Channah Osinga, MS , Natcha Jintaganon, MS , Dirk Steijger, MS , Marjolein De Vugt, PhD , David Neal, MD, PhD
Journal of the American Medical Informatics Association, ocaf173
https://doi.org/10.1093/jamia/ocaf173
Published: 27 October 2025
Abstract
Objective: This content analysis study investigates potential biases in image generation by 2 artificial intelligence (AI) tools, DALL-E 3 and Midjourney, in portraying older adults and individuals living with dementia. Despite widespread use of generative AI in various sectors, there is limited research on how these models might perpetuate stereotypes and stigmatization through their images.
Materials and Methods:1056 images were generated using specified prompts categorized into 3 groups: general older adults, dementia-related, and control. Each prompt began with “photorealistic portrait” followed by specific scene descriptions. Four researchers conducted content analysis on each generated image, focusing on factors, such as portrait style, setting, posture, apparent sex of subjects, and emotional affect. The analysis was executed with blinding and randomization protocols to ensure unbiased assessment. Chi-square tests examined the relationship between prompt categories and variables.
Results: Results revealed significant disparities in depictions of older adults and those with dementia compared with control images. Both models more often portrayed subjects in response to dementia-related prompts with negative affect, in less favorable emotional states. However, DALL-E 3 also generated more personas displaying positive affect in response to these prompts. Variations in depiction styles between the 2 AI models were noted, with DALL-E 3 showing a broader diversity of outputs.
Discussion and Conclusions: The findings highlight AI’s potential to reinforce stigmatizing stereotypes through biased image generation. Recommendations include selecting prompts carefully to avoid negative depictions and advocating for greater AI explainability and inclusivity by design. Future research should explore other AI models, other forms of bias, and strategies to mitigate biases.
Keywords: artificial intelligence, ageism, dementia, bias, ethics
Dirk Steijger, Hannah Christie, Sil Aarts, Wijnand IJselsteijn, Hilde Verbeek, Marjolein de Vugt
Aging Research Reviews
https://doi.org/10.1016/j.arr.2025.102741
Published: June 2025
Abstract
Background: Dementia has an impact on the quality of life (QoL) of people with dementia. Tailored services are crucial for improving their QoL. Advances in artificial intelligence (AI) offer opportunities for personalised care, potentially delaying institutionalisation and enhancing QoL. However, AI’s specific role in approaches to support QoL for people with dementia remains unclear. This scoping review aims to synthesise the scientific evidence and grey literature on how AI can support the QoL of people with dementia.
Method: Following Joanna Briggs Institute guidelines, we searched PubMed, Scopus, ACM Digital Library, and Google Scholar in January 2024. Studies on AI, QoL (using Lawton’s four-domain QoL definition), and people with dementia across various care settings were included. Two reviewers conducted a two-stage screening, and a narrative synthesis identified common themes arising from the individual studies to address the research question.
Results: The search yielded 5.467 studies, after screening, thirty studies were included. Three AI categories were identified: monitoring systems, social robots, and AI approaches for performing activities of daily living. Most studies were feasibility studies, with little active involvement of people with dementia during the research process. Most AI-based approaches were monitoring systems targeting Lawton’s behavioural competence (capacity for independent functioning) domain.
Conclusion: This review highlights that AI applications for enhancing QoL in people with dementia are still in early development, with research largely limited to small-scale feasibility studies rather than demonstrating clinical effectiveness. While AI holds promise, further exploration and rigorous real-world validation are needed before AI can meaningfully impact the daily lives of people with dementia.
Keywords: Artificial intelligence; Dementia; Long-term care; Quality of life; Scoping review.