Use and effect of embodied conversational agents for improving eating behavior and decreasing loneliness among community-dwelling older adults: A randomized controlled trial (Preprint)

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

BACKGROUND

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

METHODS

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

FINDINGS

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

CONCLUSION

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

The Role of Chatbots in Enhancing Health Care for Older Adults: A Scoping Review

OBJECTIVES

This scoping review aimed to review the characteristics, applications, evaluation approaches, and challenges regarding the use of chatbots in older adults.

DESIGN

The scoping review followed the methodological framework by Arksey and O'Malley, with revisions proposed by Levac et al. The findings were reported using the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews checklist.

SETTING AND PARTICIPANTS

The reviewed articles primarily focused on older adults, with research conducted in both clinical and nonclinical settings.

METHODS

Studies published from January 2010 to May 2023 were searched through 8 databases. A total of 29 studies were identified and evaluated in this review.

RESULTS

Results showed that the chatbots were mainly delivered via mobile applications (n = 11), most of them used text as input (n = 16) and output modality (n = 13), and most of them targeted at improving the overall well-being of the older adults (n = 9); most chatbots were designed for fulfilling complex health care needs (n = 7) and health information collection (n = 6). Evaluation approaches of chatbots captured in this review were divided into technical performance, user acceptability, and effectiveness; challenges of applying chatbots to older adults lie in the design of the chatbot, user perception, and operational difficulties.

CONCLUSIONS AND IMPLICATIONS

The use of chatbots in the field of older adults is still emerging, with a lack of specifically designed options for older users. Data about the health impact of chatbots as alternative interventions were still limited. More standardized evaluation criteria and robust controlled experiments are needed for further research regarding the effectiveness of chatbots in older adults.

Qualitative Analysis of Conversational Chatbots to Alleviate Loneliness in Older Adults as a Strategy for Emotional Health

This article presents an exploration of conversational chatbots designed to alleviate loneliness among older adults. In addition to technical evaluation, it delves into effective communication between these systems and this demographic group, considering linguistic nuances, communicative preferences, and specific emotional needs. The intrinsic importance of chatbots as innovative solutions in combating loneliness is highlighted, emphasizing their ability to be understanding and empathetic allies, contributing to emotional well-being and socialization. The article explores how improved emotional well-being can positively impact the health and quality of life of older adults. The methodology, rooted in triangulation between a literature review and qualitative research through interviews and focus groups with older adults, provides a comprehensive insight into the findings. Ethical, technical, and design considerations such as privacy, autonomy, technology adaptation, and usability are also addressed. The article concludes with practical recommendations for developing user-friendly interfaces that encourage the active participation of older adults in chatbots. This holistic approach not only analyzes the technical effectiveness of chatbots in mitigating loneliness in older adults but delves into human, ethical, and practical aspects, enriching the understanding and implementation of these agents for social and emotional support.