The Effect of Using PARO for People Living With Dementia and Chronic Pain: A Pilot Randomized Controlled Trial

The story of pain in people with dementia: a rationale for digital measures

BACKGROUND

The increasingly older world population presents new aging-related challenges, especially for persons with dementia unable to express their suffering. Pain intensity and the effect of pain treatment are difficult to assess via proxy rating and both under- and overtreatment lead to neuropsychiatric symptoms, inactivity, care-dependency and reduced quality of life. In this debate piece, we provide a rationale on why valid digitalization, sensing technology, and artificial intelligence should be explored to improve the assessment of pain in people with dementia.

MAIN TEXT

In dementia care, traditional pain assessment relies on observing the manifestations of typical pain behavior. At the same time, pain treatment is complicated by polypharmacy, potential side effects, and a lack of around-the-clock, timely measures. But proper pain treatment requires objective and accurate measures that capture both the levels of pain and the treatment effects. Sensing systems research for personalized pain assessment is underway, with some promising results regarding associations between physiological signals and pain. Digital phenotyping, making use of everyday sensor data for monitoring health behaviors such as patterns of sleep or movement, has shown potential in clinical trials and for future continuous observation. This emerging approach requires transdisciplinary collaboration between medical and engineering sciences, with user involvement and adherence to ethical practices.

CONCLUSION

Digital phenotyping based on physiological parameters and sensing technology may increase pain assessment objectivity in older adults with dementia. This technology must be designed with user involvement and validated; however, it opens possibilities to improve pain relief and care.

A systematic review on the efficacy of artificial intelligence in geriatric healthcare: a critical analysis of current literature

OBJECTIVE

To carry out systematic analysis of existing literature on role of Artificial Intelligence in geriatric patient healthcare.

METHODS

A detailed online search was carried out using search phrases in reliable sources of information like Pubmed database, Embase database, Ovid database, Global Health database, PsycINFO, and Web of Science. Study specific information was gathered, including the organisation, year of publication, nation, setting, design of the research, information about population, size of study sample, group dynamics, eligibility and exclusion requirements, information about intervention, duration of exposure to the intervention , comparators, details of outcome measures, scheduling of evaluations, and consequences. After information gathering, the reviewers gathered to discuss any differences.

RESULTS

Thirty-one studies were finally selected for systemic review. Although there was some disagreement on the acceptance of AI-enhanced treatments in LTC settings, this review indicated that there was little consensus about the efficacy of those initiatives for older individuals. Social robots have been shown to increase social interaction and mood, but the data was more conflicting and less definitive for the other innovations and consequences. The majority of research evaluated a variety of results, which made it impossible to synthesise them in a meaningful way and prevented a meta-analysis. In addition, many studies have moderate to severe bias risks due to underpowered design CONCLUSION: It is challenging to determine whether AI supplemented technologies for geriatric patients are significantly beneficial. Although some encouraging findings were made, more study is required.

Intelligent Robot Interventions for People With Dementia: Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

The application of intelligent robots in therapy is becoming more and more important for people with dementia. More extensive research is still needed to evaluate its impact on behavioral and psychological dementia symptoms, as well as quality of life in different care settings.

OBJECTIVE

The purpose of this research is to methodically assess how well intelligence robot interventions work for patients with dementia.

METHODS

In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines, a comprehensive search was conducted on PubMed, CINAHL, the Cochrane Library, Embase, and Web of Science from the time of their founding to February 2024, to identify relevant randomized controlled trials on the use of intelligent robots in people with dementia. Two authors (WF and RZ) independently applied the Cochrane Collaboration bias assessment tool to assess the included studies' quality. The intervention effect of intelligent robots on patients with dementia was summarized using a fixed-effect model or a random-effects model with Stata software (version 16.0; StataCorp). Subgroup analysis was performed according to the intelligent robot type and the intervention duration. Publication bias was tested using funnel plots, Egger tests, and the trim-and-fill method.

RESULTS

In total, 15 studies were finally included for systematic review, encompassing 705 participants, of which 12 studies were subjected to meta-analysis. The meta-analysis found that compared with the control group, intelligent robot intervention significantly reduced the levels of agitation (standardized mean difference -0.36, 95% CI -0.56 to -0.17; P<.001) and anxiety (weighted mean difference -1.93, 95% CI -3.13 to -0.72; P=.002) in patients with dementia. However, the intervention of intelligent robots had no significant effect on the following (all P>.05): cognitive function, neuropsychiatric symptoms, depression, quality of life, step count during the day, and the hours of lying down during the night of patients with dementia. Subgroup analysis revealed that the improvement of depression was related to the duration of the intervention (≤12 vs 12 weeks: 0.08, 95% CI -0.20 to 0.37 vs -0.68, 95% CI -1.00 to -0.37; P=.26) and was independent of the type of intelligent robots (animal robots vs humanoid robots: -0.30, 95% CI -0.75 to 0.15 vs 0.07, 95% CI -0.21 to -0.34; P=.26).

CONCLUSIONS

This study shows that intelligent robot intervention can help improve the agitation and anxiety levels of people with dementia. The intervention may be more effective the longer it is implemented. The appearance of the intelligent robot has no effect on the intervention effect. Further research is needed to help collect physiological data, such as physical activity in people with dementia; explore the impact of other intelligent robot design features on the intervention effect; and provide a reference for improving intelligent robots and intervention programs.

TRIAL REGISTRATION

PROSPERO CRD42024523007; https://tinyurl.com/mwscn985.

Investigating the effectiveness of socially assistive robot on depression and cognitive functions of community dwelling older adults with cognitive impairments

We evaluated a socially assistive robot (SAR) named Hyodol during a six-week intervention. This study enrolled 69 older adults with cognitive decline. To screen the eligibility, we have used the following three criteria, namely Korean-Mini-Mental Status Exam score ≤ 26). Clinical Dementia Rating 0.5-2), and Diagnostics and Statistical Manual V. Participants were divided into three groups based on their cognitive function (i.e. very mild cognitive impairment (vMCI), mild cognitive impairment (MCI), and moderate cognitive impairment (MOCI). The groups were instructed to use Hyodol at home for a six-week period. Baseline and post-intervention surveys were performed after six weeks to examine the changes in perceived health, depression, and cognitive function. The vMCI group showed a reduction in the depression score after the intervention (t = -2.447, p = 0.040), in comparison to their peers in the control group. Further, the MCI group showed an improvement in the cognitive function score after the intervention (t = 2.690, p = 0.021). No significant improvement was found among MOCI participants who used the SARs. The significance of this study was to examine whether participants with different levels of cognitive functioning would diverge after a period of intervention using the Hyodol SARs. Moreover, it presented preliminary data for services and policies for home care treatment targeted to cognitive decline in older adults.

Effectiveness of digital intelligence interventions on depression and anxiety in older adults: A systematic review and meta-analysis

BACKGROUND

Depression and anxiety are common mental disorders in later life. Digital intelligence interventions overcome the limitations of conventional psychotherapy and offer new treatments for depression and anxiety. However, the effectiveness among older adults remains unclear.

METHODS

Databases including Pubmed, Web of Science, the Cochrane Library, Medline, CINAHL, PsycINFO, and Embase were searched for Randomized Controlled Trials (RCTs) from inception to November 22, 2023. Statistical analyses were conducted using Stata 18.0 and Review Manager 5.4.

RESULTS

The initial search found 9369 papers, with 21 meeting the inclusion criteria (e.g., RCTs involving older adults aged 50 and older that assessed digital intelligence interventions on depression and anxiety symptoms). Meta-analyses revealed that, compared to control groups, digital intelligence interventions significantly reduced depression symptoms (SMD: -0.58; 95 % CI: -0.80, -0.35) and anxiety symptoms (SMD: -0.39; 95 % CI: -0.58, -0.19). Subgroup analysis revealed that internet-based Cognitive Behavioral Therapy (iCBT), interventions lasting 7 to 10 weeks, and the use of the Patient Health Questionnaire (PHQ) and Generalized Anxiety Disorder-7 (GAD-7) scales, especially in other regions, had the most pronounced effects.

CONCLUSIONS

Digital intelligence interventions reduce depressive and anxious symptoms in older adults, supporting the development of evidence-based treatment guidelines in the digital era.

Integrating Digital Assistive Technologies Into Care Processes: Mixed Methods Study

BACKGROUND

Current challenges in patient care have increased research on technology use in nursing and health care. Digital assistive technologies (DATs) are one option that can be incorporated into care processes. However, how the application of DATs should be introduced to nurses and care professionals must be clarified. No structured and effective education concepts for the patient-oriented integration of DATs in the nursing sector are currently available.

OBJECTIVE

This study aims to examine how a structured and guided integration and education concept, herein termed the sensitization, evaluative introduction, qualification, and implementation (SEQI) education concept, can support the integration of DATs into nursing practices.

METHODS

This study used an explanatory, sequential study design with a mixed methods approach. The SEQI intervention was run in 26 long-term care facilities oriented toward older adults in Germany after a 5-day training course in each. The participating care professionals were asked to test 1 of 6 DATs in real-world practice over 3 days. Surveys (n=112) were then administered that recorded the intention to use DATs at 3 measurement points, and guided qualitative interviews with care professionals (n=12) were conducted to evaluate the learning concepts and effects of the intervention.

RESULTS

As this was a pilot study, no sample size calculation was carried out, and P values were not reported. The participating care professionals were generally willing to integrate DATs-as an additional resource-into nursing processes even before the 4-stage SEQI intervention was presented. However, the intervention provided additional background knowledge and sensitized care professionals to the digital transformation, enabling them to evaluate how DATs fit in the health care sector, what qualifies these technologies for correct application, and what promotes their use. The care professionals expressed specific ideas and requirements for both technology-related education concepts and nursing DATs.

CONCLUSIONS

Actively matching technical support, physical limitations, and patients' needs is crucial when selecting DATs and integrating them into nursing processes. To this end, using a structured process such as SEQI that strengthens care professionals' ability to integrate DATs can help improve the benefits of such technology in the health care setting. Practical, application-oriented learning can promote the long-term implementation of DATs.

The use of technology by seniors with neurocognitive disorders in long-term care: a scoping review

BACKGROUND

To map the current state of knowledge about the use of technology with seniors with neurocognitive disorders in long-term care to foster interactions, wellness, and stimulation.

METHODS

Cumulative Index to Nursing and Allied Health Literature (CINAHL Plus); MEDLINE; PsycINFO; Embase and Web of Science were searched in eligible literature, with no limit of time, to describe the current use of technology by seniors with neurocognitive disorders in long-term care. All types of literature were considered except for theses, editorial, social media. This scoping review was built around the recommendations of Peters et al. (2020 version). Three researchers collaborated on the selection of articles and independently reviewed the papers, based on the eligibility criteria and review questions.

RESULTS

The search yielded 3,605 studies, of which 39 were included. Most technology type reported was robotics. Included studies reports different positive effects on the use of such technology such as increase of engagement and positive.

CONCLUSION

The study highlights different types and potential benefits of technology for long-term care residents with neurocognitive disorders, emphasizing the crucial need for additional research to refine interventions and their use.

The Effect of Social Robots on Depression and Loneliness for Older Residents in Long-Term Care Facilities: A Meta-Analysis of Randomized Controlled Trials

OBJECTIVES

Depression and loneliness are challenges facing older residents living in long-term care facilities. Social robots might be a solution as nonpharmacologic interventions. The purpose of this study was to explore the effects of concrete forms of social robots on depression and loneliness in older residents in long-term care facilities by a systematic review and meta-analysis of randomized controlled trials.

DESIGN

This is a systematic review and meta-analysis.

SETTING AND PARTICIPANTS

Older residents in long-term care facilities.

METHODS

Six electronic databases of PubMed, Embase, Scopus, Web of Science, MEDLINE, and CINAHL plus were searched in August 2023. Random effect models of meta-analyses, subgroup analyses, and meta-regressions were performed for statistical analyses.

RESULTS

After evaluation, 8 studies were selected for both qualitative and quantitative synthesis. Social robot interventions had significant positive effects on decreasing depression and loneliness with large effect sizes. Group-based robot activities had a better effect on improving depression than individual-based robot activities. Longer durations of interventions produced significantly more improvement in depression.

CONCLUSION AND IMPLICATION

Social robots with physical manifestation provide the opportunity for older adults' social engagement and interactions with robots and others. Social robot interventions are recommended for older residents in long-term care facilities to promote psychosocial well-being in daily care routines.

Effectiveness of animal-assisted therapy and pet-robot interventions in reducing depressive symptoms among older adults: A systematic review and meta-analysis

BACKGROUND

Systematic reviews suggest that animal-assisted therapy (AAT) and pet-robot interventions (PRI) achieve a reduction in mental health variables such as depressive symptoms. However, these systematic reviews include both randomised and non-randomised studies, which prevents an adequate assessment of the effect of confounding variables.

OBJECTIVE

This systematic review and meta-analysis aimed to evaluate the comparative effectiveness of AAT and PRI through randomized controlled trials (RCTs) in reducing depression in older adults.

METHODS

Our study is a systematic review. We searched three databases of scientific articles: SCOPUS, Web of Science and PubMed. We included studies that their population was older adults, aged 65 years or older, with or without a clinical condition, clinical diagnosis based on mental examination/test or documentation from medical records, accredited by the facilities' staff. We included trials in which the comparator was a passive intervention or an active intervention. We used the Cochrane risk-of-bias tool for randomised trials (RoB 2) to assess the risk of bias for each study. Our study was registered in PROSPERO (CRD42023393740).

RESULTS

Twenty-three studies were included in this systematic review. However, only 19 trials were included in the meta-analysis. At the overall risk of bias level, 78.9% of the studies were at high risk of bias (n = 15). We found that AAT (g= -0.72; 95%CI -1.13 to -0.31; p = 0.001) has a moderate and statistically significant effect as an intervention to reduce depressive symptoms in older adults. However, the PRIs do not show a significant effect on reducing depressive symptoms in older adults. In addition, a sub-analysis based on dog-assisted therapy (g= -0.65; 95%CI -1.21 to -0.08; p = 0.025), a specific type of AAT, showed a modest effect on reducing depressive symptoms.

CONCLUSIONS

Our study concluded that AAT and DAT had a moderate and statistically significant effect as interventions to reduce depressive symptoms in older adults. On the other hand, PRI did not show a significant effect in reducing depressive symptoms.

Benefits and barriers associated with the use of smart home health technologies in the care of older persons: a systematic review

BACKGROUND

Smart home health technologies (SHHTs) have been discussed in the frame of caregiving to enable aging-in-place and independence. A systematic review was conducted in accordance with the PRISMA guidelines to gather the up-to-date knowledge on the benefits and barriers of using SHHTs in the care of older persons from the perspective of older persons and their caregivers.

METHODS

Ten electronic databases were reviewed for empirical peer-reviewed literature published from 01.01.2000 to 31.12.2021 in English, German, and French reporting on experimental, qualitative, quantitative, and other empirical study designs were included. Included studies contained user-feedback from older persons over 65 years of age or their caregivers (formal and informal). We used an extraction document to collect relevant data from all included studies and applied narrative synthesis to analyze data related to benefits and barriers of SHHTs.

RESULTS

163 empirical peer-reviewed articles were included, the majority of those published between 2014 and 2021. Five first-order categories of benefits and five of barriers were found with individual sub-themes. SHHTs could be useful in the care context where continuous monitoring is needed. They improve self-management and independent living of older persons. Barriers currently exist with respect to ease of usability, social acceptance, and cost.

CONCLUSIONS

SHHTs could be useful in the care context but are not without concerns. Researchers and policy makers can use the information as a starting point to better understand how the roles and outcomes of SHHTs could be improved for the care of older persons, while caregivers of older adults could use our findings to comprehend the scope of SHHTs and to decide when and where such technology could best address their individual family needs. Limitations lie in the possible exclusion of relevant articles published outside the inclusion criteria as well as the fact that due to digital divide, our review represents opinions of those who could and wanted to participate in the included 163 studies.

TRIAL REGISTRATION

This review has been registered as PROSPERO CRD42021248543. A protocol was completed in March 2021 with the PRISMA-P guidance. We have extended the review period from 2000 to 2020 since the registration of the protocol to 2000-2021.

Clinical effectiveness of pharmacological and non-pharmacological treatments for the management of anxiety in community dwelling people living with dementia: A systematic review and meta-analysis

People living with dementia commonly experience anxiety, which is often challenging to manage. We investigated the effectiveness of treatments for the management of anxiety in this population. We conducted a systematic review and meta-analysis of randomised controlled trials, and searched EMBASE, CINAHL, MEDLINE and PsycInfo. We estimated standardised mean differences at follow-up between treatments relative to control groups and pooled these across studies using random-effects models where feasible. Thirty-one studies were identified. Meta-analysis demonstrated non-pharmacological interventions were effective in reducing anxiety in people living with dementia, compared to care as usual or active controls. Specifically, music therapy (SMD-1.92(CI:-2.58,-1.25)), muscular approaches (SMD-0.65(CI:-1.02,-0.28)) and stimulating cognitive and physical activities (SMD-0.31(CI:-0.53,-0.09)). Pharmacological interventions with evidence of potential effectiveness included Ginkgo biloba, probiotics, olanzapine, loxapine and citalopram compared to placebo, olanzapine compared to bromazepam and buspirone and risperidone compared to haloperidol. Meta-analyses were not performed for pharmacological interventions due to studies' heterogeneity. This has practice implications when promoting the use of more non-pharmacological interventions to help reduce anxiety among people living with dementia.

Implementing PainChek and PARO to Support Pain Assessment and Management in Residents with Dementia: A Qualitative Study

BACKGROUND

Pain is a common problem but often undiagnosed and untreated in people with dementia.

AIMS

This study explored the experiences of residents with dementia, family, andformal carers with (1) pain assessment and management for residents with dementia; (2) the use of the PainChek app for pain assessment, and (3) the use of a social robot PARO for pain management in residents with dementia.

DESIGN

A qualitative study.

SETTINGS/PARTICIPANTS

Interviews were conducted with 13 residents withdementia, three family members, and 18 formal carers from a residential aged carefacility.

METHOD

Residents with dementia interacted with PARO for 15 mins, five days perweek for three weeks. The PainChek app assessed pain levels before and after eachsession. After three-week intervention, individual interviews were conducted withresidents, family, and formal carers who experienced or observed the use of PainChekapp and PARO for residents. Interviews were audio-recorded, transcribed, andanalyzed using thematic analysis.

RESULTS

Four themes were identified regarding pain in residents with dementia: (1) the impact, challenges and strategies of pain assessment and management; (2) benefits and barriers of using PainChek app to assess pain; (3) benefits of interacting with PARO to manage pain and behavioral symptoms; and (4) implementing PainChek app and PARO to support pain assessment and management in dementia care.

CONCLUSIONS

Technology, such as PainChek and PARO, is promising to improve painassessment and reduce pain for people with dementia. Barriers to using technologyinclude limited staff training and the implementation of person-centered care.

Increasing efficiency and well-being? a systematic review of the empirical claims of the double-benefit argument in socially assistive devices

BACKGROUND

Socially assistive devices (care robots, companions, smart screen assistants) have been advocated as a promising tool in elderly care in Western healthcare systems. Ethical debates indicate various challenges. One of the most prevalent arguments in the debate is the double-benefit argument claiming that socially assistive devices may not only provide benefits for autonomy and well-being of their users but might also be more efficient than other caring practices and might help to mitigate scarce resources in healthcare. Against this background, we used a subset of comparative empirical studies from a comprehensive systematic review on effects and perceptions of human-machine interaction with socially assistive devices to gather and appraise all available evidence supporting this argument from the empirical side.

METHODS

Electronic databases and additional sources were queried using a comprehensive search strategy which generated 9851 records. Studies were screened independently by two authors. Methodological quality of studies was assessed. For 39 reports using a comparative study design, a narrative synthesis was performed.

RESULTS

The data shows positive evidential support to claim that some socially assistive devices (Paro) might be able to contribute to the well-being and autonomy of their users. However, results also indicate that these positive findings may be heavily dependent on the context of use and the population. In addition, we found evidence that socially assistive devices can have negative effects on certain populations. Evidence regarding the claim of efficiency is scarce. Existing results indicate that socially assistive devices can be more effective than standard of care but are far less effective than plush toys or placebo devices.

DISCUSSION

We suggest using the double-benefit argument with great caution as it is not supported by the currently available evidence. The occurrence of potentially negative effects of socially assistive devices requires more research and indicates a more complex ethical calculus than suggested by the double-benefit argument.

The effectiveness of a therapeutic robot, 'Paro', on behavioural and psychological symptoms, medication use, total sleep time and sociability in older adults with dementia: A systematic review and meta-analysis

OBJECTIVE

To evaluate the effectiveness of a therapeutic robot, 'Paro', on anxiety, agitation, depression, apathy, medication use, total sleep time, and sociability among older adults with dementia.

DESIGN

Systematic review and meta-analysis with narrative synthesis.

SETTING AND PARTICIPANTS

Older adults aged 60 years and above with any form of dementia in the community, nursing homes, or care facilities.

METHODS

A three-step search strategy was conducted by two independent reviewers. Nine databases were searched (January 2003 to November 2022). Randomised controlled, crossover, and cluster trials on Paro for older adults with dementia published in English were included. All relevant trials were screened and assessed for risk of bias. Data were extracted using the Cochrane data collection form. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess the quality of evidence.

RESULTS

In total, 12 articles involving 1461 participants were included. Results of the meta-analysis showed that Paro had a moderate effect on medication use (SMD: -0.63) and small effect on anxiety (SMD: -0.17), agitation (SMD: -0.27) and depression (SMD: -0.40). However, Paro exhibited negligible effect on total sleep time (SMD: -0.12). The overall quality of evidence for all outcomes were graded as low due to methodological limitations, small sample size, and wide confidence intervals. Narrative synthesis suggested that Paro reduced apathy and increase sociability.

CONCLUSION AND IMPLICATIONS

Paro could be a beneficial non-pharmacological approach to improve behavioural and psychological symptoms of dementia, reducing medication use, and increasing sociability for older adults with dementia. However, the results should be interpreted with caution as limited studies were available. Additionally, there were a variety of approaches across the studies (i.e. group and individual interventions, facilitated and non-facilitated) which made it difficult to determine which interventional approach is optimal to produce beneficial effects of Paro. Hence, more rigorous studies with a larger sample size are needed to fully understand the mechanism and effectiveness of Paro in older adults with dementia. The protocol was registered on PROSPERO (CRD42022296504).

Effectiveness of Robot Interventions for Cognitive and Psychological Outcomes among Older Adults with Cognitive Impairment: A Meta-Analysis

This review was performed to evaluate the effects of robot interventions on cognitive and psychological outcomes among older adults with cognitive impairment. Three databases (PubMed, Embase, and Cochrane Central Register of Controlled Trials) were searched for studies published in English between January 2015 and August 2021. We included studies that involved older adults with cognitive impairment, interventions using robots, outcome measures related to cognitive and psychological status, and randomized controlled trials. Ten studies included in the systematic review, and nine studies derived from these ten articles were included in the meta-analyses. The meta-analyses revealed that robot interventions significantly decreased anxiety and agitation but exerted no significant effects on cognitive function, neuropsychiatric symptoms, and quality of life. The subgroup analyses according to robot types revealed that pet-type robot interventions reduced anxiety and agitation. In addition, subgroup analysis according to the intervention format of robot interventions found that individual intervention was effective for improving agitation, but a group-based intervention was effective for improving depression. We suggest using robot interventions to improve psychological outcomes such as anxiety and agitation; however, further research is needed to determine whether robot interventions affect symptoms such as cognitive function, neuropsychiatric symptoms, and quality of life.

Network meta-analysis of comparative efficacy of animal-assisted therapy vs. pet-robot therapy in the management of dementia

Objective

This network meta-analysis aimed to compare and rank the efficacy of animal-assisted therapy (AAT) and pet-robotic therapy (PRT) in the management of dementia.

Methods

Relevant studies were identified by searching PubMed, EMBASE, the Cochrane Library, SCOPUS, and Web of Science (WoS) until October 13, 2022. Traditional meta-analysis was first conducted based on the random-effects model, then random network meta-analysis was conducted to determine the relative efficacy and rank probability of AAT and PRT.

Results

Nineteen randomized controlled trials (RCTs) were included in this network meta-analysis. Network meta-analysis revealed that PRT marginally benefited agitation alleviation compared with control (standard mean difference [SMD]: -0.37, 95% confidence interval [95%CI]: -0.72 to -0.01) although both AAT and PRT did not improve cognitive function, reduce depression, and improve Quality of Life (QoL). The SUCRA probabilities indicated that PRT ranked better than AAT in agitation, cognitive function, and QoL, although there were no differences between the two therapies.

Conclusion

The present network meta-analysis reveals that PRT may help alleviate agitated behaviors in people with dementia. However, future studies are warranted to establish evidence of the effectiveness of PRT and further evaluate the differences between different robot types in managing dementia.

Robots in Assisted Living Facilities: Scoping Review

BACKGROUND

Various technological interventions have been proposed and studied to address the growing demand for care of residents in assisted living facilities, in which a preexisting shortage of professional caregivers has been exacerbated by the COVID-19 pandemic. Care robots are one such intervention with the potential to improve both the care of older adults and the work life of their professional caregivers. However, concerns about efficacy, ethics, and best practices in the applications of robotic technologies in care settings remain.

OBJECTIVE

This scoping review aimed to examine the literature on robots used in assisted living facilities and identify gaps in the literature to guide future research.

METHODS

On February 12, 2022, following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) protocol, we searched PubMed, CINAHL Plus with Full Text, PsycINFO, IEEE Xplore digital library, and ACM Digital Library using predetermined search terms. Publications were included if they were written in English and focused on the use of robotics in assisted living facilities. Publications were excluded if they did not provide peer-reviewed empirical data, focused on user needs, or developed an instrument to study human-robot interaction. The study findings were then summarized, coded, and analyzed using the Patterns, Advances, Gaps, Evidence for practice, and Research recommendations framework.

RESULTS

The final sample included 73 publications from 69 unique studies on the use of robots in assisted living facilities. The findings of studies on older adults were mixed, with some studies suggesting positive impacts of robots, some expressing concerns about robots and barriers to their use, and others being inconclusive. Although many therapeutic benefits of care robots have been identified, methodological limitations have weakened the internal and external validity of the findings of these studies. Few studies (18/69, 26%) considered the context of care: most studies (48/69, 70%) collected data only on recipients of care, 15 studies collected data on staff, and 3 studies collected data on relatives or visitors. Theory-driven, longitudinal, and large sample size study designs were rare. Across the authors' disciplines, a lack of consistency in methodological quality and reporting makes it difficult to synthesize and assess research on care robotics.

CONCLUSIONS

The findings of this study call for more systematic research on the feasibility and efficacy of robots in assisted living facilities. In particular, there is a dearth of research on how robots may change geriatric care and the work environment within assisted living facilities. To maximize the benefits and minimize the consequences for older adults and caregivers, future research will require interdisciplinary collaboration among health sciences, computer science, and engineering as well as agreement on methodological standards.

Effects of a cognitive-based intervention program using social robot PIO on cognitive function, depression, loneliness, and quality of life of older adults living alone

Objective

Social robot interventions are being implemented to reduce cognitive decline, depression, and loneliness among older adults. However, the types, functions, and programs of effective social robots have not yet been confirmed. This study investigated whether a social robot intervention is effective in improving cognitive function, depression, loneliness, and quality of life in older adults living alone.

Methods

This study used a non-equivalent control group pre-test-post-test design. It was conducted twice a week, with each session lasting 50 mi; twelve sessions were conducted over 6 weeks. This study was conducted at three senior welfare centers in Korea. In each group, 10 or fewer participants used the PIO social robot. The total participants included 64 people in the experimental (n = 31) and control groups (n = 33), and consisted of older people over 65 years of age living alone.

Results

There was a statistically significant difference in the pre-post values for cognitive function (z = 5.21, p < 0.001), depression (z = -2.99, p = 0.003), and loneliness (t = -4.27, p < 0.001) in the experimental and control groups. However, there was no statistically significant difference for quality of life (z = 1.84, p = 0.066).

Conclusions

It was confirmed that a cognitive intervention program using the social robot PIO can improve cognitive function and reduce depression and loneliness in older adults living alone.

Intelligent Physical Robots in Health Care: Systematic Literature Review

BACKGROUND

Intelligent physical robots based on artificial intelligence have been argued to bring about dramatic changes in health care services. Previous research has examined the use of intelligent physical robots in the health care context from different perspectives; however, an overview of the antecedents and consequences of intelligent physical robot use in health care is lacking in the literature.

OBJECTIVE

In this paper, we aimed to provide an overview of the antecedents and consequences of intelligent physical robot use in health care and to propose potential agendas for future research through a systematic literature review.

METHODS

We conducted a systematic literature review on intelligent physical robots in the health care field following the guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Literature searches were conducted in 5 databases (PubMed, Scopus, PsycINFO, Embase, and CINAHL) in May 2021, focusing on studies using intelligent physical robots for health care purposes. Subsequently, the quality of the included studies was assessed using the Mixed Methods Appraisal Tool. We performed an exploratory content analysis and synthesized the findings extracted from the included articles.

RESULTS

A total of 94 research articles were included in the review. Intelligent physical robots, including mechanoid, humanoid, android, and animalistic robots, have been used in hospitals, nursing homes, mental health care centers, laboratories, and patients' homes by both end customers and health care professionals. The antecedents for intelligent physical robot use are categorized into individual-, organization-, and robot-related factors. Intelligent physical robot use in the health care context leads to both non-health-related consequences (emotional outcomes, attitude and evaluation outcomes, and behavioral outcomes) and consequences for (physical, mental, and social) health promotion for individual users. Accordingly, an integrative framework was proposed to obtain an overview of the antecedents and consequences of intelligent physical robot use in the health care context.

CONCLUSIONS

This study contributes to the literature by summarizing current knowledge in the field of intelligent physical robot use in health care, by identifying the antecedents and the consequences of intelligent physical robot use, and by proposing potential future research agendas in the specific area based on the research findings in the literature and the identified knowledge gaps.

Artificial intelligence in elderly healthcare: A scoping review

The ageing population has led to a surge in the adoption of artificial intelligence (AI) technologies in elderly healthcare worldwide. However, in the advancement of AI technologies, there is currently a lack of clarity about the types and roles of AI technologies in elderly healthcare. This scoping review aimed to provide a comprehensive overview of AI technologies in elderly healthcare by exploring the types of AI technologies employed, and identifying their roles in elderly healthcare based on existing studies. A total of 10 databases were searched for this review, from January 1 2000 to July 31 2022. Based on the inclusion criteria, 105 studies were included. The AI devices utilized in elderly healthcare were summarised as robots, exoskeleton devices, intelligent homes, AI-enabled health smart applications and wearables, voice-activated devices, and virtual reality. Five roles of AI technologies were identified: rehabilitation therapists, emotional supporters, social facilitators, supervisors, and cognitive promoters. Results showed that the impact of AI technologies on elderly healthcare is promising and that AI technologies are capable of satisfying the unmet care needs of older adults and demonstrating great potential in its further development in this area. More well-designed randomised controlled trials are needed in the future to validate the roles of AI technologies in elderly healthcare.

More than surgical tools: a systematic review of robots as didactic tools for the education of professionals in health sciences

Within the field of robots in medical education, most of the work done during the last years has focused on surgeon training in robotic surgery, practicing surgery procedures through simulators. Apart from surgical education, robots have also been widely employed in assistive and rehabilitation procedures, where education has traditionally focused in the patient. Therefore, there has been extensive review bibliography in the field of medical robotics focused on surgical and rehabilitation and assistive robots, but there is a lack of survey papers that explore the potential of robotics in the education of healthcare students and professionals beyond their training in the use of the robotic system. The scope of the current review are works in which robots are used as didactic tools for the education of professionals in health sciences, investigating the enablers and barriers that affect the use of robots as learning facilitators. Systematic literature searches were conducted in WOS and Scopus, yielding a total of 3812 candidate papers. After removing duplicates, inclusion criteria were defined and applied, resulting in 171 papers. An in-depth quality assessment was then performed leading to 26 papers for qualitative synthesis. Results show that robots in health sciences education are still developed with a roboticist mindset, without clearly incorporating aspects of the teaching/learning process. However, they have proven potential to be used in health sciences as they allow to parameterize procedures, autonomously guide learners to achieve greater engagement, or enable collective learning including patients and instructors "in the loop". Although there exist documented added-value benefits, further research and efforts needs to be done to foster the inclusion of robots as didactic tools in the curricula of health sciences professionals. On the one hand, by analyzing how robotic technology should be developed to become more flexible and usable to support both teaching and learning processes in health sciences education, as final users are not necessarily well-versed in how to use it. On the other, there continues to be a need to develop effective and standard robotic enhanced learning evaluation tools, as well good quality studies that describe effective evaluation of robotic enhanced education for professionals in health sciences. As happens with other technologies when applied to the health sciences field, studies often fail to provide sufficient detail to support transferability or direct future robotic health care education programs.

Efficacy of non-pharmacological interventions to reduce pain in people with dementia: A systematic review and meta-analysis

AIMS AND OBJECTIVES

To identify the efficacy of non-pharmacological interventions designed to reduce pain in people with dementia.

BACKGROUND

Pain is prevalent among patients with dementia but frequently remains untreated. Although non-pharmacological interventions have been used to reduce pain in people with dementia, the efficacy of these interventions for pain management in people with dementia has not been thoroughly synthesised.

DESIGN

Systematic review and meta-analysis.

METHODS

The study was conducted in accordance with PRISMA guidelines and Cochrane criteria for systematic reviews. A comprehensive search was performed using the Academic Search Complete, CINAHL, Cochrane Library, EMBASE, MEDLINE, PubMed, OVID and Web of Science databases, from databases inception to 13 March 2022. The modified Cochrane risk-of-bias tool (ROB-2) was used to evaluate the methodological quality of each included study. Standardised mean differences (SMDs) with 95% confidence intervals (CIs) were synthesised using a random-effects model to assess the efficacy of non-pharmacological interventions for reducing pain in people with dementia (using Stata 16.0).

RESULTS

The final analysis assessed 12 studies, including 989 persons with dementia. Non-pharmacological interventions were found to reduce pain in 4-8 weeks after the interventions (SMD: -0.32; 95% CI: -0.62 to -0.02). However, the effects of intervention frequency and patient age remain unknown.

CONCLUSIONS

Non-pharmacological interventions are effective for reducing pain in people with dementia. Further investigations remain necessary to explore the effectiveness of specific non-pharmacological therapies for pain reduction in people with dementia (e.g. aromatherapy, play activity, singing or robotic care).

RELEVANCE TO CLINICAL PRACTICE

The findings of this study can guide healthcare practitioners when considering the use of non-pharmacological pain management methods for people with dementia and may improve the implementation of these methods in clinical practice.

PATIENT OR PUBLIC CONTRIBUTIONS

The study suggests non-pharmacological interventions to reduce pain and underlines the relevance of health provider's viewpoints. The types, duration and length of follow-up of non-pharmacological interventions can be offered based on patient's conditions and the standard of clinical practice.

[Identification of measures conducive to learning for the introduction of digital and assistive technologies (DAT) in processes of nursing care: a qualitative study]

Background

Digital, assistive technologies (DAT) are finding their way into care processes. There are no concepts for introducing nursing professionals DAT in a structured manner. A structured concept makes sense for a sustainable implementation of DAT. This paper suggests a guideline to train nurses in dealing with DAT.

Aim

The work addresses the question of how nursing professionals experience and evaluate a structured approach of sensitization, qualification and testing with respect to DAT. This is also intended to assess the extent to which a transformative learning approach changes the willingness of nurses to use DAT.

Method

In a long-term inpatient facility, nurses have been made aware of DAT and instructed in its use. The nurses were trained in using two robotic systems and a passive exoskeleton. The experience and perception of the structural design of the educational approach were surveyed through interviews. Evaluation took place by qualitative content analysis according to Kuckartz.

Results

All 5 nurses surveyed had completed 3 years of training in nursing care. 2 of the interviewees perform tasks in the management of the care unit. All interviewee rated the structured approach positively. The approach increases the interest to think about an integration of DAT. It turns out that the accuracy of fit of DAT to care-related problems as well as the necessity to make DAT available by employers are crucial prerequisites for DAT integration into practice.

Conclusion

A structured concept can sustainably increase the willingness of nurses to use DAT. Poor implementation of DAT is based on a lack of knowledge and concepts for education and training. The reflection that has been initiated enables DAT to be checked for specific care problems.

Socially assistive robots for people with dementia: Systematic review and meta-analysis of feasibility, acceptability and the effect on cognition, neuropsychiatric symptoms and quality of life

BACKGROUND

There is increasing interest in using robots to support dementia care but little consensus on the evidence for their use. The aim of the study is to review evidence about feasibility, acceptability and clinical effectiveness of socially assistive robots used for people with dementia.

METHOD

We conducted a systematic review and meta-analysis. We searched MEDLINE, EMBASE, PsychINFO, CINHAL, IEEE Xplore Digital Library, and EI Engineering Village from inception to 04 - 02-2022 - included primary studies assessing feasibility, acceptability, or effectiveness of socially assistive robots for people with dementia. Two independent reviewers screened studies for eligibility, and assessed quality. Narrative synthesis prioritized higher quality studies, and random-effect meta-analyses compared robots with usual care (UC) or active control (AC) immediately after the intervention (short-term; ST) or long-term (LT) on cognition, neuropsychiatric symptoms, and quality of life.

FINDINGS

66 studies and four categories of robots were eligible: Companion robots (Pet and humanoid companion robots), telepresence communication robots, homecare assistive robots and multifunctional robots. PARO (companion robot seal) was feasible and acceptable but limited by its weight, cost, and sound. On meta-analysis, PARO had no ST or LT compared to UC or AC over 5-12 weeks on agitation (ST vs UC, 4 trials, 153 participants: pooled standardized mean difference (SMD) 0.25; - 0.57 to 0.06; LT vs UC; 2 trials, 77 participants, SMD = -0.24; - 0.94, 0.46), cognition (ST vs UC, 3 trials, 128 participants: SMD= 0.03; -0.32, 0.38), overall neuropsychiatric symptoms (ST vs UC, 3 trials, 169 participants: SMD= -0.01; -0.32, 0.29; ST vs AC, 2 trials, 145 participants: SMD =0.02, -0.71, 0.85), apathy (ST vs AC, 2 trials, 81 participants: SMD= 0.14; 0.29, 0.58), depression (ST vs UC, 4 trials, 181 participants; SMD= 0.08; -0.52, 0.69; LT vs UC: 2 trials, 77 participants: SMD =0.01; -0.75, 0.77), anxiety (ST vs UC: 2 trials, 104 participants, SMD= 0.24; -0.85, 1.33) and quality of life (ST vs UC, 2 trials, 127 participants: SMD=-0.05; -0.52, 0.42; ST vs AC: 2 trials, 159 participants, SMD =-0.36, -0.76, 0.05). Robotic animals, humanoid companion robots, telepresence robots and multifunctional robots were feasible and acceptable. However, humanoid companion robots have speech recognition problems, and telepresence robots and multifunctional robots were often difficult to use. There was mixed evidence about the feasibility of homecare robots. There was little evidence on any of these robots' effectiveness.

CONCLUSION

Although robots were generally feasible and acceptable, there is no clear evidence that people with dementia derive benefit from robots for cognition, neuropsychiatric symptoms, or quality of life. We recommend that future research should use high quality designs to establish evidence of effectiveness.

Management of Chronic Pain in Long-Term Care: A Systematic Review and Meta-Analysis

OBJECTIVES

Pain, a complex subjective experience, is common in care home residents. Despite advances in pain management, optimal pain control remains a challenge. In this updated systematic review, we examined effectiveness of interventions for treating chronic pain in care home residents.

DESIGN

A Cochrane-style systematic review and meta-analysis using PRISMA guidelines.

SETTING AND PARTICIPANTS

Randomized and nonrandomized controlled trials and intervention studies included care home residents aged ≥60 years receiving interventions to reduce chronic pain.

METHODS

Six databases were searched to identify relevant studies. After duplicate removal, articles were screened by title and abstract. Full-text articles were reviewed and included if they implemented a pain management intervention and measured pain with a standardized quantitative pain scale. Meta-analyses calculated standardized mean differences (SMDs) using random-effect models. Risk of bias was assessed using the Cochrane Risk-of-Bias Tool 2.0.

RESULTS

We included 42 trials in the meta-analysis and described 13 more studies narratively. Studies included 26 nondrug alternative treatments, 8 education interventions, 7 system modifications, 3 nonanalgesic drug treatments, 2 analgesic treatments, and 9 combined interventions. Pooled results at trial completion revealed that, except for nonanalgesic drugs and health system modification interventions, all interventions were at least moderately effective in reducing pain. Analgesic treatments (SMD -0.80; 95% CI -1.47 to -0.12; P = .02) showed the greatest treatment effect, followed by nondrug alternative treatments (SMD -0.70; 95% CI -0.95 to -0.45; P < .001), combined interventions (SMD -0.37; 95% CI -0.60 to -0.13; P = .002), and education interventions (SMD -0.31; 95% CI -0.48 to -0.15; P < .001).

CONCLUSIONS AND IMPLICATIONS

Our findings suggest that analgesic drugs and nondrug alternative pain management strategies are the most effective in reducing pain among care home residents. Clinicians should also consider implementing nondrug alternative therapies in care homes, rather than relying solely on analgesic drug options.

A systematic review of opioid prevalence in Australian residential aged care facilities

OBJECTIVE

To systematically review the prevalence of opioid prescribing, dispensing and administration in Australian residential aged care facilities (RACFs).

METHODS

MEDLINE, Embase, CINAHL, AgeLine, Web of Science Core Collection, InformIT and International Pharmaceutical Abstracts (inception to September 2021) were searched for studies reporting opioid prevalence in Australian RACFs. Regular and as-required (i.e. pro re nata, PRN) opioid uses were considered. Screening, data extraction and quality assessment were performed independently by two review authors.

RESULTS

Twenty-three studies (n = 286,141 residents) reported opioid prevalence, of which 16 provided overall regular or PRN prescribing, dispensing or administration data. Five studies reported 28%-34% of residents were prescribed regular opioids over assessment periods ranging from one week to one month. Five studies reported 11%-42% of residents were prescribed PRN opioids over assessment periods ranging from one week to 30 months. Three studies reported 27%-50% of residents were dispensed an opioid over 12 months. Five studies reported 21%-29% were administered both regular and PRN opioids over 24 hours. Two studies reported 22%-42% of residents were administered PRN opioids over 1 week to 12 months. Two studies reported 6%-13% of residents were using doses >100 mg oral morphine equivalents/day.

CONCLUSIONS

Up to half of the residents were dispensed opioids over 12 months. The prevalence of opioid prescribing, dispensing and administration was highly variable, suggesting the potential value of opioid quality indicators and analgesic stewardship interventions to ensure opioid appropriateness.

Artificial intelligence for older people receiving long-term care: a systematic review of acceptability and effectiveness studies

Artificial intelligence (AI)-enhanced interventions show promise for improving the delivery of long-term care (LTC) services for older people. However, the research field is developmental and has yet to be systematically synthesised. This systematic review aimed to synthesise the literature on the acceptability and effectiveness of AI-enhanced interventions for older people receiving LTC services. We conducted a systematic search that identified 2720 records from Embase, Ovid, Global Health, PsycINFO, and Web of Science. 31 articles were included in the review that evaluated AI-enhanced social robots (n=22), environmental sensors (n=6), and wearable sensors (n=5) with older people receiving LTC services across 15 controlled and 14 non-controlled trials in high-income countries. Risk of bias was evaluated using the RoB 2, RoB 2 CRT, and ROBINS-I tools. Overall, AI-enhanced interventions were found to be somewhat acceptable to users with mixed evidence for their effectiveness across different health outcomes. The included studies were found to have high risk of bias which reduced confidence in the results. AI-enhanced interventions are promising innovations that could reshape the landscape of LTC globally. However, more trials are required to support their widespread implementation. Pathways are needed to support more high-quality trials, including in low-income and middle-income countries.

Can the Paro be my Buddy? Meaningful experiences from the perspectives of older adults

This study aimed to explore meaningful experiences of older Taiwanese adults who had received a Paro (social robot) companion. Semi-structured qualitative interviews elicited the perspectives of 25 older adults living in a long-term care facility after they had interacted with an individual Paro companion for 8 weeks. Thematic analysis was used in this study as it allows for rich, detailed, and complex descriptions of qualitative data. Analysis identified four themes: Bridging my social bonds; Acting as a comfort Buddy; Relieving my emotional distress; and Encountering Paro with distancing. Although Paro's functioning has some limits, such as lacking speech, most participants expressed that the experience was positive. These findings revealed that the meaningful experiences expressed by participants at the end of the intervention with Paro might provide the value of companionship and improve interpersonal relationships for older adults in geriatric nursing.

Feasibility study protocol of the PainChek app to assess the efficacy of a social robot intervention for people with dementia

AIM

This study aims to test the feasibility of the PainChek app to assess pain for people with dementia living in residential aged care facilities (RACFs). It will also identify the optimal dosage and efficacy of a social robot (personal assistant robot [PARO]) intervention on chronic pain for people with dementia.

DESIGN

This is a feasibility randomized controlled trial with three groups.

METHODS

Forty-five residents living with dementia and chronic pain will be recruited from one RACF. The intervention consists of an individual 15-min non-facilitated session with a PARO robot twice a day (Group 1), a PARO robot once a day (Group 2), or a Plush-Toy (non-robotic PARO) once a day (Group 3) from Monday to Friday for 4 weeks. Participants will be followed at 4 and 8 weeks after baseline assessments. The primary outcome will be the feasibility of using the PainChek app to measure changes in pain levels before and after each session. Secondary outcomes include staff-rated pain levels, neuropsychiatric symptoms, quality of life and changes in psychotropic and analgesic medication use. Participants, staff and family perceptions of using PARO and the PainChek app will be collected after the 4-week intervention.

DISCUSSION

This study will test the use of the PainChek app and PARO to improve pain management for people with dementia. Results from this study will help determine its usefulness, feasibility and acceptability for pain management in people with dementia living in RACFs.

IMPACT

As pain is a significant problem for people with dementia, this project will generate evidence on the use of the PainChek to measure the efficacy of a social robot intervention that has the potential to improve the quality of pain care in people with dementia.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry number (ACTRN12621000837820) date registered 30/06/2021.

Non-pharmacological interventions for pain in people with dementia: A systematic review

CONTEXT

Pain commonly occurs in people living with dementia but is often undertreated. Non-pharmacological interventions are a safer first-line option for pain management, but evidence-based interventions for people living with dementia have not been established. An increasing number of studies have examined the effect of non-pharmacological interventions in pain management. However, the evidence that specifically focuses on people living with dementia has not been systematically reviewed.

OBJECTIVES

This review aimed to systematically synthesize current evidence on non-pharmacological interventions to manage pain in people living with dementia.

METHODS

A comprehensive search of the literature was conducted in PubMed, CINAHL, Scopus, and Web of Science databases. Studies were included if they were 1) peer-reviewed original quantitative research, 2) tested the effect of non-pharmacological interventions on pain in people with dementia, and 3) English language. Studies were excluded if they 1) included both pharmacological and non-pharmacological interventions and did not report separate results for the non-pharmacological interventions; 2) enrolled participants with and without dementia and did not have separate results reported for individuals with dementia; 3) tested dietary supplements as the intervention; and 4) were not original research, such as reviews, editorials, commentaries, or case studies. Title, abstract, and full text were screened. Quality assessment was conducted using the Cochrane Risk of Bias tool and Johns Hopkins Level of Evidence. Pain assessment tools, participant characteristics, study designs, intervention condition, and results were extracted. Results were synthesized through grouping the type of the interventions and weighting evidence based on quality and design of the studies.

RESULTS

A total of 11 articles and 12 interventions were identified. A total of 486 participants were included. Interventions that have shown a positive impact on pain include ear acupressure, music therapy, reflexology, tailored pain intervention, painting and singing, personal assistive robot, cognitive-behavioral therapy, play activity, and person-centered environment program. Nevertheless, a majority of the interventions were only evaluated once. Moreover, most studies had similar sample characteristics and setting.

CONCLUSION

Overall, the quality of included studies were mostly low to mixed quality and most participants only had mild to moderate baseline pain, which limits detection of the intervention's effect. Hence, these findings need to be duplicated in studies with a greater sample size, a more diverse population (race, gender, and settings), and a more rigorous design to validate the results.

Effectiveness of robot therapy in the management of behavioural and psychological symptoms for individuals with dementia: A systematic review and meta-analysis

Robot therapy presents a promising alternative in dementia care. However, its effectiveness has not been verified comprehensively. This systematic review and meta-analysis aim at evaluating the effectiveness of robot therapy in the management of behavioural and psychological symptoms for individuals with dementia. Studies assessing the effectiveness of robot therapy were identified using 10 academic research databases: CENTRAL, CINAHL, CNKI, The Cochrane Library, Embase, IEEE Xplore, MEDLINE, PubMed, Scopus, and ProQuest Dissertations & Theses. Additional references were identified from the reference lists of included studies and relevant reviews. Data extraction and risk of bias assessment were conducted independently by two review authors. Meta-analyses and subgroup analyses were performed and the heterogeneity of studies was examined. 18 published articles from 14 studies involving a total of 1256 participants were included. Participants with robot therapy had a significant decrease in agitation (SMD -0.38, 95% CI -0.66, -0.09; p = 0.01) and a significant increase in social interaction (SMD 0.49, 95% CI 0.01, 0.97; p = 0.04) while effects for depression, anxiety, cognitive status, and quality of life were not statistically significant. Results from this review show that robot therapy can effectively reduce agitation and increase social interactions for individuals with dementia. Future clinical practice should consider the potential of robot therapy as an option to be implemented into current dementia programmes. Further large-scale trials are required for the thorough investigation of different intervention formats and robot types, while considering potential confounding factors.

Effects of robotic care interventions for dementia care: A systematic review and meta-analysis randomised controlled trials

BACKGROUND

The role of robotic care has been studied because it may be a care option applicable to dementia care. However, the effects of robotic care in dementia care are still inconclusive.

AIM

To explore the span of the effects of robotic care intervention among patients with dementia.

DESIGN

Systematic review and meta-analysis.

METHODS

This study searched systematically using the following databases: Academic Search Complete, CINAHL, Cochrane Library, MEDLINE, PubMed, SocINDEX, UpToDate (OVID) and Web of Science. The eligibility criteria were patients with dementia, randomised controlled trials and publications in English. The PEDro scale was used to assess the methodological quality in the included studies. The meta-analysis was performed using a fixed-effects model to calculate the pooled effects of robotic care interventions. STATA 16.0 was used for statistical analysis. The results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.

RESULTS

A total of 15 studies met the eligibility criteria and included 1684 participants. Overall, the robotic care interventions had positive effects on agitation (SMD = 0.09; 95% CI [-0.22-0.33]), anxiety (SMD = -0.07; 95% CI [-0.42-0.28]), cognitive function (SMD = 0.16; 95% CI [-0.08-0.40]), depression (SMD = -0.35; 95% CI [-0.69-0.02]), neuropsychiatric symptoms (SMD = 0.16; 95% CI [-0.29-0.61]), total hours of sleep during daytime (SMD = -0.31; 95% CI [-0.55 to 0.07]) and quality of life (SMD = 0.24; 95% CI [-0.23-0.70]).

CONCLUSION

Robotic care intervention may be an effective and alternative intervention for improving the health outcomes for people with dementia. The robotic care effect on anxiety should be confirmed. Further studies may consider the frequency, duration of intervention and possible negative outcomes after robotic care interventions.

RELEVANCE TO CLINICAL PRACTICE

As a non-pharmacological approach, nursing staff may consider the robotic care intervention in providing care for patients with dementia since this intervention has clinical benefits.

Are Chronic Pain Patients with Dementia Being Undermedicated?

In dementia, neuropathological changes alter the perception and expression of pain. For clinicians and family members, this knowledge gap leads to difficulties in recognizing and assessing chronic pain, which may consequently result in persons with dementia receiving lower levels of pain medication compared to those without cognitive impairment. Although this situation seems to have improved in recent years, considerable geographical variation persists. Over the last decade, opioid use has received global attention as a result of overuse and the risk of addiction, while the literature on older persons with dementia actually suggests undertreatment. This review stresses the importance of reliable assessment and the regular evaluation and monitoring of symptoms in persons with dementia. Based on current evidence, we concluded that chronic pain is still undertreated in dementia.

Social Robot Interventions for People with Dementia: A Systematic Review on Effects and Quality of Reporting

Background:

Using non-pharmacological interventions is a current approach in dementia care to manage responsive behaviors, to maintain functional capacity, and to reduce emotional stress. Novel technologies such as social robot interventions might be useful to engage people with dementia in activities and interactions as well as to improve their cognitive, emotional, and physical status.

Objective:

Assessing the effects and the quality of reporting of social robot interventions for people with dementia.

Methods:

In our systematic review, we included quasi-experimental and experimental studies published in English, French, or German, irrespective of publication year. Searching CINAHL, Cochrane Library, MEDLINE, PsycINFO, and Web of Science Core Collection was supplemented by citation tracking and free web searching. To assess the methodological quality of included studies, we used tools provided by the Joanna Briggs Institute. To assess the reporting of the interventions, we applied CReDECI 2 and TIDieR.

Results:

We identified sixteen studies published between 2012 and 2018, including two to 415 participants with mostly non-defined type of dementia. Eight studies had an experimental design. The predominant robot types were pet robots (i.e., PARO). Most studies addressed behavioral, emotion-related, and functional outcomes with beneficial, non-beneficial, and mixed results. Predominantly, cognitive outcomes were not improved. Overall, studies were of moderate methodological quality.

Conclusion:

Heterogeneous populations, intervention characteristics, and measured outcomes make it difficult to generalize the results with regard to clinical practice. The impact of social robot interventions on behavioral, emotion-related, and functional outcomes should therefore be assessed considering the severity of dementia and intervention characteristics.

The effect of a social robot intervention on sleep and motor activity of people living with dementia and chronic pain: A pilot randomized controlled trial

OBJECTIVE

To investigate the effect of a social robot intervention on sleep and motor activity in nursing home residents living with dementia and chronic pain.

METHOD

A pilot randomized controlled trial was conducted with 41 residents from three Australian nursing homes. People living with dementia and chronic pain were randomized into either a 30-minute daily social robot (PARO) condition or a usual care condition for six weeks. Sleep and motor activity were assessed by actigraphy at four-time points: week 0 at baseline, week one, week six, and after the intervention. Data were reduced into daytime (8:00am - 7:59pm) and night-time (8:00pm - 7:59am) summaries. Change scores for each time point compared with baseline were computed for data analysis and the generalized estimating equation model with imbalanced baseline values added as covariates were performed.

RESULTS

At week one, residents in the PARO group had a greater increase in the night sleep period (1.81, 95 % CI: 0.22-3.84, p = 0.030, Cohen's d = 0.570). At week six, residents in the PARO group showed a greater increase in daytime wakefulness (1.91, 95 % CI: 0.09-3.73, p = 0.042, Cohen's d = 0.655) and a greater reduction in daytime sleep (-1.35, 95 % CI: -2.65 to -0.05, p = 0.040, Cohen's d = 0.664). No significant results were found for motor activity.

CONCLUSION

PARO could improve sleep patterns for nursing home residents living with dementia and chronic pain, but the effect of PARO on motor activity needs further research. Australian New Zealand Clinical Trials Registry (ACTRN12618000082202).