However, these exciting advances are only half the story. Alongside familiar worries about privacy, autonomy, and hidden bias, AI is becoming a new social determinant of health. Its benefits do not reach everyone equally. Digital literacy tends to follow and deepen existing disparities in race and ethnicity, education, income, and location. These gaps are global as well as local. Many of the countries with the fastest aging populations have the least access to these tools. AI could widen inequalities both within and between nations. Unless we work to close these gaps, the people who could gain the most from AI may be the last to actually receive the benefit.

Older adults are especially at risk of being left out of the health benefits of AI, due to limited internet access, fewer devices, less familiarity with digital tools, and understandable hesitation about change. AI-assisted fall detection and prevention, home safety monitoring, and remote connection with family members and health providers have improved older adults' quality of life. Yet these tools remain out of reach for much of the aging population.

As a health and aging researcher, I feel both excitement and worry. I am genuinely excited about what AI can do for older adults, and I am also genuinely concerned about who might be left out. Healthy aging in this new era will depend not only on how powerful these tools become, but on how fairly we share them.