How do "robopets" impact the health and well-being of residents in care homes? A systematic review of qualitative and quantitative evidence

Tackling social disconnection: an umbrella review of RCT-based interventions targeting social isolation and loneliness

BACKGROUND

Social isolation and loneliness are urgent public health concerns associated with negative physical and mental health outcomes. Understanding effective remedies is crucial in addressing these problems. This umbrella review aimed to synthesize and critically appraise scientific evidence on the effectiveness of social isolation and loneliness interventions overall and across subgroups. We focused on systematic reviews (SRs) of randomized controlled trials (RCTs).

METHODS

We searched seven databases (June 2022 and updated June 2023) and supplemented the search with grey literature and reference screening to identify SRs published since 2017. Screening, data extraction, and quality assessment using the AMSTAR2 tool were conducted independently by author pairs, with disagreements resolved through discussion.

RESULTS

We included 29 SRs, 16 with meta-analysis and 13 with narrative synthesis. All SRs focused on loneliness, with 12 additionally examining social isolation. Four SRs focused on young people, 11 on all ages, and 14 on older adults. The most frequently examined intervention types were social (social contact, social support), psychological (therapy, psychoeducation, social skills training), and digital (e.g., computer use and online support). Meta-analyses indicated small-to-moderate beneficial effects, while narrative synthesis demonstrated mixed or no effect. Social interventions for social isolation and psychological interventions for loneliness were the most promising. However, caution is warranted due to the effects' small magnitude, significant heterogeneity, and the variable quality of SRs. Digital and other interventions showed mixed or no effect; however, caution is advised in interpreting these results due to the highly diverse nature of the interventions studied.

CONCLUSIONS

This overview of SRs shows small to moderate effectiveness of social interventions in reducing social isolation and psychological ones in tackling loneliness. Further rigorously conducted RCTs and SRs are needed to guide policy decisions regarding the implementation of efficacious and scalable interventions. Evaluation should focus on both preventive structural interventions and tailored mitigating strategies that address specific types and causes of loneliness.

Efficacy of relational agents for loneliness across age groups: a systematic review and meta-analysis

BACKGROUND

Loneliness is a serious public health concern. Although previous interventions have had some success in mitigating loneliness, the field is in search of novel, more effective, and more scalable solutions. Here, we focus on "relational agents", a form of software agents that are increasingly powered by artificial intelligence and large language models (LLMs). We report on a systematic review and meta-analysis to investigate the impact of relational agents on loneliness across age groups.

METHODS

In this systematic review and meta-analysis, we searched 11 databases including Ovid MEDLINE and Embase from inception to Sep 16, 2022. We included randomised controlled trials and non-randomised studies of interventions published in English across all age groups. These loneliness interventions, typically attempt to improve social skills, social support, social interaction, and maladaptive cognitions. Peer-reviewed journal articles, books, book chapters, Master's and PhD theses, or conference papers were eligible for inclusion. Two reviewers independently screened studies, extracted data, and assessed risk of bias via the RoB 2 and ROBINS-I tools. We calculated pooled estimates of Hedge's g in a random-effects meta-analysis and conducted sensitivity and sub-group analyses. We evaluated publication bias via funnel plots, Egger's test, and a trim-and-fill algorithm.

FINDINGS

Our search identified 3,935 records of which 14 met eligibility criteria and were included in our meta-analysis. Included studies comprised 286 participants with individual study sample sizes ranging from 4 to 42 participants (x̄ = 20.43, s = 11.58, x̃ = 20). We used a Bonferroni correction with αBonferroni = 0.05 / 4 = 0.0125 and applied Knapp-Hartung adjustments. Relational agents reduced loneliness significantly at an adjusted αBonferroni (g = -0.552; 95% Knapp-Hartung CI, -0.877 to -0.226; P = 0.003), which corresponds to a moderate reduction in loneliness.

CONCLUSION

Our results are currently the most comprehensive of their kind and provide promising evidence for the efficacy of relational agents. Relational agents are a promising technology that can alleviate loneliness in a scalable way and that can be a meaningful complement to other approaches. The advent of LLMs should boost their efficacy, and further research is needed to explore the optimal design and use of relational agents. Future research could also address shortcomings of current results, such as small sample sizes and high risk of bias. Particularly young audiences have been overlooked in past research.

Making robots matter in dementia care: Conceptualising the triadic interaction between caregiver, resident and robot animal

While previous research studies have focused on either caregivers' or residents' perception and use of social robots, this article offers an empirical and theoretical examination of joint activities in triadic human-robot interaction. The symptomatology of dementia creates an asymmetrical relation wherein the impetus to employ a robot often originates from the caregiver. Drawing on field work and video recorded interactions in dementia care homes, the article investigates how caregivers draw on embodied resources to involve residents and robot animals in interaction. The analysis demonstrates how caregivers promote commitment and encounter resistance with residents. We draw on the theory of sociomaterial interactionism to study situated interaction between bodies in a meaning-generating process. By re-conceptualising the theoretical notions of manipulation and recruitment, the article offers an approach for studying orientations that distinguish between reciprocity of agential objects. We show that caregivers usually distinguish between interactions with people and machines by anticipating a specific response from the robots (manipulation), while they invite participation in a broader sense from residents (recruitment). Social friction arises, however, if caregivers act upon the residents as embodied objects in manipulative ways.

No playing around with robots? Ambivalent attitudes toward the use of Paro in elder care

This paper explores the ways in which health care professionals, family carers, and older persons expressed attitudes and opinions on using Paro, a social robot designed to stimulate patients with dementia. Thereafter, we critically evaluate existing prejudicial views toward Paro users to provide recommendations for its future use. Using an exploratory qualitative interview method, we recruited a total of 67 participants in Switzerland. They included 23 care professionals, 17 family carers, and 27 older persons. Data obtained were analyzed thematically. Study findings present general agreement that Paro is an appealing and beneficial social robot, but it is not a tool that everyone feels comfortable with. Because it is perceived as "child play," it would be demeaning for competent adults to play with such things. Consequently, Paro is appropriate only for persons with dementia. These findings brought forth ethical concerns about deception, infantilization, and respecting older persons' dignity. The idea of who is an appropriate Paro user led to our discussions on predicting future Paro users. The meaning of using social robotics in nursing homes can be conditioned by a rigid interpretation of adulthood and playful behavior. To protect future selves when one is living with dementia from prejudices, it may be useful for older persons and their loved ones to plan their future care situations to ensure that they are treated in accordance with their delineated decisions.

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.

The effects of aftercare/resettlement services on crime and violence in children and youth: A systematic review

Background

High rates of youth re-offending indicate that young custody-leavers face challenges when reintegrating into their communities. Aftercare and resettlement programs can occur pre-, during, and post-release and generally provide multiple forms of support services to address youths' transitional needs.

Objectives

The present review examines (1) the impact of youth aftercare/resettlement programs on crime-related outcomes, (2) how treatment effect is moderated by participant, program, and study characteristics, (3) whether some types of interventions are more effective than others, (4) barriers/facilitators to effective program implementation, (5) the theory of change underlying resettlement interventions, and (6) available research on intervention cost.

Search Methods

A comprehensive set of keywords and synonyms was combined in a Boolean search across 26 electronic databases. Multiple gray literature sources were also searched, including 23 journals, 4 meeting archives, 11 organization websites, 3 open access journal websites, and the CVs of 8 well-known researchers in the field. The search was completed in January 2023.

Selection Criteria

For objectives 1-3, studies were included if they utilized a randomized controlled design or quasi-experimental comparison group design in which participants were matched on at least some baseline variables and included at least one quantitative individual-measure of crime. For objective 4, included studies presented process evaluations of aftercare/reentry programs, clearly stated their research goals, and used qualitative methods in an appropriate way to answer the stated research question. For objectives 5 and 6, no specific methods were required; any study meeting the criteria for objectives 1-4 which presented findings on theory of change or cost data were included. For all outcomes, only studies conducted in a westernized country, and published after 1991 in English, French, or German were considered.

Data Collection and Analysis

Two coders conducted primary data extraction for the included studies. Data were entered into a Microsoft Excel database. After data extraction, the two coders validated the coding by cross-checking the database with each research report. Discrepancies between coders were discussed until consensus was reached. Where consensus could not be reached, a third coder was consulted. Study risk of bias was addressed using the ROBINS-I (Sterne et al., 2016), ROB-2 (Higgins et al., 2019), and the critical appraisal skills programme (CASP, 2018). Objectives 1-3 were addressed by synthesizing quantitative outcomes from rigorous impact evaluations of aftercare interventions using random effects models and meta-regression. Thematic and narrative analysis was conducted to address objectives 4-6.

Results

The search resulted in 15 impact studies, representing 4,718 participants across 21 program sites, and 35 effect sizes. The 21 impact evaluations were rated as having either low/moderate bias (k = 11) or serious bias (k = 10). The synthesis of 15 impact studies found no significant effects for arrest (k = 14; OR = 1.044, 95% prediction interval [0.527, 2.075], t = 0.335) or incarceration (k = 8, OR = 0.806, 95% prediction interval [2.203, 1.433], t = -1.674). A significant pooled effect was found for conviction (k = 13, OR = 1.209, 95% prediction interval [1.000, 1.462], t = 2.256), but results were highly sensitive to the inclusion of specific studies. No meaningful pattern of results emerged in moderator analyses with respect to study, sample, program component, or program delivery characteristics. The 19 process studies were rated as either high quality (k = 12) or moderate quality (k = 7). Thematic synthesis of the process evaluations revealed 15 themes related to the strengths/challenges of program implementation. The assessment of program cost (k = 7) determined a lack of data within the literature, preventing any summative analysis.

Authors' Conclusions

Current evidence is promising with respect to conviction outcomes but overall does not find that aftercare/resettlement interventions have a reliably positive impact on crime-related outcomes for young people who have offended. High variability across outcomes and reported data resulted in small sample sizes per outcome and limited moderator analyses. Multiple challenges for program implementation exist; additional rigorous research is sorely needed to further investigate the nuances of the program effects.

Can 'What Is Known' about Social Isolation and Loneliness Interventions Sufficiently Inform the Clinical Practice of Health Care and Social Service Professionals Who Work with Older Adults? Exploring Knowledge-to-Practice Gaps

Establishing intervention effectiveness is an important component of a broader knowledge translation (KT) process. However, mobilizing the implementation of these interventions into practice is perhaps the most important aspect of the KT cycle. The purpose of the current study was to conduct an umbrella review to (a) identify promising interventions for SI&L in older adults, (b) interpret (translate) the findings to inform clinical knowledge and practice interventions in different settings and contexts, and (c) highlight research gaps that may hinder the uptake of these interventions in practice. The broader purpose of this study was to inform evidence-based clinical practice guidelines on SI&L for HCSSPs. In line with other reviews, our study noted variations in methods and intervention designs that prohibit definitive statements about intervention effectiveness. Perhaps, the most significant contribution of the current review was in identifying knowledge-to-practice gaps that inhibit the implementation of interventions into practice-based realities.

Exploring the impact of socially assistive robots on health and wellbeing across the lifespan: An umbrella review and meta-analysis

BACKGROUND

Socially assistive robots offer an alternate source of connection for interventions within health and social care amidst a landscape of technological advancement and reduced staff capacity. There is a need to summarise the available systematic reviews on the health and wellbeing impacts to evaluate effectiveness, explore potential moderators and mediators, and identify recommendations for future research and practice.

OBJECTIVE

To explore the effect of socially assistive robots within health and social care on psychosocial, behavioural, and physiological health and wellbeing outcomes across the lifespan (PROSPERO registration number: CRD42023423862).

DESIGN

An umbrella review utilising meta-analysis, narrative synthesis, and vote counting by direction of effect.

METHODS

14 databases were searched (ProQuest Health Research Premium collection, Scopus, PubMed, Web of Science, ASM Digital Library, IEEE Xplore, Cochrane Reviews, and EPISTEMONIKOS) from 2005 to May 4, 2023. Systematic reviews including the effects of socially assistive robots on health outcomes were included and a pooled meta-analysis, vote counting by direction of effect, and narrative synthesis were applied. The second version of A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2) was applied to assess quality of included reviews.

RESULTS

35 reviews were identified, most focusing on older adults with or without dementia (n = 24). Pooled meta-analysis indicated no effect of socially assistive robots on quality of life (standard mean difference (SMD) = 0.43), anxiety (SMD = -0.02), or depression (SMD = 0.21), although vote counting identified significant improvements in social interaction, mood, positive affect, loneliness, stress, and pain across the lifespan, and narrative synthesis identified an improvement in anxiety in children. However, some reviews reported no significant difference between the effects of socially assistive robots and a plush toy, and there was no effect of socially assistive robots on psychiatric outcomes including agitation, neuropsychiatric symptoms, and medication use.

DISCUSSION

Socially assistive robots show promise for improving non-psychiatric outcomes such as loneliness, positive affect, stress, and pain, but exert no effect on psychiatric outcomes such as depression and agitation. The main mechanism of effect within group settings appeared to be the stimulation of social interaction with other humans. Limitations include the low quality and high amount of overlap between included reviews.

CONCLUSION

Socially assistive robots may help to improve loneliness, social interaction, and positive affect in older adults, decrease anxiety and distress in children, and improve mood, stress, and reduce pain across the lifespan. However, before recommendations for socially assistive robots can be made, a cost-effectiveness analysis of socially assistive robots to improve mood across the lifespan, and a quantitative analysis of the effects on pain, anxiety, and distress in children are required.

Robotic misinformation in dementia care: emotions as sense-making resources in residents' encounters with robot animals

Robot animals, designed to mimic living beings, pose ethical challenges in the context of caring for vulnerable patients, specifically concerning deception. This paper explores how emotions become a resource for dealing with the misinformative nature of robot animals in dementia care homes. Based on observations of encounters between residents, care workers, and robot animals, the study shows how persons with dementia approach the ambiguous robots as either living beings, material artifacts, or something in-between. Grounded in interactionist theory, the research demonstrates that emotions serve as tools in the sense-making process, occurring through interactions with the material object and in collaboration with care workers. The appreciation of social robots does not solely hinge on them being perceived as real or fake animals; persons with dementia may find amusement in "fake" animals and express fear of "real" ones. This observation leads us to argue that there is a gap between guidelines addressing misinformation and robots and the specific context in which the technology is in use. In situations where small talk and play are essential activities, care workers often prioritize responsiveness to residents rather than making sure that the robot's nature is transparent. In these situations, residents' emotional expressions serve not only as crucial resources for their own sense-making but also as valuable indicators for care workers to comprehend how to navigate care situations.

Assimilation of socially assistive robots' by older adults: an interplay of uses, constraints and outcomes

By supporting autonomy, aging in place, and wellbeing in later life, Socially Assistive Robots are expected to help humanity face the challenges posed by the rapid aging of the world's population. For the successful acceptance and assimilation of SARs by older adults, it is necessary to understand the factors affecting their Quality Evaluations Previous studies examining Human-Robot Interaction in later life indicated that three aspects shape older adults' overall QEs of robots: uses, constraints, and outcomes. However, studies were usually limited in duration, focused on acceptance rather than assimilation, and typically explored only one aspect of the interaction. In the present study, we examined uses, constraints, and outcomes simultaneously and over a long period. Nineteen community-dwelling older adults aged 75-97 were given a SAR for physical training for 6 weeks. Their experiences were documented via in-depth interviews conducted before and after the study period, short weekly telephone surveys, and reports produced by the robots. Analysis revealed two distinct groups: (A) The 'Fans' - participants who enjoyed using the SAR, attributed added value to it, and experienced a successful assimilation process; and (B) The 'Skeptics' - participants who did not like it, negatively evaluated its use, and experienced a disappointing assimilation process. Despite the vast differences between the groups, both reported more positive evaluations of SARs at the end of the study than before it began. Overall, the results indicated that the process of SARs' assimilation is not homogeneous and provided a profound understanding of the factors shaping older adults' QE of SARs following actual use. Additionally, the findings demonstrated the theoretical and practical usefulness of a holistic approach in researching older SARs users.

Bridging gaps in the design and implementation of socially assistive technologies for dementia care: the role of occupational therapy

Dementia is a global health challenge, and people living with dementia (PLWD) are especially susceptible to reduced engagement in meaningful occupations, including social participation. In the past few decades, socially assistive technologies continue to be developed amidst a rapidly evolving technological landscape to support the social health of PLWD and their caregivers. Examples include social robots, virtual reality, smart home technology, and various digital technologies, such as mobile applications for tablets and smartphones. Despite an increasing body of research and interest in this field, several gaps relating to the design and implementation process of socially assistive technologies continue to undermine their relevance for PLWD in daily life. In this paper, some of these gaps are highlighted and the role of occupational therapy in the design and implementation of socially assistive technology is presented. In the design process, occupational therapists are uniquely skilled to advise and advocate for the tailoring and personalisation of technology to address the occupational needs of PLWD. In the implementation of socially assistive technologies, occupational therapists are skilled to educate, train, and conduct ongoing evaluations with PLWD and their caregivers, to incorporate socially assistive technologies into their routine and daily lives. We recommend that occupational therapists should continue to be acquainted with such technologies through continuous professional development and educational curricula. Moreover, we highlight the necessary collaboration between occupational therapists, technology developers, and researchers to enhance the process of designing and implementing socially assistive technology, so that their relevance for PLWD and their caregivers can be maximised.Implications for rehabilitationDevelopers and designers of socially assistive technology should consider the disease trajectory of different types of dementia, as well as the different needs, abilities, preferences, occupations and routines of people living with dementia (PLWD) and/or their caregivers.Collaborations between technology developers, researchers, and occupational therapists should take place iteratively throughout the process of designing and implementing socially assistive technology to maximise their relevance and applicability for people living with dementia and their caregivers.To continue enhancing the current role of occupational therapy in socially assistive technology provision, occupational therapists should keep up to date with socially assistive technology that are being developed to support the social health of PLWD.

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.

Effectiveness of social support programmes on loneliness in community-dwelling older adults: study protocol for a meta-analysis of randomised controlled trials

BACKGROUND

The prevalence of loneliness among older adults is of great importance in the field of public health. Numerous studies have provided evidence supporting the effectiveness of social support as a powerful intervention for reducing loneliness in older individuals. However, the specific types of social support that yield positive results are yet to be determined. Therefore, this study aims to conduct a comprehensive review to compare and analyse the effectiveness of different support mechanisms in alleviating loneliness among community-dwelling older adults.

METHODS AND ANALYSIS

A thorough search will be conducted on various electronic databases, including EMBASE, PubMed, the Cochrane Library, Web of Science, PsycINFO, Scopus, Google Scholar, China National Knowledge Infrastructure Library, China Science and Technology Journal Database (Weipu), WanFang Database, and China Biology Medicine Disc. The search will include randomised controlled trials published in English or Chinese that focus on interventions for loneliness in older individuals, with loneliness as the primary measure of interest. The selection and choice of articles will be the responsibility of both reviewers. The JBI Critical Appraisal Checklist for Randomised Controlled Trials will be used to assess the methodological quality of the included trials. When sufficient data are obtained and the study is relatively homogeneous, a random-effects or fixed-effects model will be employed to conduct a meta-analysis, yielding a descriptive synthesis of the findings.

ETHICS AND DISSEMINATION

Ethics approval will not be sought for this systematic review as it will exclusively focus on published papers. The review findings will be showcased at a conference dedicated to this specific field and published in an appropriate journal that undergoes peer evaluation.

PROSPERO REGISTRATION NUMBER

CRD42020226523.

Digital interventions to reduce social isolation and loneliness in older adults: An evidence and gap map

Background

Social isolation and loneliness are more common in older adults and are associated with a serious impact on their well-being, mental health, physical health, and longevity. They are a public health concern highlighted by the COVID-19 pandemic restrictions, hence the need for digital technology tools to enable remotely delivered interventions to alleviate the impact of social isolation and loneliness during the COVID-19 restrictions.

Objectives

To map available evidence on the effects of digital interventions to mitigate social isolation and/or loneliness in older adults in all settings except hospital settings.

Search Methods

We searched the following databases from inception to May 16, 2021, with no language restrictions. Ovid MEDLINE, Embase, APA PsycInfo via Ovid, CINAHL via EBSCO, Web of Science via Clarivate, ProQuest (all databases), International Bibliography of the Social Sciences (IBSS) via ProQuest, EBSCO (all databases except CINAHL), Global Index Medicus, and Epistemonikos.

Selection Criteria

Titles and abstracts and full text of potentially eligible articles were independently screened in duplicate following the eligibility criteria.

Data Collection and Analysis

We developed and pilot tested a data extraction code set in Eppi-Reviewer and data were individually extracted and coded based on an intervention-outcome framework which was also used to define the dimensions of the evidence and gap map.

Main Results

We included 200 articles (103 primary studies and 97 systematic reviews) that assessed the effects of digital interventions to reduce social isolation and/or loneliness in older adults. Most of the systematic reviews (72%) were classified as critically low quality, only 2% as high quality and 25% were published since the COVID-19 pandemic. The evidence is unevenly distributed with clusters predominantly in high-income countries and none in low-income countries. The most common interventions identified are digital interventions to enhance social interactions with family and friends and the community via videoconferencing and telephone calls. Digital interventions to enhance social support, particularly socially assistive robots, and virtual pets were also common. Most interventions focused on reducing loneliness and depression and improving quality of life of older adults. Major gaps were identified in community level outcomes and process indicators. No included studies or reviews assessed affordability or digital divide although the value of accessibility and barriers caused by digital divide were discussed in three primary studies and three reviews. Adverse effects were reported in only two studies and six reviews. No study or review included participants from the LGBTQIA2S+ community and only one study restricted participants to 80 years and older. Very few described how at-risk populations were recruited or conducted any equity analysis to assess differences in effects for populations experiencing inequities across PROGRESS-Plus categories.

Authors' Conclusions

The restrictions placed on people during the pandemic have shone a spotlight onto social isolation and loneliness, particularly for older adults. This evidence and gap map shows available evidence on the effectiveness of digital interventions for reducing social isolation or loneliness in older adults. Although the evidence is relatively large and recent, it is unevenly distributed and there is need for more high-quality research. This map can guide researchers and funders to consider areas of major gaps as priorities for further research.

Potential Facilitators of and Barriers to Implementing the MINI Robot in Community-Based Meeting Centers for People With Dementia and Their Carers in the Netherlands and Spain: Explorative Qualitative Study

BACKGROUND

Social robots, as a form of digital health technologies, are used to support emotional, cognitive, and physical care and have shown promising outcomes in enhancing social well-being in people with dementia (PwD) by boosting emotions, social interactions, and activity participation.

OBJECTIVE

The goal is to investigate the attitude of stakeholders and potential facilitators and the barriers to implementing the social robot MINI in community-based meeting centers (MCs) for PwD and carers in the Netherlands and Spain.

METHODS

Based on the British Medical Research Council guidance for process evaluation of the implementation of complex interventions and the model for tracing the facilitators of and barriers to the adaptive implementation of innovations in dementia care, an explorative qualitative study was conducted. Following the introduction of the MINI robot, 11 stakeholders were interviewed in 3 MCs in the Netherlands and 1 in Spain, as well as stakeholders in health and welfare organizations in both countries. In addition, 12 adults with dementia participated in focus groups. The data were thematically analyzed and narratively described.

RESULTS

Overall, the stakeholder opinion and interest in the MINI robot were positive. The most important (expected) facilitating factors mentioned by stakeholders appeared to be human resources, funding, the impact of the MINI robot on the users and programs of the MCs, characteristics of the innovation, and collaboration with other care and welfare organizations. However, the (expected) barriers mentioned concerned the physical context and functionalities of the MINI robot, the user context, and MC activity policies.

CONCLUSIONS

The findings will inform professional stakeholders, such as MC directors and managers, as well as care and welfare organizations, on the practicality of using the MINI robot in MCs. Furthermore, our research will aid MINI robot developers in tailoring its features to PwD's preferences and demands and MC policies, which will contribute to the MINI robot's effective adoption and deployment.

The Impact of Socially Assistive Robots on Human Flourishing in the Context of Dementia: A Scoping Review

Socially assistive robots are being developed and tested to support social interactions and assist with healthcare needs, including in the context of dementia. These technologies bring their share of situations where moral values and principles can be profoundly questioned. Several aspects of these robots affect human relationships and social behavior, i.e., fundamental aspects of human existence and human flourishing. However, the impact of socially assistive robots on human flourishing is not yet well understood in the current state of the literature. We undertook a scoping review to study the literature on human flourishing as it relates to health uses of socially assistive robots. Searches were conducted between March and July 2021 on the following databases: Ovid MEDLINE, PubMed and PsycINFO. Twenty-eight articles were found and analyzed. Results show that no formal evaluation of the impact of socially assistive robots on human flourishing in the context of dementia in any of the articles retained for the literature review although several articles touched on at least one dimension of human flourishing and other related concepts. We submit that participatory methods to evaluate the impact of socially assistive robots on human flourishing could open research to other values at stake, particularly those prioritized by people with dementia which we have less evidence about. Such participatory approaches to human flourishing are congruent with empowerment theory.

Animal-assisted and robotic animal-assisted interventions within dementia care: A systematic review

BACKGROUND

Animal-assisted interventions and robotic animal interventions are becoming increasingly popular to support the care of people with dementia and may have the potential to improve a range of psychosocial outcomes. This review aims to identify, describe, and compare animal-assisted and robotic animal interventions delivered to people with dementia, their characteristics, effectiveness, and the proposed mechanisms underlying any potential impact.

METHODS

A systematic literature search was conducted in MEDLINE, AMED, EMBASE, PsycINFO, OVID Nursing, PubMed, CINAHL and Web of Science. Random-effects meta-analyses of randomised controlled trials (RCTs) were conducted to summarise studies that evaluated common outcomes (agitation, depression, quality of life). A narrative approach was used to synthesise other findings.

RESULTS

Fifty-one studies were included: 18 RCTs; 12 non-randomised trials, 13 cohort studies, 7 qualitative studies and one mixed-methods study. Meta-analyses were conducted for a small number of RCTs, with effectiveness of animal-assisted interventions demonstrated for agitation. Narrative findings suggested animal-assisted and robotic animal interventions may be promising in improving depression, agitation, and quality of life. Three potential mechanisms of action were identified for both animal-assisted and robotic animal interventions, namely enhancing social connections, providing engaging and meaningful activities, and the affect-generating aspect of the human-animal bond. A fourth mechanism was identified for animal-assisted interventions only: promoting physical activity. Robotic animals appear to have a place in complex human-animal relationships, but a greater understanding of robotic animal interventions is required to harness the benefits that may be derived from their use.

CONCLUSION

Delivering these interventions appear promising in improving psychosocial outcomes for people with dementia. As most included studies had methodological limitations, these findings are preliminary, but contribute to the body of evidence providing an understanding in terms of intervention characteristics and mechanisms of action. When developing intervention guidance, attention should be given to potential mechanisms and fundamental characteristics such as session content, delivery format and facilitator role.

What are the effects of animals on the health and wellbeing of residents in care homes? A systematic review of the qualitative and quantitative evidence

BACKGROUND

There is some evidence to suggest that animal-assisted interventions can have beneficial impact for residents in long-term care, but the focus of the evidence has largely been on behavioural and psychosocial measured outcomes. Animals, either as companion animals or in the form of pet/animal-assisted therapy, may provide benefits in the form of social contact, as well as opportunities for sensory experiences and meaningful engagement not picked up by outcome tools. This review aimed to create a state-of-knowledge synthesis, bringing together qualitative and quantitative findings, on the impact of animal-human interaction on care home residents and care home staff.

METHODS

Fourteen databases were searched from inception to July 2020. Forward and backward citation chasing of included articles was conducted. Screening was undertaken independently by a team of reviewers. Thematic synthesis and meta-analysis were used to synthesise the qualitative and quantitative data.

RESULTS

Thirty-four studies, published in 40 articles (20 qualitative and 20 quantitative) were included. Five themes relating to resident wellbeing were identified in the qualitative evidence synthesis. These were animals as 'living beings', reminiscence and storytelling, caring (as 'doing' and 'feeling'), respite (from loneliness, institutionalisation, and illness), and sensory engagement. A sixth theme related to staff perceptions and wellbeing, and a seventh to animal health and wellbeing. Maintaining identity was identified as an overarching theme. The majority of randomised trials had small sample sizes and were rated as low quality, mostly showing no evidence of beneficial effect. There was, however, limited evidence of a positive effect of pet/animal interaction on outcomes of loneliness, anxiety and depression, supporting the themes of respite and sensory engagement.

CONCLUSIONS

The presence of animals can significantly impact the health and wellbeing of some care home residents. Residents had meaningful relationships with animals and derived pleasure and comfort from them. Interacting with animals offered residents a way to maintain a sense of self in the care homes, and with support, residents with dementia could also express their identities. Facilitating residents to interact with animals as part of person-centred care may also help residents to feel 'at home' in the care home.

TRIAL REGISTRATION

PROSPERO registration no: CRD42017058201.

[Future trends and possible applications of digital technologies in setting-based prevention and health promotion-a Delphi survey]

BACKGROUND

Digital technologies show a high potential for health promotion and prevention, but an analysis throughout the planning, implementation, and evaluation phases of setting-based health promotion has not yet taken place. It also remains unclear to what extent digital technologies promote participation, partnerships, empowerment, and equity in settings.

PURPOSE

This study is aimed at exploring future trends and possible uses of technologies throughout the phases of setting-based health promotion over the next 5 years. Further, it discusses the use of technologies to build participation, partnerships, empowerment, and equity in settings, and highlights the differences in the predictions of experts from science and practice.

METHOD

A two-stage web-based Delphi survey with experts in setting-based health promotion/prevention was conducted. We conducted a content analysis for open questions and a quantitative analysis for closed questions.

RESULTS

According to the experts (N = 42, complete participation in the first round of the survey), digital transformation will increasingly find its way into the various process phases over the next 5 years. In particular, technologies for behavioral change in hybrid formats are expected. The use of technology in the future can lead to more participation, partnerships, empowerment, and equity in settings on the one hand, but on the other hand can also reinforce exclusion and injustice if no suitable underlying conditions are provided.

DISCUSSION

Research is needed on technologies for changing setting structures. The development of digital competencies and infrastructures in settings is essential to support the development of health-promoting settings digitally.

PROTOCOL: The effects of resettlement/re-entry services on crime and violence in children and youth: A systematic review

This is the protocol for a Campbell systematic review. The goal of the study is to examine the impacts of aftercare/resettlement interventions on youth with respect to criminogenic outcomes, and to examine factors related to intervention success. Specific objectives are as follows: (1) What is the impact of aftercare/resettlement interventions on youth with respect to outcomes of crime and violence? (2) How is the treatment effect of aftercare/resettlement interventions on crime and violence outcomes moderated by factors such as participant (e.g., age, race, ethnicity, sex, offender type), treatment (e.g., intensity and quality of implementation), methodological (e.g., measurement of crime, study design, timing of follow-up measures), and study characteristics (e.g., date of publication, peer-reviewed status)? (3) Are some types of aftercare/resettlement interventions more effective than others? (4) What are the barriers and facilitators to effective implementation of aftercare/resettlement interventions? (5) What are the mechanisms (theory of change) underlying aftercare/resettlement interventions? (6) What does the available research suggest regarding the cost of aftercare/resettlement interventions?

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.

Use of a Humanoid Robot in Supporting Dementia Care: A Qualitative Analysis

Introduction

Cognitive impairment significantly affects independence in persons with dementia, and consistent supervision is often needed. While interest has arisen in using humanoid robots, such as Pepper, to assist with daily caregiving activities, little is known about the perceptions of using Pepper to assist people with dementia.

Objective

This study aimed to explore the perceptions of nonhealthcare workers, care partners, and healthcare workers on the use of a Pepper robot in dementia care.

Methods

This was a secondary qualitative analysis. Data were collected from a pilot study conducted from November 2020 to March 2021 using an online survey. The survey consisted of quantitative and qualitative questions; this study only focused on the qualitative responses. The detailed procedures and the quantitative results were published elsewhere. Participants included nonhealthcare workers, care partners, and healthcare workers.

Results

A total of 194 participants responded to the open-ended question. Participants described potential benefits of Pepper including assisting with daily activities, monitoring safety and medication use, initiating reminders, and promoting activities and social interactions. Participants had concerns about privacy, cost, poor acceptance/trust, Pepper making mistakes, limitations in environmental navigation and responding to emergencies, misuse of Pepper, and Pepper replacing humans. Participants suggested that Pepper should be tailored to each individual's background, preferences, and functions and recommended improving the logistics of using Pepper, offering more emotional support and responses, and using a more natural appearance and voice.

Conclusion

Pepper may support dementia care; yet some concerns need to be addressed. Future research should consider incorporating these comments when designing robots for dementia care.

The ethics of pet robots in dementia care settings: Care professionals' and organisational leaders' ethical intuitions

BACKGROUND

Pet robots are gaining momentum as a technology-based intervention to support the psychosocial wellbeing of people with dementia. Current research suggests that they can reduce agitation, improve mood and social engagement. The implementation of pet robots in care for persons with dementia raises several ethical debates. However, there is a paucity of empirical evidence to uncover care providers' ethical intuitions, defined as individuals' fundamental moral knowledge that are not underpinned by any specific propositions.

OBJECTIVES

Explore care professionals' and organisational leaders' ethical intuitions before and when implementing pet robots in nursing homes for routine dementia care.

MATERIALS AND METHODS

We undertook a secondary qualitative analysis of data generated from in-depth, semi-structured interviews with 22 care professionals and organisational leaders from eight nursing homes in Ireland. Data were analysed using reflexive thematic analysis. Ethical constructs derived from a comprehensive review of argument-based ethics literature were used to guide the deductive coding of concepts. An inductive approach was used to generate open codes not falling within the pre-existing concepts.

FINDINGS

Ethical intuitions for implementing pet robots manifested at three levels: an (1) individual-relational, (2) organisational and (3) societal level. At the individual-relational level, ethical intuitions involved supporting the autonomy of residents and care providers, using the robots to alleviate residents' social isolation, and the physical and psychosocial impacts associated with their use. Some care providers had differing sentiments about anthropomorphizing pet robots. At the organisational level, intuitions related to the use of pet robots to relieve care provision, changes to the organisational workflow, and varying extents of openness amongst care providers to use technological innovations. At the societal level, intuitions pertained conceptions of dementia care in nursing homes, and social justice relating to the affordability and availability of pet robots. Discrepancies between participants' ethical intuitions and existing philosophical arguments were uncovered.

CONCLUSION

Care professionals and organisational leaders had different opinions on how pet robots are or should be implemented for residents with dementia. Future research should consider involving care practitioners, people with dementia, and their family members in the ethics dialogue to support the sustainable, ethical use of pet robots in practice.

Barriers and facilitators of digital interventions use to reduce loneliness among older adults: a protocol for a qualitative systematic review

INTRODUCTION

Digital interventions are considered as a potential solution to loneliness in older adults. However, this type of intervention has had limited acceptance among older adults (aged ≥60 years). To ensure the use of digital interventions in older adults, possible barriers and facilitating factors should be better understood from the user's perspective. We aim to systematically examine the barriers and facilitators to the implementation of digital interventions designed to reduce loneliness in older adults by identifying, evaluating and synthesising qualitative studies.

METHODS AND ANALYSIS

A comprehensive search of qualitative studies for barriers and facilitators for use of digital interventions will be conducted in the following databases: PubMed, MEDLINE, CINAHL, Embase, Scopus, Cochrane Library and Web of Science. Studies reported in English will be considered for this review. Grey literature will not be included. Two reviewers (HZ and XL) will independently screen the literatures, and any differences will be solved by turning to the third reviewer (JN). The Joanna Briggs Institute (JBI) Qualitative Research Critical Appraisal Checklist will be used by two reviewers to independently assess the validity of the methods used. Relevant data about the populations, context, culture, geographical location, study methods and barriers and facilitators to the implementation of digital interventions will be extracted using the JBI standardised data extraction tool. JBI meta-aggregation methods will be implemented to synthesise the data, which will generate themes and categories based on the data. The final synthesis will establish confidence levels using the JBI ConQual approach.

ETHICS AND DISSEMINATION

The protocol does not require ethical approval. The data are based on published scientific databases. The results will be disseminated through journal articles and scientific conference presentations (if feasible).

PROSPERO REGISTRATION NUMBER

CRD42022328609.

Bond formation with pet-robots: An integrative approach

The challenge of long-term interaction between humans and robots is still a bottleneck in service robot research. To gain an understanding of sustained relatedness with robots, this study proposes a conceptual framework for bond formation. More specifically, it addresses the dynamics of children bonding with robotic pets as the basis for certain services in healthcare and education. The framework presented herein offers an integrative approach and draws from theoretical models and empirical research in Human Robot Interaction and also from related disciplines that investigate lasting relationships, such as human-animal affiliation and attachment to everyday objects. The research question is how children’s relatedness to personified technologies occurs and evolves and what underpinning processes are involved. The subfield of research is child-robot interaction, within the boundaries of social psychology, where the robot is viewed as a social agent, and human-system interaction, where the robot is regarded as an artificial entity. The proposed framework envisions bonding with pet-robots as a socio-affective process towards lasting connectedness and emotional involvement that evolves through three stages: first encounter, short-term interaction and lasting relationship. The stages are characterized by children’s behaviors, cognitions and feelings that can be identified, measured and, maybe more importantly, managed. This model aims to integrate fragmentary and heterogeneous knowledge into a new perspective on the impact of robots in close and enduring proximity to children.

Digital care technologies in people with dementia living in long-term care facilities to prevent falls and manage behavioural and psychological symptoms of dementia: a systematic review

Fall prevention and management of behavioural and psychological symptoms of dementia (BPSD) in long-term care (LTC) facility is a major challenge. The objective of this systematic review is to assess the evidence of digital technology in their management. All studies of English-language excluding case-reports were eligible for review. Databases chosen were MEDLINE, EMBASE, Scopus, Web of Science and PSYCINFO from January 2000 to June 2020. Downs and Black checklist was used to check for risk of bias. Papers with a focus in LTC setting, using digital technology as intervention for older adults with dementia, and with measurable outcomes (outcomes that are quantified, not descriptive) were included in the final review. Seventeen original papers (8 RCTs, 8 quasi-experimental and 1 mixed method) were included. Three articles examining position-sensor technology for fall prevention showed mixed results. Two showed no difference and 1 showed small reduction in fall after alarm removal but the positive effect might be due to bias. Overall, the sample sizes were too small to draw meaningful conclusion. Fourteen studies (9 pet robots of which 8 were robotic seal/PARO) were identified for BPSD and results were mixed. Overall, PARO might have modest benefit in BPSD compared to usual care but might be no better than plush toy with more hallucinations or delusions seen in advanced dementia. However, the significant heterogeneity in methodology (intervention intensity, lack of record in psychoactive drug use), clinical tools used (different BPSD scales, different digital technologies) and variability in outcomes made it difficult to draw clear-cut conclusion. Studies involving other digital technologies are scarce and in pilot phases; hence, conclusion is premature. One limitation of the review was that only 9 out of 17 studies were of good quality. The limited research work in position-sensors meant insufficient evidence to prove efficacy for their use in LTC setting. The possible modest benefit of PARO in BPSD (e.g. in agitation, apathy or reduction in psychoactive drugs) was off-set by possible adverse events such as delusions or hallucinations in advanced dementia.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10433-021-00627-5.

Emotionale Reaktionen älterer Menschen gegenüber Sozial Assistiven Robotern

Dieser Beitrag der Zeitschrift Gruppe. Interaktion. Organisation. (GIO) beschreibt unterschiedliche emotionale Reaktionen älterer Personen auf in verschiedenen Settings eingesetzte Sozial Assistive Roboter (SAR). In Folge des demographischen Wandels gibt es zunehmend mehr Personen in hohem Lebensalter, welche zuhause oder in Institutionen Unterstützung benötigen. Der Einsatz von Robotern zur Unterstützung wird als eine Möglichkeit gesehen, den gesellschaftlichen Herausforderungen zu begegnen. Gerade SAR werden zunehmend für ältere Personen erprobt und eingesetzt. Systematische Reviews zeigen das positive Potenzial von SAR auf ältere Menschen hinsichtlich (sozial-)psychologischer und physiologischer Parameter, gleichzeitig hat der Einsatz von SAR bei älteren Menschen eine intensive ethische Diskussion ausgelöst. Emotionen von Nutzenden gegenüber Robotern stehen dabei im Fokus, da diese einen wichtigen Aspekt der Akzeptanz und Wirkung darstellen. Dabei werden vor allem Fragen, die mit einer emotionalen Bindung an den Roboter zusammenhängen, kritisch diskutiert. Das Institut für Altersforschung (IAF) der Ostschweizer Fachhochschule (OST) hat im Rahmen von Feldtestungen mit unterschiedlichen SAR bei unterschiedlichen Personengruppen und Einsatzbereichen geforscht. Im Rahmen einer Sekundäranalyse wurden eine Bandbreite emotionaler Reaktionen bis hin zu Bindungen der verschiedenen Nutzergruppen registriert. Es konnte gezeigt werden, dass sozio-emotionale Bedürfnisse von Nutzenden durch den SAR gestillt werden können, und es zu Ablehnung kommen kann, wenn diesen nicht Rechnung getragen wird. Emotionale Bindungen sind jedoch differenziert zu betrachten, da der Einsatz von SAR, gerade bei vulnerablen Personen, trotz funktionaler Bindung auch neu induzierte negative Gefühle hervorrufen kann. Beim Einsatz von SAR in der Praxis es ist wichtig, alle Emotionen der Nutzenden gegenüber SAR frühzeitig zu erheben und im Hinblick auf mögliche unterwünschte Wirkungen wie (zu) starkem emotionalen Attachment zu beurteilen. Die dargestellten explorativen Studien ermöglichen es, exemplarische Einsatzfelder mit positivem Potential zu definieren, aber auch ethisch problematische Situationen zu beschreiben, um diese in Zukunft vermeiden zu können.

Exploring the effect of implementing affordable socially assistive pet robots in eight care homes before and during the COVID-19 pandemic: a stratified cluster randomised controlled trial and mixed-method study

Background

Robot pets may assist in the challenges of supporting an aging population with growing dementia prevalence. Prior work has focused on the impacts of the robot seal Paro on older adult well-being, but recent studies have suggested the good acceptability and implementation feasibility of more affordable devices (Joy for All [JfA] cats and dogs).

Objective

We aimed to address the limited effectiveness research on JfA devices.

Methods

We conducted an 8-month, stratified, cluster randomized controlled trial in 8 care homes in Cornwall, United Kingdom. Over 4 months, 4 care homes each received 2 JfA devices (1 cat and 1 dog; intervention group), and 4 homes received care as usual (control group). Psychometrics were collected before and after the intervention to compare the change from baseline to follow-up between the groups. In the final 4 months, all 8 care homes received devices, but only qualitative data were collected owing to COVID-19 and reduced capacity. The primary outcome was neuropsychiatric symptoms (Neuropsychiatric Inventory [NPI] Nursing Home version). Care provider burden was a secondary outcome (occupational disruptiveness NPI subscale), alongside the Challenging Behavior scale, the Holden communication scale, the Campaign to End Loneliness questionnaire, and medication use. Qualitative data were collected through care staff observation calendars and end-of-study interviews to understand use, experience, and impact. We also collected demographic data and assessed dementia severity. In total, 253 residents had robot interaction opportunities, and 83 were consented for direct data collection.

Results

There was a significant difference in the total change from baseline to follow-up between the intervention and control groups for NPI (P<.001) and occupational disruptiveness (P=.03). Neuropsychiatric symptoms increased in the control group and decreased in the intervention group. No significant difference was seen for communication issues or challenging behavior. For NPI subdomains, there were significant differences from baseline to follow-up in delusions (P=.03), depression (P=.01), anxiety (P=.001), elation (P=.02), and apathy (P=.009), all of which decreased in the intervention group and increased slightly in the control group. The summative impact results suggested that most residents (46/54, 85%) who interacted with robots experienced a positive impact. Those who interacted had significantly higher dementia severity scores (P=.001). The qualitative results suggested good adoption, acceptability, and suitability for subjectively lonely individuals and lack of a novelty effect through sustained use, and demonstrated that the reasons for use were entertainment, anxiety, and agitation.

Conclusions

Affordable robot pets hold potential for improving the well-being of care home residents and people with dementia, including reducing neuropsychiatric symptoms and occupational disruptiveness. This work suggests no novelty effect and contributes toward understanding robot pet suitability. Moreover, interactions were more common among residents with more moderate/severe dementia and those subjectively lonely.

Trial Registration

ClinicalTrials.gov NCT04168463; https://www.clinicaltrials.gov/ct2/show/NCT04168463

The effect of cognitive function healthcare using AI robot for older adults: A systematic review and meta-analysis

Background

With rapidly aging populations in most parts of the world, it is only natural that the need for caregivers for older adults is going to increase in the near future. Therefore, most technologically proficient countries are in the process of using artificial intelligence (AI) to build socially assistive robots (SAR) to play the role of caregivers in enhancing interaction and social participation among older adults.

Objective

This study aimed to examine the effect of intervention through AI SAR on the cognitive function of older adults through a systematic literature review.

Methods

We conducted a meta-analysis of the various existing studies on the effect of AI SAR on the cognitive function of older adults to standardize the results and clarify the effect of each method and indicator. Cochrane collaboration and the systematic literature review flow of PRISMA (Preferred Reporting Item Systematic Reviews and Meta-Analyses) were used on original, peer-reviewed studies published from January 2010 to March 2022. The search words were derived by combining keywords including Population, Intervention, and Outcome—according to the Population, Intervention, Comparison, Outcome, Time, Setting, and Study Design principle—for the question “What is the effect of AI SAR on the cognitive function of older adults in comparison with a control group?” (Population: adults aged ≥65 years; Intervention: AI SAR; Comparison: comparison group; Outcome: popular function; and Study Design: prospective study). For any study, if one condition among subjects, intervention, comparison, or study design was different from those indicated, the study was excluded from the literature review.

Results

In total, 9 studies were selected (6 randomized controlled trials and 3 quasi-experimental design studies) for the meta-analysis. Publication bias was examined using the contour-enhanced funnel plot method to confirm the reliability and validity of the 9 studies. The meta-analysis revealed that the average effect size of AI SAR was shown to be Hedges g=0.43 (95% CI –0.04 to 0.90), indicating that AI SAR are effective in reducing the Mini Mental State Examination scale, which reflects cognitive function.

Conclusions

The 9 studies that were analyzed used SAR in the form of animals, robots, and humans. Among them, AI SAR in anthropomorphic form were able to improve cognitive function more effectively. The development and expansion of AI SAR programs to various functions including health notification, play therapy, counseling service, conversation, and dementia prevention programs are expected to improve the quality of care for older adults and prevent the overload of caregivers. AI SAR can be considered a representative, digital, and social prescription program and a nonpharmacological intervention program that communicates with older adults 24 hours a day. Despite its effectiveness, ethical issues, the digital literacy needs of older adults, social awareness and reliability, and technological advancement pose challenges in implementing AI SAR. Future research should include bigger sample sizes, pre-post studies, as well as studies using an older adult control group.

Determinants of implementing of pet robots in nursing homes for dementia care

BACKGROUND

Pet robots have been employed as viable substitutes to pet therapy in nursing homes. Despite their potential to enhance the psychosocial health of residents with dementia, there is a lack of studies that have investigated determinants of implementing pet robots in real-world practice. This study aims to explore the determinants of implementing pet robots for dementia care in nursing homes, from the perspectives of healthcare professionals and organisational leaders.

METHODS

A descriptive qualitative study, conceptualised and guided using the Consolidated Framework of Implementation Research (CFIR), was conducted. We conducted semi-structured interviews with healthcare professionals and organisational leaders from nursing homes. Data was transcribed and analysed using Framework Analysis, based on the CFIR as an a priori framework.

RESULTS

A total of 22 participants from eight nursing homes were included. Determinants were mapped to constructs from all five CFIR domains. Determinants relating to the characteristics of pet robots include their design, realisticness and interactivity, affordability, cleanability, perceived evidence strength and comparative advantages to live pets. Determinants relating to external influences (outer setting) include national regulatory guidelines, funding and networks with other organisations. With regards to characteristics of nursing homes (inner setting), determinants include the relevance of pet robots in relation to the needs of residents with dementia, alignment with care processes, infection control mandates and their relative priority. In the domain 'characteristics of individuals', determinants were associated with individuals' beliefs on the role of technology, desires to enhance residents' quality of life, and differential attitudes on the use of robots. Finally, in the domain 'implementation process', assessments and care planning were identified as determinants.

CONCLUSIONS

Overall, while sentiments around determinants within CFIR domains of pet robots' characteristics, outer setting and implementation process were similar, participants' opinions on the determinants within the 'inner setting' and 'characteristics of individuals' were more varied. This could be due to different organisational structures, disciplinary differences and personal experiences of using pet robots. Many determinants in different domains were interrelated. Findings provide a springboard for identifying and designing implementation strategies to guide the translation of pet robots from research into real-world practice.

Social Robot Interventions in Mental Health Care and Their Outcomes, Barriers, and Facilitators: Scoping Review

BACKGROUND

The use of social robots as innovative therapeutic tools has been increasingly explored in recent years in an effort to address the growing need for alternative intervention modalities in mental health care.

OBJECTIVE

The aim of this scoping review was to identify and describe social robot interventions in mental health facilities and to highlight their outcomes as well as the barriers and facilitators to their implementation.

METHODS

A scoping review of the literature published since 2015 was conducted using the Arksey and O'Malley's framework. The MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and PsycINFO databases were searched, and 2239 papers were retrieved. The papers included were primary empirical studies published in peer-reviewed literature. Eligible studies were set in mental health facilities and they included participants with a known mental health disorder. The methodological quality of the included papers was also assessed using the Mixed Methods Appraisal Tool.

RESULTS

A total of 30 papers met the eligibility criteria for this review. Studies involved participants with dementia, cognitive impairment, schizophrenia, depression, autism spectrum disorder, attention-deficit hyperactivity disorder, and an intellectual disability. The outcomes studied included engagement, social interaction, emotional state, agitation, behavior, and quality of life.

CONCLUSIONS

The methodological weaknesses of the studies conducted this far and the lack of diversity in the conditions studied limit the generalizability of the results. However, despite the presence of certain barriers to their implementation (eg, technical problems, unsuitable environment, staff resistance), social robot interventions generally show positive effects on patients with mental health disorders. Studies of stronger methodological quality are needed to further understand the benefits and the place of social robots in mental health care.

Bursting out of our bubble: using creative techniques to communicate within the systematic review process and beyond

BACKGROUND

Increasing pressure to publicise research findings and generate impact, alongside an expectation from funding bodies to go beyond publication within academic journals, has generated interest in alternative methods of science communication. Our aim is to describe our experience of using a variety of creative communication tools, reflect on their use in different situations, enhance learning and generate discussion within the systematic review community.

METHODS

Over the last 5 years, we have explored several creative communication tools within the systematic review process and beyond to extend dissemination beyond traditional academic mechanisms. Central to our approach is the co-production of a communication plan with potential evidence users which facilitates (i) the identification of key messages for different audiences, (ii) discussion of appropriate tools to communicate key messages and (iii) exploration of avenues to share them. We aim to involve evidence users in the production of a variety of outputs for each research project cognisant of the many ways in which individuals engage with information.

RESULTS

Our experience has allowed us to develop an understanding of the benefits and challenges of a wide range of creative communication tools. For example, board games can be a fun way of learning, may flatten power hierarchies between researchers and research users and enable sharing of large amounts of complex information in a thought provoking way, but they are time and resource intensive both to produce and to engage with. Conversely, social media shareable content can be quick and easy to produce and to engage with but limited in the depth and complexity of shareable information.

DISCUSSION

It is widely recognised that most stakeholders do not have time to invest in reading large, complex documents; creative communication tools can be a used to improve accessibility of key messages. Furthermore, our experience has highlighted a range of additional benefits of embedding these techniques within our project processes e.g. opening up two-way conversations with end-users of research to discuss the implications of findings.

The Usability and Impact of a Low-Cost Pet Robot for Older Adults and People With Dementia: Qualitative Content Analysis of User Experiences and Perceptions on Consumer Websites

Background

Worldwide, populations are aging exponentially. Older adults and people with dementia are especially at risk of social isolation and loneliness. Social robots, including robotic pets, have had positive impacts on older adults and people with dementia by providing companionship, improving mood, reducing agitation, and facilitating social interaction. Nevertheless, the issue of affordability can hinder technology access. The Joy for All (JfA) robotic pets have showed promise as examples of low-cost alternatives. However, there has been no research that investigated the usability and impact of such low-cost robotic pets based on perceptions and experiences of its use with older adults and people with dementia.

Objective

The aim of our study was to explore the usability and impact of the JfA robotic cat, as an example of a low-cost robot, based on perceptions and experiences of using the JfA cat for older adults and people with dementia.

Methods

We used a novel methodology of analyzing a large volume of information that was uploaded by reviewers of the JfA cat onto online consumer review sites. Data were collected from 15 consumer websites. This provided a total of 2445 reviews. Next, all reviews were screened. A total of 1327 reviews that contained information about use of the JfA cat for older adults or people with dementia were included for analysis. These were reviews that contained terms relating to “older adults,” “dementia,” and “institutional care” and were published in the English language. Descriptive statistics was used to characterize available demographic information, and textual data were qualitatively analyzed using inductive content analysis.

Results

Most reviews were derived from consumer sites in the United States, and most reviewers were family members of users (ie, older adults and people with dementia). Based on the qualitative content analysis, 5 key themes were generated: prior expectations, perceptions, meaningful activities, impacts, and practicalities. Reviewers had prior expectations of the JfA cat, which included circumstantial reasons that prompted them to purchase this technology. Their perceptions evolved after using the technology, where most reported positive perceptions about their appearance and interactivity. The use of the robot provided opportunities for users to care for it and incorporate it into their routine. Finally, reviewers also shared information about the impacts of device and practicalities related to its use.

Conclusions

This study provides useful knowledge about the usability and impact of a low-cost pet robot, based on experiences and perceptions of its use. These findings can help researchers, robot developers, and clinicians understand the viability of using low-cost robotic pets to benefit older adults and people with dementia. Future research should consider evaluating design preferences for robotic pets, and compare the effects of low-cost robotic pets with other more technologically advanced robotic pets.

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.

Companion robots for older adults: Rodgers' evolutionary concept analysis approach

This study aims to analyze the concept of companion robots for older adults from the perspective of nursing. This study employed a concept analysis. The literature from July 2011 to June 2021 was sought from databases using specific keywords. Any quantitative or qualitative study published in English or Korean focusing on companion robots for older adults was included in the study. Rodgers' evolutionary concept analysis was used to clarify the antecedents, attributes, and consequences. Seventy-five eligible articles were studied. The findings were categorized into antecedents, attributes, and consequences. Companion robot antecedents were classified into individual factors, attitude toward robots, and caregiver and social factors. The defining attributes included human-robot interaction, function, features, structure, cost, and management of the robot being a companion. Consequences were categorized into user, caregiver, and health related. Companion robots are designed to enhance well-being, quality of life, and independence by providing service and companionship and assisting daily life. This mainly includes cognitive and social support, mobility support, relaxation, health monitoring, and self-care support through human-robot interaction. The attributes, antecedents, and consequences of companion robots identified in this study can inform future decision making and interventions by caregivers for aging in place.

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.

Interventions for reducing loneliness: An umbrella review of intervention studies

Loneliness is a common phenomenon associated with several negative health outcomes. Current knowledge regarding interventions for reducing loneliness in randomised controlled trials (RCTs) is conflicting. The aim of the present work is to provide an overview of interventions to reduce loneliness, using an umbrella review of previously published systematic reviews and meta-analyses. We searched major databases from database inception to 31 March 2020 for RCTs comparing active versus non-active interventions for reducing loneliness. For each intervention, random-effects summary effect size and 95% confidence intervals (CIs) were calculated. For significant outcomes (p-value < 0.05), the GRADE (Grading of Recommendations Assessment, Development and Evaluation) tool was used, grading the evidence from very low to high. From 211 studies initially evaluated, seven meta-analyses for seven different types of interventions were included (median number of RCTs: 8; median number of participants: 600). Three interventions were statistically significant for reducing loneliness, that is, meditation/mindfulness, social cognitive training and social support. When applying GRADE criteria, meditation/mindfulness (mean difference, MD = -6.03; 95% CI: -9.33 to -2.73; very low strength of the evidence), social cognitive training (8 RCTs; SMD = -0.49; 95% CI: -0.84 to -0.13; very low strength of the evidence) and social support (9 RCTs; SMD = -0.13; 95% CI: -0.25 to -0.01; low strength of the evidence) significantly decreased the perception of loneliness. In conclusion, three intervention types may be utilised for reducing loneliness, but they are supported by a low/very low certainty of evidence indicating the need for future large-scale RCTs to further investigate the efficacy of interventions for reducing loneliness.

Use of Robotic Pet in a Distributed Layout Elderly Housing with Services: A Case Study on Elderly People with Cognitive Impairment

In recent years, robotic pets have been used by many countries worldwide as a method for treating behavioral and psychological symptoms of dementia (BPSD). The seal robot PARO was loaned intermittently to a distributed layout elderly housing with services over a seven-month period, during which it was observed that three residents with cognitive dysfunctions showed improvements in their BPSD and the nursing care load of the staff was reduced during the periods when PARO was present. The objective of this study is to investigate, through a case study, the effects of intermittent interaction with PARO on those with cognitive dysfunctions and the staff workers. The short version of the Dementia Behavior Disturbance Scale (DBD-13) was used as the medical outcome index, and the KJ method was used to analyze the qualitative data, such as staff reports and interviews. The results show that the DBD-13 total scores reduced during the periods when PARO was present and increased during the periods when PARO was absent. The KJ method yielded similar findings. The use of DBD-13 and the KJ method complemented the results of each other and increased the persuasive power of the findings. By using the KJ method, it was further determined that the workload of the staff was reduced, allowing them to recuperate, which reconfirmed the value of PARO. Further case studies will be undertaken in the future with the aim of constructing a methodology for implementing case studies.

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.

Digital technologies to support people living with dementia in the care home setting to engage in meaningful occupations: protocol for a scoping review

BACKGROUND

People living with all stages of dementia should have the opportunity to participate in meaningful occupations. For those living in care homes, this may not always occur and residents may spend significant parts of the day unengaged, especially those living with more advanced dementia. Digital technologies are increasingly being used in health care and could provide opportunities for people living with dementia (PLWD) in care homes to engage in meaningful occupations and support care staff to provide these activities. With technology advancing at a rapid rate, the objective of this scoping review is to provide an up-to-date systematic map of the research on the diverse range of digital technologies that support engagement in meaningful occupations. In particular, focus will be given to barriers and facilitators to inform future intervention design and implementation strategies, which have not yet been clearly mapped across the full range of these digital technologies.

METHOD

A scoping review will be conducted to systematically search for published research using a comprehensive search strategy on thirteen databases. Published, peer-reviewed studies that focused on PLWD in the care home setting and assessed any form of digital technology that supported a meaningful occupation will be included. All methodologies which meet the criteria will be included. Data will be extracted and charted to report the range of digital technologies, underlying mechanisms of action, facilitators and barriers to implementation.

DISCUSSION

Mapping the range of technologies to support PLWD to engage in meaningful occupations will identify gaps in research. The systematic search will include a diverse range of technologies such as software to enhance care planning, tablets devices, smartphones, communication robots and social media platforms, rather than focussing on a specific design or interface. This will enable comparison between mechanisms of action, barriers and facilitators to implementation which will be useful for future research and intervention design.

TRIAL REGISTRATION

Open Science Framework https://doi.org/10.17605/OSF.IO/7UDM2.

A Minimal Design of a Human Infant Presence: A Case Study Toward Interactive Doll Therapy for Older Adults With Dementia

We introduce a minimal design approach to manufacture an infant-like robot for interactive doll therapy that provides emotional interactions for older people with dementia. Our approach stimulates their imaginations and then facilitates positive engagement with the robot by just expressing the most basic elements of humanlike features. Based on this approach, we developed HIRO, a baby-sized robot with an abstract body representation and no facial features. The recorded voice of a real human infant emitted by robots enhances the robot’s human-likeness and facilitates positive interaction between older adults and the robot. Although we did not find any significant difference between HIRO and an infant-like robot with a smiling face, a field study showed that HIRO was accepted by older adults with dementia and facilitated positive interaction by stimulating their imagination. We also discuss the importance of a minimal design approach in elderly care during post–COVID-19 world.

Barriers and facilitators to the implementation of social robots for older adults and people with dementia: a scoping review

Background

Psychosocial issues, such as social isolation and loneliness among older adults and people with dementia, continue to pose challenges with a rapidly aging population worldwide. Social robots are a rapidly emerging field of technology, developed to help address the psychosocial needs of this population. Although studies have reported positive findings regarding their psychosocial benefits, their implementation in real-world practice remains a challenge. Nevertheless, little is known about the factors affecting their implementation. The purpose of this review is to provide a systematic overview of the barriers and facilitators affecting the implementation of social robots for older adults and people with dementia.

Method

The Arksey and O’Malley approach with methodological enhancement by Levac et al. was used to guide the conduct of this review. Seven electronic databases were searched. In addition, hand searching and backward citation tracing was conducted. Three independent reviewers were involved in the screening and data charting process. Findings were synthesised and categorised into the five domains outlined in the Consolidated Framework of Implementation Research (CFIR).

Results

A total of 53 studies were included in the final review. Most of the included studies were based in participants’ homes and in care facilities. Barriers and facilitators were mapped onto 18 constructs in the five domains of the CFIR. The most frequently cited barriers were mapped to the constructs within the domain of “Intervention characteristics”, where issues such as the complexity of using the technology and technical obstacles impeded implementation. Most facilitators were mapped onto the domain “Patient needs and resources”. Overall, existing research are disproportionately focused on the internal validity (i.e. characteristics) of social robots, and there is significantly less research investigating their external validity, such as organisational or wider contextual factors that can affect their implementation in real-world practice.

Conclusion

This review has identified and synthesised the breadth of evidence on the barriers and facilitators to the implementation of social robots for older adults and people with dementia. Future research should pay more attention to investigating the contextual factors, using an implementation framework, to identify barriers and facilitators to guide the implementation of social robots.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02277-9.

Effectiveness of Companion Robot Care for Dementia: A Systematic Review and Meta-Analysis

Background and Objectives

Dementia and central nervous system degeneration are common problems in aging societies with regard to the number of people affected and total medical expenses. Socially assistive robotic technology has gradually matured; currently, most scholars believe it can be used as companions in long-term care facilities and to work as caregivers alongside staff to improve the social interaction and mental state of older adults and patients with dementia. Therefore, this study measured the effect of the duration of exposure to socially assistive robots in older adults with dementia.

Research Design and Methods

Seven databases were searched up to February 2019 through the consultation of appropriate Internet sites and the use of criteria lists recommended by relevant experts. Randomized controlled trials comparing socially assistive robot use with a control group in older adults with dementia and using at least one of the primary outcomes of agitation, depression, and quality of life were included.

Results

Thirteen randomized controlled trials were identified from 873 articles, 7 of which were included in the meta-analysis. The pooled effect estimate from 3 trials with 214 participants revealed that the pet-type robot improved patients’ agitation level, with a standardized mean difference of −0.37 (95% CI: −0.64 to −0.10, p < .01) and no heterogeneity (I² = 0%). The results also revealed that length of each session and pet-type robot exposure time per week were associated with reduced depression levels (β = −0.06, Q = 21.213, df = 1, p < .001 and β = −0.019, Q = 7.532, df = 1, p < .01, respectively). However, the results for quality of life were nonsignificant.

Discussion and Implications

Pet-type robot systems seem to be a potential activity in long-term care facilities for dementia care. Further research is warranted to establish a comprehensive intervention plan related to the use of pet-type robots.

The CARESSES Randomised Controlled Trial: Exploring the Health-Related Impact of Culturally Competent Artificial Intelligence Embedded Into Socially Assistive Robots and Tested in Older Adult Care Homes

This trial represents the final stage of the CARESSES project which aimed to develop and evaluate a culturally competent artificial intelligent system embedded into social robots to support older adult wellbeing. A parallel group, single-blind randomised controlled trial was conducted across older adult care homes in England and Japan. Participants randomly allocated to the Experimental Group or Control Group 1 received a Pepper robot for up 18 h across 2 weeks. Two versions of the CARESSES artificial intelligence were tested: a fully culturally competent system (Experimental Group) and a more limited version (Control Group 1). Control Group 2 (Care As Usual) participants did not receive a robot. Quantitative outcomes of interest reported in the current paper were health-related quality of life (SF-36), loneliness (ULS-8), and perceptions of robotic cultural competence (CCATool-Robotics). Thirty-three residents completed all procedures. The difference in SF-36 Emotional Wellbeing scores between Experimental Group and Care As Usual participants over time was significant (F[1] = 6.614, sig = .019, η_p² = .258), as was the comparison between Any Robot used and Care As Usual (F[1] = 5.128, sig = .031, η_p² = .146). There were no significant changes in SF-36 physical health subscales. ULS-8 loneliness scores slightly improved among Experimental and Control Group 1 participants compared to Care As Usual participants, but this was not significant. This study brings new evidence which cautiously supports the value of culturally competent socially assistive robots in improving the psychological wellbeing of older adults residing in care settings.

Impacts of Low-cost Robotic Pets for Older Adults and People With Dementia: Scoping Review

BACKGROUND

Older adults and people with dementia are particularly vulnerable to social isolation. Social robots, including robotic pets, are promising technological interventions that can benefit the psychosocial health of older adults and people with dementia. However, issues such as high costs can lead to a lack of equal access and concerns about infection control. Although there are previous reviews on the use of robotic pets for older adults and people with dementia, none have included or had a focus on low-cost and familiarly and realistically designed pet robots.

OBJECTIVE

The aim of this review is to synthesize evidence on the delivery and impact of low-cost, familiarly and realistically designed interactive robotic pets for older adults and people with dementia.

METHODS

The Arksey and O'Malley framework was used to guide this review. First, the research question was identified. Second, searches were conducted on five electronic databases and Google Scholar. Studies were selected using a two-phase screening process, where two reviewers independently screened and extracted data using a standardized data extraction form. Finally, the results were discussed, categorized, and presented narratively.

RESULTS

A total of 9 studies were included in the review. Positive impacts related to several psychosocial domains, including mood and affect, communication and social interaction, companionship, and other well-being outcomes. Issues and concerns associated with its use included misperceptions of the robotic pets as a live animal, ethical issues of attachment, negative reactions by users, and other pragmatic concerns such as hygiene and cost.

CONCLUSIONS

Overall, the findings resonate with previous studies that investigated the effectiveness of other social robots, demonstrating the promise of these low-cost robotic pets in addressing the psychosocial needs of older adults and people with dementia. The affordability of these robotic pets appeared to influence the practicalities of real-world use, such as intervention delivery and infection control, which are especially relevant in light of COVID-19. Moving forward, studies should also consider comparing the effects of these low-cost robots with other robotic pets.

Qualitative Research on the Primary Effect of Fish Pet Ownership Using the Bottleium, a Bottle-Type Aquarium, on Community-Dwelling Older Adults in Japan: A Potential Preventive Measure Towards Social Isolation

Aging increases the risk of social isolation, which could lead to conditions such as depressive mood. Pet ownership is known to reduce social isolation. However, previous studies have mainly focused on mammals as pets, which could be difficult at old age. A small ornamental fish is relatively easy to culture and might be a suitable alternative. In this research, we aimed to elucidate the possible effects of fish ownership on the psychological state of community-dwelling older adults in Japan. A Bottleium, a bottle-type aquarium, was selected to lower the burden of fish ownership. A workshop was hosted in 2019 and participants brought home their own Bottleium, with fish and water snail inside. Nineteen participants gave consent to the follow-up interview a month later. Five themes, "observation of fish and water snail," "interaction between the fish and the owner," "taking care of the fish as pet owner," "facilitation of interpersonal interaction," and "development of support system," emerged from thematic analysis. The promotion of animal-to-human, and human-to-human interaction and development of responsibility could relate to a sense of social inclusion and ikigai-kan, a purpose of life. Fish ownership, when using equipment that suits the physical capability of older adults, could act as a positive stimulus.

Managing loneliness and chronic illness in older adults

An increased lifespan does not necessarily equate to a high quality of life. This article discusses strategies to help older adult patients cope with loneliness, social isolation, and chronic illness to improve their health and quality of life.