Study Objectives: Wrist accelerometry is widely used for inferring sleep-wake state. Previous works demonstrated poor wake detection, without cross-device generalizability and validation in different age range and sleep disorders. We developed a robust deep learning model for to detect sleep-wakefulness from triaxial accelerometry and evaluated its validity across three devices and in a large adult population spanning a wide range of ages with and without sleep disorders. Methods: We collected wrist accelerometry simultaneous to polysomnography (PSG) in 453 adults undergoing clinical sleep testing at a tertiary care sleep laboratory, using three devices. We extracted features in 30-second epochs and trained a 3-class model to detect wake, sleep, and sleep with arousals, which was then collapsed into wake vs. sleep using a decision tree. To enhance wake detection, the model was specifically trained on randomly selected subjects with low sleep efficiency and/or high arousal index from one device recording and then tested on the remaining recordings. Results: The model showed high performance with F1 Score of 0.86, sensitivity (sleep) of 0.87, and specificity (wakefulness) of 0.78, and significant and moderate correlation to PSG in predicting total sleep time (R=0.69) and sleep efficiency (R=0.63). Model performance was robust to the presence of sleep disorders, including sleep apnea and periodic limb movements in sleep, and was consistent across all three models of accelerometer. Conclusions: We present a deep model to detect sleep-wakefulness from actigraphy in adults with relative robustness to the presence of sleep disorders and generalizability across diverse commonly used wrist accelerometers.

Urinary tract infection (UTI) flare-ups pose a significant health risk for older adults with chronic conditions. These infections often go unnoticed until they become severe, making early detection through innovative smart home technologies crucial. Traditional machine learning (ML) approaches relying on simple binary classification for UTI detection offer limited utility to nurses and practitioners as they lack insight into prediction uncertainty, hindering informed clinical decision-making. This paper presents a clinician-in-the-loop (CIL) smart home system that leverages ambient sensor data to extract meaningful behavioral markers, train robust predictive ML models, and calibrate them to enable uncertainty-aware decision support. The system incorporates a statistically valid uncertainty quantification method called Conformal-Calibrated Interval (CCI), which quantifies uncertainty and abstains from making predictions ("I don't know") when the ML model's confidence is low. Evaluated on real-world data from eight smart homes, our method outperforms baseline methods in recall and other classification metrics while maintaining the lowest abstention proportion and interval width. A survey of 42 nurses confirms that our system's outputs are valuable for guiding clinical decision-making, underscoring their practical utility in improving informed decisions and effectively managing UTIs and other condition flare-ups in older adults.

Background and Objectives: This paper focuses on using AI to assess the cognitive function of older adults with mild cognitive impairment or mild dementia using physiological data provided by a wearable device. Cognitive screening tools are disruptive, time-consuming, and only capture brief snapshots of activity. Wearable sensors offer an attractive alternative by continuously monitoring physiological signals. This study investigated whether physiological data can accurately predict scores on established cognitive tests. Research Design and Methods: We recorded physiological signals from 23 older adults completing three NIH Toolbox Cognitive Battery tests, which assess working memory, processing speed, and attention. The Empatica EmbracePlus, a wearable device, measured blood volume pulse, skin conductance, temperature, and movement. Statistical features were extracted using wavelet-based and segmentation methods. We then applied supervised learning and validated predictions via cross-validation, hold-out testing, and bootstrapping. Results: Our models showed strong performance with Spearman's ρof 0.73-0.82 and mean absolute errors of 0.14-0.16, significantly outperforming a naive mean predictor. Sensor roles varied: heart-related signals combined with movement and temperature best predicted working memory, movement paired with skin conductance was most informative for processing speed, and heart in tandem with skin conductance worked best for attention. Discussion and Implications: These findings suggest that wearable sensors paired with AI tools such as supervised learning and feature engineering can noninvasively track specific cognitive functions in older adults, enabling continuous monitoring. Our study demonstrates how AI can be leveraged when the data sample is small. This approach may support remote assessments and facilitate clinical interventions.

Domestic AI agents faces ethical, autonomy, and inclusion challenges, particularly for overlooked groups like children, elderly, and Neurodivergent users. We present the Plural Voices Model (PVM), a novel single-agent framework that dynamically negotiates multi-user needs through real-time value alignment, leveraging diverse public datasets on mental health, eldercare, education, and moral reasoning. Using human+synthetic curriculum design with fairness-aware scenarios and ethical enhancements, PVM identifies core values, conflicts, and accessibility requirements to inform inclusive principles. Our privacy-focused prototype features adaptive safety scaffolds, tailored interactions (e.g., step-by-step guidance for Neurodivergent users, simple wording for children), and equitable conflict resolution. In preliminary evaluations, PVM outperforms multi-agent baselines in compliance (76% vs. 70%), fairness (90% vs. 85%), safety-violation rate (0% vs. 7%), and latency. Design innovations, including video guidance, autonomy sliders, family hubs, and adaptive safety dashboards, demonstrate new directions for ethical and inclusive domestic AI, for building user-centered agentic systems in plural domestic contexts. Our Codes and Model are been open sourced, available for reproduction: https://github.com/zade90/Agora

The paper asserts that emulating empathy in human-robot interaction is a key component to achieve satisfying social, trustworthy, and ethical robot interaction with older people. Following comments from older adult study participants, the paper identifies a gap. Despite the acceptance of robot care scenarios, participants expressed the poor quality of the social aspect. Current human-robot designs, to a certain extent, neglect to include empathy as a theorized design pathway. Using rhetorical theory, this paper defines the socio-cultural expectations for convincing empathetic relationships. It analyzes and then summarizes how society understands, values, and negotiates empathic interaction between human companions in discursive exchanges, wherein empathy acts as a societal value system. Using two public research collections on robots, with one geared specifically to gerontechnology for older people, it substantiates the lack of attention to empathy in public materials produced by robot companies. This paper contends that using an empathetic care vocabulary as a design pathway is a productive underlying foundation for designing humanoid social robots that aim to support older people's goals of aging-in-place. It argues that the integration of affective AI into the sociotechnical assemblages of human-socially assistive robot interaction ought to be scrutinized to ensure it is based on genuine cultural values involving empathetic qualities.

Voice-controlled interfaces can support older adults in clinical contexts -- with chatbots being a prime example -- but reliable Automatic Speech Recognition (ASR) for underrepresented groups remains a bottleneck. This study evaluates state-of-the-art ASR models on language use of older Dutch adults, who interacted with the Welzijn.AI chatbot designed for geriatric contexts. We benchmark generic multilingual ASR models, and models fine-tuned for Dutch spoken by older adults, while also considering processing speed. Our results show that generic multilingual models outperform fine-tuned models, which suggests recent ASR models can generalise well out of the box to real-world datasets. Moreover, our results indicate that truncating generic models is helpful in balancing the accuracy-speed trade-off. Nonetheless, we also find inputs which cause a high word error rate and place them in context.

Utilizing offline reinforcement learning (RL) with real-world clinical data is getting increasing attention in AI for healthcare. However, implementation poses significant challenges. Defining direct rewards is difficult, and inverse RL (IRL) struggles to infer accurate reward functions from expert behavior in complex environments. Offline RL also encounters challenges in aligning learned policies with observed human behavior in healthcare applications. To address challenges in applying offline RL to physical activity promotion for older adults at high risk of falls, based on wearable sensor activity monitoring, we introduce Kolmogorov-Arnold Networks and Diffusion Policies for Offline Inverse Reinforcement Learning (KANDI). By leveraging the flexible function approximation in Kolmogorov-Arnold Networks, we estimate reward functions by learning free-living environment behavior from low-fall-risk older adults (experts), while diffusion-based policies within an Actor-Critic framework provide a generative approach for action refinement and efficiency in offline RL. We evaluate KANDI using wearable activity monitoring data in a two-arm clinical trial from our Physio-feedback Exercise Program (PEER) study, emphasizing its practical application in a fall-risk intervention program to promote physical activity among older adults. Additionally, KANDI outperforms state-of-the-art methods on the D4RL benchmark. These results underscore KANDI's potential to address key challenges in offline RL for healthcare applications, offering an effective solution for activity promotion intervention strategies in healthcare.

Physical activity is a modifiable lifestyle factor with potential to support cognitive resilience. However, the association of moderate-to-vigorous physical activity (MVPA) intensity, and timing, with cognitive function and region-specific brain structure remain poorly understood. We analyzed data from 45,892 UK Biobank participants aged 60 years and older with valid wrist-worn accelerometer data, cognitive testing, and structural brain MRI. MVPA was measured both continuously (mins per week) and categorically (thresholded using >=150 min/week based on WHO guidelines). Associations with cognitive performance and regional brain volumes were evaluated using multivariable linear models adjusted for demographic, socioeconomic, and health-related covariates. We conducted secondary analyses on MVPA timing and subgroup effects. Higher MVPA was associated with better performance across cognitive domains, including reasoning, memory, executive function, and processing speed. These associations persisted in fully adjusted models and were higher among participants meeting WHO guidelines. Greater MVPA was also associated with subcortical brain regions (caudate, putamen, pallidum, thalamus), as well as regional gray matter volumes involved in emotion, working memory, and perceptual processing. Secondary analyses showed that MVPA at any time of day was associated with cognitive functions and brain volume particularly in the midday-afternoon and evening. Sensitivity analysis shows consistent findings across subgroups, with evidence of dose-response relationships. Higher MVPA is associated with preserved brain structure and enhanced cognitive function in later life. Public health strategies to increase MVPA may support healthy cognitive aging and generate substantial economic benefits, with global gains projected to reach USD 760 billion annually by 2050.

We introduce scenario-based cognitive status identification in older drivers from naturalistic driving videos, leveraging large vision models. In recent times, cognitive decline including Dementia and Mild Cognitive Impairment (MCI), is often underdiagnosed due to the time-consuming and costly nature of current diagnostic methods. By analyzing real-world driving behavior captured through in-vehicle sensors, this study aims to extract "digital fingerprints" that correlate with functional decline and clinical features of dementia. Moreover, modern large vision models can draw meaningful insights from everyday driving patterns across different roadway scenarios to early detect cognitive decline. We propose a framework that uses large vision models and naturalistic driving videos to analyze driver behavior, identify cognitive status and predict disease progression. We leverage the strong relationship between real-world driving behavior as an observation of the current cognitive status of the drivers where the vehicle can be utilized as a "diagnostic tool". Our method identifies early warning signs of functional impairment, contributing to proactive intervention strategies. This work enhances early detection and supports the development of scalable, non-invasive monitoring systems to mitigate the growing societal and economic burden of cognitive decline in the aging population.

Learning to play a musical instrument can protect your brain from aging, building up a defense against cognitive decline that lasts a lifetime. Researchers from Canada and China discovered older adults who had spent years playing music were better at understanding speech in noisy environments, like a crowded room, compared to those who didn't play music. Their brains worked more like younger people's brains, needing less energy to focus than older non-musicians' brains had to use to make up for age-related mental declines. Playing music was found to build up a person's'cognitive reserve,' which is like a backup system in the brain. This reserve helps the brain stay efficient and work more like a younger brain, even as someone grows older.