1. Introduction
n recent years, with the increase in the elderly population worldwide [1, 2, 3, 4], human societies face an increasing prevalence of fragility in the elderly [5]. This fragility leads to other consequences such as dependence, chronic diseases, reduced quality of life, long-term hospitalization, and increased care costs for the elderly [6, 7, 8, 9, 10, 11]. Today, to manage and reduce fragility in these people, a new technology called elderly remote health monitoring is used, increasing significantly to help the elderly [12]. This technology’s main aim is to reduce fragility and the length of hospital stay, and the cost of treatment for the elderly [13, 14]. Given the importance of determining the requirements of remote care systems, the present study was conducted to determine the capabilities and needs of elderly c health monitoring. 
2. Methods & Materials
This study was a descriptive-analytical that was conducted in 2019 in two main stages. In the first stage, a review study was conducted to identify the capabilities and requirements of elderly remote health monitoring. At this stage, the keywords aging, home care, remote monitoring, remote health, and information technology were searched in the following scientific databases and the period 2013 to October 2019: PubMed, Scopus, Web of Science, Google Scholar.
The information items resulting from the comprehensive search of scientific databases were designed in a questionnaire. The questionnaire consisted of five parts and 97 questions reviewed and approved by a geriatrician and two health information management specialists. In the second stage, the validity and reliability of the designed questionnaire were examined. At this stage, the questionnaire was completed by ten specialists in geriatrics and health information management, and the following formula was used to evaluate its validity (Formula 1): 



In this regard, “ne” is the number of specialists who have answered the “necessary” option, and n is the total number of specialists who have completed the questionnaire. In this study, the internal consistency method (Cronbach’s alpha) was used to assess items’ reliability. The retest test method (Spearman-Brown coefficient) was used to evaluate the reliability of the correlation between two components of a scale with a time and space interval.
3. Results
Based on the Results of the first phase of the study, 1738 articles were retrieved from searches in databases to identify the capabilities and requirements of elderly remote health monitoring. After deleting duplicate articles (n=468), articles that were not in English (n=380), and also articles irrelevant to the purpose of the research (n=858), finally, 32 articles were selected. The capabilities and requirements of elderly remote health monitoring were identified in five parts and 97 items by reviewing related articles. The identified capabilities and requirements were: system applications (n=18), functional requirements (n=19), non-functional requirements (n=27), types of tools (n=18), and communication infrastructure (n=15). 
The content validity calculation Results in the first step showed that out of 97 items of the questionnaire completed by 5 experts, 51 items the content validity ratio values were lower than 99%. In the second step of calculating, content validity was recalculated by referring to the relevant experts, providing information, discussing the items, and getting their final opinions. Finally, out of 97 identified items, 69 items with a content validity ratio of over 99% were approved as capabilities and requirements of the elderly remote health monitoring. As a result, the approved capabilities and requirements were: system applications (n=12), functional requirements (n=15), non-functional requirements (n=14), types of tools (n=13), and communication infrastructure. (n=15) (Table 1). 



Cronbach’s alpha coefficient was used to evaluate the questionnaire’s internal reliability, calculated to be 90 among 15 geriatricians and 15 health information management specialists. Also, to assess the questionnaire’s external reliability, the retest test method was used in which 10 experts completed the questionnaire in two stages with an interval of one week, and the correlation coefficient was 0.85.
4. Conclusion
In this study, the remote monitoring system’s capabilities and requirements for the health of the elderly in five parts of system applications, functional needs, non-functional requirements, tools, and communication infrastructure were identified and validated. The specified requirements are in line with the culture and technology, and communication infrastructure in Iran. Therefore, the use of these capabilities and requirements by remote health system designers will better understand the needs of vulnerable elderly in various dimensions. However, further research is needed to identify the identity and clinical information requirements of the elderly remote health monitoring. One of the limitations of this study is the low sample size to determine validity and reliability. It is suggested that in future studies, the validity and reliability of the questionnaire in a larger sample size be investigated using factor analysis.
Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of the Tehran University of Medical Sciences (Code: 36240-31-02-97).
Funding
The paper was extracted from the  PhD. dissertation of the first author, Department of Health Information Technology, Esfarayen Faculty of Medical Sciences, Esfarayen.
Authors' contributions
All authors equally contributed to preparing this article.
Conflict of interest
The authors declared no conflict of interest.
Acknowledgments
The authors would like to thank the Department of Health Information Management and the Elderly Research Center of Tehran University of Medical Sciences and all participants.


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