A multi-perspective evaluation of a service robot for seniors: the voice of different stakeholders

A scoping review of the use of intelligent assistive technologies in rehabilitation practice with older adults

PURPOSE

There is growing interest in intelligent assistive technologies (IATs) in the rehabilitation and support of older adults, however, the factors contributing to or preventing their use in practice are not well understood. This study aimed to develop an overview of current knowledge on barriers and facilitators to the use of smart technologies in rehabilitative practice with older adults.

MATERIALS AND METHODS

We undertook a scoping review following guidelines proposed by Arksey and O'Malley (2005) and Levac et al. (2010). A computerised literature search was conducted using the Scopus and Ovid databases, yielding 7995 citations. Of these, 94 studies met inclusion criteria. Analysis of extracted data identified themes which were explored in semi-structured interviews with a purposefully selected sample of seven clinical rehabilitation practitioners (three physical therapists, two occupational therapists, and two speech-language pathologists).

RESULTS

Barriers and facilitators to using these technologies were associated with accessibility, reported effectiveness, usability, patient-centred considerations, and staff considerations.

CONCLUSIONS

Collaborative efforts of policy-makers, researchers, manufacturers, rehabilitation professionals, and older persons are needed to improve the design of technologies, develop appropriate funding and reimbursement strategies, and minimise barriers to their appropriate use to support independence and quality of life. Any strategies to improve upon barriers to prescribing smart technologies for older people should leverage the expertise of rehabilitation professionals operating at the interface between older people; their health/mobility; their families; and technology-based solutions.

Humanoid robots for assisting people with physical disabilities in activities of daily living: a scoping review

The aim of this scoping review was to gather, summarize, and map the knowledge of peoples' experiences on humanoid robots, capable of assisting people with activities of daily living. The review was guided by the framework of Joanna Briggs Institute and PRISMA-ScR. We found 44 papers describing nine robots that could assist with a variety of tasks listed in the International Classification of Functioning, Disability, and Health. The mixed population experienced little or no anxiety toward the robots, and most accepted the robots' ability to monitor for safety reasons. Some participants disliked the robots' large size and slow movements. Most of the participants found the robots easy to use. They wanted improvements in the robots' functionality and the ability to personalize services. Several of the participants found the services interesting and useful, but not for themselves. The experiences of humanoid robotic assistance showed an insufficient level of technical readiness for assisting in physical assistance, a lack of personalization and readiness for use in home settings. The practical relevance of these findings lies in guiding future research and development toward a more individualized approach focusing on user needs and experiences to enhance the efficacy and integration of humanoid robots in health-care.

When a notification at the right time is not enough: the reminding process for socially assistive robots in institutional care

Reminding is often identified as a central function of socially assistive robots in the healthcare sector. The robotic reminders are supposed to help people with memory impairments to remember to take their medicine, to drink and eat, or to attend appointments. Such standalone reminding technologies can, however, be too demanding for people with memory injuries. In a co-creation process, we developed an individual reminder robot together with a person with traumatic brain injury and her care personnel. During this process, we learned that while current research describe reminding as a prototypical task for socially assistive robots, there is no clear definition of what constitutes a reminder nor that it is based on complex sequences of interactions that evolve over time and space, across different actions, actors and technologies. Based on our data from the co-creation process and the first deployment, we argue for a shift towards a sequential and socially distributed character of reminding. Understanding socially assistive robots as rehabilitative tools for people with memory impairment, they need to be reconsidered as interconnected elements in institutional care practices instead of isolated events for the remindee.

Care-receivers with physical disabilities' perceptions on having humanoid assistive robots as assistants: a qualitative study

BACKGROUND

People with physical disabilities due to disease or injury face barriers to their daily activities and participation in society. Many depend on formal or informal caregivers for assistance to live independently. However, future healthcare challenges due to demographic changes threaten access to home care and assistants. Assistive technologies, such as robots for physical assistance, can support the independence and autonomy of people with physical disabilities. This study explore Norwegian care-receivers' perceptions of using robot assistance in their homes, including preferences for tasks acceptable or unacceptable for robot assistance and the underlying reasons.

METHOD

Purposive sampling was employed to recruit 18 participants, aged between 18 and 77 years, with differences in physical function including diagnoses such as stroke, spinal cord injury, amputations, and muscular dystrophy. Qualitative data were gathered through four focus group interviews wherein participants watched videos featuring a humanoid assistive robot, EVEr3. The collected data underwent analysis using reflexive thematic analysis.

RESULTS

Three themes with associated sub-themes were constructed: (a) How a robot could assist in daily life, (b) The robot's appearance and functionality, and (c) Concerns about having a robot as an assistant. The participants welcomed the idea of a future robotic assistant in areas that may contribute to an increased feeling of independence and autonomy.

CONCLUSION

A robot assisting in activities of daily living would need to be individually customized to meet the needs of each user in terms of which tasks to assist with, how to assist in these defined tasks, and how it is controlled.

The perspectives of older adults with mild cognitive impairment and their caregivers on the use of socially assistive robots in healthcare: exploring factors that influence attitude in a pre-implementation stage

BACKGROUND

Due to increasing age and an increasing prevalence rate of neurocognitive disorders such as Mild Cognitive Impairment (MCI) and dementia, independent living may become challenging. The use of socially assistive robots (SARs) is one solution that can enable older adults with cognitive impairment to remain independent. However, at present, there is a lack of knowledge about the attitudes of older adults with MCI and their caregivers towards SARs.

METHODS

This study relies on a constructivist grounded theory approach. Semi-structured interviews were conducted to gain a deeper insight into attitudes of two different stakeholder groups; older adults with MCI and their (in)formal caregivers.

RESULTS

Forty individual semi-structured interviews were conducted with older adults with MCI (N = 30) and (in)formal caregivers (N = 10). Data revealed different perspectives on SARs in healthcare for the involved stakeholders. Two main topics could be derived: (1) perspectives on robot assistance, discussing different viewpoints on the potential value of robots as helpers, and (2) perspectives on implementation, revealing different factors that could affect implementation. Both topics may explain a positive, impartial or negative attitude towards SARs.

CONCLUSIONS

This study identified different factors that should be taken into account when implementing a SAR in the home environment of older adults. Despite the fact that the benefits of SARs are often recognized, many older participants currently seem not ready yet to commit to the use of a SAR.IMPLICATIONS FOR REHABILITATIONThis study explores the attitudes towards a SAR, developed to stimulate and support older adults with Mild Cognitive Impairment (MCI) on a physical, cognitive and social level.The results give a deeper insight into different factors contributing to a (non-) successful implementation of SARs in the home environment of older adults with MCI.

The Godspeed Questionnaire Series in the Assessment of the Social Robot TIAGo by Older Individuals

(1) Background: A robot in care for older adults requires solid research confirming its acceptance. The aim of this study was to present the Polish version of the Godspeed Questionnaire Series (GQS) and assess the perception of the social robot TIAGo; (2) Methods: The study involved older individuals living in the community and care homes and measured perception after interaction with TIAGo using five series of GQS (S1: Anthropomorphism, S2: Animacy, S3: Likeability, S4: Perceived intelligence, and S5: Perceived safety); (3) Results: We studied 178 individuals (age: 75.2 ± 9.6 years, 103 women). Good internal consistency was found. Cronbach's Alpha was 0.90 for the entire tool (from 0.75 to 0.94 for the individual series). Mean scores for S1 and S2 were comparable but lower than all others (p < 0.001). Average scores for S3 and S4 did not differ but were higher than those of S5. Age, gender and education did not impact the answers, as did the ease of use of technology and self-assessment of independence. Solely, the place of residence influenced the results of S3 and S5; people living in institutions scored higher (p < 0.05 and p < 0.001, respectively); (4) Conclusions: Acceptance does not go hand in hand with the perception of anthropomorphism and animacy.

The Effects of Stakeholder Perceptions on the Use of Humanoid Robots in Care for Older Adults: Postinteraction Cross-Sectional Study

BACKGROUND

Efficient use of humanoid social robots in the care for older adults requires precise knowledge of expectations in this area. There is little research in this field that includes the interaction of stakeholders with the robot. Even fewer studies have compared the perceptions of older people (as care recipients) and professional caregivers (representing those taking care of older adults in teams with robots).

OBJECTIVE

The aim of this study was to analyze whether specific aspects of the perceptions about humanoid robots influence attitudes after interacting with the robot and to compare the opinions of different stakeholders (older people and their professional caregivers) on this topic. We analyzed the potential impact of the differences in perception of the robot between stakeholder groups with respect to how the robot should be designed and tailored to fit the specific needs of future users. We also attempted to define areas where targeted educational activities could bring the attitudes of the two groups of stakeholders closer to each other.

METHODS

The studied group was a conveniently available sample of individuals who took part in the presentation of and interaction with a humanoid social robot. Among them, there were 48 community-dwelling older adults (aged ≥60 years), who were participants of day care units (which may signal the presence of self-care needs), and 53 professional caregivers. The participants were asked to express their views after an interaction with a humanoid social robot (TIAGo) using the Users' Needs, Requirements and Abilities Questionnaire (UNRAQ) and the Godspeed Questionnaire Series (GQS).

RESULTS

Compared to the caregivers, older adults not only assessed the robot more positively with respect to its roles as a companion and assistant (P=.009 and P=.003, respectively) but also had higher scores on their need to increase their knowledge about the robot (P=.049). Regarding the robot's functions, the greatest differences between groups were observed for the social aspects on the UNRAQ, including decreasing the sense of loneliness (P=.003) and accompanying the user in everyday activities (P=.005). As for the GQS, the mean scores of the Animacy, Likeability, and Perceived Intelligence scales were significantly higher for older participants than for caregivers (P=.04, P<.001, and P<.001, respectively). The only parameter for which the caregivers' scores were higher than those of the older adults was the Artificial-Lifelike item from the Anthropomorphism scale of the GQS (P=.03).

CONCLUSIONS

The acceptance of the social functions of a humanoid robot is related to its perception in all analyzed aspects, whereas the expected usefulness of a care robot is not linked to aspects of anthropomorphism. Successful implementation of robots in the care for older people thus depends on considering not only the fears, needs, and requirements of various stakeholders but also on the perceptions of the robot. Given the differences between the stakeholders, targeted and properly structured educational and training activities for caregivers and prospective users may enable a seamless integration of robotic technologies in care provision.

An integrative review on the acceptance of artificial intelligence among healthcare professionals in hospitals

Artificial intelligence (AI) in the domain of healthcare is increasing in prominence. Acceptance is an indispensable prerequisite for the widespread implementation of AI. The aim of this integrative review is to explore barriers and facilitators influencing healthcare professionals' acceptance of AI in the hospital setting. Forty-two articles met the inclusion criteria for this review. Pertinent elements to the study such as the type of AI, factors influencing acceptance, and the participants' profession were extracted from the included studies, and the studies were appraised for their quality. The data extraction and results were presented according to the Unified Theory of Acceptance and Use of Technology (UTAUT) model. The included studies revealed a variety of facilitating and hindering factors for AI acceptance in the hospital setting. Clinical decision support systems (CDSS) were the AI form included in most studies (n = 21). Heterogeneous results with regard to the perceptions of the effects of AI on error occurrence, alert sensitivity and timely resources were reported. In contrast, fear of a loss of (professional) autonomy and difficulties in integrating AI into clinical workflows were unanimously reported to be hindering factors. On the other hand, training for the use of AI facilitated acceptance. Heterogeneous results may be explained by differences in the application and functioning of the different AI systems as well as inter-professional and interdisciplinary disparities. To conclude, in order to facilitate acceptance of AI among healthcare professionals it is advisable to integrate end-users in the early stages of AI development as well as to offer needs-adjusted training for the use of AI in healthcare and providing adequate infrastructure.

Socially Assistive Devices in Healthcare-a Systematic Review of Empirical Evidence from an Ethical Perspective

Socially assistive devices such as care robots or companions have been advocated as a promising tool in elderly care in Western healthcare systems. Ethical debates indicate various challenges. An important part of the ethical evaluation is to understand how users interact with these devices and how interaction influences users' perceptions and their ability to express themselves. In this review, we report and critically appraise findings of non-comparative empirical studies with regard to these effects from an ethical perspective.Electronic databases and other sources were queried using a comprehensive search strategy generating 9851 records. Studies were screened independently by two authors. Methodological quality of studies was assessed. For 22 reports on 21 datasets using a non-comparative design a narrative synthesis was performed.Data shows positive findings in regard to attitudes and emotional reactions of users. Varying perception of a social relation and social presence are the most commonly observed traits of interaction. Users struggle with understanding technical complexities while functionality of the devices is limited. This leads to a behavioral alignment of users towards the requirements of the devices to be able to make use of them.This evidence adds to three important ethical debates on the use of socially assistive devices in healthcare in regard to (1) reliability of existing empirical evidence to inform normative judgements, (2) ethical significance of the social presence of devices and (3) user autonomy in regard to behavioral alignment.

Social Values of Care Robots

Care robots have the potential to address the challenge of aging societies, such as labor shortages or the aging workforce. While previous studies have focused mainly on the productivity or workability of care robots, there has been an increasing need to understand the social value of care robots. This study attempted to identify the social values of care robots by conducting focus group interviews (FGIs) with twenty-four care recipients and caregivers and by using analytic hierarchy processes (AHPs) with thirteen individuals with expertise in the care service and care robot industries. Our results show that the labor- and health-related benefits, the technology innovation, and the provision of essential care work have the highest importance among the criteria of care robots' social values. The criteria that receive lowest priority are cost, the autonomy and needs of the care recipients, and the organizational innovation. Our study suggests that along with the private benefits and costs of care robots, their social values also need to be considered to improve the quality of care and to unlock the potential of the care robot industries.

Dances with Social Robots: A Pilot Study at Long-Term Care

Dance therapy can have significant physical, emotional and cognitive benefits for older adults. In particular, social robots can be developed to autonomously facilitate dance sessions to engage these individuals with the aim of improving quality of life. To successfully integrate and promote long-term use of social robots into long-term care homes for such recreational activities, it is important to explore both residents’ and staff’s perceptions of such robots. In this paper, we present the first pilot human–robot interaction study that investigates the overall experiences and attitudes of both residents and staff in a long-term care home for robot-facilitated dance sessions. In general, the questionnaire results from our study showed that both staff and residents had positive attitudes towards the robot-facilitated dance activity. Encouraging trends showed residents had higher ratings for statements on perceived ease of use, safety, and enjoyment than the staff. However, the staff had a statistically significantly higher rating for willingness to use the robots for dance facilitation. Some key statistical differences were also determined with respect to: (1) gender within the resident group (men had higher ratings for the robots being useful in helping facilitate recreational activities), as well as between staff and residents (resident men had higher perceived safety), and (2) prior robot experience (residents with limited prior experience had higher ratings on perceived ease of use and perceived enjoyment than staff with the same level of experience). The robot-facilitated dance activity was positively received by both older adults and staff as an activity of daily living that can enhance wellbeing while also being safe, easy to use and enjoyable.

No thank you to humanized robots: attitudes to care robots in elder care services

The growing older population will increase the demands on the health and welfare systems, including elder care services. One way of meeting these growing service needs is to shift from traditional care services to technologically oriented services. Robotic innovations are gradually being introduced to elder care services. The aim was to explore attitudes toward the use of care robots in elder care services - specifically focusing on situations and interaction, influence, and emotions in interaction with care robots. Data were obtained from visitors at a welfare technology fair (n = 124). The results show that the most negative attitudes concerned if the care robots were humanized and had emotions. The attitudes toward interacting with care robots in general were predominately positive. In conclusion, concrete usage scenarios in elder care services need to be detected, based both on users' needs, digital literacy and on the maturity of the technology itself.

Designing Robots for Elderly from the Perspective of Potential End-Users: A Sociological Approach

The proposed research aims to investigate the problem of age-friendly robot designing from the perspective of the potential end-users. The initial objectives addressed three main issues: how the elderly envision robots and their knowledge on technological development; age-friendly robot design; the elderly's involvement in the robot design process. The empirical material analyzed are the results of in-depth interviews with people aged 70+. A sociological approach is proposed, based mainly on criticism of writing and the analytical and synthetic method. The theoretical framework is the perspective of an ageing society and technogerontology. The sociological approach enables better understanding of the sensitive problems of age-friendly robot designing from the individual point of view. It is concluded with a conceptual discussion on designing robots for the elderly. In particular, it is revealed how these issues could help in shaping social consensus about age-friendly technologies.

Robots in Eldercare: How Does a Real-World Interaction with the Machine Influence the Perceptions of Older People?

(1) Background: Using autonomous social robots in selected areas of care for community-dwelling older adults is one of the promising approaches to address the problem of the widening care gap. We posed the question of whether a possibility to interact with the technology to be used had an impact on the scores given by the respondents in various domains of needs and requirements for social robots to be deployed in care for older individuals. (2) Methods: During the study, the opinions of older people (65+; n = 113; with no severe cognitive impairment) living in six social care institutions about a robot in care for older people were collected twice using the Users’ Needs, Requirements and Abilities Questionnaire (UNRAQ): after seeing a photo of the robot only and after a 90−150 min interaction with the TIAGo robot. (3) Results: Mean total scores for both assistive and social functions were higher after the interaction (p < 0.05). A positive correlation was found between opinion changes in social and assistive functions (r = 0.4842; p = 0.0000). (4) Conclusions: Preimplementation studies and assessments should include the possibility to interact with the robot to provide its future users with a clear idea of the technology and facilitate necessary customisations of the machine.

User-Centered Design of Companion Robot Pets Involving Care Home Resident-Robot Interactions and Focus Groups With Residents, Staff, and Family: Qualitative Study

Background

Globally, pressure is increasing on health and social care resources due to the aging population and growing prevalence of dementia. Companion robots, such as Paro, demonstrate strong potential for helping reduce this pressure through reported benefits including reduced agitation, depression, loneliness, care provider burden, and medication use. However, we previously identified that user-centered design of robot pets is both essential and understudied. We observed that commonly used robot pets are poorly matched to end-user requirements, and that end users and developers of robot pets differ significantly in their perception of appropriate design. This may explain some of the contradictory outcome research and variance in results for robot pets, such as Paro.

Objective

In response to the literature gap, we aimed to provide user-centered insights into the design of robot pets from key stakeholders to inform future robot development and the choice of robots for real-world implementation and research. We focused on understanding user requirements.

Methods

We conducted a qualitative study with 65 participants from 5 care homes (26 care home residents, 29 staff members. and 10 family members). Care home residents formed groups of between 3 and 4 individuals and experienced free interactions with a range of 8 companion robots and toys, including Paro and more affordable alternatives. The robots provided had a range of esthetics, shell types, interactivity levels, and designs for comparison. Care staff and family members observed the interactions. All participants then engaged in focus groups within their stakeholder category to discuss preferences and user requirements in companion robot design. Both free interactions and focus groups were video and audio recorded, transcribed, and subjected to thematic analysis.

Results

Care home residents, family members, and staff were open and accepting of the use of companion robot pets, with the majority suggesting that they would keep a device for themselves or the residents. The most preferred device was the Joy for All cat, followed by the Joy for All dog. In discussions, the preferred design features included familiar animal embodiment (domestic pet), soft fur, interactivity, big appealing eyes, simulated breathing, and movements. Unfamiliar devices were more often seen as toy-like and suitable for children, producing some negative responses.

Conclusions

This work provides important and user-centered insights into future robot designs for care home residents by means of a comprehensive comparison with key stakeholders. This work strongly supports the use of familiar embodiment in future robot pet designs, with domestic cat and dog morphologies appearing most acceptable. The results have implications for future robot designs and the selection of robot pets for both research and real-world implementations.

Titrating Support: Stakeholder Perspectives on Improving a Mobile Telepresence Robot for People with Alzheimer's Disease and Related Dementias (Preprint)

Background

By 2050, nearly 13 million Americans will have Alzheimer disease and related dementias (ADRD), with most of those with ADRD or mild cognitive impairment (MCI) receiving home care. Mobile telepresence robots may allow persons with MCI or ADRD to remain living independently at home and ease the burden of caregiving. The goal of this study was to identify how an existing mobile telepresence robot can be enhanced to support at-home care of people with MCI or ADRD through key stakeholder input.

Objective

The specific aims were to assess what applications should be integrated into the robot to further support the independence of individuals with MCI or ADRD and understand stakeholders’ overall opinions about the robot.

Methods

We conducted in-person interviews with 21 stakeholders, including 6 people aged >50 years with MCI or ADRD living in the community, 9 family caregivers of people with MCI or ADRD, and 6 clinicians who work with the ADRD population. Interview questions about the robot focused on technology use, design and functionality, future applications to incorporate, and overall opinions. We conducted a thematic analysis of the data obtained and assessed the patterns within and across stakeholder groups using a matrix analysis technique.

Results

Overall, most stakeholders across groups felt positively about the robot’s ability to support individuals with MCI or ADRD and decrease caregiver burden. Most ADRD stakeholders felt that the greatest benefits would be receiving help in emergency cases and having fewer in-person visits to the doctor’s office. Caregivers and clinicians also noted that remote video communication with their family members using the robot was valuable. Adding voice commands and 1-touch lifesaving or help buttons to the robot were the top suggestions offered by the stakeholders. The 4 types of applications that were suggested included health-related alerts; reminders; smart-home–related applications; and social, entertainment, or well-being applications. Stakeholders across groups liked the robot’s mobility, size, interactive connection, and communication abilities. However, stakeholders raised concerns about their physical stability and size for individuals living in smaller, cluttered spaces; screen quality for those with visual impairments; and privacy or data security.

Conclusions

Although stakeholders generally expressed positive opinions about the robot, additional adaptations were suggested to strengthen functionality. Adding applications and making improvements to the design may help mitigate concerns and better support individuals with ADRD to live independently in the community. As the number of individuals living with ADRD in the United States increases, mobile telepresence robots are a promising way to support them and their caregivers. Engaging all 3 stakeholder groups in the development of these robots is a critical first step in ensuring that the technology matches their needs. Integrating the feedback obtained from our stakeholders and evaluating their effectiveness will be important next steps in adapting telepresence robots.

UNRAQ-A Questionnaire for the Use of a Social Robot in Care for Older Persons. A Multi-Stakeholder Study and Psychometric Properties

(1) Background: while there exist validated measures to assess the needs of older people, there are comparatively few validated tools to assess needs and requirements for the use of robots. Henceforth, the aim of the study is to present and validate such a tool. (2) Methods: The study group included 720 subjects (mean age 52.0 ± 37.0, 541 females) who agreed to fill the Users' Needs, Requirements, and Abilities Questionnaire (UNRAQ). The validation part of the study included 125 persons. (3) Results: the acceptance of the robot was good in the whole group. The social functions were rated worse than assistive ones. A correlation was found between the scores of social and assistive functions. The respondents claimed that older adults were not prepared to interact with the robot and not very good at handling it, and were sceptical about their willingness to learn to operate the robot. The Cronbach alpha value for the whole questionnaire was 0.95 suggesting excellent internal consistency, and the ICC value of 0.88 represents excellent agreement; (4) Conclusions: We observed a good overall acceptance of the robot across the studied group. There is considerable demand for the use of a social robot in care for older people.

Status and Influential Factors of Intelligent Healthcare in Nursing Homes in China

With the support of the Chinese government, nursing homes have increasingly adopted Internet and intelligent information technology to provide daily healthcare services to residents. However, no research has reported the status of intelligent healthcare in nursing homes. From September 2017 to May 2018, we conducted a survey of 197 nursing homes and collected information on their general characteristics, the intelligent healthcare services provided, the effectiveness of the application products used, and the attitudes of the staff and residents toward intelligent healthcare. Overall, 79.69% of the surveyed nursing homes have provided intelligent healthcare services, including medical care services (eg, chronic disease management and intelligent nursing) and daily life services (eg, fall monitoring and wireless positioning). Portable health monitoring devices and data management and service platforms are the most used healthcare products. The attitudes of staff probably affected the development of intelligent healthcare. Financial investment and the attitudes of staff and residents are factors that influence the effectiveness of the application of intelligent healthcare products in nursing homes. With the support of national policies, nursing homes have implemented primary intelligent healthcare. Stakeholders play pivotal roles in the provision of intelligent healthcare services.

Humanoid robots in the care of older persons: A scoping review

The aim was to examine how humanoid robots have been used in the care of older persons and identify possible benefits and challenges associated with such use from older persons' points of view. The study was a scoping review based on Arksey and O'Malley's methodological framework. To identify peer-reviewed and non-peer-reviewed literature, a systematic search of the PubMed, Cinahl and Google Scholar electronic databases was conducted for studies published between 2013 and 2019. The PRISMA-ScR guidelines have served as a guideline. A total of 12 studies were included and resulted in four main categories related to how humanoid robots have been used in care of older persons (domain of use): Supports everyday life, Provides interaction, Facilitates cognitive training and Facilitates physical training. Potential for humanoid robots to be accepted as companions for older persons was seen, but technical issues, such as humanoid robots' slow response time or errors, emerged as key challenges. Older persons' perceived enjoyment of using a humanoid robot might also decrease over time. Validated measurements to estimate the effectiveness of using humanoid robots in the care of older persons are needed.

Exploring the Potential of Emerging Technologies to Meet the Care and Support Needs of Older People: A Delphi Survey

Some emerging technologies have potential to address older people’s care and support needs. However, there is still a gap in the knowledge on the potential uses of these technologies in some care domains. Therefore, a two-round Delphi survey was conducted to establish a consensus of opinion from a group of health and social technology experts (n = 21) on the potential of 10 emerging technologies to meet older people’s needs in five care and support domains. Experts were also asked to provide reasons for their choices in free-text spaces. The consensus level was set at 70%. Free-text responses were analyzed using thematic analysis. Voice activated devices was the technology that reached experts consensus in all assessed care domains. Some technologies (e.g., Artificial intelligence (AI) enabled apps and wearables and Internet of things (IoT) enabled homes) also show potential to support basic self-care and access to healthcare needs of older people. However, most of the remaining technologies (e.g., robotics, exoskeletons, virtual and augmented reality (VR/AR)) face a range of technical and acceptability issues that may hinder their adoption by older people in the near future. Findings should encourage the R & D community to address some of the identified challenges to improve the adoption of emerging technologies by older people.

Implementation of robotic devices in nursing care. Barriers and facilitators: an integrative review

BACKGROUND

Robots in healthcare are gaining increasing attention; however, their implementation is challenging due to the complexity of both interventions themselves and the contexts in which they are implemented. The objective of this integrative review is to identify barriers to and facilitators of the implementation of robotic systems in nursing.

METHODS

Articles published from 2002 to 2019 reporting on projects to implement robotic devices in nursing care were searched on Medline (via PubMed), CINAHL and databases on funded research projects (Community Research and Development Information Services and Technische Informationsbibliothek) and in journals for robotic research in November 2017 and July 2019 for an update. No restrictions regarding study designs were imposed. All included articles underwent quality assessments with design-specific critical appraisal tools. Barriers to and facilitators of implementation were classified using the Context and Implementation of Complex Interventions framework.

RESULTS

After removing all duplicates, the search revealed 11 204 studies, of which 17 met the inclusion criteria and were included in the synthesis. The majority of the studies dealt with the implementation of robots designed to support individuals, either living at home or in nursing homes (n=11). The studies were conducted in Europe, the USA and New Zealand and were carried out in nursing homes, individual living environments, hospital units and laboratories. The quality of reporting and quality of evidence were low in most studies. The most frequently reported barriers were in socioeconomic and ethical domains and were within the implementation outcomes domain. The most frequently reported facilitators were related to the sociocultural context, implementation process and implementation strategies.

DISCUSSION

This review identified barriers to and facilitators of the implementation of robotic devices in nursing within different dimensions. The results serve as a basis for the development of suitable implementation strategies to reduce potential barriers and promote the integration of elements to facilitate implementation.

PROSPERO REGISTRATION NUMBER

CRD42018073486.

An Acceptance Test for Assistive Robots

Socially assistive robots have been used in the care of elderly or dependent people, particularly with patients suffering from neurological diseases, like autism and dementia. There are some proposals, but there are no standardized mechanisms for assessing a particular robot’s suitability for specific therapy. This paper reports the evaluation of an acceptance test for assistive robots applied to people with dementia. The proposed test focuses on evaluating the suitability of a robot during therapy sessions. The test measures the rejection of the robot by the patient based on observational data. This test would recommend what kind of robot and what functionalities can be used in therapy. The novelty of this approach is the formalization of a specific validation process that only considers the reaction of the person to whom the robot is applied, and may be used more effectively than existing tests, which may not be adequate for evaluating assistance robots. The test’s feasibility was tested by applying it to a set of dementia patients in a specialized care facility.

The Feasibility and Utility of a Personal Health Record for Persons With Dementia and Their Family Caregivers for Web-Based Care Coordination: Mixed Methods Study

Background

Managing the complex and long-term care needs of persons living with Alzheimer disease and related dementias (ADRD) can adversely impact the health of informal caregivers and their care recipients. Web-based personal health records (PHRs) are one way to potentially alleviate a caregiver’s burden by simplifying ADRD health care management

Objective

This study aimed to evaluate Personal Health Record for Persons with Dementia and Their Family Caregivers (PHR-ADRD), a free web-based information exchange tool, using a multiphase mixed methods approach.

Methods

Dementia caregivers (N=34) were surveyed for their well-being and perceptions of PHR-ADRD feasibility and utility at 6 and 12 months using close- and open-ended questions as well as a semistructured interview (n=8). Exploratory analyses compared participants’ characteristics as well as PHR-ADRD use and experiences based on overall favorability status.

Results

Feasibility and utility scores decreased over time, but a subset of participants indicated that the system was helpful. Quantitative comparisons could not explain why some participants indicated favorable, neutral, or unfavorable views of the system overall or had not engaged with PHR-ADRD. Qualitative findings suggested that technology literacy and primary care provider buy-in were barriers. Both qualitative and qualitative findings indicated that time constraints to learn and use the system affected most participants.

Conclusions

Development and dissemination of PHRs for family caregivers of persons with ADRD should aim to make systems user-friendly for persons with limited time and technological literacy. Establishing health care provider buy-in may be essential to the future success of any PHR system.

Significant challenges when introducing care robots in Swedish elder care

Introduction: Care robots are machines, operating partly or completely autonomously, that are intended to assist older people and their caregivers. Care robots are seen as one part of the solution to the aging population, allowing fewer professional caregivers to provide the necessary assistance and care. Despite the potential benefits, the dissemination of care robots, and welfare technology in general, is limited in Swedish elder care.Purpose: To explore the challenges of introducing welfare technology, particularly care robots, in elder care.Materials and methods: Twenty-one individual interviews with key actors at the societal level, analysed by thematic analysis.Results: The challenges, from the societal actors' perspectives, were related to; the beliefs in technology, attitudes, ethics, collaboration, and the need for knowledge and skills regarding care robots (individual and group challenges). Challenges of a national character were: national governance, infrastructure, laws and regulations, economics, and procurement (systemic and societal challenges). In addition, the necessary preconditions for successful introduction were revealed as: the utility of the technology, implementation, evaluation and safety, security, and integrity (preconditional challenges).Conclusions: The introduction of care robots in elder care services seems to be more challenging than that of welfare technology in general, given the context and prevailing attitudes and preconceptions about robotics. Significant challenges need to be managed, at all levels of the society, before care robots can become an integral part of daily care and assist older people and their caregivers in activities and rehabilitation.IMPLICATION FOR REHABILITATIONThe challenges described by the societal actors', are partly similar to those of the end users', in terms of attitudes, ethics, knowledge and skills, and collaboration. This consensus should provide a solid foundation for the conceptualization and introduction of care robots in elderly care.The challenges follow the pattern of an ecosystem involving all sections of society, which are intertwined and require consideration before the expected benefits can be realised.A user-centred approach is necessary to support the design, implementation, and usefulness of care robots and their suitability for meeting the real needs of older persons and professional caregivers.

Technological Frames and Care Robots in Eldercare

Care robots are often portrayed as an exciting new technology for improving care practices. Whether these robots will be accepted and integrated into care work or not, is likely to be affected by the assumptions, expectations and understandings held by potential end users, such as frontline staff and the people that are cared for. This paper describes how the conceptual framework of technological frames was used to identify the nature of care robots, care robots in use and care robot strategy as shared group level assumptions, expectations and understandings of care robots among care staff and potential care receivers. Focus groups were conducted with 94 participants. These groups consisted of line managers, frontline care staff, older people and students training to become carers. The technological frame of the nature of care robots revealed two complementary components: care robots as a threat to the quality of care, and care robots as substitute for humans and human care, held together by imaginaries of care robots. The technological frame of care robots in use revealed aspects of prospective end-users’ uncertainty of their ability to handle care robots, and their own perceived lack of competence and knowledge about care robots. In addition, the following potential criteria for successful use of care robots were identified: adequate training, incentives for usage (needs and motives), usability, accessibility and finances. The technological frame of care robot strategy was revealed as believed cost savings and staff reduction. The novelty of the results, and their relevance for science and practice, is derived from the theoretical framework which indicates that adoption of care robots will be dependent on how well societies succeed in collectively shaping congruent technological frames among different stakeholders and aligning technological development accordingly.

A Systematic Review of Robotics Research in Support of In-Home Care for Older Adults

The aging population is growing at an unprecedented rate globally and robotics-enabled solutions are being developed to provide better independent living for older adults. In this study, we report the results from a systematic review of the state-of-the-art in home robotics research for caring for older adults. This review aims to address two questions: (1) What research is being done towards integrating robotics for caring for older adults? (2) What are the research and technology challenges that robots are facing in the home? Sixty-three papers have been identified and studied in this review by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Common themes that are consistent across the reviewed papers are distinguished and consolidated as follows: (1) Ambient assisted living, where smart home environments and physical support tools are studied; (2) Robot ecosystem, where robotic devices are used to provide various services; (3) Social interaction, where the social isolation problem has been targeted. We also summarize the results of similar literature reviews we came across during our search. The results of this study present the current research trends and technologies used in each category. The challenges and limitations of robotics applications are also identified. Suggestions for accelerating the deployment of robots at home for providing older adults with independent care in the home are presented based on the results and insights from this study.

Care Robot Orientation: What, Who and How? Potential Users’ Perceptions

Exploring the specific field of care robot orientation generates many questions regarding the meaning, content and how it should be conducted. The issue is important due to the general digitalisation and implementation of welfare technology and care robots. The aim of the study was to explore perceptions of care robot orientation from the potential users’ perspective. Data were collected by focus group interviews in Finland, Germany and Sweden. In all three countries, potential user groups were represented: older adults, relatives, professional caregivers and care service managers. A qualitative descriptive method was used for analysing data. The data revealed three aspects of care robot orientation: (1) What care robot orientation is, (2) Who needs it and by Whom it should be given and (3) How it should be performed. The need for care robot orientation is general in society. In the absence of knowledge about care robots, it is nearly impossible to know what to ask for or actually seek information about. Therefore, care robot orientation must be founded on agile implementation planning for care robots, with a firm basis in trustworthy knowledge and information and respecting individuals’ wishes. This also gives rise to an ethical challenge when care robots are offered to people having reduced decision-making ability (dementia, cognitive impairment), along with the issue of who then should make the decision. The mapping of the What, Who/Whom and How aspects of care robot orientation offers a foundation for the creation of orientation models, which might facilitate structured and goal-oriented care robot orientation strategies.

Enablers and barriers to the implementation of socially assistive humanoid robots in health and social care: a systematic review

OBJECTIVES

Socially assistive humanoid robots are considered a promising technology to tackle the challenges in health and social care posed by the growth of the ageing population. The purpose of our study was to explore the current evidence on barriers and enablers for the implementation of humanoid robots in health and social care.

DESIGN

Systematic review of studies entailing hands-on interactions with a humanoid robot.

SETTING

From April 2018 to June 2018, databases were searched using a combination of the same search terms for articles published during the last decade. Data collection was conducted by using the Rayyan software, a standardised predefined grid, and a risk of bias and a quality assessment tool.

PARTICIPANTS

Post-experimental data were collected and analysed for a total of 420 participants. Participants comprised: older adults (n=307) aged ≥60 years, with no or some degree of age-related cognitive impairment, residing either in residential care facilities or at their home; care home staff (n=106); and informal caregivers (n=7).

PRIMARY OUTCOMES

Identification of enablers and barriers to the implementation of socially assistive humanoid robots in health and social care, and consequent insights and impact. Future developments to inform further research.

RESULTS

Twelve studies met the eligibility criteria and were included. None of the selected studies had an experimental design; hence overall quality was low, with high risks of biases. Several studies had no comparator, no baseline, small samples, and self-reported measures only. Within this limited evidence base, the enablers found were enjoyment, usability, personalisation and familiarisation. Barriers were related to technical problems, to the robots' limited capabilities and the negative preconceptions towards the use of robots in healthcare. Factors which produced mixed results were the robot's human-like attributes, previous experience with technology and views of formal and informal carers.

CONCLUSIONS

The available evidence related to implementation factors of socially assistive humanoid robots for older adults is limited, mainly focusing on aspects at individual level, and exploring acceptance of this technology. Investigation of elements linked to the environment, organisation, societal and cultural milieu, policy and legal framework is necessary.

PROSPERO REGISTRATION NUMBER

CRD42018092866.

Older People’s Needs and Opportunities for Assistive Technologies

Older adults experience a disconnect between their needs and adoption of technologies that have potential to assist and to support more independent living. This paper reviewed research that links people’s needs with opportunities for assistive technologies. It searched 13 databases identifying 923 papers with 34 papers finally included for detailed analysis. The research papers identified needs in the fields of health, leisure, living, safety, communication, family relationship and social involvement. Amongst these, support for activities of daily living category was of most interest. In specific sub-categories, the next most reported need was assistive technology to support walking and mobility followed by smart cooking/kitchen technology and assistive technology for social contacts with family member/other people. The research aimed to inform a program of research into improving the adoption of technologies where they can ameliorate identified needs of older people.