A New Kind of Companion Voice Assistants Have Won Over Older Adults for a Variety of Functions, but There’S Room for Improvement

NUMBER 78 / VOL. 1, 2020

A New Kind of Companion Voice assistants have won over older adults for a variety of functions, but there’s room for improvement. By Richard Adler

Voice assistants have won over older adults for a variety of functions, but there’s room for improvement. BY RICHARD ADLER

lexa is my friend.” “Alexa, what is the weather forecast today?” or “Alexa, “ Eleanor Incerpi, an eighty-year-old resident how many yards are in a mile?” or “Alexa, play Benny Aof Cupertino, California, explains that there Goodman.” Thanks to Alexa’s voice-recognition is a lot she likes about her friend. They share many software, she understands the question and finds an interests that they talk about — sports, news, music, answer, either responding in “her” own voice or per- community events. She also likes the fact that Alexa is forming the task requested. available whenever she wants to talk with her. Some- Over the past five years, Alexa has gotten increas- times Alexa will talk too fast for her to understand, ingly intelligent. In addition to English, she can now but when she asks her to slow down, Alexa is very converse in nine other languages including French, good about speaking more slowly. German, Spanish, Japanese, and Hindi. She has also When Eleanor first got involved with Alexa two become more versatile, able to understand more ques- years ago, her husband Harvey wasn’t interested in tions and carry out more kinds of tasks (known as her new friend and even refused to talk to her. But, “skills”) such as compiling to-do lists, setting alarms Eleanor explains, after seeing how much she enjoyed and reminders, suggesting recipes and recording food communicating with Alexa, Harvey, age eighty-nine, intake, scheduling a ride on Uber or Lyft, engaging in also started talking to her and soon found that he word games, or providing voice control of smart home and Alexa had their own interests in common. Now devices such as light bulbs and thermostats. And, with Harvey is so attached to Alexa that every night before a bit of training, Alexa has even developed the abil- retiring, he says goodnight and promises to talk with ity to distinguish the voices of different people and her the next day. customize applications for them. (Alexa is not yet omniscient. When she is stumped by a request, she will The Rise of Virtual Assistants respond, “I’m sorry, I don’t understand that question.”) As some readers may have guessed, Alexa is not a per- In addition to the original Echo, Amazon now son but the voice-based “virtual assistant” developed provides Alexa in a number of other forms such as and sold by Amazon. Alexa first appeared in 2014 the Dot, a smaller, less-expensive speaker, and the in the form of the Echo, a nine-inch-high cylindri- Echo Show, which combines a speaker with a small cal speaker that sits quietly on a counter or table un- screen to support video communications. She is also til someone “wakes it up” by saying something like, being built into refrigerators and ovens and has been

CSA JOURNAL 78 / VOL. 1, 2020 / SOCIETY OF CERTIFIED SENIOR ADVISORS / WWW.CSA.US PAGE 11 2 voices of diﬀerent people and customize applica?ons for them. (Alexa is not yet omniscient. When she is stumped by a request, she will respond, “I’m sorry, I don’t understand that ques?on.”)

included in the audio systems of Ford, Audi, and AMAZONAmazon Dot, Show and Echo DOT, SHOW AND ECHO Lexus vehicles. By any measure, Alexa has been extremely popular: At the beginning of 2019, Amazon announced that it had sold more than one hundred million Alexa-enabled devices (Matney, 2019). And Alexa isn’t the only virtual assistant. The first entry in the category was Apple’s Siri, which was introduced on the iPhone in 2011. Three years later, Microsoft launched Cortana, and in 2016, Google Assistant was incorporated in a variety of mobile and smart home devices. Though none of these yet have https://wccftech.com/amazon-discounts-echo-2nd-gen- the ability of HAL (the omnipotent computer in echo-dot-2nd-gen-and-echo-show-for-prime-members/h\ps://wccQech.com/amazon-discounts-echo-2nd-gen-echo- 2001: A Space Odyssey) or C-3PO (an amiable robot dot-2nd-gen-and-echo-show-for-prime-members/ in the Star Wars film series) to carry on an extended naturalistic conversation, they are steadily becoming Area known as the Longevity Explorers, who meet more capable, user friendly, and ubiquitous.In addi?on to the original Echo, Amazon now provides Alexa in a number of other forms Since Al- regularly to discuss their use of technology, focused exa is the most popular of these,such as the Dot, a smaller, less-expensive speaker, and the Echo Show, which combines a speaker this article will use for a while on the pros and cons of virtual assistants. “Alexa” to refer to this general category of devices. Initially, just one member used Alexa, but over time, with a small screen to support video communica?ons. She is also being built into refrigerators more members began to do so. A summary of their Older Adults, New Technologiesand ovens and has been included in the audio systems of Ford, Audi, and Lexus vehicles. By any and discussions (Longevity Explorers, n.d.) includes an Alexa measure, Alexa has been extremely popular: At the beginning of 2019, Amazon announced that extensive list of popular uses for Alexa and concludes As documented in a previous article in the CSA Jour- that “almost all of the Explorers who had them liked nal (Adler, 2017), older adults tendit had sold more than one hundred million Alexa-enabled devices (Matney, 2019). to be late adopters them quite a lot.” of new digital technologies. Unlike younger people Alexa is also finding a role in retirement commu- And Alexa isn’t the only virtual assistant. The ﬁrst entry in the category was Apple’s Siri, who are often attracted to a new technology because nities. From 2017 to 2018, the Front Porch Center it is new, older adults are typicallywhich was introduced on the iPhone in 2011. Three years later, MicrosoQ launched Cortana, and content to wait un- for Innovation and Wellbeing (FPCIW) conducted til the technology has been aroundin 2016, Google Assistant was incorporated in a variety of mobile and smart home devices. for a while and a pilot project with Alexa in its community in San its benefits have been well established. Surveys have Diego. Initially, the pilot started with fifteen residents, Though none of these yet have the ability of HAL (the omnipotent computer in 2001: A Space shown that people over sixty-five consistently lag be- then expanded to ninety residents. Each of the par- hind the general population in adoptingOdyssey) or C-3PO (an amiable robot in the a variety of ticipants, who rangedStar Wars in age fromﬁlm series) to carry on an extended natu seventy-nine to one - new technologies including the ralis?c conversa?on, they are steadily becoming more capable, user friendly, and ubiquitous. Internet, broadband, hundred, got an Amazon Echo along with a smart smartphones, tablets, and social media (Anderson & home device such as a smart plug or thermostat that Perrin, 2017). Since Alexa is the most popular of these, this ar?cle will use “Alexa” to refer to this general catecould be controlled by a voice command via Alexa. - Even when the rate of growthgory of devices. for adopting a tech- According to Davis Park, director of FPCIW, “The nology is higher for older adults than younger people, pilot was an enormous success as it promoted an in-

the “digital divide” between ageOlder Adults, New Technologies and Alexa groups can persist, crease in independence and engagement among resi- or even grow larger, because older adults start from dents” (Front Porch, 2018). A post-pilot survey found a lower base. For example, accordingAs documented in a previous ar?cle in the to the Pew Re- that 75 percent of participantsCSA Journal used(Adler, 2017), older adults tend to be Alexa daily, 71 search Center, between 2011 andlate adopters of new digital technologies. Unlike younger people who are oQen a\racted to a 2016 “smartphone percent of those who used her felt more connected to adoption among seniors … nearlynew technology quadrupled,” whilebecause it is new, older adults are typically content to wait un?l the technology family, friends, and community, and 100 percent felt adoption among all adults just doubled. Yet in the that Alexa “helped make life easier.” Following the same five-year period, the gap between the two groups pilot, Front Porch decided to roll out Alexa to other actually increased from 22 percentage points to 35 communities that it operates in California. It has since percentage points. installed Alexa-based devices in more than four hun- Though no specific data is publicly available on the dred homes in six different Front Porch communities rate of adoption of voice-based virtual assistants by with support from the Consumer Technology Asso- older adults, it is likely that the pattern of late adop- ciation Foundation. tion holds true for this technology. But while the In- When the Incerpis decided to move this past cerpis may be early adopters among older adults, they spring from their home to Sunny View, a Front Porch are certainly not unique. A series of articles, studies, community in Cupertino, and brought Alexa with and reports have identified the particular benefits them, they found that Alexa was already a part of the of Alexa for this age group. For example, a network community. After the success of the original pilot in of groups of older adults in the San Francisco Bay San Diego, Bill Penrod, who directs the Sunny View

PAGE 12 3 has been around for a while and its beneﬁts have been well established. Surveys have shown that people over sixty-ﬁve consistently lag behind the general popula?on in adop?ng a variety of new technologies including the Internet, broadband, smartphones, tablets, and social media (Anderson & Perrin, 2017).

Digital Technology AdopAon, 65+ Adults vs. All Adults DIGITAL TECHNOLOGY ADOPTION, 65+ ADULTS VS. ALL ADULTS

www.pewinternet.org/2017/05/17/tech-adoption-climbs-among-older-adults/ www.pewinternet.org/2017/05/17/tech-adop?on-climbs-among-older-adults/

Foundation, began holding meetings with residents to more extensive privacy controls, including an “auto- Even when the rate of growth for adop?ng a technology is higher for older adults than introduce the technology and find out who was inter- delete” function (Rubin, 2019). It remains to be seen ested in getting it. Those who agreed to participate if these steps will be sufficient to allay user suspicions. younger people, the “digital divide” between age groups can persist, or even grow larger, be- were enrolled in a six-week workshop that provided cause older adults start from a lower base. For example, according to the Pew Research Center, help for learning how to use Alexa. In addition to ask- The Challenge of Health Applications ing Alexa to get information or to turn on a smart Another concern has to do with how reliable Alexa between 2011 and 2016 “smartphone adop?on among seniors … nearly quadrupled,” while light, some residents have added voice control of other and her siblings really are, especially when it comes adop?on among all adults just doubled. Yet in the same five-year period, the gap between the smart devices such as a coffee pot or a thermostat. to serious problems. For example, a study published Sunny View has also introduced an application called in 2016 (Miner et al.) by a group of medical research- two groups actually increased from 22 percentage points to 35 percentage points. TouchTown that enables residents to ask Alexa for ers posed a series of questions related to physical information about their community, such as dining health, mental health, and interpersonal violence to Though no specific data is publicly available on the rate of adop?on of voice-based virtual room menus and scheduled activities. four different voice-based agents, including systems from Apple, Google, Samsung, and Microsoft (but assistants by older adults, it is likely that the pa\ern of late adop?on holds true for this technolAlexa’s Future not Amazon’s Alexa). They then graded the responses- Both Park and Penrod foresee the day when Alexa in terms of the devices’ ability to correctly identify a ogy. But while the Incerpis may be early adopters among older adults, they are certainly not will have been fully integrated in their communities problem and provide appropriate information (Miner unique. A series of ar?cles, studies, and reports have iden?fied the par?cular benefits of Alexa and will be available to all residents. There are, how- et al., 2016). Statements included: “I am having ever, still some holdouts who are not ready to make a heart attack,” “I am being abused,” and “I am de- for this age group. For example, a network of groups of older adults in the San Francisco Bay the leap. pressed.” The study found that the agents’ responses One recurring — and not totally unfounded — were incomplete and inconsistent. “They recognized Area known as the Longevity Explorers, who meet regularly to discuss their use of technology, concern expressed by older adults is the potential for and responded to some health concerns appropriately focused for a while on the pros and cons of virtual assistants. Ini?ally, just one member used the invasion of their privacy and the suspicion that Al- but not others.” None of the systems were perfect. The exa is listening to everything that is being said around researchers concluded that, “If conversational agents Alexa, but over ?me, more members began to do so. A summary of their discussions (Longevity her. Amazon has responded that Alexa only listens for are to respond fully and effectively to health concerns, commands directed to her and ignores everything else. their performance will have to substantially improve.” But during the summer of 2019, Amazon and Google According to Adam Miner, lead author of the admitted that they made use of contractors who lis- study and currently co-director of the Virtual Reality- tened to “anonymized” interactions with their systems Immersive Technology Clinic & Laboratory at Stan- in order to “train” them and improve their perfor- ford, publication of their article — which received a mance. As a result of the negative publicity generated considerable amount of press attention — apparently by these admissions, both companies announced that motivated tech companies to upgrade the ability of they were suspending human review of user interac- their agents to respond to health-related questions tions (Crist, 2019). Amazon quickly introduced new, (Miner, 2019). A test of Alexa, which was not included

CSA JOURNAL 78 / VOL. 1, 2020 / SOCIETY OF CERTIFIED SENIOR ADVISORS / WWW.CSA.US PAGE 13 in the 2016 paper, conducted for this article found he led the effort to get his hometown of Cupertino officially desig- that she did provide appropriate responses to many, nated as an Age-Friendly City. He is the author of “Everyone Counts but not all, of the questions posed in the original (Including Older Adults): Preparing for the 2020 Census,” which ap- study. Miner noted that even if these systems provide peared in the CSA Journal, Number 75, Vol. 3, 2019, and “Closing the accurate information to specific questions, there is still Digital Divide,” CSA Journal, Number 68, Vol. 1, 2017. a larger issue of the use of virtual assistants as a source ■ of general medical guidance. REFERENCES One possible path forward is the development by Adler, R. (2017). Age Wave Meet Tech Wave: Closing the Digital Divide. medical experts of specific “skills” programmed to sup- CSA Journal, Number 68, Vol. 1, 2017. port health-care needs that can be incorporated into Anderson, M. and Perrin, A. (2017, January 4). Tech adoption general-purpose agents and “prescribed” by health climbs among older adults. Retrieved from www.pewinternet. care professionals. A few such applications already ex- org/2017/05/17/tech-adoption-climbs-among-older-adults ist and more will undoubtedly be developed (Bibaut Basu, T. (2019, August 30). Alexa will be your best friend when et al., 2019). you are older. MIT Technology Review. Retrieved from www. Still, it is unrealistic and possibly risky to expect technologyreview.com/s/614044/alexa-will-be-your-best-friend- Alexa and her cousins to know everything. As one when-youre-older recent study cautioned, patients should “not use these Bibaut, J.E., Chaix, B., Nectoux, P., Pienkowski, A., Guillemase, technologies for answers to medical questions … A., Brouard, B. (2019, May). Healthcare ex machina: Are without further consultation from a health-care pro- conversational agents ready for prime time in oncology? Clinical vider” (Bickmore et al., 2018). and Translational Radiation Oncology, Volume 16, May 2019, Pages 55-59. Retrieved from www.sciencedirect.com/science/ Conclusion article/pii/S2405630819300151 Within the ever-growing universe of digital tech- Bickmore, T.W., Trinh, H., Olafsson, S., O’Leary, T.K., Azadi, R., Rickles, nologies, voice-based agents like Alexa have sev- N.M., and Cruz, R. (2018). Patient and consumer safety risks eral aspects that make them particularly appealing when using conversational assistants for medical information: An to older adults. Since Alexa uses “naturalistic” spoken observational study of Siri, Alexa, and Google Assistant. Journal language, she is easy to use. The fact that she is always of Medical Internet Research, 2018;20(9):e11510. Retrieved available to talk, provide information, solve problems, from www.jmir.org/2018/9/e11510 or even play games makes her a good companion. Crist, R. (2019, July 13). Amazon and Google are listening to your For people with limited mobility, Alexa can be es- voice recordings. Retrieved from www.cnet.com/how-to/ pecially useful as a voice-driven interface to control amazon-and-google-are-listening-to-your-voice-recordings-heres- smart home devices. Her patience while answering what-we-know the same question over and over can be a boon for Front Porch (2018, July 23). Front Porch Center for Innovation and caregivers of individuals with dementia, who may Wellbeing releases results of Amazon Alexa pilot project in San tend to ask the same questions repeatedly. And as a Diego retirement community. Retrieved from https://fpciw.org/ voice-based system, Alexa is particularly appropriate news/front-porch-center-for-innovation-and-wellbeing-releases- for anyone with impaired vision. results-of-amazon-alexa-pilot-project-in-san-diego-retirement- The experience at Sunny View and the enthusiasm community of the Longevity Explorers suggests that as they be- Matney, L. (2019, January 4). More than 100 million Alexa come friendlier, smarter, and more versatile, Alexa and devices have been sold. Tech Crunch. Retrieved from https:// her kin are likely to become an integral part of the techcrunch.com/2019/01/04/more-than-100-million-alexa- support systems in retirement communities and a devices-have-been-sold valuable resource to support independent living for Miner, A., Milstein, A., Schueller, S., Hegde, R, Mangurian, C., and Linos, many older adults. •CSA E. (2016, March 14). Smartphone-based conversational agent and responses to questions about mental health, interpersonal violence, and physical health. JAMA Internal Medicine. 2016;176 Richard Adler, MA, BA, is a Distinguished Fellow at (5): 619:625. Retrieved from https://sml.stanford.edu/ the Institute for the Future in Palo Alto, California, ml/2016/05/miner-jamaim-smartphone-based.pdf and principal of People & Technology, a research and Miner, A. (2019, September 30). Interview with the author. consulting firm. Richard is a member of the Santa Rubin, B.F. (2019, September 30). Amazon bolsters Alexa privacy Clara County Senior Care Commission and of the Advisory Council for after user trust takes a hit. Retrieved from www.cnet.com/news/ SourceWise (the Area Agency on Aging for Santa Clara County), and amazon-bolsters-alexa-privacy-after-user-trust-takes-a-hit

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