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Yen HY, Huang CW, Chiu HL, Jin G. The Effect of Social Robots on Depression and Loneliness for Older Residents in Long-Term Care Facilities: A Meta-Analysis of Randomized Controlled Trials. J Am Med Dir Assoc 2024; 25:104979. [PMID: 38614134 DOI: 10.1016/j.jamda.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 04/15/2024]
Abstract
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.
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Affiliation(s)
- Hsin-Yen Yen
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan; International PhD Program in Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chih Wei Huang
- International Center for Health Information Technology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Huei-Ling Chiu
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan; International PhD Program in Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan.
| | - Grace Jin
- Stanford University School of Medicine, Stanford, CA, USA
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Irfan B, Kuoppamäki S, Skantze G. Recommendations for designing conversational companion robots with older adults through foundation models. Front Robot AI 2024; 11:1363713. [PMID: 38860032 PMCID: PMC11163135 DOI: 10.3389/frobt.2024.1363713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 05/07/2024] [Indexed: 06/12/2024] Open
Abstract
Companion robots are aimed to mitigate loneliness and social isolation among older adults by providing social and emotional support in their everyday lives. However, older adults' expectations of conversational companionship might substantially differ from what current technologies can achieve, as well as from other age groups like young adults. Thus, it is crucial to involve older adults in the development of conversational companion robots to ensure that these devices align with their unique expectations and experiences. The recent advancement in foundation models, such as large language models, has taken a significant stride toward fulfilling those expectations, in contrast to the prior literature that relied on humans controlling robots (i.e., Wizard of Oz) or limited rule-based architectures that are not feasible to apply in the daily lives of older adults. Consequently, we conducted a participatory design (co-design) study with 28 older adults, demonstrating a companion robot using a large language model (LLM), and design scenarios that represent situations from everyday life. The thematic analysis of the discussions around these scenarios shows that older adults expect a conversational companion robot to engage in conversation actively in isolation and passively in social settings, remember previous conversations and personalize, protect privacy and provide control over learned data, give information and daily reminders, foster social skills and connections, and express empathy and emotions. Based on these findings, this article provides actionable recommendations for designing conversational companion robots for older adults with foundation models, such as LLMs and vision-language models, which can also be applied to conversational robots in other domains.
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Affiliation(s)
- Bahar Irfan
- Division of Speech, Music and Hearing, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Sanna Kuoppamäki
- Division of Health Informatics and Logistics, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Gabriel Skantze
- Division of Speech, Music and Hearing, KTH Royal Institute of Technology, Stockholm, Sweden
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Tsai YIP, Beh J, Ganderton C, Pranata A. Digital interventions for healthy ageing and cognitive health in older adults: a systematic review of mixed method studies and meta-analysis. BMC Geriatr 2024; 24:217. [PMID: 38438870 PMCID: PMC10910826 DOI: 10.1186/s12877-023-04617-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 12/17/2023] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Currently, there is no systematic review to investigate the effectiveness of digital interventions for healthy ageing and cognitive health of older adults. This study aimed to conduct a systematic review to evaluate the effectiveness of digital intervention studies for facilitating healthy ageing and cognitive health and further identify the considerations of its application to older adults. METHODS A systematic review and meta-analysis of literature were conducted across CINAHL, Medline, ProQuest, Cochrane, Scopus, and PubMed databases following the PRISMA guideline. All included studies were appraised using the Mixed Methods Appraisal Tool Checklist by independent reviewers. Meta-analyses were performed using JBI SUMARI software to compare quantitative studies. Thematic analyses were used for qualitative studies and synthesised into the emerging themes. RESULTS Thirteen studies were included. Quantitative results showed no statistically significant pooled effect between health knowledge and healthy behaviour (I2 =76, p=0.436, 95% CI [-0.32,0.74]), and between cardiovascular-related health risks and care dependency I2=0, p=0.426, 95% CI [0.90,1.29]). However, a statistically significant cognitive function preservation was found in older adults who had long-term use of laptop/cellphone devices and had engaged in the computer-based physical activity program (I2=0, p<0.001, 95% CI [0.01, 0.21]). Qualitative themes for the considerations of digital application to older adults were digital engagement, communication, independence, human connection, privacy, and cost. CONCLUSIONS Digital interventions used in older adults to facilitate healthy ageing were not always effective. Health knowledge improvement does not necessarily result in health risk reduction in that knowledge translation is key. Factors influencing knowledge translation (i.e., digital engagement, human coaching etc) were identified to determine the intervention effects. However, using digital devices appeared beneficial to maintain older adults' cognitive functions in the longer term. Therefore, the review findings suggest that the expanded meaning of a person-centred concept (i.e., from social, environmental, and healthcare system aspects) should be pursued in future practice. Privacy and cost concerns of technologies need ongoing scrutiny from policy bodies. Future research looking into the respective health benefits can provide more understanding of the current digital intervention applied to older adults. STUDY REGISTRATION PROSPERO record ID: CRD42023400707 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=400707 .
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Affiliation(s)
- Yvette I-Pei Tsai
- School of Nursing & Midwifery, University of Newcastle, Callaghan, Australia.
| | - Jeanie Beh
- Centre for Design Innovation, Swinburne University of Technology, Melbourne, Australia
| | - Charlotte Ganderton
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Adrian Pranata
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
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Kwon JY, Ju DY. Living Lab-Based Service Interaction Design for a Companion Robot for Seniors in South Korea. Biomimetics (Basel) 2023; 8:609. [PMID: 38132547 PMCID: PMC10741588 DOI: 10.3390/biomimetics8080609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/28/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
A living lab is a valuable method for designing tangible and intangible service elements, ensuring a comprehensive user experience. Developing a digital companion service, which users may be unfamiliar with, requires observing user behavior in real-world environments and analyzing living and behavioral patterns. A living lab starts with understanding user characteristics and behaviors. Living lab methods have an impact on the accuracy and precision of service design. The number of seniors in South Korea is rapidly increasing, leading to a rise in social issues like solitary deaths and suicide. Addressing these problems has led to a growing demand for companion robots. To design effective companion services, understanding seniors' living environments and their cognitive and behavioral traits is essential. This opinion piece, based on a national R&D project, presents the development of a digital companion for seniors. It offers insights, providing a comprehensive overview of living lab-based service interaction design and proposing methodologies about living lab environment construction and experimentation and considerations when designing robot interaction functions and appearance. The living lab environment includes real living spaces, laboratories, virtual reality settings, and senior welfare centers. Using the research findings, we created service scenarios, analyzed senior language characteristics, and developed the concept and facial expressions of the digital companion. To successfully introduce a novel service, it is crucial to analyze users' real-life behavior and adjust the service accordingly.
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Affiliation(s)
| | - Da Young Ju
- Department of AI Design & Design Science, Kookmin University, 77 Jeongneung-ro, Seongbuk-gu, Seoul 02707, Republic of Korea;
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Bradwell HL, Cooper L, Edwards KJ, Baxter R, Tomaz SA, Ritchie J, Gaudl S, Veliz-Reyes A, Ryde GC, Križaj T, Warren A, Chatterjee A, Willis K, Haynes R, Hennessy CH, Whittaker AC, Asthana S, Jones RB. Staff perceptions towards virtual reality-motivated treadmill exercise for care home residents: a qualitative feedback study with key stakeholders and follow-up interview with technology developer. BMJ Open 2023; 13:e073307. [PMID: 37996232 PMCID: PMC10668234 DOI: 10.1136/bmjopen-2023-073307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVES Health and care resources are under increasing pressure, partly due to the ageing population. Physical activity supports healthy ageing, but motivating exercise is challenging. We aimed to explore staff perceptions towards a virtual reality (VR) omnidirectional treadmill (MOTUS), aimed at increasing physical activity for older adult care home residents. DESIGN Interactive workshops and qualitative evaluation. SETTINGS Eight interactive workshops were held at six care homes and two university sites across Cornwall, England, from September to November 2021. PARTICIPANTS Forty-four staff participated, including care home, supported living, clinical care and compliance managers, carers, activity coordinators, occupational therapists and physiotherapists. INTERVENTIONS Participants tried the VR treadmill system, followed by focus groups exploring device design, potential usefulness or barriers for care home residents. Focus groups were audio-recorded, transcribed verbatim and thematically analysed. We subsequently conducted a follow-up interview with the technology developer (September 2022) to explore the feedback impact. RESULTS The analysis produced seven key themes: anticipated benefits, acceptability, concerns of use, concerns of negative effects, suitability/unsuitability, improvements and current design. Participants were generally positive towards VR to motivate care home residents' physical activity and noted several potential benefits (increased exercise, stimulation, social interaction and rehabilitation). Despite the reported potential, staff had safety concerns for frail older residents due to their standing position. Participants suggested design improvements to enhance safety, usability and accessibility. Feedback to the designers resulted in the development of a new seated VR treadmill to address concerns about falls while maintaining motivation to exercise. The follow-up developer interview identified significant value in academia-industry collaboration. CONCLUSION The use of VR-motivated exercise holds the potential to increase exercise, encourage reminiscence and promote meaningful activity for care home residents. Staff concerns resulted in a redesigned seated treadmill for those too frail to use the standing version. This novel study demonstrates the importance of stakeholder feedback in product design.
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Affiliation(s)
| | - Leonie Cooper
- Centre for Health Technology, University of Plymouth, Plymouth, UK
| | | | - Rory Baxter
- Centre for Health Technology, University of Plymouth, Plymouth, UK
| | - Simone A Tomaz
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - John Ritchie
- Faculty of Arts & Humanities, University of Stirling, Stirling, UK
| | - Swen Gaudl
- Department of Applied IT, University of Gothenburg, Gothenburg, Sweden
| | | | - Gemma C Ryde
- Institute of Cardiovascular and Medical Sciences, University of Stirling, Stirling, UK
| | - Tanja Križaj
- Centre for Health Technology, University of Plymouth, Plymouth, UK
| | - Alison Warren
- Centre for Health Technology, University of Plymouth, Plymouth, UK
| | | | - Katharine Willis
- Faculty of Arts, Humanities & Business, University of Plymouth, Plymouth, UK
| | - Richard Haynes
- Faculty of Arts & Humanities, University of Stirling, Stirling, UK
| | | | - Anna C Whittaker
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Sheena Asthana
- Centre for Health Technology, University of Plymouth, Plymouth, UK
| | - Ray B Jones
- Centre for Health Technology, University of Plymouth, Plymouth, UK
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Ngũnjiri A, Memiah P, Kimathi R, Wagner FA, Ikahu A, Omanga E, Kweyu E, Ngunu C, Otiso L. Utilizing User Preferences in Designing the AGILE (Accelerating Access to Gender-Based Violence Information and Services Leveraging on Technology Enhanced) Chatbot. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7018. [PMID: 37947574 PMCID: PMC10647327 DOI: 10.3390/ijerph20217018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/13/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Technology advancements have enhanced artificial intelligence, leading to a user shift towards virtual assistants, but a human-centered approach is needed to assess for acceptability and effectiveness. The AGILE chatbot is designed in Kenya with features to redefine the response towards gender-based violence (GBV) among vulnerable populations, including adolescents, young women and men, and sexual and gender minorities, to offer accurate and reliable information among users. METHODS We conducted an exploratory qualitative study through focus group discussions (FGDs) targeting 150 participants sampled from vulnerable categories; adolescent girls and boys, young women, young men, and sexual and gender minorities. The FGDs included multiple inquiries to assess knowledge and prior interaction with intelligent conversational assistants to inform the user-centric development of a decision-supportive chatbot and a pilot of the chatbot prototype. Each focus group comprised 9-10 members, and the discussions lasted about two hours to gain qualitative user insights and experiences. We used thematic analysis and drew on grounded theory to analyze the data. RESULTS The analysis resulted in 14 salient themes composed of sexual violence, physical violence, emotional violence, intimate partner violence, female genital mutilation, sexual reproductive health, mental health, help-seeking behaviors/where to seek support, who to talk to, and what information they would like, features of the chatbot, access of chatbot, abuse and HIV, family and community conflicts, and information for self-care. CONCLUSION Adopting a human-centered approach in designing an effective chatbot with as many human features as possible is crucial in increasing utilization, addressing the gaps presented by marginalized/vulnerable populations, and reducing the current GBV epidemic by moving prevention and response services closer to people in need.
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Affiliation(s)
- Anne Ngũnjiri
- LVCT Health Kenya, Nairobi P.O. Box 19835-00202, Kenya; (A.N.); (R.K.); (A.I.); (E.O.); (L.O.)
| | - Peter Memiah
- Graduate School, University of Maryland, 620 W. Lexington Street, Baltimore, MD 21201, USA
| | - Robert Kimathi
- LVCT Health Kenya, Nairobi P.O. Box 19835-00202, Kenya; (A.N.); (R.K.); (A.I.); (E.O.); (L.O.)
| | - Fernando A. Wagner
- School of Social Work, University of Maryland, 525 W. Redwood Street, Baltimore, MD 21201, USA;
| | - Annrita Ikahu
- LVCT Health Kenya, Nairobi P.O. Box 19835-00202, Kenya; (A.N.); (R.K.); (A.I.); (E.O.); (L.O.)
| | - Eunice Omanga
- LVCT Health Kenya, Nairobi P.O. Box 19835-00202, Kenya; (A.N.); (R.K.); (A.I.); (E.O.); (L.O.)
| | - Emmanuel Kweyu
- Faculty of Information Technology, Strathmore University, Nairobi P.O. Box 59857-00200, Kenya;
| | - Carol Ngunu
- Department of Health, Nairobi City County, Nairobi P.O. Box 30075-00100, Kenya;
| | - Lilian Otiso
- LVCT Health Kenya, Nairobi P.O. Box 19835-00202, Kenya; (A.N.); (R.K.); (A.I.); (E.O.); (L.O.)
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Hung L, Wong KLY, Wong J, Park J, Mousavi H, Zhao H. Facilitators and barriers to using AI-enabled robots with older adults in long-term care from staff perspective: a scoping review protocol. BMJ Open 2023; 13:e075278. [PMID: 37903609 PMCID: PMC10619074 DOI: 10.1136/bmjopen-2023-075278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/12/2023] [Indexed: 11/01/2023] Open
Abstract
INTRODUCTION Assistive and service robots have been increasingly designed and deployed in long-term care (LTC) but little evidence guides their use. This scoping review synthesises existing studies on facilitators and barriers to using artificial intelligence (AI)-enabled robots with older adults in LTC settings. METHODS AND ANALYSIS We will follow the Joanna Briggs Institute's scoping review methodology for the study, to be conducted from November 2023 to April 2024. We will focus on literature exploring the use of AI-enabled robots with older adults in an LTC setting from healthcare providers' perspectives. Three steps will be taken: (a) keywords and index terms will be identified from MEDLINE and CINAHL databases; (b) comprehensive searches will be conducted in MEDLINE, CINAHL, Embase, Web of Science, Scopus, AgeLine, PsycINFO, ProQuest and Google, using keywords and index terms identified in step (a); and (c) examining reference lists of the included studies and selecting items in the reference lists which meet the inclusion criteria. Searches for grey literature will also be conducted via Google. The results will be presented in a charting table and a narrative summary will be presented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. ETHICS AND DISSEMINATION Ethics approval and participation consent are not required because the data are publicly available. The results will be presented via a journal article and conference presentations.
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Affiliation(s)
- Lillian Hung
- IDEA Lab, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karen Lok Yi Wong
- IDEA Lab, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joey Wong
- IDEA Lab, University of British Columbia, Vancouver, British Columbia, Canada
| | - Juyoung Park
- Phyllis & Harvey Sandler School of Social Work, Florida Atlantic University, Boca Raton, Florida, USA
| | - Hossein Mousavi
- IDEA Lab, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hui Zhao
- School of Nursing, James Madison University, Harrisonburg, Virginia, USA
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Zhou YL, Chen CL, Chang SJ, Wu BS. Home-Based Intelligent Exercise System for Seniors' Healthcare: The Example of Golf Croquet. Sports (Basel) 2023; 11:207. [PMID: 37999424 PMCID: PMC10674598 DOI: 10.3390/sports11110207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/14/2023] [Accepted: 10/24/2023] [Indexed: 11/25/2023] Open
Abstract
In 2020, the world experienced the threat of the COVID-19 epidemic, and seniors and chronic disease patients generally reduced their exercise and social activities to avoid increasing the risk of infection, which could lead to increased loneliness and even many diseases. Combining golf croquet games with a mobile application (App) and AIoT companion robots, this research constructs a home-based intelligent exercise system, uses the technology acceptance model (TAM), deduces users' intention to use this system based on perceived usefulness and perceived ease of use, and adds the needs of love and belonging, esteem, cognitive, aesthetic, and self-actualization in Maslow's hierarchy of needs theory (HNT) to conduct an analysis of system needs. This study collected empirical data, totaling 320 participants including seniors and their caregivers, from elderly care centers in northern Taiwan using a cross-sectional survey and purposive sampling. Based on regression and variance analysis, the results show that participants have a high level of acceptance of this system, believing that it is easy to learn and operate and can increase interaction with others, improve self-confirmation, satisfy the thirst for knowledge, increase the feeling of happiness, and fulfill self-actualization needs. In the future, by collecting and recording the process of seniors using the App, so as to find out their health problems as soon as possible, expand their daily life through this exercise, and achieve the goal of happy living and better healthcare.
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Affiliation(s)
- Yu-Li Zhou
- Taiwan Economy and Industry Association, Taipei 100008, Taiwan;
| | - Chia-Li Chen
- Department of Information Management, Lunghwa University of Science and Technology, Taoyuan 333326, Taiwan; (C.-L.C.); (B.-S.W.)
| | - Shih-Jui Chang
- Center for Professional Competency Certification, Lunghwa University of Science and Technology, Taoyuan 333326, Taiwan
| | - Bo-Sheng Wu
- Department of Information Management, Lunghwa University of Science and Technology, Taoyuan 333326, Taiwan; (C.-L.C.); (B.-S.W.)
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Fardeau E, Senghor AS, Racine E. The Impact of Socially Assistive Robots on Human Flourishing in the Context of Dementia: A Scoping Review. Int J Soc Robot 2023; 15:1-51. [PMID: 37359430 PMCID: PMC10115607 DOI: 10.1007/s12369-023-00980-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 06/28/2023]
Abstract
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.
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Affiliation(s)
- Erika Fardeau
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, 110 Avenue Des Pins Ouest, Montréal, QC H2W 1R7 Canada
| | - Abdou Simon Senghor
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, 110 Avenue Des Pins Ouest, Montréal, QC H2W 1R7 Canada
- Division of Experimental Medicine, McGill University, Montréal, QC Canada
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, 110 Avenue Des Pins Ouest, Montréal, QC H2W 1R7 Canada
- Division of Experimental Medicine, McGill University, Montréal, QC Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC Canada
- Department of Medicine and Department of Social and Preventive Medicine, Université de Montréal, Montréal, QC Canada
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Haltaufderheide J, Lucht A, Strünck C, Vollmann J. Socially Assistive Devices in Healthcare-a Systematic Review of Empirical Evidence from an Ethical Perspective. SCIENCE AND ENGINEERING ETHICS 2023; 29:5. [PMID: 36729304 PMCID: PMC9894988 DOI: 10.1007/s11948-022-00419-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 11/12/2022] [Indexed: 06/18/2023]
Abstract
Socially assistive devices such as care robots or companions have been advocated as a promising tool in elderly care in Western healthcare systems. Ethical debates indicate various challenges. An important part of the ethical evaluation is to understand how users interact with these devices and how interaction influences users' perceptions and their ability to express themselves. In this review, we report and critically appraise findings of non-comparative empirical studies with regard to these effects from an ethical perspective.Electronic databases and other sources were queried using a comprehensive search strategy generating 9851 records. Studies were screened independently by two authors. Methodological quality of studies was assessed. For 22 reports on 21 datasets using a non-comparative design a narrative synthesis was performed.Data shows positive findings in regard to attitudes and emotional reactions of users. Varying perception of a social relation and social presence are the most commonly observed traits of interaction. Users struggle with understanding technical complexities while functionality of the devices is limited. This leads to a behavioral alignment of users towards the requirements of the devices to be able to make use of them.This evidence adds to three important ethical debates on the use of socially assistive devices in healthcare in regard to (1) reliability of existing empirical evidence to inform normative judgements, (2) ethical significance of the social presence of devices and (3) user autonomy in regard to behavioral alignment.
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Affiliation(s)
- Joschka Haltaufderheide
- Institute for Medical Ethics and History of Medicine, Ruhr-University Bochum, Markstr. 258a, 44799, Bochum, Germany.
| | - Annika Lucht
- Institute for Medical Ethics and History of Medicine, Ruhr-University Bochum, Markstr. 258a, 44799, Bochum, Germany
| | - Christoph Strünck
- School of Life Sciences, University of Siegen, Siegen, Germany
- Institute of Gerontology, Technical University Dortmund, Dortmund, Germany
| | - Jochen Vollmann
- Institute for Medical Ethics and History of Medicine, Ruhr-University Bochum, Markstr. 258a, 44799, Bochum, Germany
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11
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Ekoh PC, Okolie TJ, Nnadi FB, Oyinlola O, Walsh CA. Understanding the impact of digital technology on the well-being of older immigrants and refugees: A scoping review. Digit Health 2023; 9:20552076231194947. [PMID: 38321989 PMCID: PMC10846041 DOI: 10.1177/20552076231194947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/28/2023] [Indexed: 02/08/2024] Open
Abstract
Background The fast-paced development of digital technologies in the areas of social media, pet robots, smart homes, and artificial intelligence, among others, profoundly influence the daily lives of older adults. Digital technology can improve the well-being and quality of life of older adults, older immigrants and refugees who suffer migration-associated stress, loneliness, health and psychosocial challenges. Aims The aim of this scoping review is to map out extant empirical literature that has examined the implication of digital technology among older refugees and immigrants. Methods Using a1 five-stage framework, we conducted a scoping review of peer-reviewed empirical studies published in English with no time restrictions. We searched nine databases for the reviews, and abstracts were reviewed using Rayyan QCRi(c) before the full-text review. The comprehensive database search yielded 4134 articles, of which 15 met the inclusion criteria. Results The results of the review suggest that digital technology is essential to the well-being, quality of life of older immigrants and refugees, especially for maintaining and building new social support networks, navigating opportunities, coping with migration-induced stress through e-leisure, and staying connected to their culture. The literature also revealed poor utilisation of digital technologies amongst older immigrants and refugees, suggesting barriers to access. Conclusion The study concluded by highlighting the need for more research and interventions that focus on multiple strategies, including education for increased access to and utilisation of digital technology to ensure that more older migrants can benefit from the advantages of digital technology in a safe way.
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Affiliation(s)
- Prince Chiagozie Ekoh
- Faculty of Social Work, University of Calgary, 2500 University Drive NW Calgary, Alberta, Canada
- Department of Social Work, University of Nigeria, Enugu, Nigeria
| | - Tochukwu Jonathan Okolie
- Department of Social Work, University of Nigeria, Enugu, Nigeria
- Department of Sociology and Gerontology, Miami University, Oxford, USA
| | | | - Oluwagbemiga Oyinlola
- School of Social Work, McGill University, Montréal, QC, Canada
- Medical Social Services Department, University College Hospital, Ibadan, Oyo, Nigeria
| | - Christine A Walsh
- Faculty of Social Work, University of Calgary, 2500 University Drive NW Calgary, Alberta, Canada
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12
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Winkle K, Lagerstedt E, Torre I, Offenwanger A. 15 Years of (Who)man Robot Interaction: Reviewing the H in Human-Robot Interaction. ACM TRANSACTIONS ON HUMAN-ROBOT INTERACTION 2022. [DOI: 10.1145/3571718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Recent work identified a concerning trend of disproportional gender representation in research participants in Human-Computer Interaction (HCI). Motivated by the fact that Human-Robot Interaction (HRI) shares many participant practices with HCI, we explored whether this trend is mirrored in our field. By producing a dataset covering participant gender representation in all 684 full papers published at the HRI conference from 2006-2021, we identify current trends in HRI research participation. We find an over-representation of men in research participants to date, as well as inconsistent and/or incomplete gender reporting which typically engages in a binary treatment of gender at odds with published best practice guidelines. We further examine if and how participant gender has been considered in user studies to date, in-line with current discourse surrounding the importance and/or potential risks of gender based analyses. Finally, we complement this with a survey of HRI researchers to examine correlations between the who is doing with the who is taking part, to further reflect on factors which seemingly influence gender bias in research participation across different sub-fields of HRI. Through our analysis we identify areas for improvement, but also reason for optimism, and derive some practical suggestions for HRI researchers going forward.
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13
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Bricout J, Greer J, Fields N, Xu L, Tamplain P, Doelling K, Sharma B. The "humane in the loop": Inclusive research design and policy approaches to foster capacity building assistive technologies in the COVID-19 era. Assist Technol 2022; 34:644-652. [PMID: 34048326 DOI: 10.1080/10400435.2021.1930282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The COVID-19 pandemic is emerging as a driver of greater reliance on wireless technologies, including intelligent assistive technologies, such as robots and artificial intelligence. We must integrate the humane "into the loop" of human-AT interactions to realize the full potential of wireless inclusion for people with disabilities and older adults. Embedding ethics into these new technologies is critical and requires a co-design approach, with end users participating throughout. Developing humane AT begins with a participatory, user-centered design embedded in an iterative co-creation process, and guided by an ethos prioritizing beneficence, user autonomy and agency. To gain insight into plausible AT development pathways ("futures"), we use scenario planning as a tool to articulate themes in the research literature. Four plausible scenarios are developed and compared to identify one as a desired "humane" future for AT development. Policy and practice recommendations derived from this scenario, and their implications for the role of AT in the advancement of human potential are explored.
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Affiliation(s)
- John Bricout
- School of Social Work, University of Minnesota, Twin Cities, Minnesota, USA
| | | | - Noelle Fields
- School of Social Work, University of Texas at Arlington
| | - Ling Xu
- School of Social Work, University of Texas at Arlington
| | | | - Kris Doelling
- School of Social Work, University of Texas at Arlington
| | - Bonita Sharma
- School of Social Work, University of Texas at San Antonio
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14
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Bradwell H, Edwards KJ, Winnington R, Thill S, Allgar V, Jones RB. 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. JMIR Aging 2022; 5:e38864. [PMID: 35830959 PMCID: PMC9407160 DOI: 10.2196/38864] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/10/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
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
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Affiliation(s)
- Hannah Bradwell
- Centre for Health Technology, University of Plymouth, University of PlymouthDrake Circus, Plymouth, GB
| | - Katie J Edwards
- Centre for Health Technology, University of Plymouth, University of PlymouthDrake Circus, Plymouth, GB
| | - Rhona Winnington
- Auckland University of Technology, 90 Akoranga Drive, Auckland, NZ
| | - Serge Thill
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Nijmegen, NL
| | - Victoria Allgar
- Centre for Health Technology, University of Plymouth, University of PlymouthDrake Circus, Plymouth, GB
| | - Ray B Jones
- Centre for Health Technology, University of Plymouth, University of PlymouthDrake Circus, Plymouth, GB
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15
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de Saille S, Kipnis E, Potter S, Cameron D, Webb CJR, Winter P, O’Neill P, Gold R, Halliwell K, Alboul L, Bell AJ, Stratton A, McNamara J. Improving Inclusivity in Robotics Design: An Exploration of Methods for Upstream Co-Creation. Front Robot AI 2022; 9:731006. [PMID: 35832932 PMCID: PMC9272459 DOI: 10.3389/frobt.2022.731006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 04/14/2022] [Indexed: 11/19/2022] Open
Abstract
Disabled people are often involved in robotics research as potential users of technologies which address specific needs. However, their more generalised lived expertise is not usually included when planning the overall design trajectory of robots for health and social care purposes. This risks losing valuable insight into the lived experience of disabled people, and impinges on their right to be involved in the shaping of their future care. This project draws upon the expertise of an interdisciplinary team to explore methodologies for involving people with disabilities in the early design of care robots in a way that enables incorporation of their broader values, experiences and expectations. We developed a comparative set of focus group workshops using Community Philosophy, LEGO® Serious Play® and Design Thinking to explore how people with a range of different physical impairments used these techniques to envision a “useful robot”. The outputs were then workshopped with a group of roboticists and designers to explore how they interacted with the thematic map produced. Through this process, we aimed to understand how people living with disability think robots might improve their lives and consider new ways of bringing the fullness of lived experience into earlier stages of robot design. Secondary aims were to assess whether and how co-creative methodologies might produce actionable information for designers (or why not), and to deepen the exchange of social scientific and technical knowledge about feasible trajectories for robotics in health-social care. Our analysis indicated that using these methods in a sequential process of workshops with disabled people and incorporating engineers and other stakeholders at the Design Thinking stage could potentially produce technologically actionable results to inform follow-on proposals.
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Affiliation(s)
- Stevienna de Saille
- Department of Sociological Studies, University of Sheffield, Sheffield, United Kingdom
- *Correspondence: Stevienna de Saille,
| | - Eva Kipnis
- Management School, University of Sheffield, Sheffield, United Kingdom
| | - Stephen Potter
- Centre for Assistive Technology and Connected Healthcare (CATCH), University of Sheffield, Sheffield, United Kingdom
| | - David Cameron
- Information School, University of Sheffield, Sheffield, United Kingdom
| | - Calum J. R. Webb
- Department of Sociological Studies, University of Sheffield, Sheffield, United Kingdom
| | - Peter Winter
- Department of Sociology, University of Bristol, Bristol, United Kingdom
| | - Peter O’Neill
- Department of Computing, Sheffield Hallam University, Sheffield, United Kingdom
| | | | | | - Lyuba Alboul
- Department of Robotics, Sheffield Hallam University, Sheffield, United Kingdom
| | - Andy J. Bell
- Advanced Manufacturing Research Centre (AMRC), Rotherham, United Kingdom
| | - Andrew Stratton
- Department of Computer Science, University of Sheffield, Sheffield, United Kingdom
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16
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Koh WQ, Casey D, Hoel V, Toomey E. Strategies for implementing pet robots in care homes and nursing homes for residents with dementia: protocol for a modified Delphi study. Implement Sci Commun 2022; 3:58. [PMID: 35659111 PMCID: PMC9164492 DOI: 10.1186/s43058-022-00308-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/15/2022] [Indexed: 01/21/2023] Open
Abstract
Background Pet robots are a type of technology-based innovation that have shown positive psychosocial benefits for people with dementia in residential facilities, such as improving mood and social interaction and reducing agitation. Nevertheless, little is known about how pet robots can be implemented in care homes and nursing homes for dementia care in real-world practice. The objectives of this study are to (1) identify contextualised implementation strategies for implementing pet robots into care homes and nursing homes for dementia care and (2) achieve consensus on the most relevant strategies. Method This study is informed by a preceding scoping review and qualitative study, which used the Consolidated Framework of Implementation Research (CFIR) to identify multi-level determinants of implementation (i.e. barriers and facilitators). We will use the CFIR-ERIC matching tool to identify relevant implementation strategies from the Expert Recommendations for Implementing Change (ERIC) taxonomy to address these determinants. Data from the scoping review and qualitative study will be used to contextualise the generic ERIC strategies for our setting. After that, a group of key stakeholders will be consulted to further contextualise and refine these strategies. Next, a two-round modified Delphi process will be conducted. Fifty-four international expert participants including healthcare professionals and organisational leaders from care homes and nursing homes and academic researchers will be recruited through purposive sampling. During the first Delphi round, participants will be invited to rate the relevance of each implementation strategy on a 9-point Likert scale and provide comments or suggestions. Descriptive statistics will be used to identify whether consensus has been obtained. Inductive qualitative content analysis will be used to analyse and summarise textual responses for any new statements suggested by participants. Statements that do not reach consensus and new statements suggested in round 1 will be taken to the next round, which will follow the same rating process. Discussion This study will identify strategies for implementing pet robots in care homes and nursing homes for residents with dementia, which will have practical utility for clinicians, organisations and researchers. It will also demonstrate the practical application (and adaptation) of the CFIR-ERIC tool to identify and contextualise ERIC strategies. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00308-z.
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Affiliation(s)
- Wei Qi Koh
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, H91 E3YV, Galway, Ireland.
| | - Dympna Casey
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, H91 E3YV, Galway, Ireland
| | - Viktoria Hoel
- Institute for Public Health and Nursing Research, University of Bremen, 28359, Bremen, Germany.,Leibniz Science Campus Digital Public Health, 28359, Bremen, Germany
| | - Elaine Toomey
- School of Allied Health, University of Limerick, V94 T9PX, Limerick, Ireland.,Health Research Institute, University of Limerick, V94 T9PX, Limerick, Ireland
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17
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The Use of Robotic Pets by Community-Dwelling Older Adults: A Scoping Review. Int J Soc Robot 2022. [DOI: 10.1007/s12369-022-00892-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Koh WQ, Toomey E, Flynn A, Casey D. Determinants of implementing of pet robots in nursing homes for dementia care. BMC Geriatr 2022; 22:457. [PMID: 35624435 PMCID: PMC9136197 DOI: 10.1186/s12877-022-03150-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/17/2022] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Wei Qi Koh
- National University of Ireland Galway, Galway, H91 E3YV, Ireland.
| | | | - Aisling Flynn
- National University of Ireland Galway, Galway, H91 E3YV, Ireland
| | - Dympna Casey
- National University of Ireland Galway, Galway, H91 E3YV, Ireland
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19
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Moyle W, Murfield J, Lion K. Therapeutic use of the humanoid robot, Telenoid, with older adults: A critical interpretive synthesis review. Assist Technol 2022:1-8. [PMID: 35358024 DOI: 10.1080/10400435.2022.2060375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 10/18/2022] Open
Abstract
This review sought to critically evaluate the use of the teleoperated humanoid robotic communications device, Telenoid, for therapeutic purposes with older adults, and identify and highlight key considerations for future research and clinical practice within gerontechnology. A critical interpretive synthesis was conducted, with nine electronic databases and online sources searched using the keyword "Telenoid." Studies were included in the review if they were: written in English; reported primary research; employed a qualitative, quantitative, or mixed-method design; and described or measured effects, experiences, or perceptions of using Telenoid for therapeutic purposes with older adults. Critical engagement with the studies identified key themes, as well as opportunities to advance future research. Ten studies involving Telenoid were identified, with eight focused on older adults living with dementia. Study findings centered around two themes: effects (including positive effects and negative reactions), and challenges and considerations (including technical issues, operator training, acceptability, and dosage). Although several issues currently challenge the use of Telenoid, available studies show some therapeutic potential of using Telenoid with older adults, including those living with dementia, particularly for communication and mood. Higher-quality studies are required to advance understanding, and considerations for the field are outlined to aid development.
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Affiliation(s)
- Wendy Moyle
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Nursing & Midwifery, Griffith University, Brisbane, Australia
- Australian Aged Care Technologies Collaborative, Griffith University, Brisbane, Australia
| | - Jenny Murfield
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Nursing & Midwifery, Griffith University, Brisbane, Australia
- Australian Aged Care Technologies Collaborative, Griffith University, Brisbane, Australia
| | - Katarzyna Lion
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Australian Aged Care Technologies Collaborative, Griffith University, Brisbane, Australia
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20
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Chiu CJ, Lo YH, Ho MH, Montayre J, Zhao IY. Association between loneliness and acceptance of using robots and pets as companions among older Chinese immigrants during the COVID-19 pandemic. Australas J Ageing 2022; 41:414-423. [PMID: 35438833 PMCID: PMC9111400 DOI: 10.1111/ajag.13075] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/19/2022] [Accepted: 03/27/2022] [Indexed: 11/28/2022]
Abstract
Objectives To examine loneliness experienced by middle‐aged and older Chinese immigrants and its association with accepting technology as a companion (apps, Internet and robots) versus owning pets, when social distancing measures were implemented in New Zealand during the first COVID‐19 outbreak. Methods This study conducted a community‐based cross‐sectional survey. Chinese immigrants who were 45–87 years old (n = 173) were invited to answer an online survey in the Chinese language, collecting demographic data, responses to the 6‐item De Jong Gierveld Loneliness Scale and experiences in using technology and pet ownership. Descriptive analyses and inferential statistics tests were utilised in the data analysis. Results A moderate level of overall loneliness with a mean score of 3.68 (SD 1.84), ranging from 0 to 6, was reported by participants. Emotional and social loneliness ranged from 0 to 3 with mean scores of 1.69 (SD 0.98) and 1.99 (SD 1.24), respectively. Self‐reported health, financial status, English language abilities, transportation and experiences of using the Internet and apps were significantly related to experiencing loneliness. Loneliness had a weak association with acceptance of robots and pets, but 67.8% and 58.3% of participants who felt lonely, accepted companionship of robots and pets, respectively. Conclusions The level of loneliness among older and middle‐aged immigrants increased during the COVID‐19 pandemic. Further evidence of the specific dimensions of loneliness and the utility of technology to alleviate loneliness among immigrant groups is needed. Interventions tailored for older people with specific cultural requirements to address loneliness are needed.
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Affiliation(s)
- Ching-Ju Chiu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Hsuan Lo
- Department of Statistics, College of Management, National Cheng Kung University, Tainan, Taiwan
| | - Mu-Hsing Ho
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Jed Montayre
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
| | - Ivy Yan Zhao
- WHO Collaborating Centre for Community Health Services, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR
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21
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Koh WQ, Whelan S, Heins P, Casey D, Toomey E, Dröes RM. 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. JMIR Aging 2022; 5:e29224. [PMID: 35191844 PMCID: PMC8905483 DOI: 10.2196/29224] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/29/2021] [Accepted: 12/28/2021] [Indexed: 12/20/2022] Open
Abstract
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.
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Affiliation(s)
- Wei Qi Koh
- School of Nursing and Midwifery, College of Medicine, Nursing & Health Sciences, National University of Ireland, Galway, Ireland
| | - Sally Whelan
- Irish Centre for Autism & Neurodevelopmental Research, National University of Ireland Galway, Galway, Ireland
| | - Pascale Heins
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Dympna Casey
- School of Nursing and Midwifery, College of Medicine, Nursing & Health Sciences, National University of Ireland, Galway, Ireland
| | - Elaine Toomey
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Rose-Marie Dröes
- Department of Psychiatry, Amsterdam University Medical Centers, VUmc/Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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22
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Robotic Companion Pets and Seniors With Dementia in Nursing Homes. Prof Case Manag 2022; 27:85-90. [PMID: 35099422 DOI: 10.1097/ncm.0000000000000553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Dosso JA, Kailley JN, Guerra GK, Robillard JM. Older adult perspectives on emotion and stigma in social robots. Front Psychiatry 2022; 13:1051750. [PMID: 36713914 PMCID: PMC9878396 DOI: 10.3389/fpsyt.2022.1051750] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/20/2022] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Social robot adoption by older adults and people living with dementia is limited by several barriers, including a lack of emotional alignment with social robots and perceptions of stigma around social robot use. The goal of this work was to address these barriers by engaging end-users in discussions on factors that could affect emotional connection to a social robot and considerations around using a social robot in public. METHODS We conducted seven 90-min online workshops with older adults with (n = 2) and without dementia (n = 25) and care partners (n = 17). Older adults with and without dementia were in their 50s - 80s, and care partners were in their 30s - 70s. Seven older adults, seven care partners, and one older adult with dementia indicated that they had used a robot before. Online workshops had 4-8 participants each, and began with video demonstrations of pet-like robot MiRo and tabletop robot T-Top, as well as a live demonstration of MiRo. Participants completed the Multi-Dimensional Robot Attitude Scale before the workshops and the Psychosocial Impact of Assistive Devices Scale and two Zoom polls during the workshops. The audio and chat responses from the workshops were transcribed verbatim and content analysis was performed on the transcripts. RESULTS Our analysis revealed three broad themes and 10 subthemes. In their discussions on features and applications, participants highlighted preferred forms of communication with a robot and ways in which a robot could support connection between people. For example, robots could improve the quality of communication between care partners and the person for whom they care. While many agreed that a social robot should match their level of emotion and interactivity, participants had different preferences for social robot emotional range and display features. Finally, participants discussed considerations around showing a robot to other people; several participants suggested that a robot could help raise awareness of ageing and dementia while others shared concerns about stigma and attracting negative attention from an audience. DISCUSSION Incorporating these findings into the design and implementation of social robots will result in devices that are better-suited to the needs of older adults, people living with dementia, and care partners.
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Affiliation(s)
- Jill A Dosso
- Division of Neurology, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.,British Columbia Children's and Women's Hospital, Vancouver, BC, Canada
| | - Jaya N Kailley
- Division of Neurology, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.,British Columbia Children's and Women's Hospital, Vancouver, BC, Canada
| | - Gabriella K Guerra
- Division of Neurology, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.,British Columbia Children's and Women's Hospital, Vancouver, BC, Canada
| | - Julie M Robillard
- Division of Neurology, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.,British Columbia Children's and Women's Hospital, Vancouver, BC, Canada
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24
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Robinson F, Nejat G. An analysis of design recommendations for socially assistive robot helpers for effective human-robot interactions in senior care. J Rehabil Assist Technol Eng 2022; 9:20556683221101389. [PMID: 35733614 PMCID: PMC9208044 DOI: 10.1177/20556683221101389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/26/2022] [Indexed: 11/15/2022] Open
Abstract
As the global population ages, there is an increase in demand for assistive technologies that can alleviate the stresses on healthcare systems. The growing field of socially assistive robotics (SARs) offers unique solutions that are interactive, engaging, and adaptable to different users’ needs. Crucial to having positive human-robot interaction (HRI) experiences in senior care settings is the overall design of the robot, considering the unique challenges and opportunities that come with novice users. This paper presents a novel study that explores the effect of SAR design on HRI in senior care through a results-oriented analysis of the literature. We provide key design recommendations to ensure inclusion for a diverse set of users. Open challenges of considering user preferences during design, creating adaptive behaviors, and developing intelligent autonomy are discussed in detail. SAR features of appearance and interaction mode along with SAR frameworks for perception and intelligence are explored to evaluate individual developments using metrics such as trust, acceptance, and intent to use. Drawing from a diverse set of features, SAR frameworks, and HRI studies, the discussion highlights robot characteristics of greatest influence in promoting wellbeing and aging-in-place of older adults and generates design recommendations that are important for future development.
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Affiliation(s)
- Fraser Robinson
- Autonomous Systems and Biomechatronics Laboratory (ASBLab), Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Goldie Nejat
- Autonomous Systems and Biomechatronics Laboratory (ASBLab), Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
- Toronto Rehabilitation Institute, Toronto, ON, Canada
- Baycrest Health Sciences, Rotman Research Institute, Toronto, ON, Canada
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Edwards KJ, Jones RB, Shenton D, Page T, Maramba I, Warren A, Fraser F, Križaj T, Coombe T, Cowls H, Chatterjee A. The Use of Smart Speakers in Care Home Residents: Implementation Study. J Med Internet Res 2021; 23:e26767. [PMID: 34932010 PMCID: PMC8726051 DOI: 10.2196/26767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/17/2021] [Accepted: 11/18/2021] [Indexed: 01/19/2023] Open
Abstract
Background The use of smart speakers to improve well-being had been trialed in social care by others; however, we were not aware of their implementation in most care homes across a region in the Southwest of the United Kingdom. For the widespread adoption of new technology, it must be locally demonstrable and become normalized. Objective The aim of this study was to install smart speakers in care homes in a rural and coastal region and to explore if and how the devices were being used, the barriers to their implementation, and their potential benefits. Methods Email, workshops, drop-in sessions, phone, and cold calling was used to contact all 230 care homes, offering a free smart speaker and some advisory support. Care homes accepting the devices were asked to complete a feedback diary. Nonresponse rate for diary completion was high and was thus supplemented with a telephone survey. Results Over the course of 7 months, we installed 156 devices in 92 care homes for older people, 50 devices for people with physical or mental health needs, and 8 for others. The devices were used mainly for music but also for poetry, recipes, light controls, jokes, and video calls. Care home managers reported the benefits for the residents, including enhanced engagement with home activities, enjoyment, calming effects, and the acquisition of new skills. Implementation problems included internet connectivity, staff capacity, and skills. Conclusions Affordable consumer devices such as smart speakers should be installed in all care homes to benefit residents. Voice-activated technologies are easy to use and promote interaction. This study indicates that implementation in care homes was possible and that smart speakers had multifaceted benefits for residents and staff. Most care homes in this region now use smart speakers for their residents, thereby normalizing this practice.
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Affiliation(s)
- Katie J Edwards
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - Ray B Jones
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - Deborah Shenton
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - Toni Page
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - Inocencio Maramba
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - Alison Warren
- School of Health Professions, University of Plymouth, Plymouth, United Kingdom
| | - Fiona Fraser
- School of Health Professions, University of Plymouth, Plymouth, United Kingdom
| | - Tanja Križaj
- School of Health Professions, University of Plymouth, Plymouth, United Kingdom
| | - Tristan Coombe
- School of Nursing and Midwifery, University of Plymouth, Truro, United Kingdom
| | - Hazel Cowls
- School of Nursing and Midwifery, University of Plymouth, Truro, United Kingdom
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Bradwell HL, Edwards K, Shenton D, Winnington R, Thill S, Jones RB. User-Centered Design of Companion Robot Pets Involving Care Home Resident-Robot Interactions and Focus Groups With Residents, Staff, and Family: Qualitative Study. JMIR Rehabil Assist Technol 2021; 8:e30337. [PMID: 34723825 PMCID: PMC8593804 DOI: 10.2196/30337] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/04/2021] [Accepted: 09/27/2021] [Indexed: 01/30/2023] Open
Abstract
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.
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Affiliation(s)
- Hannah Louise Bradwell
- Centre for Health Technology, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Katie Edwards
- Centre for Health Technology, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Deborah Shenton
- Faculty of Arts and Humanities, University of Plymouth, Plymouth, United Kingdom
| | | | - Serge Thill
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Ray B Jones
- Centre for Health Technology, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
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Bradwell HL, Aguiar Noury GE, Edwards KJ, Winnington R, Thill S, Jones RB. Design recommendations for socially assistive robots for health and social care based on a large scale analysis of stakeholder positions. HEALTH POLICY AND TECHNOLOGY 2021. [DOI: 10.1016/j.hlpt.2021.100544] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Hori Y, Kato K, Kobayashi M, Inoue Y, Lai K, Sugishita A, Okamoto Y, Kamiya S, Shibata T. Use of Robotic Pet in a Distributed Layout Elderly Housing with Services: A Case Study on Elderly People with Cognitive Impairment. JOURNAL OF ROBOTICS AND MECHATRONICS 2021. [DOI: 10.20965/jrm.2021.p0784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
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.
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Ihamäki P, Heljakka K. Robot Pets as "Serious Toys"- Activating Social and Emotional Experiences of Elderly People. INFORMATION SYSTEMS FRONTIERS : A JOURNAL OF RESEARCH AND INNOVATION 2021; 26:1-15. [PMID: 34413702 PMCID: PMC8364409 DOI: 10.1007/s10796-021-10175-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 05/09/2023]
Abstract
When robots are used as part of meaningful play, for example to enhance wellbeing, they can be considered "serious toys". Our study examines the potential of robotic pet toys viewed as companions, which activate social and emotional experiences of the elderly by increasing their wellbeing. In order to study the benefits of using Golden Pup, a commercial robot dog, we designed and performed a research intervention at a senior day activity center with 10 participants of ages 65-80+ years who were joined by a playful group of preschoolers. In this study, we were mainly interested in the firsthand user experiences.This study suggests how robotic pets can be used to activate the social and emotional experiences of elderly, and illustrated the role of building a relationship with a robotic pet. We present novel results on how a robot dog with a natural interface (NUI) may be used to evoke social and emotional experiences in older adults as part of playful, intergenerational group activities.
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Obayashi K, Kodate N, Masuyama S. Assessing the Impact of an Original Soft Communicative Robot in a Nursing Home in Japan: Will Softness or Conversations Bring more Smiles to Older People? Int J Soc Robot 2021; 14:645-656. [PMID: 34394770 PMCID: PMC8349236 DOI: 10.1007/s12369-021-00815-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 11/07/2022]
Abstract
It has been reported that robotics-aided care can contribute to enhancing older people's social participation and quality of life in nursing homes, while simultaneously reducing the burden on care professionals at nighttime. Due to increasing demand for social care and the relative workforce shortage, it is likely that a greater number and variety of robots will be introduced and implemented in the future. While the benefits of applying robots and assistive technologies are recognized, the current limitations and weaknesses have also been identified. One of these is the difficulty associated with a user-centered design, involving older adults with impaired cognitive and sensory abilities in nursing homes. In order to overcome this challenge, a project was carried out to develop a soft and compact bedside communication robot with an input/output device, connected to existing technologies (e.g. monitoring camera, biological sensor). Drawing on the principle of gemba (deference to frontline professionals' experience, expertise and skills), users' feedback was reflected in the iterative steps of robot development. The original soft and communicative robot was introduced and its effectiveness was tested by measuring older people's reactions and changes in their behaviors and engagement levels. The article reports the development process and results of a small-scale evaluation study, comparing the impact of this original soft-type robot with and without its communicative functions. The human-robot interactions were captured on video, and the analysis revealed that while communicative robots reduced the psychosocial burden on older adults, positive emotional, verbal, visual and behavioral engagement was generated with the help of the non-verbal plush toy.
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Affiliation(s)
- Kazuko Obayashi
- Faculty of Healthcare Management, Nihon Fukushi University, Mihama, Japan
- Social Welfare Corporation Tokyo Seishin-kai, Nishitokyo, Japan
- Universal Accessibility and Ageing Research Centre, Nishitokyo, Japan
| | - Naonori Kodate
- Universal Accessibility and Ageing Research Centre, Nishitokyo, Japan
- School of Social Policy, Social Work and Social Justice, University College Dublin, Hanna Sheehy Skeffington Building, Belfield, Dublin 4, D04 N9Y1 Ireland
- Institute for Future Initiatives, University of Tokyo, Tokyo, Japan
- Public Policy Research Center, Hokkaido University, Sapporo, Japan
- La Fondation France-Japon, L’ École des hautes études en sciences sociales, Paris, France
| | - Shigeru Masuyama
- Universal Accessibility and Ageing Research Centre, Nishitokyo, Japan
- Traveler’s Medical Center, Tokyo Medical University, Tokyo, Japan
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Tulsulkar G, Mishra N, Thalmann NM, Lim HE, Lee MP, Cheng SK. Can a humanoid social robot stimulate the interactivity of cognitively impaired elderly? A thorough study based on computer vision methods. THE VISUAL COMPUTER 2021; 37:3019-3038. [PMID: 34345091 PMCID: PMC8323964 DOI: 10.1007/s00371-021-02242-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 06/13/2023]
Abstract
Social Assistive Robotics is increasingly being used in care settings to provide psychosocial support and interventions for the elderly with cognitive impairments. Most of these social robots have provided timely stimuli to the elderly at home and in care centres, including keeping them active and boosting their mood. However, previous investigations have registered shortcomings in these robots, particularly in their ability to satisfy an essential human need: the need for companionship. Reports show that the elderly tend to lose interests in these social robots after the initial excitement as the novelty wears out and the monotonous familiarity becomes all too familiar. This paper presents our research facilitating conversations between a social humanoid robot, Nadine, and cognitively impaired elderly at a nursing home. We analysed the effectiveness of human-humanoid interactions between our robot and 14 elderly over 29 sessions. We used both objective tools (based on computer vision methods) and subjective tools (based on observational scales) to evaluate the recorded videos. Our findings showed that our subjects engaged positively with Nadine, suggesting that their interaction with the robot could improve their well-being by compensating for some of their emotional, cognitive, and psychosocial deficiencies. We detected emotions associated with cognitively impaired elderly during these interactions. This study could help understand the expectations of the elderly and the current limitations of Social Assistive Robots. Our research is aligned with all the ethical recommendations by the NTU Institutional Review Board.
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Affiliation(s)
- Gauri Tulsulkar
- Institute of Media Innovation, Nanyang Technological University, Singapore, Singapore
| | - Nidhi Mishra
- Institute of Media Innovation, Nanyang Technological University, Singapore, Singapore
| | - Nadia Magnenat Thalmann
- Institute of Media Innovation, Nanyang Technological University, Singapore, Singapore
- MIRALab, University of Geneva, Geneva, Switzerland
| | - Hwee Er Lim
- Goshen Consultancy Services Pte Ltd, Singapore, Singapore
| | - Mei Ping Lee
- Goshen Consultancy Services Pte Ltd, Singapore, Singapore
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Barriers and facilitators to the implementation of social robots for older adults and people with dementia: a scoping review. BMC Geriatr 2021; 21:351. [PMID: 34107876 PMCID: PMC8191065 DOI: 10.1186/s12877-021-02277-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/10/2021] [Indexed: 11/12/2022] Open
Abstract
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.
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Peters MDJ, Marnie C. Human costs of aged care productivity: Innovation versus staffing and skills mix. Collegian 2021. [DOI: 10.1016/j.colegn.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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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. Int J Soc Robot 2021; 14:245-256. [PMID: 33907589 PMCID: PMC8062829 DOI: 10.1007/s12369-021-00781-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 01/30/2023]
Abstract
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, ηp2 = .258), as was the comparison between Any Robot used and Care As Usual (F[1] = 5.128, sig = .031, ηp2 = .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.
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Hudson J, Ungar R, Albright L, Tkatch R, Schaeffer J, Wicker ER. Robotic Pet Use Among Community-Dwelling Older Adults. J Gerontol B Psychol Sci Soc Sci 2021; 75:2018-2028. [PMID: 32789476 PMCID: PMC7566965 DOI: 10.1093/geronb/gbaa119] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Indexed: 11/19/2022] Open
Abstract
Objective The primary purpose of this study was to explore the efficacy of robotic pets in alleviating loneliness for older adults. Method Self-reported lonely individuals with AARP Medicare Supplement plans insured by UnitedHealthcare who participated in a program with a robotic pet (n = 20) were recruited to participate in semi-structured interviews. Participants were asked to provide feedback about their experiences interacting with a robotic pet, their perceptions about the potential impact on loneliness, and recommendations for improving the program. Interviews were audio-recorded and transcribed verbatim. Participants’ responses were analyzed using qualitative content analysis. Constant comparison and consensus-gaining processes were used to develop categories that later formed representative themes. Results Seven themes emerged from analysis: Openness to Adoption of Robotic Pet, Reactions to Pet and its Attributes, Integration of Pet in Daily Life, Strategic Utilization and Forging New Connections, Deriving Comfort and Camaraderie, Advice for Future Users, and Recommendations for Enhancing Ownership Experience. Participants living alone, with fewer social connections and less active lifestyles, derived the most benefit from interacting with their pets. Common responses to pets included cuddling, petting, grooming, and sleeping with them. Some shared or loaned their pets, while others refused to loan their pets to interested peers. Most reported showing their pets to others, which helped some facilitate communication and social connections. Conclusion Robotic pets may be an effective solution for alleviating loneliness in older adults, especially among those who live alone, have fewer social connections, and live less active lifestyles.
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Affiliation(s)
- Janella Hudson
- Research for Aging Populations, Optum, Ann Arbor, Michigan
| | - Rachel Ungar
- Research for Aging Populations, Optum, Ann Arbor, Michigan
| | - Laurie Albright
- UnitedHealth Group, Medicare and Retirement, Minneapolis, Minnesota
| | - Rifky Tkatch
- Research for Aging Populations, Optum, Ann Arbor, Michigan
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Koh WQ, Ang FXH, Casey D. Impacts of Low-cost Robotic Pets for Older Adults and People With Dementia: Scoping Review. JMIR Rehabil Assist Technol 2021; 8:e25340. [PMID: 33497349 PMCID: PMC8082946 DOI: 10.2196/25340] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/12/2020] [Accepted: 01/04/2021] [Indexed: 01/26/2023] Open
Abstract
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.
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Affiliation(s)
- Wei Qi Koh
- National University of Ireland Galway, Galway, Ireland
| | | | - Dympna Casey
- National University of Ireland Galway, Galway, Ireland
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Tsujimura M, Ide H, Yu W, Kodate N, Ishimaru M, Shimamura A, Suwa S. The essential needs for home-care robots in Japan. JOURNAL OF ENABLING TECHNOLOGIES 2020. [DOI: 10.1108/jet-03-2020-0008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This study aims to compare the level of needs for home-care robots amongst older adults, family caregivers and home-care staff and clarify the factors constituting these needs.
Design/methodology/approach
A cross-sectional, anonymous questionnaire survey was administered. It included 52 items related to needs for home-care robots rated on a four-point Likert scale. Means and standard deviations were calculated, and the Kruskal-Wallis test was performed for each item. Factor analysis was conducted on the needs of home-care staff.
Findings
Responses from 79 older adults, 54 family caregivers and 427 home-care staff were analysed. For all three groups, the level of agreement was high for the following needs: to inform family and support personnel immediately when older adults fall, about their location in case of natural disasters and about mismanagement of fire by older adults with dementia. For family caregivers and home-care staff, the level of need concerning monitoring was higher than for older adults. Extracted using factor analysis, the six factors representing the essential needs for home-care robots were risk minimisation, daily monitoring of the physical condition, supporting activities of daily living (ADL) and instrumental ADL, pre-empting problems, communication and miscellaneous support.
Originality/value
The results showed that the education of caregivers and the co-design process of robot development should involve home-care staff, older adults and family caregivers, which are important for making decisions about the use of home-care robots for older adults.
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Bradwell HL, Johnson CW, Lee J, Winnington R, Thill S, Jones RB. Microbial contamination and efficacy of disinfection procedures of companion robots in care homes. PLoS One 2020; 15:e0237069. [PMID: 32845891 PMCID: PMC7449478 DOI: 10.1371/journal.pone.0237069] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 07/20/2020] [Indexed: 01/18/2023] Open
Abstract
Background Paro and other robot animals can improve wellbeing for older adults and people with dementia, through reducing depression, agitation and medication use. However, nursing and care staff we contacted expressed infection control concerns. Little related research has been published. We assessed (i) how microbiologically contaminated robot animals become during use by older people within a care home and (ii) efficacy of a cleaning procedure. Methods This study had two stages. In stage one we assessed microbial load on eight robot animals after interaction with four care home residents, and again following cleaning by a researcher. Robot animals provided a range of shell-types, including fur, soft plastic, and solid plastic. Stage two involved a similar process with two robot animals, but a care staff member conducted cleaning. The cleaning process involved spraying with anti-bacterial product, brushing fur-type shells, followed by vigorous top-to-tail cleaning with anti-bacterial wipes on all shell types. Two samples were taken from each of eight robots in stage one and two robots in stage two (20 samples total). Samples were collected using contact plate stamping and evaluated using aerobic colony count and identification (gram stain, colony morphology, coagulase agglutination). Colony counts were measured by colony forming units per square centimetre (CFU/cm2). Results Most robots acquired microbial loads well above an acceptable threshold of 2.5 CFU/cm2 following use. The bacteria identified were micrococcus species, coagulase negative staphylococcus, diptheriods, aerobic spore bearers, and staphylococcus aureus, all of which carry risk for human health. For all devices the CFU/cm2 reduced to well within accepted limits following cleaning by both researcher and care staff member. Conclusions Companion robots will acquire significant levels of bacteria during normal use. The simple cleaning procedure detailed in this study reduced microbial load to acceptable levels in controlled experiments. Further work is needed in the field and to check the impact on the transmission of viruses.
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Affiliation(s)
| | | | - John Lee
- Department of Microbiology, Royal Cornwall Hospital, Truro, Cornwall, United Kingdom
| | - Rhona Winnington
- Department of Nursing, Auckland University of Technology, Auckland, New Zealand
| | - Serge Thill
- Donders Centre of Cognition, Radboud University, Nijmegen, The Netherlands
| | - Ray B. Jones
- Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
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Bradwell HL, Winnington R, Thill S, Jones RB. Ethical perceptions towards real-world use of companion robots with older people and people with dementia: survey opinions among younger adults. BMC Geriatr 2020; 20:244. [PMID: 32664904 PMCID: PMC7359562 DOI: 10.1186/s12877-020-01641-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 07/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Use of companion robots may reduce older people's depression, loneliness and agitation. This benefit has to be contrasted against possible ethical concerns raised by philosophers in the field around issues such as deceit, infantilisation, reduced human contact and accountability. Research directly assessing prevalence of such concerns among relevant stakeholders, however, remains limited, even though their views clearly have relevance in the debate. For example, any discrepancies between ethicists and stakeholders might in itself be a relevant ethical consideration while concerns perceived by stakeholders might identify immediate barriers to successful implementation. METHODS We surveyed 67 younger adults after they had live interactions with companion robot pets while attending an exhibition on intimacy, including the context of intimacy for older people. We asked about their perceptions of ethical issues. Participants generally had older family members, some with dementia. RESULTS Most participants (40/67, 60%) reported having no ethical concerns towards companion robot use when surveyed with an open question. Twenty (30%) had some concern, the most common being reduced human contact (10%), followed by deception (6%). However, when choosing from a list, the issue perceived as most concerning was equality of access to devices based on socioeconomic factors (m = 4.72 on a scale 1-7), exceeding more commonly hypothesized issues such as infantilising (m = 3.45), and deception (m = 3.44). The lowest-scoring issues were potential for injury or harm (m = 2.38) and privacy concerns (m = 2.17). Over half (39/67 (58%)) would have bought a device for an older relative. Cost was a common reason for choosing not to purchase a device. CONCLUSIONS Although a relatively small study, we demonstrated discrepancies between ethical concerns raised in the philosophical literature and those likely to make the decision to buy a companion robot. Such discrepancies, between philosophers and 'end-users' in care of older people, and in methods of ascertainment, are worthy of further empirical research and discussion. Our participants were more concerned about economic issues and equality of access, an important consideration for those involved with care of older people. On the other hand the concerns proposed by ethicists seem unlikely to be a barrier to use of companion robots.
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Affiliation(s)
- Hannah L Bradwell
- Center for Health Technology, University of Plymouth, Plymouth, Devon, UK.
| | - Rhona Winnington
- Department of Nursing, Auckland University of Technology, 90 Akoranga Drive, Auckland, New Zealand
| | - Serge Thill
- Donders Centre for Cognition, Radboud University, Nijmegen, 6525, HR, The Netherlands
| | - Ray B Jones
- Center for Health Technology, University of Plymouth, Plymouth, Devon, UK
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Koutentakis D, Pilozzi A, Huang X. Designing Socially Assistive Robots for Alzheimer's Disease and Related Dementia Patients and Their Caregivers: Where We are and Where We are Headed. Healthcare (Basel) 2020; 8:E73. [PMID: 32225117 PMCID: PMC7349047 DOI: 10.3390/healthcare8020073] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 01/06/2023] Open
Abstract
Over the past few years there has been a large rise in the field of robotics. Robots are being in used in many industries, but there has not been a large surge of robots in the medical field, especially the robots for healthcare use. However, as the aging population keeps growing, current medical staff and healthcare providers are increasingly burdened by caring for the ever-growing number of senior patients, especially those with cognitive impairment of Alzheimer's disease (AD) and Alzheimer's disease-related dementia (ADRD) patients. As a result, we can expect to see a large increase in the field of medical robotics, especially in forms of socially assistive robots (SARs) for senior patients and healthcare providers. In fact, SARs can alleviate AD and ADRD patients and their caregivers' unmet medical needs. Herein, we propose a design outline for such a SAR, based on a review of the current literature. We believe the next generation of SARs will enhance health and well-being, reduce illness and disability, and improve quality of life for AD and ADRD patients and their caregivers.
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Affiliation(s)
| | | | - Xudong Huang
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA; (D.K.); (A.P.)
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Pilozzi A, Huang X. Overcoming Alzheimer's Disease Stigma by Leveraging Artificial Intelligence and Blockchain Technologies. Brain Sci 2020; 10:E183. [PMID: 32210011 PMCID: PMC7139597 DOI: 10.3390/brainsci10030183] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/11/2020] [Accepted: 03/20/2020] [Indexed: 01/19/2023] Open
Abstract
Alzheimer's disease (AD) imposes a considerable burden on those diagnosed. Faced with a neurodegenerative decline for which there is no effective cure or prevention method, sufferers of the disease are subject to judgement, both self-imposed and otherwise, that can have a great deal of effect on their lives. The burden of this stigma is more than just psychological, as reluctance to face an AD diagnosis can lead people to avoid early diagnosis, treatment, and research opportunities that may be beneficial to them, and that may help progress towards fighting AD and its progression. In this review, we discuss how recent advents in information technology may be employed to help fight this stigma. Using artificial intelligence (AI) technologies, specifically natural language processing (NLP), to classify the sentiment and tone of texts, such as those of online posts on various social media sites, has proven to be an effective tool for assessing the opinions of the general public on certain topics. These tools can be used to analyze the public stigma surrounding AD. Additionally, there is much concern among individuals that an AD diagnosis, or evidence of pre-clinical AD such as a biomarker or imaging test results, may wind up unintentionally disclosed to an entity that may discriminate against them. The lackluster security record of many medical institutions justifies this fear to an extent. Adopting more secure and decentralized methods of data transfer and storage, and giving patients enhanced ability to control their own data, such as a blockchain-based method, may help to alleviate some of these fears.
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Affiliation(s)
| | - Xudong Huang
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA;
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Requirements for Robotic Interpretation of Social Signals “in the Wild”: Insights from Diagnostic Criteria of Autism Spectrum Disorder. INFORMATION 2020. [DOI: 10.3390/info11020081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The last few decades have seen widespread advances in technological means to characterise observable aspects of human behaviour such as gaze or posture. Among others, these developments have also led to significant advances in social robotics. At the same time, however, social robots are still largely evaluated in idealised or laboratory conditions, and it remains unclear whether the technological progress is sufficient to let such robots move “into the wild”. In this paper, we characterise the problems that a social robot in the real world may face, and review the technological state of the art in terms of addressing these. We do this by considering what it would entail to automate the diagnosis of Autism Spectrum Disorder (ASD). Just as for social robotics, ASD diagnosis fundamentally requires the ability to characterise human behaviour from observable aspects. However, therapists provide clear criteria regarding what to look for. As such, ASD diagnosis is a situation that is both relevant to real-world social robotics and comes with clear metrics. Overall, we demonstrate that even with relatively clear therapist-provided criteria and current technological progress, the need to interpret covert behaviour cannot yet be fully addressed. Our discussions have clear implications for ASD diagnosis, but also for social robotics more generally. For ASD diagnosis, we provide a classification of criteria based on whether or not they depend on covert information and highlight present-day possibilities for supporting therapists in diagnosis through technological means. For social robotics, we highlight the fundamental role of covert behaviour, show that the current state-of-the-art is unable to characterise this, and emphasise that future research should tackle this explicitly in realistic settings.
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