Care-MOVE: A Smartphone-Based Application for Continuous Monitoring of Mobility, Environmental Exposure and Cognitive Status in Older Patients

This study presents Care-MOVE, a smartphone-based application designed for continuous, passive, and unobtrusive monitoring of mobility, environmental exposure, and cognitive status in older adults within a telemedicine framework. The system integrates movement-related data collected through smartphone sensors (GPS, activity recognition, and caloric expenditure estimation) with contextual air quality information and standardized neuropsychological assessments, resulting in a comprehensive multimodal dataset (Care-MOVE Dataset). An exploratory proof-of-concept study was conducted on a subsample of 53 participants aged over 65, each monitored continuously for five days, contributing on average more than 30,000 longitudinal records. To investigate whether daily motor behavior can serve as a digital biomarker of cognitive functioning, several Machine Learning and Deep Learning models were evaluated using a Leave-One-User-Out (LOUO) cross-validation strategy. The comparative analysis included traditional classifiers (Logistic Regression, Random Forest, Gradient Boosting, K-Nearest Neighbors, and Support Vector Machines) as well as temporal deep learning architectures (1D CNN, LSTM, GRU, and Transformer). Among all of the evaluated approaches, the Support Vector Machine with RBF kernel achieved the best performance, reaching an accuracy of 98.1%, a balanced accuracy of 0.988, and an F1-score of 0.981, demonstrating robust generalization across unseen subjects. For this reason, the study was designed and presented as an exploratory proof-of-concept rather than a definitive clinical validation. This integrated approach not only enables the collection of detailed and contextualized data but also opens new perspectives for proactive digital healthcare, focused on risk prevention, improving quality of life, and promoting autonomy in elderly patients.