While commercial conversational agents (CA) (i.e. Google assistant, Siri, Alexa) are widely used, these systems have limitations in error-handling, flexibility, personalization and overall dialogue management that are amplified in care coordination settings. In this paper, we synthesize and articulate these limitations through quantitative and qualitative analysis of 56 older adults interacting with a commercial CA deployed in their home for a 10 week period. We look at the CA as a compensatory technology in an older adult's care network. We argue that the CA limitations are rooted in the rigid cue-and-response style of task-oriented interactions common in CAs. We then propose a redesign for CA conversation flow to favor flexibility and personalization that is nonetheless viable within the limitations of current AI and machine learning technologies. We explore design tradeoffs to better support the usability needs of older adults compared to current design optimizations driven by efficiency and privacy goals.

In the Spring of 2020, closures and safe distancing orders swept much of the United States due to the COVID-19 pandemic. This paper presents a case study of pivoting an in-person empowerment program focused on lifestyle interventions for people newly diagnosed with Mild Cognitive Impairment (MCI) to an online program. Working as rapidly as possible to sustain participant engagement, our design decisions and subsequent iterations point to initial constraints in telehealth capabilities, as well as learning on the fly as new capabilities and requirements emerged. We present the discovery of emergent practices by family members and healthcare providers to meet the new requirements for successful online engagement. For some participants, the online program led to greater opportunities for empowerment while others were hampered by the lack of in-person program support. Providers experienced a sharp learning curve and likewise missed the benefits of in-person interaction, but also discovered new benefits of online collaboration. This work lends insights and potential new avenues for understanding how lifestyle interventions can empower people with MCI and the role of technology in that process.

Conversational agents (CAs) such as Google Home or Alexa offer empowering opportunities for dyads composed of older adults with mild cognitive impairment (MCI) and their care partners. CAs support coordination and planning between the two, and can amplify the support that the care partner needs to provide. In this study, we observed how ten such dyads interacted with a Google Home over 10 weeks. We logged and analyzed 3,878 total interactions, interviewed the dyads to better understand their experiences, and also surveyed their individual preferences and priorities for automated assistance in the home. We found that CAs empowered both the people who had MCI, and their care partners. We observed that the utility of the CA in the day-to-day lives of users largely depended on how much the care partner scaffolded promising functionality, setting it up and contextualizing it for specific needs and desires.