AI 中文总结
本研究针对认知障碍老年群体使用生成式AI的安全与自主冲突问题，通过对45名患者及照护者的质性研究，提出五种可及性导向机制，发现机制效果随障碍程度变化，强调需设计平衡安全与自主的动态AI方案。
AI 中文摘要
生成式AI系统正被越来越多存在认知障碍的老年人用于信息检索、健康管理、沟通等日常任务。尽管这些系统提供灵活的基于语言的支持，但其开放式输出会带来过度依赖、误解及不当决策的风险。过往研究多关注可用性与 adoption（采用），却较少涉及系统设计如何塑造用户在决策中的参与度，以及护理场景中代理权的分配。我们对45名认知障碍个体及其照护者开展质性研究，识别出五种可及性导向机制：AI能力约束、人工监督嵌入、认知参与维持、人机关系调节、风险透明化与控制，系统通过这些机制构建交互。这些机制通过在用户与照护者间重新分配决策权限，既支持又约束用户；其效果随认知障碍程度变化：保护性机制支持重度障碍用户，却可能限制轻度障碍用户的自主性。随着障碍程度加深，因用户参与度降低，相关张力变得不明显。本研究结果凸显需设计动态方案，以平衡AI辅助护理中的安全与自主性。
英文摘要
Generative AI systems are increasingly used by older adults with cognitive impairment for everyday tasks such as information seeking, health management, and communication. While these systems provide flexible, language-based support, their open-ended outputs introduce risks of over-reliance, misinterpretation, and inappropriate decision-making. Prior work has focused on usability and adoption, with limited attention to how system design shapes users' participation in decision-making and the distribution of agency in care contexts. We present a qualitative study of 45 individuals with cognitive impairment and their caregivers. We identify five accessibility-oriented mechanisms: AI Capability Constraint, Human Oversight Embedding, Cognitive Engagement Maintenance, Human-AI Relationship Regulation, and Risk Transparency and Control, through which systems structure interaction. These mechanisms both support and constrain users by redistributing decision-making across users and caregivers. We show that their effects vary by impairment level: while protective mechanisms support users with severe impairment, they can restrict autonomy for those with mild impairment. As impairment progresses, tensions become less visible as user participation diminishes. Our findings highlight the need for dynamic designs that balance safety and autonomy in AI-supported care.
CommentsAccepted to ASSETS 2026
