Older adults’ participation and experiences in design thinking for AI-driven assistive technology: a scoping review

Background Population ageing and the rapid integration of artificial intelligence (AI) into assistive technologies have created a need to engage older adults as active partners in technology design. AI-driven assistive technologies are frequently developed with limited older-adult involvement, a pattern associated with low adoption, poor fit with daily routines, and the reinforcement of ageist assumptions about older adults as passive recipients of care. Design thinking (DT)—an empathy-driven, iterative, human-centred methodology—offers a structured framework for engaging older adults as co-designers. To date, no scoping review has mapped how older adults participate in DT processes for AI-driven assistive technology, or the ethical and experiential dimensions of that participation. Methods This scoping review followed Arksey and O’Malley’s five-stage framework with Levac et al. refinements and was reported in accordance with the PRISMA extension for Scoping Reviews (PRISMA-ScR). The protocol was prospectively registered on the Open Science Framework ( https://doi.org/10.17605/OSF.IO/8W2S5 ). Systematic searches across Web of Science, IEEE Xplore, Scopus, and PubMed/MEDLINE (10–16 March 2026; updated 20 June 2026) identified 176 records. Following deduplication (n = 146) and two-stage independent screening, 15 studies were included. Data were charted in duplicate using a piloted extraction form extended with experiential and ethical dimensions, appraised descriptively (JBI; MMAT), and synthesised through inductive thematic synthesis. Results The 15 included studies (2015–2025) spanned seven countries and a range of AI-driven assistive technologies, including large language model (LLM)-based conversational agents and companion robots, smart-home sensing and fall-detection systems, embodied conversational agents, and AI-enabled wearables. Thematic synthesis generated four analytical themes: (1) uneven participation across the DT cycle, concentrated in the empathise and test phases; (2) facilitators and barriers to meaningful participation; (3) a continuum of agency from tokenistic consultation to genuine co-design; and (4) structural and ethical conditions shaping inclusion. Evidence gaps were most pronounced for older adults with cognitive impairment and for older adults in low- and middle-income countries (LMICs). Conclusions Meaningful participation of older adults in DT for AI-driven assistive technology is methodologically and ethically important for producing acceptable, usable, and contextually appropriate technology. This evidence map offers guidance for geriatric researchers, clinicians, digital-health implementers, and policymakers committed to inclusive co-design with older adults, and identifies priority gaps for future primary research. Trial registration Open Science Framework https://doi.org/10.17605/OSF.IO/8W2S5