**Background:** Chronic obstructive pulmonary disease (COPD) affects approximately 14.2% of older adults and represents a major cause of morbidity, mortality, and economic burden, with over 50 billion dollars spent annually in the United States and 2047–10,701 euros per patient per year in Europe. Pulmonary rehabilitation is a cost-effective therapy with level II evidence for preventing exacerbations and improving physical function, yet it remains underused in community settings. Tele-monitoring, telemedicine, and tele-rehabilitation solutions have been proposed to improve home-based clinical management, but no prior systematic review had focused specifically on older adults with COPD—a population facing unique barriers including limited technology skills, and impairments in hearing, vision, communication, or cognition.
**Methods:** On November 11, 2022, four databases (PubMed/Medline, Scopus, Web of Science, and Cochrane CENTRAL) were systematically searched by two independent investigators. Eligible studies were RCTs enrolling older adults with COPD, using any tele-monitoring device as intervention, with any comparator, and HR-QoL as the primary outcome. Secondary outcomes included pulmonary function, physical function, adherence/feasibility, costs, and safety. Quality assessment was performed using the Jadad scale and the Cochrane RoBv.2 tool. The review was registered with PROSPERO (CRD42022340500).
**Results:** From 1845 records identified, 988 were screened after deduplication, and 5 RCTs met eligibility criteria, assessing a total of 584 patients (291 intervention, 293 control). The studies were published between 2012 and 2020 and conducted in Hong Kong, Japan, China, Italy, and as an international collaboration. The tele-monitoring devices used were: ASTRI telecare system (mobile phone with respiratory rate sensor and pulse oximeter), WeChat social media platform, Pedometer (Kens Lifecorder EX), SweetAge monitoring system (wristband with sensors for heart rate, activity, temperature, and galvanic skin response, plus pulse oximeter), and CHROMED monitoring platform (device measuring within-breath respiratory mechanical impedance using forced oscillation technique).
For the primary outcome of HR-QoL, assessed in 4 studies, none reported statistically significant improvements in tele-monitored groups. Chau et al. found no significant group differences in CRQ subscales (dyspnea, fatigue, emotion, mastery; all p>0.05). Jiang et al. reported no significant differences in CAT scores (p=0.53). Walker et al. found no significant between-group differences in EQ-5D, CAT, or PHQ-9 scores (all p>0.05). Kawagoshi et al. showed CRQ improvement in both groups but no significant advantage for the tele-monitored group.
For secondary outcomes, pulmonary function showed no significant between-group differences in the two studies assessing it. Physical function results were mixed: Kawagoshi et al. reported that the pedometer-monitored group had significantly greater increase in daily walking time (51.3±63.7 min/day vs. 12.3±25.5 min/day) and changes in walking time correlated with 6MWT (r=0.401, p=0.038). However, Jiang et al. found no significant differences in SGRQ or Ex-SRES scores.
Safety outcomes showed promising trends. Pedone et al. reported that the SweetAge system was associated with a lower incidence rate of respiratory events (28/100 person-years vs. 42/100 person-years; IRR 0.67, 95% CI 0.32–1.36) and hospital admissions (13/100 person-years vs. 20/100 person-years; IRR 0.66, 95% CI 0.21–1.86). Walker et al. found that the CHROMED platform was associated with 54% fewer repeat hospitalizations (p=0.017), with previously hospitalized patients showing the greatest reduction (−53%, p=0.017) and potential cost savings of −3736€/patient/year (p=0.010). The largest cost differences were in patients with prior COPD hospitalization (€4147 vs. €6949, p=0.008).
Adherence and feasibility data revealed several barriers: patients withdrew due to discomfort with wearable devices, disruption of daily life rhythm, difficulty carrying devices, cold weather affecting belt use, and technical issues. Dropout rates varied across studies, with causes including death, worsening condition, lack of motivation, and personal reasons.
Quality assessment using the Jadad scale classified all 5 studies as high quality (scores of 3 or 4 out of 5). According to RoBv.2, all studies had low risk of bias for randomization, outcome measurement, and result selection, but 2 studies (40%) showed some concerns regarding deviations from intended interventions due to unclear intention-to-treat analysis.
**Clinical Implications:** This systematic review found no evidence that tele-monitoring devices significantly improve HR-QoL in older adults with COPD. The positive effects on HR-QoL observed in some studies appeared attributable to pulmonary rehabilitation itself rather than the monitoring technology. However, the SweetAge system and CHROMED platform showed promising reductions in respiratory events and hospitalizations, which could translate into meaningful clinical and economic benefits. The authors emphasize that older adults face specific barriers to technology adoption, and tailored strategies are needed to improve engagement. The small number of included studies (5 RCTs) and high heterogeneity of devices precluded meta-analysis and highlight a significant knowledge gap. Further research is needed to identify optimal tele-monitoring approaches for improving HR-QoL in this population.