[Maintenance and improvement of quality of life among elderly patients using a pet-type robot]

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.

Robot therapy aids mental health in patients with hematological malignancy during hematopoietic stem cell transplantation in a protective isolation unit

Patients with hematological malignancy experience physical and psychological pain, such as a sense of isolation and confinement due to intensive chemotherapy in a protective isolation unit (PIU). We examined whether the intervention of a robotic puppy, aibo (manufactured by Sony), could improve patients' mental health as an alternative therapy for pet therapy, which is not feasible in PIU. This study included 21 patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) (n = 16) or autologous HSCT (n = 5). The patients were randomly divided into the aibo and control groups. Psychological effects were regularly assessed by measuring the levels of salivary stress hormone chromogranin A (CgA), serum oxytocin, and serum cortisol and the quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR) scores. The aibo group demonstrated a significant decrease in CgA level, while the control group showed the opposite trend. In addition, changes in serum oxytocin and cortisol levels indicated that aibo helped reduce stress. There was no significant difference in the QIDS-SR scores between the two groups; however, the psychomotor activity in the aibo group improved significantly. These findings suggest that aibo intervention during a stay in a PIU can improve the mental health of patients with hematological malignancies who have undergone HSCT.

Nursing Perceptions of Robotic Technology in Healthcare: A Pretest-Posttest Survey Analysis Using an Educational Video

OCCUPATIONAL APPLICATIONSWe used a survey to evaluate the perceptions of nurses and nursing students on robotic technology for nursing care before and after reviewing an educational video that included examples of medical, care, and healthcare service robotic technology. We found that the perception of robotic technology was innately favorable and became more favorable after the video. It is beneficial for engineers to incorporate nurses' frontline knowledge into the design process from the beginning, while functional changes can be implemented since nurses comprise the largest group of healthcare professionals in hospitals and are the end users of technological devices. Educating nurses in state-of-the-art technology specific to what designers are developing can enable them to provide relevant insight. Designers and engineers can use this insight to create user-friendly, effective technology that improves not only patient care but also nurse job satisfaction.

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

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

Development and Usability Validation of a Social Robot Platform for Physical and Cognitive Stimulation in Elder Care Facilities

This article shows our work for developing an elder care platform for social interaction and physical and cognitive stimulation using the Pepper robot and Android OS as clients, based on the knowledge acquired on our long-term social robotics research experience. The first results of the user’s acceptance of the solution are presented in this article. The platform is able to provide different services to the user, such as information, news, games, exercises or music. The games, which have a bi-modal way of interacting (speech and a touch screen interface), have been designed for cognitive stimulation based on the items of the mini-mental state examination. The results of the user’s performance are stored in a cloud database and can be reviewed by therapists through a web interface that also allows them to establish customized therapy plans for each user. The platform has been tested and validated, first using adult people and then deployed to an elder care facility where the robot has been interacting with users for a long period of time. The results and feedback received have shown that the robot can help to keep the users physically and mentally active as well as establish an emotional link between the user and the robot.

Robot Pets as "Serious Toys"- Activating Social and Emotional Experiences of Elderly People

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.

Why visiting one's ageing mother is not enough: on filial duties to prevent and alleviate parental loneliness

As people grow old, many risk becoming chronically lonely which is associated with e.g. depression, dementia, and increased mortality. Whoever else should help to protect them from this risk, various philosophers have argued that any children that they might have will often be among them. Proceeding on this assumption, this article considers what filial duties to protect ageing parents from loneliness consist of, or might consist of. I develop my answer by showing that a view that may be intuitively plausible, namely that they simply require children to visit their ageing parents regularly when they can do so at reasonable cost and call, text, and/or email them from time to time, is defective in three respects. First, it ignores children's potential responsibilities to encourage and/or facilitate social interaction between their parents and third parties. Second, it ignores their potential responsibilities to help provide their parents with non-human companionship. Third, it elides over their duties to coordinate their efforts to offer loneliness protection with others. What I end up proposing instead, then, is an approach for protecting ageing parents from loneliness that is multi-faceted.

Are friends electric? The benefits and risks of human-robot relationships

Social robots that can interact and communicate with people are growing in popularity for use at home and in customer-service, education, and healthcare settings. Although growing evidence suggests that co-operative and emotionally aligned social robots could benefit users across the lifespan, controversy continues about the ethical implications of these devices and their potential harms. In this perspective, we explore this balance between benefit and risk through the lens of human-robot relationships. We review the definitions and purposes of social robots, explore their philosophical and psychological status, and relate research on human-human and human-animal relationships to the emerging literature on human-robot relationships. Advocating a relational rather than essentialist view, we consider the balance of benefits and harms that can arise from different types of relationship with social robots and conclude by considering the role of researchers in understanding the ethical and societal impacts of social robotics.

Can robots tackle late-life loneliness? Scanning of future opportunities and challenges in assisted living facilities

This future-oriented study examines the opportunities and challenges offered by social robots and communication technology when aiming to decrease emotional and social loneliness in older people residing in assisted living (AL). The paper draws on prior literature on loneliness, elder care and social robots. The aim is to scan the futures regarding technology support for the frail older people in future AL. The analytical frame was built on Robert Weiss' division of relational functions: attachment, social integration, opportunity for nurturance, reassurance of worth, sense of reliable alliance, and guidance in stressful situations, and on a distinction between direct and indirect social robots. Our examinations show that social robots could tackle both emotional and social loneliness in assisted living by empowering people to engage in different forms of social interaction inside and outside the facility. However, ethical concerns of objectification, lack of human contact, and deception need to be thoroughly considered when implementing social robots in care for frail older people.

Supporting Active and Healthy Aging with Advanced Robotics Integrated in Smart Environment

The technological advances in the robotic and ICT fields represent an effective solution to address specific societal problems to support ageing and independent life. One of the key factors for these technologies is the integration of service robotics for optimising social services and improving quality of life of the elderly population. This chapter aims to underline the barriers of the state of the art, furthermore the authors present their concrete experiences to overcome these barriers gained at the RoboTown Living Lab of Scuola Superiore Sant'Anna within past and current projects. They analyse and discuss the results in order to give recommendations based on their experiences. Furthermore, this work highlights the trend of development from stand-alone solutions to cloud computing architecture, describing the future research directions.

Effect of Pet Insects on the Psychological Health of Community-Dwelling Elderly People: A Single-Blinded, Randomized, Controlled Trial

Background: There is evidence that animal-assisted therapy has positive effects on mental health, especially in elderly people. Caring for insects is easy, relatively inexpensive, and does not require much space. Objective: The aim of this 8-week randomized, controlled, single-blinded study was to investigate the effect of pet insects on the psychological health of community-dwelling elderly people. Methods: Elderly subjects (≥65 years old) attending a community center in Daegu, Korea, were enrolled in the study between April and May 2014 and randomized at a 1:1 ratio to receive insect therapy and health advice or only health advice. The insect group received 5 crickets in a cage with sufficient fodder and a detailed instruction manual. At baseline and at 8 weeks, all subjects underwent psychometric tests via a direct interview [Beck Anxiety Inventory, Geriatric Depression Scale (GDS-15), Mini-Mental State Examination (MMSE), 36-Item Short Form Health Survey, Insomnia Severity Index, Fatigue Severity Scale, and Brief Encounter Psychosocial Instrument] and laboratory analyses of inflammatory and oxidative stress markers (erythrocyte sedimentation rate, high-sensitivity C-reactive protein, biological antioxidant potential, and derivatives of reactive oxygen metabolites). Results: The insect-caring (n = 46) and control (n = 48) groups did not differ in baseline characteristics. The insect-caring group had significantly lower GDS-15 scores at week 8 (3.20 vs. 4.90, p = 0.004) and, after adjustment for baseline values, a significantly greater change in GDS-15 scores relative to baseline (-1.12 vs. 0.20, p = 0.011). They also had a significantly greater change in MMSE scores relative to baseline (1.13 vs. 0.31, p = 0.045). The two groups did not differ in terms of other psychometric and laboratory tests. No serious risks or adverse events were reported. Conclusion: Caring for insects, which is cost-effective and safe, was associated with a small to medium positive effect on depression and cognitive function in community-dwelling elderly people.

Investigating the effectiveness of technologies applied to assist seniors: A systematic literature review

BACKGROUND

Recently, a number of Information and Communication Technologies have emerged with the aim to provide innovative and efficient ways to help seniors in their daily life and to reduce the cost of healthcare. Studies have been conducted to introduce an assistive technology to support seniors and to investigate the acceptance of these assistive technologies; however, research illustrating the effectiveness of assistive technologies is scant.

METHOD

This study undertakes a systematic literature review of ScienceDirect, PubMed, ProQuest and IEEE Explore databases to investigate current empirical studies on the assistive technologies applied in aged care. Our systematic review of an initial set of 2035 studies published from 2000 to 2014 examines the role of assistive technologies in seniors' daily lives, from enhancements in their mobility to improvements in the social connectedness and decreases in readmission to hospitals.

RESULTS

This study found eight key issues in aged care that have been targeted by researchers from different disciplines (e.g., ICT, health and social science), namely, dependent living, fall risk, chronic disease, dementia, social isolation, depression, poor well-being, and poor medication management. This paper also identified the assistive technologies that have been proposed to overcome those problems, and we categorised these assistive technologies into six clusters, namely, general ICT, robotics, telemedicine, sensor technology, medication management applications, and video games. In addition, we analyzed the effectiveness of the identified technologies and noted that some technologies can change and enhance seniors' daily lives and relieve their problems. Our analysis showed a significant growth in the number of publications in this area in the past few years. It also showed that most of the studies in this area have been conducted in North America.

CONCLUSION

Assistive technologies are a reality and can be applied to improve quality of life, especially among older age groups. This study identified various assistive technologies proposed by ICT researchers to assist the elderly. We also identified the effectiveness of the proposed technologies. This review shows that, although assistive technologies have been positively evaluated, more studies are needed regarding the outcome and effectiveness of these technologies.

The benefit of pets and animal-assisted therapy to the health of older individuals

Many studies utilizing dogs, cats, birds, fish, and robotic simulations of animals have tried to ascertain the health benefits of pet ownership or animal-assisted therapy in the elderly. Several small unblinded investigations outlined improvements in behavior in demented persons given treatment in the presence of animals. Studies piloting the use of animals in the treatment of depression and schizophrenia have yielded mixed results. Animals may provide intangible benefits to the mental health of older persons, such as relief social isolation and boredom, but these have not been formally studied. Several investigations of the effect of pets on physical health suggest animals can lower blood pressure, and dog walkers partake in more physical activity. Dog walking, in epidemiological studies and few preliminary trials, is associated with lower complication risk among patients with cardiovascular disease. Pets may also have harms: they may be expensive to care for, and their owners are more likely to fall. Theoretically, zoonotic infections and bites can occur, but how often this occurs in the context of pet ownership or animal-assisted therapy is unknown. Despite the poor methodological quality of pet research after decades of study, pet ownership and animal-assisted therapy are likely to continue due to positive subjective feelings many people have toward animals.

Comparison of Verbal and Emotional Responses of Elderly People with Mild/Moderate Dementia and Those with Severe Dementia in Responses to Seal Robot, PARO

Introduction: The differences in verbal and emotional responses to a baby seal robot, PARO, of elderly people with dementia residing at an elderly nursing care facility were analyzed. There were two groups of elderly people: one was with mild/moderate dementia (M-group) that consisted with 19 elderly residents in the general ward, and the other was with severe dementia (S-group) that consisted with 11 elderly residents in the dementia ward.

Method: Each elderly resident in both groups interacted with either PARO or a control (stuffed lion toy: Lion) brought by a staff at each resident’s private room. Their responses were recorded on video. Behavioral analysis of the initial 6 min of the interaction was conducted using a time sampling method.

Results: In both groups, subjects talked more frequently to PARO than to Lion, showed more positive changes in emotional expression with PARO than with Lion, and laughed more frequently with PARO than with Lion. Subjects in M-group even showed more negative emotional expressions with Lion than with PARO. Furthermore, subjects in S-group showed neutral expression more frequently with Lion than with PARO, suggesting more active interaction with PARO. For subjects in M-group, frequencies of touching and stroking, frequencies of talking to staff member, and frequencies of talking initiated by staff member were significantly higher with Lion than with PARO.

Conclusion: The elderly people both with mild/moderate dementia and with severe dementia showed greater interest in PARO than in Lion. The results suggest that introducing PARO may increase willingness of the staff members to communicate and work with elderly people with dementia, especially those with mild/moderate dementia who express their demand of communication more than those with severe dementia.

Does owning a pet protect older people against loneliness?

BACKGROUND

Pet ownership is thought to make a positive contribution to health, health behaviours and the general well-being of older people. More specifically pet ownership is often proposed as a solution to the problem of loneliness in later life and specific 'pet based' interventions have been developed to combat loneliness. However the evidence to support this relationship is slim and it is assumed that pet ownership is a protection against loneliness rather than a response to loneliness. The aim of this paper is to examine the association between pet ownership and loneliness by exploring if pet ownership is a response to, or protection against, loneliness using Waves 0-5 from the English Longitudinal Study of Ageing (ELSA).

METHODS

Using data from 5,210 men and women in the English Longitudinal Study of Ageing, cross-sectional and longitudinal regression analysis was used to assess the bi-directional relationship between loneliness and pet ownership among adults aged 50 + .

RESULTS

In 2001 (wave 0) 41% of participants were pet owners compared with 30% in 2010 (Wave 5). The association between pet ownership and loneliness is stronger in women than men, and in both directions (i.e. pet ownership predicting loneliness and loneliness predicting pet ownership) and of the similar magnitude (OR 1.2-1.4). Age, social relationships, demographic factors and health behaviour variables have only a minimal influence upon the association between loneliness and pet ownership. The results of our longitudinal analysis showed that women who reported being lonely always in Waves 0 to 5 were more likely to have a pet in Wave 5.

CONCLUSION

Reported loneliness is dependent on socio-demographic characteristics such as gender, household income, household living arrangements and health status. Taking those factors into account, owning a pet significantly influences later reporting of loneliness in women in our longitudinal analysis. In the reverse direction, reported loneliness influences pet ownership in later waves. In both directions, the relatively strong gender interaction suggests the association is limited to women with effects for men minimal or non-existent.

Care robots for the supermarket shelf: a product gap in assistive technologies

The literature on the development of assistive robots is dominated by technological papers with little consideration of how such devices might be commercialised for a mass market at a price that is affordable for older people and their families as well as public services and care insurers. This article argues that the focus of technical development in this field is too ambitious, neglecting the potential market for an affordable device that is aleady in the realm of the 'adjacent possible' given current technology capabilities. It also questions on both ethical and marketing grounds the current effort to develop assistive robots with pet-like or human-like features. The marketing literature on 'really new products' has so far not appeared to inform the development of assistive robots but has some important lessons. These include using analogies with existing products and giving particular attention to the role of early adopters. Relevant analogies for care robots are not animals or humans but useful domestic appliances and personal technologies with attractive designs, engaging functionality and intuitive usability. This points to a strategy for enabling mass adoption - which has so far eluded even conventional telecare - of emphasising how such an appliance is part of older people's contemporary lifestyles rather than a sign of age-related decline and loss of independence.

Animal-assisted interventions for elderly patients affected by dementia or psychiatric disorders: a review

OBJECTIVE

The aim of this literature review was to assess the effects of Animal-Assisted Interventions (AAI) on elderly patients with dementia or various psychiatric disorders.

METHODS

We conducted a comprehensive literature search using the online PubMed network of the US National Library of Medicine & National Institutes of Health, Embase, PsycINFO, with the purpose of investigating AAI effects on cognitive functions, mood, and behaviour.

RESULTS

A total of 18 articles on dementia and 5 on psychiatric disorders were included in the present review. AAI were found to have positive influences on demented patients by reducing degree of agitation and by improving degree and quality of social interaction. Few studies have assessed the effects of AAI on mood, and even fewer have assessed its consequences on cognitive functions. The results that are available indicate a positive effect on communication and coping ability, but none on cognitive performance. A substitute pet robot yielded encouraging results, but its use requires further investigation. The few studies conducted for elderly patients presenting a variety of psychiatric diagnoses produced controversial findings.

CONCLUSIONS

In spite of the encouraging results of AAI, much more research examining the issue of optimal AAI duration, frequency of sessions, and suitable target group is needed.

Virtual reality and robotics for stroke rehabilitation: where do we go from here?

Promoting functional recovery after stroke requires collaborative and innovative approaches to neurorehabilitation research. Task-oriented training (TOT) approaches that include challenging, adaptable, and meaningful activities have led to successful outcomes in several large-scale multisite definitive trials. This, along with recent technological advances of virtual reality and robotics, provides a fertile environment for furthering clinical research in neurorehabilitation. Both virtual reality and robotics make use of multimodal sensory interfaces to affect human behavior. In the therapeutic setting, these systems can be used to quantitatively monitor, manipulate, and augment the users' interaction with their environment, with the goal of promoting functional recovery. This article describes recent advances in virtual reality and robotics and the synergy with best clinical practice. Additionally, we describe the promise shown for automated assessments and in-home activity-based interventions. Finally, we propose a broader approach to ensuring that technology-based assessment and intervention complement evidence-based practice and maintain a patient-centered perspective.

Using robots to help people habituate to visible disabilities

We explore a new way of using robots as human-human social facilitators: inter-ability communication. This refers to communication between people with disabilities and those without disabilities. We have interviewed people with head and facial movement disorders (n = 4), and, using a vision-based approach, recreated their movements on our 27 degree-of-freedom android robot. We then conducted an exploratory experiment (n = 26) to see if the robot might serve as a suitable tool to allow people to practice inter-ability interaction on a robot before doing it with a person. Our results suggest a robot may be useful in this manner. Furthermore, we have found a significant relationship between people who hold negative attitudes toward robots and negative attitudes toward people with disabilities.

Robot therapy: a new approach for mental healthcare of the elderly - a mini-review

Mental healthcare of elderly people is a common problem in advanced countries. Recently, high technology has developed robots for use not only in factories but also for our living environment. In particular, human-interactive robots for psychological enrichment, which provide services by interacting with humans while stimulating their minds, are rapidly spreading. Such robots not only simply entertain but also render assistance, guide, provide therapy, educate, enable communication, and so on. Robot therapy, which uses robots as a substitution for animals in animal-assisted therapy and activity, is a new application of robots and is attracting the attention of many researchers and psychologists. The seal robot named Paro was developed especially for robot therapy and was used at hospitals and facilities for elderly people in several countries. Recent research has revealed that robot therapy has the same effects on people as animal therapy. In addition, it is being recognized as a new method of mental healthcare for elderly people. In this mini review, we introduce the merits and demerits of animal therapy. Then we explain the human-interactive robot for psychological enrichment, the required functions for therapeutic robots, and the seal robot. Finally, we provide examples of robot therapy for elderly people, including dementia patients.

Social Effects of Robot Therapy in a Care House– Change of Social Network of the Residents for One Year –

Robot therapy in the form of two seal robots was conducted for a year at a care house in Japan. Residents and robots interacted over 9 hours a day. To determine psychological and social robot influence, individual residents were interviewed using the “free pile sort” method and their social interaction was analyzed. After robot use was discontinued, follow-up showed that robots encouraged residents to communicate with each other and strengthen their individual ties during the year of robot use.

Robot Therapy for Prevention of Dementia at Home – Results of Preliminary Experiment

In robot therapy for senile dementia patients, a seal-like robot, Paro, was left in patients’ homes for a week to determine its neuropsychological influence. Efficacy was evaluated by the diagnosis method of neuronal dysfunction (DIMENSION), which detects a lack of smoothness of scalp potential distribution resulting from cortical neuronal impairment by analyzing recorded a patient’s electroencephalogram (EEG). Interaction with Paro by patients was observed by their families. In a preliminary experiment, 5 subjects were studied after informed consent was received from them or their families in accordance with the medical ethics committee of the University of Tsukuba and the AIST ethics committee.