Dementia describes the deterioration of cognitive and memory skills, affecting people’s abilities to perform everyday tasks beyond normal aging. While dementia is considered to be a top global health priority and includes health, social, and economic burdens, there is currently no disease-modifying treatment available. As an individual’s dementia progresses, so does their independence and quality of life. Utilizing digital health interventions, in such cases, opens the possibility of providing care and support to people with dementia and their caregivers. In recent years, we have seen a rise in digital health interventions to improve public health outcomes and promote healthy aging among older adults while reducing the economic burden. Digital health interventions are digital and mobile technologies that support and achieve health objectives. Within dementia research, there have been explorations on the impacts of digital health interventions on caregivers and family members, as well as on people with dementia. Results from these studies indicated that digital health interventions can be safely and positively used among this population group. Additionally, we have also seen the general acceptance of older adults towards digital health interventions, which aim to support and promote independent living. Older adults, however, face a barrier when it comes to accessing these interventions due to their disability, digital literacy, and financial costs. Therefore, there has been a recent trend in utilizing voice technology to mitigate this barrier.

Since the introduction of Apple’s Siri in 2011 and Amazon’s Alexa with their Echo smart speaker in 2015, voice assistants have become largely integrated into daily life. As a form of digital health technology, voice assistants are becoming more ubiquitous with older adults due to their low cost, high usability and accessibility, and user-friendly interactions that do not require the mobility needed for screen-based technologies. While research has shown positive results on well-being, quality of life, and independence in older adults using voice assistant technology, research on people with dementia has thus far been limited. Currently, most voice-based interventions focus on easing caregiver burden or providing psychosocial support to caregivers and family members. While technology enables the delivery of personalized, person-centered care, this scarcity of evidence raises questions about the safety, efficacy, and long-term impact of voice assistants on the quality of life of people with dementia. Further, despite the benefits of voice assistants in dementia research, there remain significant gaps in our understanding of how to design, optimize, and ethically implement these interventions. Therefore, the GRACE project aims to combine value-sensitive designs with the Multiphase Optimisation Strategy (MOST) to develop a voice assistant to provide lifestyle and cognitive interventions to people with early dementia.

Along with a pilot study for the ethical design and technological considerations of GRACE, the key milestones of the study will follow the three-phase MOST framework. This includes developing a conceptual model and optimization criteria and conducting optimization and evaluation trials with the final GRACE prototype. To promote citizen science, we aim to involve public participation and key stakeholders in our study design during all stages of the GRACE project.

Collaboration and thesis work: Are you interested in doing your Master’s thesis with us? Please contact Dr. Rasita Vinay (rasita.vinay@ibme.uzh.ch) with your CV and a motivational letter.

OSF registry: View project page

Grace Version 1, being evaluated with younger adults. See also the following articles:

1. Vinay, R., Tommila, N., Schlögl, M., Klöppel, S., Biller-Andorno, N., Kowatsch, T. (2024) Demonstrating GRACE: Our Embodied Voice Assistant Providing Cognitive Interventions, In: Proc of the ACM MuC ’24: Mensch und Computer 2023, 1-4 September, Karlsruhe, Germany.
2. Vinay, R., Tommila, N., Schlögl, M., Klöppel, S., Biller-Andorno, N., Kowatsch, T. (2024) GRACE: Towards an Embodied Voice Assistant for Improving Quality of Life by Leveraging Elements of Cognitive Stimulation, In: Proc of the ACM MuC ’24: Mensch und Computer 2023, 1-4 September, Karlsruhe, Germany.

Grace Version 2, being evaluated with older adults.

Vinay, R., Tommila, N., Schlögl, M., Klöppel, S., Biller-Andorno, N., Kowatsch, T. (2024) Demonstrating GRACE: Our Embodied Voice Assistant Providing Cognitive Interventions, In: Proc of the ACM MuC ’24: Mensch und Computer 2023, 1-4 September, Karlsruhe, Germany (forthcoming).

Vinay, R., Tommila, N., Schlögl, M., Klöppel, S., Biller-Andorno, N., Kowatsch, T. (2024) GRACE: Towards an Embodied Voice Assistant for Improving Quality of Life by Leveraging Elements of Cognitive Stimulation, In: Proc of the ACM MuC ’24: Mensch und Computer 2023, 1-4 September, Karlsruhe, Germany (forthcoming).

Vinay, R., Klöppel, S., Schlögl, M., Kowatsch, T. (2024) Exploring the role of value-sensitive designs for large-language model-based voice assistants targeting people with dementia, Munich Center for Machine Learning’s AI Ethics Conference on The Ethics of Generative AI & Conversational Agents, Ludwig Maximilian University, Munich, 12-13 September 2024, Abstract and Oral Presentation **only 3 out of 70 abstracts have been selected; 4% acceptance rate** (forthcoming).

Vinay, R., Probst, J., Huynh, P., Schlögl, M., Kowatsch, T., Nißen, M. (2024) Top-funded digital health companies offering lifestyle interventions for dementia prevention: Company overview and evidence analysis, medRxiv, 2024.03.29.24305069, 10.1101/2024.03.29.24305069.

Bérubé, C., Nißen, M., Vinay, R., Geiger, A., Budig, T., Bhandari, A., Pe Benito, C.R., Ibarcena, N., Pistolese, O., Li, P., Sawad, A.B., Fleisch, E., Stettler, C., Hemsley, B., Berkovsky, S., Kowatsch, T., Kocaballi, A.B. (2024) Proactive Behavior in Voice Assistants: A Systematic Review and Conceptual Model, Computers in Human Behavior Reports 14:100411, 10.1016/j.chbr.2024.100411.

Schneider, C., Nißen, M.K., Kowatsch, T., Vinay, R. (2023) Impact of digital assistive technologies on the quality of life for people with dementia: a scoping review, BMJ Open, 14(2), 10.1136/bmjopen-2023-080545.

Schneider, C., Kowatsch, T., Vinay, R. (2023) Impact of digital assistive technologies on the quality of life for people with dementia: protocol for a scoping review, BMJ Open, 13:e077017, 10.1136/bmjopen-2023-077017.

Our study aims to design, develop and evaluate a voice assistant – GRACE, that provides multicomponent lifestyle and cognitive interventions to people with early dementia.

Dr. Rasita Vinay, Nora Tommila, Priyam Joshi & Prof. Dr. Tobias Kowatsch

March 2023 – December 2024

Esther Brill & Prof. Dr. med. Stefan Klöppel, University Hospital of Old Age Psychiatry and Psychotherapy

PD Dr. med. Mathias Schlögl, MPH, EMBA HSG, Barmelweid

PD Dr. med. Thomas Münzer, Geriatrische Klinik St.Gallen

Internal funding by the Chair for Digital Health Interventions, School of Medicine, University of St.Gallen (third-party grants are currently being reviewed).