAL ON SELECTED AREAS IN COMMUNICATIONS/SUPPLEMENT, VOL. 31, NO. 9, SEPTEMBER 2013 mHealth Technologies for Chronic Diseases and Elders: A Systematic Review Giovanni Chiarini, Pradeep Ray, Senior Member, IEEE, Shahriar Akter, Cristina Masella, and Aura Ganz, Fellow, IEEE Abstract—mHealth (healthcare using mobile wireless technolo- gies) has the potential to improve healthcare and the quality of life for elderly and chronic patients. Many studies from all over the world have addressed this issue in view of the aging population in many countries. However, there has been a lack of any consolidated evidence-based study to classify mHealth from the dual perspectives of healthcare and technology. This paper reports the results of an evidence-based study of mHealth solutions for chronic care amongst the elderly population and proposes a taxonomy of a broad range of mHealth solutions from the perspective of technological complexity. A systematic literature review was conducted over 10 online databases and the findings were classified into four categories of predominant mHealth solutions, that is, self-healthcare, assisted healthcare, supervised healthcare and continuous monitoring. The findings of the study have major implications for information manage- ment and policy development in the context of the Millennium Development Goals (MDGs) related to healthcare in the world. Index Terms—Chronic, elderly, mobile health, systematic re- view, taxonomy, technologies, ubiquitous health. I. I NTRODUCTION M HEALTH (healthcare using mobile wireless technolo- gies, also called mobile health technologies) has the potential to transform the healthcare system in aging societies by opening up novel opportunities for global access to health services and medical care for chronic diseases. According to the United Nation’s 2009 World Population Ageing report, the number of people aged 60 years or over was 600 million in 2000, a tripling of what it was in 1950, and over the span of the next 40 years, this number is projected to triple once again, taking the count to 2 billion. Furthermore, the average age of people over 60 is increasing: currently, one in every seven people in this age group is 80 years or above and by 2050, one in five will be 80 or over, with nearly four-fifths of them living in less developed regions [1]. Additionally, the total number of persons globally who report a long-standing health problem or disability is 860 million, with NCDs (i.e. Manuscript received April 15, 2012; accepted July 10, 2012 G. Chiarini and C. Masella are with the Department of Management, Economics and Industrial Engineering (DIG), Politecnico di Milano, Italy (e-mail: giovanni.chiarini@mail.polimi.it; cristina.masella@polimi.it). P. Ray is with the School of Information Systems, University of New South Wales, Australia (e-mail: p.ray@unsw.edu.au). S. Akter is with the School of Management and Marketing, University of Wollongong, Australia (e-mail: sakter@uow.edu.au). A. Ganz is with the Electrical and Computer Engineering Department, University of Massachusetts, USA (e-mail: ganz@ecs.umass.edu). Digital Object Identifier 10.1109/JSAC.2013.SUP.0513001 non-communicable diseases, such as, cardiovascular diseases and diabetes, cancers and chronic respiratory diseases) still the leading cause of death in the world [2]. In this context, mobile health technologies are playing an instrumental role in serving patients by making healthcare more affordable, accessible and available. The ITU report [3] shows that at the end of 2009, there were approximately 4.6 billion mobile cellular subscriptions, with the average penetration rate, in developed countries, of above 100%. Moreover, the latest gen- eration of smartphones are increasingly viewed as handheld computers rather than as phones, due to their powerful on- board computing capability, capacious memories, large screens and open operating systems that encourage application devel- opment [4]. Therefore, it is clear that the potential for mobile technologies to transform healthcare and clinical intervention in the community is tremendous (between $1.96 billion and $5.83 billion in saved healthcare costs worldwide by 2014 [5]) especially in assisting elders and people with chronic conditions to live independently. In fact, in a recent Price Waterhouse Cooper report, the global mobile health market is expected to reach US$23 billion by 2017. Among the various categories, monitoring services will account for the largest share globally (approximately 65%), and they will be driven primarily by solutions that aid chronic disease management (US$10.7 billion) and independent aging (US$4.3 billion), with revenues accruing from both developed countries and large developing countries, such as China and India [6]. Currently, the key stakeholders–mobile operators, device vendors, healthcare providers, content players, foundations and governments–have already launched several mHealth ser- vices and applications worldwide [6] and, at the moment, the GSMA tracker [7] reports more than 300 commercial deployments globally. In particular, developments in new mHealth solutions and technologies specifically for the elderly are steadily proliferating [8]–[10] and to date, they have targeted a wide range of applications such as: medication adherence, vital signs’ monitoring, activity monitoring and alert systems, wellness and rehabilitation, remote consultation, and solutions for caregivers [11]. However, at the moment, the most successful smartphone applications (apps) are generally targeted only to younger and healthier populations [4], while the solutions for seniors face resistance due usually to precon- ceptions about cost, lack of awareness about what is available, and caution about sharing personal health information [11]. In 0733-8716/13/$31.00 c  2013 IEEE