Exploring Expectations, Ethical Dimensions, and Values for Voice-Enabled AI Assistants That Support Older Adults and Informal Family Caregivers: Participatory Speculative Design Study

Background: Continuous advancements in voice artificial intelligence technologies aim to assist older adults and caregivers, potentially improving quality of life and reducing caregiving burdens. Although research has explored the potential of voice-enabled artificial intelligence (VAI) assistants, such as Alexa (Amazon.com, Inc) and Google Home, to support older adults' health in informal care settings, there remains a significant gap in understanding the ethical dimensions and values that may influence their future adoption by caregivers and care recipients. Objective: This research aims to explore older adult and informal family caregivers' perspectives of VAI assistants for supporting informal care, including the ethical dimensions and values that influence their decisions about future adoption for these purposes. Methods: This research uses participatory speculative design to explore older adults' and informal family caregivers' perspectives of how VAI might support informal care in the future, and the ethical concerns they have about adopting VAI technologies. We conducted 8 workshop sessions with older adults and caregivers (n=9) over four months. Each phase focused on one of three goals: (1) to understand existing experiences, (2) to envision future VAI technologies, and (3) to reflect on ethical values that shape acceptance. In workshops, we aimed to gain insights into their experiences and challenges in managing informal care tasks and how future implementation of VAI might support the caregiving process to address their needs and concerns while emphasizing the ethical dimensions they value. Results: The findings suggest older adults and informal family caregivers see potential opportunities for VAIs to support informal aging care by automating daily health tasks to improve efficiency, enhancing mental health and well-being, and offering companionship. However, participants felt that VAI alone might not be sufficient to address the complex needs of informal care. Additionally, they raised several ethical concerns related to transparency, privacy, inclusiveness, trust, affordability, and autonomy, which they felt needed to be addressed to encourage adoption of VAI technologies for informal care in the future. Conclusions: Based on the findings, we offer insights and design implications for VAI systems that balance efficiency with ethical values to support diverse caregiving needs and potentially encourage future adoption in the informal care space.