People aged 65 years and older represent 19% of the Canadian population and are expected to reach 25% by 2030 [1]. With the accelerated aging of the population, the prevalence of both major and mild cognitive disorders is increasing [2]. Cognitive disorders correspond to an alteration in one or more cognitive functions, regardless of the mechanism involved, its origin, or reversibility, and may be neurological, psychiatric, drug induced, and so on [3]. The prevalence of major cognitive disorders, such as Alzheimer disease, doubles every 5 years after the age of 65 years [4]. In 2015-2016, a total of 87% of residents in Canadian nursing homes had some type of cognitive impairment, 69% had dementia, 50% had behavioral disorders, and 31% had depression [5]. Of these residents, 82% required assistance with their care or were dependent on all care related to activities of daily living [5]. At the same time, the proportion of older people with dementia living outside a long-term care facility or nursing home was 61%, including 69% of those aged younger than 80 years and 58% of those aged 80 years and older [6]. The consequences of these cognitive disorders, which manifest themselves as a decline in performance in one or more cognitive domains [7], are often far-reaching for the individual, his or her family, health care professionals, and society. In Canada, the economic burden incurred by the health care system for caring for people with cognitive impairment was around CAD $10.4 billion (equivalent to US $7.2 billion) in 2016 and would reach CAD $16.6 billion (equivalent to US$ 11.5 billion) by 2031 [8].

Such a picture calls for mechanisms to maintain cognitive health in older adults. There are 2 main ones: vascular health and cognitive reserve [9]. Some of the protective factors acting on these mechanisms have been identified. First, physical activity contributes to maintaining vascular health and developing cognitive reserve, making it a preferred intervention for preventing cognitive impairment or delaying its progression [10]. Second, social participation, either direct or indirect contact between individuals in which information, attitudes, and norms are shared, has been shown to be a protective factor against cognitive decline [11].

Finally, cognitive engagement is associated with an increase in cognitive reserve [12]. This factor has 2 components: cognitive stimulation and cognitive training. On the one hand, cognitive stimulation is achieved through individual or group activities that involve different cognitive functions and consist of new learning activities, such as learning a new language [12]. Cognitive training, on the other hand, is based on the repetition of standardized tasks that target specific cognitive functions, such as the use of sophisticated video games [12]. These key protective factors (eg, physical activity, social participation, and cognitive engagement) can be promoted in a variety of ways, notably through the use of digital health technologies.

According to Health Canada, digital health technologies include stand-alone software applications as well as integrated software systems and instruments that can be used with platforms such as computers, smartphones, tablets, wearable devices, and environmental sensors [13,14]. Digital technologies for older adults, also known as gerontechnologies, have been used in many aspects of health care for older adults [2]. For example, mobile apps used to stimulate cognitive functions, connected devices to monitor physical activity, and digital platforms to facilitate communication with loved ones or consultation with health care professionals can be found among older people living with neurocognitive disorders [15]. Several studies have demonstrated the positive impact of digital health technologies on various aspects of an older person’s life, such as health, housing, services and transactions, mobility and transportation, access to information, communication and work, leisure, and personal fulfillment [16]. These technologies can improve access to health information, enable faster diagnosis and treatment, and improve access to care and services for older people with cognitive impairment at home, in health care facilities, and in rural and remote communities [13,17].

However, the potential benefits associated with the use of these technologies cannot be realized without the engagement of the people who use them. Thus, despite the growing interest in digital health technologies and the availability of evidence on the feasibility and effectiveness of health interventions using these technologies in a cognitively impaired population [18], little is known about the engagement of older people with cognitive impairment with these tools. Nevertheless, the success of digital health interventions depends on their adoption and optimal use, which implies an experienced and ongoing engagement of the people who use them. For example, some people may have access to the technology and possess the skills to use it but choose not to engage with a digital health service [19]. Other people engage with these technologies and then decide to abandon them. A systematic review and meta-analysis of attrition and adherence in smartphone-based interventions for mental health problems found attrition rates as high as 30% and very low adherence rates ranging from 2% to 10% [20]. Several factors could influence attrition in digital health interventions. In their study of barriers to adoption of mobile phone–based mental health interventions by older adults, Pywell et al [21] highlighted factors that may lead older adults to disengage. For example, participants felt that if they did not make sufficient progress while using digital health technologies, if they did not gain a better understanding of their symptoms and how they might affect them, or if they had to invest a lot of time and effort, then they would give up. These findings underscore the importance of increasing engagement, as there is evidence that higher levels of engagement are associated with better cognitive health [20].

For older people living with cognitive impairment, engagement with digital health technologies can be particularly challenging, and even more so for people from cultural or linguistic minority groups. Indeed, digital health technologies may contribute to increasing health inequalities due to systematic differences and people’s ability to engage with digital platforms [19].

The engagement of older people with cognitive impairment with digital health technologies is therefore a key factor in maximizing the benefits of these tools. This engagement can be influenced by conditions related to the design of digital health technologies, data security and confidentiality, and support for older people with cognitive impairment. However, other factors may also influence the level of engagement with digital health technologies in this population. Indeed, it is essential to understand the concept of engagement, how it is assessed, and how it relates to the effectiveness of digital health interventions for the prevention and management of cognitive disorders in older people. This understanding can inform the development and implementation of digital health interventions that are better adapted to this population, thus contributing to their health and well-being.

The purpose of this scoping review is to describe how the engagement of older adults with cognitive impairment with digital health technologies is conceptualized and assessed, and how this engagement relates to the effectiveness of digital health interventions.

Our key synthesis questions are as follows: (1) How is engagement conceptualized and operationalized in the context of studies of digital health technologies for older adults with cognitive impairment? (2) What measures are used to assess the level of engagement of older adults with cognitive impairment with digital health technologies? (3) What facilitates or limits the engagement of older adults with cognitive impairment with digital health technologies? and (4) What are the relationships between the level of engagement and the effectiveness of digital health interventions for older adults with cognitive impairment?

The development of the search strategy and the completion of the selection phases of the review were completed in July 2024. Data extraction and analysis began in August 2024, and results are expected to be available in November 2024.