Unremarkable to Remarkable AI Agent: Exploring Boundaries of Agent Intervention for Adults With and Without Cognitive Impairment

TL;DR

This paper investigates how AI agents can intervene in the care networks of older adults as part of aging in place, focusing on boundaries that affect acceptance by healthy individuals and those with cognitive decline. Using speed dating with storyboards, the authors reveal a paradox: healthy older adults resist adopting agents now but desire deeply personalized, proactive support if decline occurs, while those experiencing memory problems and their caregivers are eager to adopt earlier and expect agents to evolve in their roles. The main contributions are (1) identifying dynamic boundaries of agent intervention across health states, (2) outlining design opportunities for agents that transition from tool to coach to advocate and from tool to advisor, and (3) proposing the concept of unremarkable-to-remarkable agents that adjust visibility with context. The findings advance caregiving technology design by stressing early adoption, role evolution, and boundary-aware, ethically grounded agent behavior to enhance aging in place and caregiver coordination.

Abstract

As the population of older adults increases, there is a growing need for support for them to age in place. This is exacerbated by the growing number of individuals struggling with cognitive decline and shrinking number of youth who provide care for them. Artificially intelligent agents could provide cognitive support to older adults experiencing memory problems, and they could help informal caregivers with coordination tasks. To better understand this possible future, we conducted a speed dating with storyboards study to reveal invisible social boundaries that might keep older adults and their caregivers from accepting and using agents. We found that healthy older adults worry that accepting agents into their homes might increase their chances of developing dementia. At the same time, they want immediate access to agents that know them well if they should experience cognitive decline. Older adults in the early stages of cognitive decline expressed a desire for agents that can ease the burden they saw themselves becoming for their caregivers. They also speculated that an agent who really knew them well might be an effective advocate for their needs when they were less able to advocate for themselves. That is, the agent may need to transition from being unremarkable to remarkable. Based on these findings, we present design opportunities and considerations for agents and articulate directions of future research.

Figures (2)

• Figure 1: Two samples from our storyboards. Example (a) depicts a conversation between an older adult and his son about the older adult's potentially unsafe driving and an agent chimes in. Example (b) is about an older adult with cognitive decline and a history of wandering off who tries to leave his house, and an agent locks the door and alerts the older adult's wife.
• Figure 2: Summary of design considerations for agent to support care coordination based on our findings. When the older adult is healthy, the agent is unremarkable and serves as a tool. As the older adult's health declines, the agent transitions to be remarkable. For the older adult, the agent shifts to serve as a coach and advocate. For the caregiver, the agent transitions from a tool to an advisor.