In today's episode, Can AI Help Us Age Better?, we’re joined by Dr. Sara Czaja and Dr. Walter “Wally” Boot from Weill Cornell Medicine, where they lead research focused on aging, cognition, and the role of emerging technologies in supporting independence and quality of life for older adults. Together, they are part of the CREATE and ENHANCE Centers, which explore how technologies like artificial intelligence, virtual reality, and digital support tools can help address challenges related to aging, cognitive health, and social connectivity.
Host(s): Dr. Mary Goldberg, Co-Director of the IMPACT Center at the University of Pittsburgh
Guest(s): Walter (Wally) Boot, PhD (CREATE / ENHANCE), Sara Czaja, PhD (CREATE / ENHANCE)
IMPACT Center | Website, Facebook, LinkedIn, Twitter
CREATE (Center for Research and Education on Aging and Technology Enhancement ) | Website https://create-center.org/
ENHANCE (Enhancing Neurocognitive Health, Abilities, Networks, & Community Engagement) Center | Website https://www.enhance-rerc.org/
Discussion Topics (Timestamps)
00:00 Introduction / Guest bios
01:20 Unsolved challenges in aging and technology
04:30 Why products still fail older adults
07:00 Misconceptions about aging and tech literacy
09:30 AI and Medicare decision support
14:30 Hallucinations, trust, and RAG systems
18:45 AI for cognitive support and caregivers
21:30 Privacy, scams, and deepfakes
25:00 VR and social isolation
29:00 VR risks: falls, cybersickness, home use
32:00 VR for wayfinding and ADL training
35:00 User-centered design and needs assessment
37:30 Community implementation + closing
[00:00:00] Introduction
Mary Goldberg:
The IMPACT Center at the University of Pittsburgh, supported by the National Institute on Disability, Independent Living, and Rehabilitation Research, proudly presents ImpacTech. Welcome to Season 5.
In today’s episode, Can AI Help Us Age Better?, we’re joined by Dr. Sara Czaja and Dr. Wally Boot from Weill Cornell Medicine, where they lead research focused on aging, cognition, and the role of emerging technologies in supporting independence and quality of life for older adults.
Together, they’re part of the CREATE and ENHANCE Centers, which explore how technologies like artificial intelligence, virtual reality, and digital support tools can help address challenges related to aging, cognitive health, and social connectivity.
Recorded remotely from a soundproof bedroom closet in Pittsburgh, Pennsylvania, I’m your host, Dr. Mary Goldberg, and this is Episode 37 of the ImpacTech Podcast Series.
[00:01:05] Aging challenges that remain unsolved
Mary Goldberg:
Hi Wally and Sara, thank you so much for joining us. I’m really excited to get an opportunity to sit down and chat with both of you about technology and aging. And of course, you know that we’re all about technology and getting the right solutions to people.
But I thought we could start with the challenges in particular. What aging challenges are still unsolved?
Sara Czaja:
Well, we can think about this from a couple of perspectives.
One challenge that I think is still prevalent is that many designers of technological products and applications still do not think of older adults as an active or viable user group.
So products may not meet their needs—or more importantly, be usable by older adult populations.
I also think there’s this misnomer that everyone now has internet and everyone is digitally savvy.
And I think there are still subpopulations of older adults that are not digitally literate or do not have access to things like the internet—particularly older adults in rural locations or lower socioeconomic groups.
Walter Boot:
Yeah, I would add to that that the pace of technology change is such that it’s really hard for everyone to keep up.
And I think older adults may experience specific challenges because of age-related changes in learning and memory.
It’s amazing even over the last couple of years with the rise of artificial intelligence, large language models, extended reality—everything is in such flux.
It’s hard for anyone to catch up.
And we still see among older adults that technology proficiency, on average, tends to be lower compared to younger adults.
And I say “on average” because there are lots of older adults who are tech whizzes and can outperform younger participants in our studies.
Sara Czaja:
And also, tagging onto what Wally said—with these dynamic changes in technology and lower technology literacy—it’s especially challenging if an older person lives alone.
Where do they find adequate instructional or technical support?
What do they do if the system needs upgrading?
Many people don’t understand what that means or what the implications are, or who to reach out to.
[00:04:15] Where technology falls short
Mary Goldberg:
So not only are the technology developers not quite prepared—or perhaps not responsive—but where do the technologies themselves still fall short, even those intended for older adults?
Sara Czaja:
From my perspective, I think some of them are overly complex.
And this move toward making things smaller and more compact isn’t necessarily helpful for older adult populations.
These issues can be addressed with user-centered design.
That means involving diverse older adults in the design process—not only to understand their constraints, but their preferences.
We’ve found in our research that older adults are much more likely to adopt a technology solution if they find it useful, can use it, and find it valuable.
If it enhances their day-to-day life.
Walter Boot:
Yeah, I would agree.
A lot of technology is designed by twenty-year-olds for twenty-year-olds without considering the needs, preferences, and abilities of older people.
And to get back to what Sara said earlier—instructional support these days just seems minimal.
You open up a box and really that’s all that’s in there.
There’s no manual.
There might be a QR code, and now you need another device to access the instructions.
That makes it harder to learn new technology.
I think that’s where a lot of developers are failing.
Mary Goldberg:
It’s kind of ironic that when you get something now, you have to go online to get the instructions.
[00:07:00] Misconceptions about older adults and technology
Mary Goldberg:
You both mentioned several misconceptions.
That older adults may be more tech literate than they are—or the opposite—that they’re less able or less digitally literate than they actually are.
Are there other misconceptions that people have about aging and technology adoption?
Sara Czaja:
I think two common perceptions are that older adults are technophobic and that older adults can’t learn new things.
We have not found that.
We find them very receptive to using technology if they see value in it, and if they feel they’ll be able to learn it and have the appropriate support.
And we’ve shown over and over again—even people in their nineties can adapt and learn new technologies.
It has everything to do with how it’s designed and the instructional support available.
[00:09:15] AI and aging support
Mary Goldberg:
You’ve both alluded to AI and miniaturization and how quickly technology is evolving.
Certainly AI is changing everything—from how we work to how we receive care.
So how are AI and large language models being explored for search and decision support in aging?
Sara Czaja:
We’re doing a project right now in our CREATE Center, funded by the National Institute on Aging.
We’re using a digital assistant—essentially a large language model.
It’s primarily a usability, feasibility, and acceptability study.
The system is called Sidekick.
And we’re looking at how older adults can use it to solve problems related to Medicare.
Why Medicare?
Because that’s a huge source of confusion—not only for older adults, but for anyone helping them.
Even simple questions like:
How do I enroll?
What plan should I choose?
Those questions are incredibly complicated.
[00:15:20] Hallucinations and verification
Sara Czaja:
We’re still in the development stages.
But I think there’s a lot of potential.
[00:17:00] AI for caregivers
Sara Czaja:
We’re also thinking about future projects for family caregivers.
For example, if someone is caring for a person with dementia and that person is repeatedly asking questions—a very common behavior.
That caregiver may be overwhelmed.
What if they could interact with an AI system in real time and get just-in-time strategies for how to respond?
That could be incredibly helpful.
But it’s still the Wild West.
Walter Boot:
And we also have a CREATE pilot project focused on educating older adults about the benefits and risks of commercial large language models.
Because if people assume this is just like Google, they may think the answers are always factual.
That’s not true.
We’re teaching things like prompt engineering—how to ask better questions.
And also how to be skeptical.
How to verify.
I think that’s critical.
[00:19:30] Trust but verify
Walter Boot:
I think teaching people to use these systems means teaching them to verify information.
We’ve all probably had that experience where you ask for a citation.
And it says:
“Here’s the perfect reference.”
And then you go look for it—and it doesn’t exist.
So trust, but verify.
That’s the model.
Mary Goldberg:
That’s interesting.
And I’ve noticed some of the systems are starting to warn you themselves—saying they may be mixing information or suggesting you clarify your prompt.
That’s at least somewhat helpful.
[00:21:15] Privacy, scams, and security
Mary Goldberg:
What should innovators be thinking about early as they develop these technologies?
Sara Czaja:
Privacy.
Information security.
Potential scams.
Where is the data going?
Who has access to it?
That’s scary.
Many technically unsophisticated people may not realize the risks.
Even we get phishing emails all the time and have to stop and think.
Is this real?
It’s becoming harder to tell.
Walter Boot:
Especially now with AI.
Deepfakes.
Voice cloning.
These tools make fraud much easier.
Older adults are often targeted because they tend to have accumulated wealth.
And even people who think they’d never fall for it—can.
People lose tens of thousands of dollars.
Education plays an important role.
But I also think financial institutions have an obligation to help prevent these situations.
And legislation—stronger consumer protections—is important too.
[00:23:30] Why social connection matters in aging
Mary Goldberg:
Let’s shift gears a little bit to another tool that I know you’ve been developing—virtual reality—and in particular its role in helping connect people.
Why is social connection such a critical issue in aging?
Sara Czaja:
The literature is very substantial in terms of the negative consequences of loneliness and social isolation.
They’re highly related, but distinct constructs.
And both can negatively affect emotional health, physical health, and cognitive health.
They’re also associated with increased co-morbidities and mortality.
The Surgeon General put out a report a couple of years ago likening social isolation and loneliness to smoking cigarettes in terms of health risk.
The pandemic really shed light on this issue, but it has always been significant.
One of the components of successful aging—and cognitive health in particular—is social engagement.
And that can become challenging for many older adults due to loss of partners, loss of friends, retirement, financial limitations, or transportation barriers.
So that’s why it can be particularly difficult.
[00:26:00] Using VR to augment connection
Sara Czaja:
We’re looking at virtual reality as a way to augment social connection—not replace it.
It can provide opportunities for people, especially those who are homebound.
For example, we have a CREATE project where one of our postdoctoral fellows is looking at the value of VR for older adults who are homebound and have multiple co-morbidities.
With VR, they can take a trip.
Go to a museum.
Experience things they otherwise couldn’t.
Walter Boot:
And I think there are a lot of potential benefits.
We’re using technology to communicate right now, but I don’t really feel like I’m “with” you.
Virtual reality creates a stronger sense of presence.
It feels like you’re co-located with someone.
You can take virtual tours of Paris together.
Go on a hot air balloon ride.
Paint together.
Sculpt together.
There’s a lot of opportunity there.
And we’re seeing some very positive early results.
Older adults seem to enjoy it.
They like talking to each other in those environments.
[00:28:45] Challenges of VR at home
Walter Boot:
But once we move into home-based interventions, there are challenges.
Safety is one.
You’re putting something over someone’s eyes that obscures their vision.
That creates trip and fall risks.
And falls in older adults can be extremely serious.
Much more serious than in younger adults.
There’s also cybersickness—or simulator sickness.
Sometimes what you’re seeing doesn’t match what your body is feeling.
That mismatch can cause dizziness, nausea, headaches.
For the most part, newer VR systems are much better.
But it still happens.
And we’ve had cases.
When that happens in a lab, that’s manageable.
But at home?
That’s different.
How do we ensure someone is safe?
How do we make sure they don’t stand up too fast, lose balance, or fall?
[00:31:15] Finding the right balance
Sara Czaja:
And we don’t want VR replacing real-world interaction.
That’s important.
It should supplement.
Not substitute.
Walter Boot:
Exactly.
We have to think carefully about who this technology is best for.
Maybe it’s not ideal for the average older adult.
But for someone who is homebound?
It could be a lifeline.
It could open up entirely new experiences.
That’s the real question:
What’s the right tool for the right problem—and the right person?
[00:32:40] Outcome measures and effectiveness
Mary Goldberg:
That’s very interesting.
And it makes me think about demographics and who the intervention is most appropriate for.
Are you looking at that?
And what about outcome measures?
How do you determine what’s effective?
Sara Czaja:
Right now, our pilot work is focused on feasibility, acceptability, safety, and usability.
Those are the first questions.
Can people use it?
Do they like it?
Is it safe?
We’ll also collect preliminary efficacy data—things like reductions in loneliness and social isolation.
And attitudinal variables.
At this stage, we’re still asking:
Does it work?
For whom?
What are the benefits?
What are the barriers?
[00:34:30] Commercial hardware and scaling
Mary Goldberg:
And is your intervention the software? Are you using commercially available hardware?
Walter Boot:
Yes, we’re using commercially available hardware.
That’s important because it makes scaling easier.
And across our studies, we use both custom applications and commercial applications depending on the goal.
We also have work through ENHANCE and the RERC that’s more focused on training.
For example, one upcoming study asks:
Can we use virtual reality to help older adults with wayfinding?
[00:36:00] VR for wayfinding and navigation
Walter Boot:
Think about going to a new doctor’s office.
Even for me, that creates anxiety.
Am I going to find where I need to go?
Am I going to get lost?
Could VR help older adults—especially those with cognitive impairment—practice navigating those environments beforehand?
Could it reduce anxiety?
Could it improve their ability to find their destination?
That’s what we want to know.
[00:37:15] VR for instrumental activities of daily living
Walter Boot:
We’re also interested in whether VR can support instrumental activities of daily living—things like cooking.
Could someone practice following a recipe in a consequence-free virtual environment?
If they make a mistake, it doesn’t matter.
There’s no danger.
And because the task closely resembles the real-world task, there may be a strong transfer of training.
That’s the exciting possibility.
Mary Goldberg:
That’s really interesting.
There are a lot of opportunities there to reduce barriers and burden across populations.