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

Ethical considerations in the use of social robots for supporting mental health and wellbeing in older adults in long-term care

Social robots are increasingly being utilized to address mental health challenges in older adults, such as depression, anxiety, and loneliness. However, ethical concerns surrounding their use are insufficiently explored in empirical research. This paper examines the ethical challenges and mitigation strategies for implementing social robots in long-term care settings. Drawing from insights gained from research across two Canadian studies involving Paro and Lovot, we highlight the critical role of an equity-focused approach to ensure the ethical use of social robots. We advocate for the respectful inclusion of the voices and desires of marginalized groups, such as older adults with dementia. Key ethical issues discussed include inequitable access, consent, substitution of human care, and concerns about infantilization. Our empirical work offers practical strategies to navigate these challenges, aiming to ensure that social robots promote mental health and wellbeing in an ethically responsible manner for older adults living in long-term care.

Intelligent assistive technology devices for persons with dementia: A scoping review

Assistive technology (AT) with context-aware computing and artificial intelligence capabilities can be applied to address cognitive and communication impairments experienced by persons with dementia (PwD). This paper aims to provide an overview of current literature regarding some characteristics of intelligent assistive technology devices (IATDs) for cognitive and communicative impairments of PwD. It also aims to identify the areas of impairment addressed by these IATDs.A multi-faceted systematic search strategy yielded records. Predefined criteria were applied for inclusion and data extraction. Thereafter data was thematically analysed and synthesised. This review demonstrates that almost all of the research involving IATDs has focused on cognitive impairments of PwD and has not yet evolved past the conceptual or prototype stages of development. Summaries of commercially available IATDs for PwD and relevant prototypes are provided at the end of this review.This research concluded that IATDs for PwD targeting cognition and communication problems primarily focus on social robots, and that they address cognitive impairments of attention, affect, and social-pragmatic communicative impairments. Future research endeavours concerning AT for PwD should explore collaboration between computer engineering and health practitioners to address the identified gaps. This may contribute to the available information for evidence-based decision making for PwD.

Adoption of Artificial Intelligence-Enabled Robots in Long-Term Care Homes by Health Care Providers: Scoping Review

BACKGROUND

Long-term care (LTC) homes face the challenges of increasing care needs of residents and a shortage of health care providers. Literature suggests that artificial intelligence (AI)-enabled robots may solve such challenges and support person-centered care. There is a dearth of literature exploring the perspectives of health care providers, which are crucial to implementing AI-enabled robots.

OBJECTIVE

This scoping review aims to explore this scant body of literature to answer two questions: (1) what barriers do health care providers perceive in adopting AI-enabled robots in LTC homes? (2) What strategies can be taken to overcome these barriers to the adoption of AI-enabled robots in LTC homes?

METHODS

We are a team consisting of 3 researchers, 2 health care providers, 2 research trainees, and 1 older adult partner with diverse disciplines in nursing, social work, engineering, and medicine. Referring to the Joanna Briggs Institute methodology, our team searched databases (CINAHL, MEDLINE, PsycINFO, Web of Science, ProQuest, and Google Scholar) for peer-reviewed and gray literature, screened the literature, and extracted the data. We analyzed the data as a team. We compared our findings with the Person-Centered Practice Framework and Consolidated Framework for Implementation Research to further our understanding of the findings.

RESULTS

This review includes 33 articles that met the inclusion criteria. We identified three barriers to AI-enabled robot adoption: (1) perceived technical complexity and limitation; (2) negative impact, doubted usefulness, and ethical concerns; and (3) resource limitations. Strategies to mitigate these barriers were also explored: (1) accommodate the various needs of residents and health care providers, (2) increase the understanding of the benefits of using robots, (3) review and overcome the safety issues, and (4) boost interest in the use of robots and provide training.

CONCLUSIONS

Previous literature suggested using AI-enabled robots to resolve the challenges of increasing care needs and staff shortages in LTC. Yet, our findings show that health care providers might not use robots because of different considerations. The implication is that the voices of health care providers need to be included in using robots.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-doi:10.1136/bmjopen-2023-075278.

Positive Emotional Responses to Socially Assistive Robots in People With Dementia: Pilot Study

Background

Interventions and care that can evoke positive emotions and reduce apathy or agitation are important for people with dementia. In recent years, socially assistive robots used for better dementia care have been found to be feasible. However, the immediate responses of people with dementia when they are given multiple sensory modalities from socially assistive robots have not yet been sufficiently elucidated.

Objective

This study aimed to quantitatively examine the immediate emotional responses of people with dementia to stimuli presented by socially assistive robots using facial expression analysis in order to determine whether they elicited positive emotions.

Methods

This pilot study adopted a single-arm interventional design. Socially assistive robots were presented to nursing home residents in a three-step procedure: (1) the robot was placed in front of participants (visual stimulus), (2) the robot was manipulated to produce sound (visual and auditory stimuli), and (3) participants held the robot in their hands (visual, auditory, and tactile stimuli). Expression intensity values for "happy," "sad," "angry," "surprised," "scared," and "disgusted" were calculated continuously using facial expression analysis with FaceReader. Additionally, self-reported feelings were assessed using a 5-point Likert scale. In addition to the comparison between the subjective and objective emotional assessments, expression intensity values were compared across the aforementioned 3 stimuli patterns within each session. Finally, the expression intensity value for "happy" was compared between the different types of robots.

Results

A total of 29 participants (mean age 88.7, SD 6.2 years; n=27 female; Japanese version of Mini-Mental State Examination mean score 18.2, SD 5.1) were recruited. The expression intensity value for "happy" was the largest in both the subjective and objective assessments and increased significantly when all sensory modalities (visual, auditory, and tactile) were presented (median expression intensity 0.21, IQR 0.09-0.35) compared to the other 2 patterns (visual alone: median expression intensity 0.10, IQR 0.03-0.22; P<.001; visual and auditory: median expression intensity 0.10, IQR 0.04-0.23; P<.001). The comparison of different types of robots revealed a significant increase when all stimuli were presented by doll-type and animal-type robots, but not humanoid-type robots.

Conclusions

By quantifying the emotional responses of people with dementia, this study highlighted that socially assistive robots may be more effective in eliciting positive emotions when multiple sensory stimuli, including tactile stimuli, are involved. More studies, including randomized controlled trials, are required to further explore the effectiveness of using socially assistive robots in dementia care.

Impact of AI-Powered Solutions in Rehabilitation Process: Recent Improvements and Future Trends

Rehabilitation is an important and necessary part of local and global healthcare services along with treatment and palliative care, prevention of disease, and promotion of good health. The rehabilitation process helps older and young adults even children to become as independent as possible in activities of daily life and enables participation in useful living activities, recreation, work, and education. The technology of Artificial Intelligence (AI) has evolved significantly in recent years. Many activities related to rehabilitation have been getting benefits from using AI techniques. The objective of this review study is to explore the advantages of AI for rehabilitation and how AI is impacting the rehabilitation process. This study aims at the most critical aspects of the rehabilitation process that could potentially take advantage of AI techniques including personalized rehabilitation apps, rehabilitation through assistance, rehabilitation for neurological disorders, rehabilitation for developmental disorders, virtual reality rehabilitation, rehabilitation of neurodegenerative diseases and Telerehabilitation of Cardiovascular. We presented a survey on the newest empirical studies available in the literature including the AI-based technology helpful in the Rehabilitation process. The novelty feature included but was not limited to an overview of the technological solutions useful in rehabilitation. Seven different categories were identified. Illustrative examples of practical applications were detailed. Implications of the findings for both research and practice were critically discussed. Most of the AI applications in these rehabilitation types are in their infancy and continue to grow while exploring new opportunities. Therefore, we investigate the role of AI technology in rehabilitation processes. In addition, we do statistical analysis of the selected studies to highlight the significance of this review work. In the end, we also present a discussion on some challenges, and future research directions.

Emotional experiences of service robots' anthropomorphic appearance: a multimodal measurement method

Anthropomorphic appearance is a key factor to affect users' attitudes and emotions. This research aimed to measure emotional experience caused by robots' anthropomorphic appearance with three levels - high, moderate, and low - using multimodal measurement. Fifty participants' physiological and eye-tracker data were recorded synchronously while they observed robot images that were displayed in random order. Afterward, the participants reported subjective emotional experiences and attitudes towards those robots. The results showed that the images of the moderately anthropomorphic service robots induced higher pleasure and arousal ratings, and yielded significantly larger pupil diameter and faster saccade velocity, than did the low or high robots. Moreover, participants' facial electromyography, skin conductance, and heart-rate responses were higher when observing moderately anthropomorphic service robots. An implication of the research is that service robots' appearance should be designed to be moderately anthropomorphic; too many human-like features or machine-like features may disturb users' positive emotions and attitudes.Practitioner Summary: This research aimed to measure emotional experience caused by three types of anthropomorphic service robots using a multimodal measurement experiment. The results showed that moderately anthropomorphic service robots evoked more positive emotion than high and low anthropomorphic robots. Too many human-like features or machine-like features may disturb users' positive emotions.

'Making the most of time during personal care': nursing home staff experiences of meaningful engagement with residents with advanced dementia

OBJECTIVES

Dementia progressively affects cognitive functioning, including the ability to communicate. Those who struggle to communicate are often considered unable to relate to other people. Frontline care workers are in a position to connect with residents. However, we know little about their perspectives. The aim of this study was to understand how and when nursing home staff meaningfully engaged with residents with advanced dementia.

METHODS

Semi-structured interviews, supplemented by informal conversations, were conducted with 21 staff from seven nursing homes. Inductive thematic analysis identified themes in the accounts.

RESULTS

Four themes related to how staff engaged with residents with advanced dementia (initiating meaningful engagement, recognising subtle reactions, practising caring behaviours, patience and perseverance). Two themes related to when meaningful engagement occurred (lacking time to connect, making the most of time during personal care).

CONCLUSION

A key barrier to implementing formal interventions to improve care is lack of staff time. Staff overcome this by using personal care time for meaningful engagement with residents. Their approach, developed through experience, is consonant with person-centred dementia care. Building on this, future research should use participatory approaches building on practice wisdom to further develop and evaluate meaningful engagement with residents with advanced dementia.

Can technology impact loneliness in dementia? A scoping review on the role of assistive technologies in delivering psychosocial interventions in long-term care

PURPOSE

We aimed to identify assistive technologies that are promising for addressing loneliness in people living with dementia in long-term care.

MATERIALS AND METHODS

A scoping review was conducted. EBSCO, PubMed, Cochrane Library, and ProQuest were searched from 2000 to 2020. The included studies were selected by three independent researchers and summarised, compared, and categorized according to technology type. Publications were eligible for inclusion when they reported on psychosocial interventions aiming to reduce loneliness and/or social isolation in people with dementia in long-term care settings.

RESULTS

Twenty-four papers were included (20 original research papers and four reviews). Most studies were conducted in Australia and Europe. The studies aimed to investigate two different types of assistive technology: social robots, and multimedia computer systems. Most studies focussed on behaviour, engagement, and mood as primary outcomes. Only one study directly aimed to alleviate loneliness.

CONCLUSIONS

Even though only one study addressed loneliness directly, it became clear that assistive technologies used to apply psychosocial interventions have the potential to impact loneliness in people with dementia in long-term care. However, it remains unclear why loneliness was not included as an outcome and how loneliness could become a key outcome in evaluating assistive technologies.IMPLICATIONS FOR REHABILITATIONLoneliness among older adults is associated with health risks, such as the development of dementia, depression, and increased mortality.Ambient Assisted Living (AAL) technologies have been studied to address loneliness for older adults; however people with dementia are often excluded from such studies.This diverse group of technologies is shown to have a promising impact on outcomes, such as social engagement, quality of life, and mood, but loneliness was studied less often.More research is needed to discover the potential of assistive technologies for people with dementia living in long-term care.

The effectiveness of a therapeutic robot, 'Paro', on behavioural and psychological symptoms, medication use, total sleep time and sociability in older adults with dementia: A systematic review and meta-analysis

OBJECTIVE

To evaluate the effectiveness of a therapeutic robot, 'Paro', on anxiety, agitation, depression, apathy, medication use, total sleep time, and sociability among older adults with dementia.

DESIGN

Systematic review and meta-analysis with narrative synthesis.

SETTING AND PARTICIPANTS

Older adults aged 60 years and above with any form of dementia in the community, nursing homes, or care facilities.

METHODS

A three-step search strategy was conducted by two independent reviewers. Nine databases were searched (January 2003 to November 2022). Randomised controlled, crossover, and cluster trials on Paro for older adults with dementia published in English were included. All relevant trials were screened and assessed for risk of bias. Data were extracted using the Cochrane data collection form. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess the quality of evidence.

RESULTS

In total, 12 articles involving 1461 participants were included. Results of the meta-analysis showed that Paro had a moderate effect on medication use (SMD: -0.63) and small effect on anxiety (SMD: -0.17), agitation (SMD: -0.27) and depression (SMD: -0.40). However, Paro exhibited negligible effect on total sleep time (SMD: -0.12). The overall quality of evidence for all outcomes were graded as low due to methodological limitations, small sample size, and wide confidence intervals. Narrative synthesis suggested that Paro reduced apathy and increase sociability.

CONCLUSION AND IMPLICATIONS

Paro could be a beneficial non-pharmacological approach to improve behavioural and psychological symptoms of dementia, reducing medication use, and increasing sociability for older adults with dementia. However, the results should be interpreted with caution as limited studies were available. Additionally, there were a variety of approaches across the studies (i.e. group and individual interventions, facilitated and non-facilitated) which made it difficult to determine which interventional approach is optimal to produce beneficial effects of Paro. Hence, more rigorous studies with a larger sample size are needed to fully understand the mechanism and effectiveness of Paro in older adults with dementia. The protocol was registered on PROSPERO (CRD42022296504).

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

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

Socially Assistive Humanoid Robots: Effects on Depression and Health-Related Quality of Life among Low-Income, Socially Isolated Older Adults in South Korea

Using a mixed-method study design, we examined the effects of a socially assistive humanoid robot (SAHR), called Hyodol, on depressive symptoms and health-related quality of life (HRQOL) of low-income, socially isolated older adults (N = 180). Quantitative outcomes were assessed at baseline (before Hyodol deployment) and at 3 and 6 months after baseline. Results showed reduced depressive symptoms and improved HRQOL at 3 months; however, these positive effects did not extend to 6 months. Ten focus group participants perceived Hyodol to be a valuable companion especially during the COVID outbreak. These results suggest that while Hyodol may have provided companionship for some low-income, socially isolated older adults during home confinement, its effects on depression and HRQOL were limited. Further research is needed to assess long-term effects of SAHRs as appropriate tools for reducing social isolation and improving behavioral health among community-dwelling older adults.

Artificial intelligence in elderly healthcare: A scoping review

The ageing population has led to a surge in the adoption of artificial intelligence (AI) technologies in elderly healthcare worldwide. However, in the advancement of AI technologies, there is currently a lack of clarity about the types and roles of AI technologies in elderly healthcare. This scoping review aimed to provide a comprehensive overview of AI technologies in elderly healthcare by exploring the types of AI technologies employed, and identifying their roles in elderly healthcare based on existing studies. A total of 10 databases were searched for this review, from January 1 2000 to July 31 2022. Based on the inclusion criteria, 105 studies were included. The AI devices utilized in elderly healthcare were summarised as robots, exoskeleton devices, intelligent homes, AI-enabled health smart applications and wearables, voice-activated devices, and virtual reality. Five roles of AI technologies were identified: rehabilitation therapists, emotional supporters, social facilitators, supervisors, and cognitive promoters. Results showed that the impact of AI technologies on elderly healthcare is promising and that AI technologies are capable of satisfying the unmet care needs of older adults and demonstrating great potential in its further development in this area. More well-designed randomised controlled trials are needed in the future to validate the roles of AI technologies in elderly healthcare.

Leading by example: Nursing home staff experiences of what facilitates them to meaningfully engage with residents with advanced dementia

OBJECTIVES

Meaningful connections promote the quality of life of people living with advanced dementia in nursing homes. However, evidence internationally suggests people living with advanced dementia in nursing homes spend the majority of time alone, with little contact with anyone. Frontline care workers are in powerful positions to meaningfully engage with residents, yet research to date has not focused on their experiences. The aim of this study was to explore the experiences of nursing home staff, specifically, what care workers feel enables them to meaningfully engage with residents living with advanced dementia.

METHODS/DESIGN

Semi-structured interviews were conducted with 21 staff from seven nursing homes. Inductive thematic analysis was used.

RESULTS

Four themes were important for facilitating care workers to meaningfully engage with residents with advanced dementia: support from managers and nurses, support from experienced care workers, a caring culture and an appropriate physical environment.

CONCLUSION

Effective leadership was the key thread that ran throughout. It was evident that meaningfully engaging with residents with advanced dementia was hard, particularly for new or inexperienced care workers. Those with experience (of care work and the residents they cared for), as well as those in formal leadership positions played key roles in facilitating care workers to: perceive it was their role to connect, understand, accept and empathise with residents, understand the importance of getting to know residents' and express their own caring attributes. Future research should focus on empirically testing leadership models that promote meaningful engagement.

The effect of robot interventions on sleep in adults: a systematic review and network meta-analysis

STUDY OBJECTIVES

Robotic pets or companion robots have demonstrated positive effects on several emotional and physiological factors in humans. Robots could constitute a complementary or alternative method to treat sleep problems, but individual studies on robots' effectiveness regarding sleep show mixed results. The aim of the current study was to compare the effects of robots, plush toys, and treatment as usual on sleep in adults.

METHODS

The current study is a systematic review and frequentist network meta-analysis of all randomized and cluster randomized controlled trials comparing the effects of robots, plush toys, and treatment as usual on total sleep time in adults.

RESULTS

Four studies were included in the analysis. Three studies were considered to have a high risk of bias, whereas one was rated with some concerns. The studies comprised 381 participants. These participants were older adults, with or without dementia, living in nursing homes. The total sleep time was the only common sleep measure included in all 4 studies. The network meta-analysis showed no statistically significant differences between the 3 experimental groups.

CONCLUSIONS

The robot interventions were not found to have positive effects on total sleep time in older adults compared with plush toys or treatment as usual. Future studies should use robots especially made to target sleep, include a thorough screening of the participants, and exclude people with adequate sleep, select appropriate sleep measures, and report the results appropriately for future meta-analyses.

CITATION

Støre SJ, Beckman L, Jakobsson N. The effect of robot interventions on sleep in adults: a systematic review and network meta-analysis. J Clin Sleep Med. 2022;18(7):1877-1884.

Social Robots Acceptance and Marketability in Italy and Germany: A Cross-National Study Focusing on Assisted Living for Older Adults

In the last years, social robots have become a trending topic. Indeed, robots which communicate with us and mimic human behavior patterns are fascinating. However, while there is a massive body of research on their design and acceptance in different fields of application, their market potential has been rarely investigated. As their future integration in society may have a vast disruptive potential, this work aims at shedding light on the market potential, focusing on the assistive health domain. A study with 197 persons from Italy (age: M = 67.87; SD = 8.87) and Germany (age: M = 62.15; SD = 6.14) investigates cultural acceptance, desired functionalities, and purchase preferences. The participants filled in a questionnaire after watching a video illustrating some examples of social robots. Surprisingly, the individual perception of health status, social status as well as nationality did hardly influence the attitude towards social robots, although the German group was somewhat more reluctant to the idea of using them. Instead, there were significant correlations with most dimensions of the Almere model (like perceived enjoyment, sociability, usefulness and trustworthiness). Also, technology acceptance resulted strongly correlated with the individual readiness to invest money. However, as most persons consider social robots as “Assistive Technological Devices” (ATDs), they expected that their provision should mirror the usual practices followed in the two Countries for such devices. Thus, to facilitate social robots’ future visibility and adoption by both individuals and health care organisations, policy makers would need to start integrating them into official ATDs databases.

Socially assistive robots for people with dementia: Systematic review and meta-analysis of feasibility, acceptability and the effect on cognition, neuropsychiatric symptoms and quality of life

BACKGROUND

There is increasing interest in using robots to support dementia care but little consensus on the evidence for their use. The aim of the study is to review evidence about feasibility, acceptability and clinical effectiveness of socially assistive robots used for people with dementia.

METHOD

We conducted a systematic review and meta-analysis. We searched MEDLINE, EMBASE, PsychINFO, CINHAL, IEEE Xplore Digital Library, and EI Engineering Village from inception to 04 - 02-2022 - included primary studies assessing feasibility, acceptability, or effectiveness of socially assistive robots for people with dementia. Two independent reviewers screened studies for eligibility, and assessed quality. Narrative synthesis prioritized higher quality studies, and random-effect meta-analyses compared robots with usual care (UC) or active control (AC) immediately after the intervention (short-term; ST) or long-term (LT) on cognition, neuropsychiatric symptoms, and quality of life.

FINDINGS

66 studies and four categories of robots were eligible: Companion robots (Pet and humanoid companion robots), telepresence communication robots, homecare assistive robots and multifunctional robots. PARO (companion robot seal) was feasible and acceptable but limited by its weight, cost, and sound. On meta-analysis, PARO had no ST or LT compared to UC or AC over 5-12 weeks on agitation (ST vs UC, 4 trials, 153 participants: pooled standardized mean difference (SMD) 0.25; - 0.57 to 0.06; LT vs UC; 2 trials, 77 participants, SMD = -0.24; - 0.94, 0.46), cognition (ST vs UC, 3 trials, 128 participants: SMD= 0.03; -0.32, 0.38), overall neuropsychiatric symptoms (ST vs UC, 3 trials, 169 participants: SMD= -0.01; -0.32, 0.29; ST vs AC, 2 trials, 145 participants: SMD =0.02, -0.71, 0.85), apathy (ST vs AC, 2 trials, 81 participants: SMD= 0.14; 0.29, 0.58), depression (ST vs UC, 4 trials, 181 participants; SMD= 0.08; -0.52, 0.69; LT vs UC: 2 trials, 77 participants: SMD =0.01; -0.75, 0.77), anxiety (ST vs UC: 2 trials, 104 participants, SMD= 0.24; -0.85, 1.33) and quality of life (ST vs UC, 2 trials, 127 participants: SMD=-0.05; -0.52, 0.42; ST vs AC: 2 trials, 159 participants, SMD =-0.36, -0.76, 0.05). Robotic animals, humanoid companion robots, telepresence robots and multifunctional robots were feasible and acceptable. However, humanoid companion robots have speech recognition problems, and telepresence robots and multifunctional robots were often difficult to use. There was mixed evidence about the feasibility of homecare robots. There was little evidence on any of these robots' effectiveness.

CONCLUSION

Although robots were generally feasible and acceptable, there is no clear evidence that people with dementia derive benefit from robots for cognition, neuropsychiatric symptoms, or quality of life. We recommend that future research should use high quality designs to establish evidence of effectiveness.

The use of technology for social interaction by people with dementia: A scoping review

People with dementia (PwD) are at risk of experiencing loneliness, which is associated with physical and mental health difficulties [1]. Technology is a possible tool to increase social connection and reduce loneliness. This scoping review aims to examine the current evidence regarding the use of technology to reduce loneliness in PwD. A scoping review was carried out. Medline, PsychINFO, Embase, CINAHL, Cochrane database, NHS Evidence, Trials register, Open Grey, ACM Digital Library and IEEE Xplore were searched in April 2021. A sensitive search strategy was constructed using combinations of free text and thesaurus terms to retrieve articles about dementia, technology and social-interaction. Pre-defined inclusion and exclusion criteria were used. Paper quality was assessed using the Mixed Methods Appraisal Tool (MMAT) and results reported according to PRISMA guidelines [2,3]. 73 papers were identified publishing the results of 69 studies. Technological interventions included robots, tablets/computers and other forms of technology. Methodologies were varied and limited synthesis was possible. There is some evidence that technology is a beneficial intervention to reduce loneliness. Important considerations include personalisation and the context of the intervention. The current evidence is limited and variable; future research is warranted including studies with specific loneliness outcome measures, studies focusing on PwD living alone, and technology as part of intervention programmes.

Novelty Experience in Prolonged Interaction: A Qualitative Study of Socially-Isolated College Students' In-Home Use of a Robot Companion Animal

Social distancing policies such as limits on public gatherings and contact with others were utilized around the world to slow the spread of COVID-19. Yet, decreased social interactions may also threaten people's well-being. In this project, we sought to understand novelty-relevant experiences surrounding in-home companion robot pets for adults that were living in some degree of social isolation due to the COVID-19 pandemic. After 6-weeks of participants living with the robot companion, we conducted semi-structured interviews (N = 9) and six themes emerged from our iterative analysis (expectations versus reality, ontological comparisons, interactions, third-party influence, identity, and comfort). Findings suggest that novelty is a complex phenomenon consisting of various elements (i.e., imagined novelty, technology novelty, and relational novelty). Each component influences the user's experience. Our findings also suggest that our understanding of novelty as a nonlinear resource may hold important implications for how we view human-robot relationships beyond initial encounters.

Perceived Service Quality in HRI: Applying the SERVBOT Framework

Services are intangible in nature and as a result, it is often difficult to measure the quality of the service. In the service literature, the service is usually delivered by a human to a human customer and the quality of the service is often evaluated using the SERVQUAL dimensions. An extensive review of the literature shows there is a lack of an empirical model to assess the perceived service quality provided by a social robot. Furthermore, the social robot literature highlights key differences between human service and social robots. For example, scholars have highlighted the importance of entertainment value and engagement in the adoption of social robots in the service industry. However, it is unclear whether the SERVQUAL dimensions are appropriate to measure social robot's service quality. The paper proposes the SERVBOT model to assess a social robot's service quality. It identifies, reliability, responsiveness, assurance, empathy, and entertainment as the five dimensions of SERVBOT. Further, the research will investigate how these five factors influence emotional engagement and future intentions to use the social robot in a concierge service setting. The model was tested using student sampling, and a total of 94 responses were collected for the study. The findings indicate empathy and entertainment value as key predictors of emotional engagement. Further, emotional engagement is a strong predictor of future intention to use a social robot in a service setting. This study is the first to propose the SERVBOT model to measure social robot's service quality. The model provides a theoretical underpinning on the key service quality dimensions of a social robot and gives scholars and managers a method to track the service quality of a social robot. The study also extends on the literature by exploring the key factors that influence the use of social robots (i.e., emotional engagement).

Pet-Assisted Therapy for Delirium and Agitation in Hospitalized Patients with Neurocognitive Impairment: A Review of Literature

Delirium leading to agitation is a common issue in elderly people and patients with underlying neurocognitive impairment. Despite use of medications to treat agitation, polypharmacy is a major concern and might lead to multiple side effects in this patient population. Therefore, it is imperative to investigate non-pharmacological methods that can provide solutions to the problem. The objective of this review was to evaluate the impact of pet-assisted therapy on elderly patients, with a major focus on agitation and delirium. For the purposes of this study, a scoping review was performed using PubMed, Google Scholar, and ClinicalTrials. We reviewed literature from 1980 to 2021. Out of the 31 studies reviewed, 14 commented on agitation with respect to pet-assisted interventions. Of these, eight studies (57%) reported a statistically significant reduction in agitation and/or delirium in patients who were exposed to pet therapy. Pet-assisted therapy can improve the standardized care in hospital-based settings for patients with neurocognitive impairment because of better companionship, reduced agitation and mood disorders, and better stability of hemodynamic status. These interventions can pave the way for better patient and hospital satisfaction.

A Library of Old Photos Supporting Conversation of Two Generations Serving Reminiscence Therapy

In Japan, a shift in family patterns has led to a sense of social isolation among older people, which increases the risk of major neurocognitive disorder. Interventions for them using old photos to implement reminiscence therapy (RT) have been proved to be effective. A super-aged society has in turn led to a shortage of medical resources and older people prefer home care over institutional care. Therefore, there is an urgent need for volunteers to help in RT. However, the age of volunteers tends to be increasingly younger. The lack of knowledge and experience of the past for the young volunteers makes it difficult for them to select appropriate stimulated materials. To improve this situation, a library of old photos for RT was developed to support conversation between the two generations. A two-factor experiment and emotion assessment scales were designed to explore the effect of different old photo types on the fluency of conversation between the two generations and their emotion. It was found that the types of old photos have little effect on older people and that conversations were almost pleasant. However, the pleasantness of older people was enhanced when using photos that they wanted to talk about (P = 0.006). Meanwhile, pleasure in conversation of the older people increased with the attention of the young people to the topic (R = 0.304, p < 0.001). Conversely, photo type has a strong impact on young people. When photos are selected that older people do not want to talk about or photos that young people do not know the content and are not interested in, concern for the topic of young people drops dramatically. Therefore, when RT, it is important to avoid using the types of photos above that cause a drop in younger people's attention.

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?

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.

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

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

Approaches to assessing the impact of robotics in geriatric mental health care: a scoping review

The goals of this scoping literature review are to (1) aggregate the current research involving socially assistive robots in the setting of geriatric psychiatry and (2) examine the outcome measures used in these studies and determine where the gaps and needs are. In light of the global COVID-19 pandemic, the geriatric psychiatric population in particular is vulnerable to both the physical and mental toll COVID-19 may cause. Recently, socially assistive robots have gained attention for their ability to aid in the care of the geriatric psychiatry population and are being explored as a realistic way to deliver certain elements of psychiatric care that have the potential to be safe even in the setting of COVID-19. The results of this review indicate that robots are in the early stages of clinical applicability, they display usability for a range of psychiatric indications, and their impact on clinical care is notable. We project that in the next few years, robotic applications will be tailored to address clinical outcomes with a greater degree of precision and efficacy.

How PARO can help older people in elderly care facilities: A systematic review of RCT

Purpose

This review aims to systematically evaluate the effects of Paro on older adults and provide a stronger basis for the rational application of Paro in aged care facilities.

Methods

Articles published between January 2003 and January 2020 via five databases (PubMed, Web of Science, EMBASE, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Chinese database SinoMed) were searched. The Cochrane collaboration tool for randomized controlled trials was used to assess the quality of all included studies.

Results

Nine articles were included in this systematic review. All articles were summarized according to three themes: quality of life, and biopsychological conditions, and drug usage.

Conclusions

The review demonstrated that interaction with Paro can be beneficial for improving quality of life (QOL), biopsychological conditions, and reducing psychotropic and pain medical usage. Since the differences of the study design and low to moderate quality of these studies, however, we should be cautious to make positive comments on the role of Paro.

Implications of nursing practice

The implications of Paro in aged care facilities have positive effects on nursing outcomes. This review helps caregivers understand the advantages and disadvantages of care robots, and promotes the integration of intelligent technology and manual services in nursing practice.

Field Testing of Ro-Tri, a Robot-Mediated Triadic Interaction for Older Adults

Older adults residing in long term care (LTC) settings commonly experience apathy, a neuropsychiatric condition with adverse consequences of increased morbidity and mortality. Activities that combine social, physical and cognitive stimuli are most effective in engaging older adults with apathy but are time consuming and require significant staff resources. We present the results from an initial pilot field study of our socially assistive robotic (SAR) system, Ro-Tri, capable of multi-modal interventions to foster social interaction between pairs of older adults. Seven paired participants attended two sessions a week for three weeks. Sessions consisted of robot-mediated triadic interactions with three types of activities repeated once over the 3 weeks. Ro-Tri gathered quantitative interaction data, head pose, vocal sound, and physiological signals to automatically evaluate older adults' activity and social engagement. Ro-Tri functioned smoothly without any technical issues. Older adults had > 90% attendance and 100% completion rate and remained engaged with the system throughout the study duration. Participants' visual attention toward the SAR system and their partners increased 7.2% and 4.7%, respectively, with their interaction effort showing an increase of 2.9%. Older adults and LTC staff had positive perceptions with the system. These initial results demonstrate Ro-Tri's ability to engage older adults, encourage social human-to-human interaction, and assess the changes using quantitative metrics. Future studies will determine SAR's impact on apathy in LTC older adults.

The Perceptions of People with Dementia and Key Stakeholders Regarding the Use and Impact of the Social Robot MARIO

People with dementia often experience loneliness and social isolation. This can result in increased cognitive decline which, in turn, has a negative impact on quality of life. This paper explores the use of the social robot, MARIO, with older people living with dementia as a way of addressing these issues. A descriptive qualitative study was conducted to explore the perceptions and experiences of the use and impact of MARIO. The research took place in the UK, Italy and Ireland. Semi-structured interviews were held in each location with people with dementia (n = 38), relatives/carers (n = 28), formal carers (n = 28) and managers (n = 13). The data was analyzed using qualitative content analysis. The findings revealed that despite challenges in relation to voice recognition and the practicalities of conducting research involving robots in real-life settings, most participants were positive about MARIO. Through the robot's user-led design and personalized applications, MARIO provided a point of interest, social activities, and cognitive engagement increased. However, some formal carers and managers voiced concern that robots might replace care staff.

Using robot animal companions in the academic library to mitigate student stress

Purpose

The purpose of this paper is to interrogate the relationship between self-reported levels of acute stress, perceived social support and interactions with robot animals in an academic library. The authors hypothesized that (1) participants would report lower stress and higher positive affect after their interaction with a robot support animal and (2) perceived supportiveness of the robot support animal would positively predict the amount of stress reduction the participants reported.

Design/methodology/approach

The authors hosted a robot petting zoo in the main library at a mid-sized Midwestern university during finals week. Participants were asked to rate their stress level prior to interacting with the robot pets (T1) and then after their interaction they were asked about their current stress level and the perceived supportiveness of the robot animal (T2). Data were analyzed using paired samples t-tests for the pretest and post-test scores.

Findings

The results showed a significant decrease in acute stress between T1 to T2, as well as a significant increase in happiness and relaxation. Participants reported feeling less bored and less tired after their interactions with the robot support animals. The findings also reveal that the degree to which individuals experienced a reduction in stress was influenced by their perceptions of the robot animal's supportiveness. Libraries could consider using robot pet therapy.

Originality/value

This study reveals the benefit of robot support animals to reduce stress and increase happiness of those experiencing acute stress in a library setting. The authors also introduce the concept of socially supportive contact as a type of unidirectional social support.

How attitudes generated by humanoid robots shape human brain activity

During interpersonal interactions, people perform actions with different forms of vitality, communicating their positive or negative attitude toward others. For example, a handshake can be "soft" or "vigorous", a caress can be 'kind' or 'rushed'. While previous studies have shown that the dorso-central insula is a key area for the processing of human vitality forms, there is no information on the perception of vitality forms generated by a humanoid robot. In this study, two fMRI experiments were conducted in order to investigate whether and how the observation of actions generated by a humanoid robot (iCub) with low and fast velocities (Study 1) or replicating gentle and rude human forms (Study 2) may convey vitality forms eliciting the activation of the dorso-central insula. These studies showed that the observation of robotic actions, generated with low and high velocities, resulted in activation of the parieto-frontal circuit typically involved in the recognition and the execution of human actions but not of the insula (Study 1). Most interestingly, the observation of robotic actions, generated by replicating gentle and rude human vitality forms, produced a BOLD signal increase in the dorso-central insula (Study 2). In conclusion, these data highlight the selective role of dorso-central insula in the processing of vitality forms opening future perspectives on the perception and understanding of actions performed by humanoid robots.

Introducing service robotics in inpatient geriatric care—a qualitative systematic review from a human resources perspective

This article in the journal Gruppe. Interaktion. Organisation. (GIO) presents a qualitative systematic review of nursing home staff perspectives on the usage of robotic devices in geriatric nursing. Robotic devices have been introduced to the field of inpatient geriatric care only recently. Although the elderly are seen as the primary users of many robotic devices in geriatric care, staff members are the driving force in the implementation and application of these devices. Hence, the Human Resources department has an important role to play in the introduction of service robotics in inpatient geriatric care. In the context of the present study, 22 empirical studies could be identified which were analysed based on the HR framework of Beer et al. (1984). Results hint at differences in staff perception of social robots and robots that support physical activities. Based on the discussion of the findings, five practical recommendations for the introduction of service robotics in inpatient geriatric care are made.

The use of technology to promote meaningful engagement for adults with dementia in residential aged care: a scoping review

INTRODUCTION

A considerable number of adults with dementia live in residential aged care facilities, where loneliness and boredom are common. Computer-based and electronic technologies have advanced significantly and there is potential for such technologies to improve engagement of residents with dementia. However, the nature and extent of the evidence supporting the use of these technologies is unclear.

OBJECTIVES

The aim of this study was to investigate the use of computer-based and electronic technologies for enhancing meaningful engagement of adults with dementia living in residential aged care.

METHODS

A scoping review was conducted. Nine databases were searched from 2008-2018. Included studies were summarized, compared and synthesized according to technology type.

RESULTS

Twenty studies were included. Most studies were conducted in Australia (n = 7) and Europe (n = 8). Study designs were quantitative (n = 12), mixed methods (n = 5), descriptive (n = 2) or qualitative (n = 1). Studies aimed to investigate interaction, engagement, behaviors or quality of life (n = 14), to examine the feasibility of technologies (n = 3), or had both aims (n = 3). Technology type fell into two categories: robotics (n = 14) and multi-media computer programs (n = 6). Across both technology types, there were conflicting results in relation to positive impact on meaningful engagement. Studies only investigated the doing, belonging and connecting aspects of meaningful engagement. Additionally, there was a lack of consistency across studies in how activity, interaction and engagement were measured.

CONCLUSION

The role and potential of new technologies to enhance meaningful engagement for those with dementia should focus on creating human-to-human interactions while taking individual preference and person-centered principles into account.

A social robot intervention on depression, loneliness, and quality of life for Taiwanese older adults in long-term care

OBJECTIVES

To investigate the effect of a social robot intervention on depression, loneliness, and quality of life of older adults in long-term care (LTC) and to explore participants' experiences and perceptions after the intervention.

DESIGN

A mixed-methods approach consisting of a single group, before and after quasi-experimental design, and individual interview.

PARTICIPANTS

Twenty older adults with depression from four LTC facilities in Taiwan were recruited.

INTERVENTION

Each participant participated in 8 weeks of observation and 8 weeks of intervention. In the observation stage, participants received usual care or activities without any research intervention. In the intervention stage, each participant was given a Paro (Personal Assistive RobOt) to keep for 24 hours, 7 days a week.

MEASUREMENTS

The Geriatric Depression Scale, the UCLA Loneliness Scale Version 3, and the World Health Organization Quality of Life Questionnaire for older adults were administered at four time points. Individual qualitative interviews with thematic analysis followed.

RESULTS

A repeated multivariate analysis of variance and Friedman's test showed no significant changes during the observation stage between T1 and T2 for depression and quality of life (p >.5). For the intervention stage, statistically significant changes in decreasing depression and loneliness and improving quality of life over time were identified. Three themes emerged from the interviews: (i) humanizing Paro through referring to personal experiences and engagement; (ii) increased social interaction with other people; and (iii) companionship resulting in improved mental well-being.

CONCLUSIONS

There were significant improvements in mental well-being in using Paro. Further research may help us to understand the advantages of using a Paro intervention as depression therapy.

Changes in technology acceptance among older people with dementia: the role of social robot engagement

OBJECTIVE

Emerging technologies such as social robots have shown to be effective in reducing loneliness and agitation for older people with dementia. However, the acceptance of technology (specifically social robots) was found to be low for older people with dementia. The current understanding of changes in technology acceptance following direct exposure is limited and lacks rigorous study design. This study examined the change in technology acceptance after a direct interaction with a humanoid social robot (Kabochan) that was deployed for long-term care facilities' residents with dementia.

METHODS

The technology acceptance was assessed using randomised control trials for a time frame of 32 weeks. A total of 103 residents clinically diagnosed with dementia, with a mean age of 87.2 years (SD = 7.4), were recruited from seven long-term care facilities in Hong Kong and were randomly allocated to either Kabochan-engagement group or control group. Participants in the engagement group interacted with Kabochan in an individual, non-facilitated approach. The behavioural engagement with Kabochan was observed by care workers and recorded into constructive engagement and non-engagement. Questionnaire surveys were taken placed at pre- and post-exposure with Kabochan to measure attitudes and beliefs towards technology. The questionnaire was based on previous studies on technology acceptance and included attitudes towards technology, perceived usefulness, perceived ease of use, technology self-efficacy, technology anxiety, and facilitating conditions.

RESULTS

Perceived ease of use was improved at week 32 for participants who interacted with Kabochan (F = 4.239, p = 0.042) with a small effect (η_p² = 0.043) in comparison to usual care group. Results further demonstrated that the magnitude of belief changes was related to the intensity of constructive behavioural engagement. Specifically, resident-robot behavioural engagement moderately improved attitudes towards technology (F = 11.62, p < 0.001, η_p² = 0.11) and perceived usefulness (F = 5.75, p = 0.02, η_p² = 0.06).

CONCLUSIONS

The study tentatively supports that exposure to Kabochan has potential for changing perceived ease of use but not for other beliefs and attitudes towards technology among long-term care residents with dementia. Direct engagement with a humanoid social robot might be promising in improving the perceived ease of use towards technology.

Effects of a Humanoid Companion Robot on Dementia Symptoms and Caregiver Distress for Residents in Long-Term Care

OBJECTIVES

To test the effects of deploying a humanoid companion robot (Kabochan) in comparison with usual care for long-term care facilities' residents with dementia.

DESIGN

A 2-arm, randomized controlled trial with ABAB withdrawal design, lasting 32 weeks. After an 8-week baseline period, Kabochan was introduced in a nonfacilitated, individual approach with experimental-group participants (n = 52) for 8 weeks, then removed for 8 weeks, and then reintroduced for another 8 weeks. The control group (n = 51) received the usual standardized care.

SETTING AND PARTICIPANTS

Seven long-term care facilities in Hong Kong. 103 residents (76% women, 87.2 ± 7.4 years) with a clinical diagnosis of dementia.

MEASURES

Outcome assessments occurred at 5 time points: baseline (week 1) and the end of each phase (weeks 8, 16, 24, and 32). Primary outcomes were assessed with the Neuropsychiatric Inventory Questionnaire (symptom severity and caregiver distress subscales) and the Geriatric Depression Scale; secondary outcomes were measured by the Hong Kong Montreal Cognitive Assessment 5-minute Protocol, the Modified Barthel Index for Activities of Daily Living, and the Quality of Life-Alzheimer's disease scale.

RESULTS

A multivariate analysis of variance indicated a statistically significant group × time interaction for neuropsychiatric-related caregiver distress at week 16 (F = 6.72, P = .011), with a moderate effect size (η_p² = 0.06). When Kabochan was removed in the withdrawal phase (weeks 17-24), the neuropsychiatric symptoms became more severe at week 24 for the intervention group (F = 4.68, P = .003), although the effect size was small to moderate (η_p² = 0.04). No statistical between-group differences were found in other health outcomes.

CONCLUSIONS AND IMPLICATIONS

The Kabochan was potentially effective at reducing short-term neuropsychiatric symptoms and relevant caregiver distress for residents with dementia. An individualized care plan with continuous monitoring is required to integrate the humanoid robot into routine dementia care.

Effects of the Level of Interactivity of a Social Robot and the Response of the Augmented Reality Display in Contextual Interactions of People with Dementia

The well-being of people with dementia (PWD) living in long-term care facilities is hindered due to disengagement and social isolation. Animal-like social robots are increasingly used in dementia care as they can provide companionship and engage PWD in meaningful activities. While most previous human–robot interaction (HRI) research studied engagement independent from the context, recent findings indicate that the context of HRI sessions has an impact on user engagement. This study aims to explore the effects of contextual interactions between PWD and a social robot embedded in the augmented responsive environment. Three experimental conditions were compared: reactive context-enhanced robot interaction; dynamic context-enhanced interaction with a static robot; a control condition with only the dynamic context presented. Effectiveness evaluations were performed with 16 participants using four observational rating scales on observed engagement, affective states, and apathy related behaviors. Findings suggested that the higher level of interactivity of a social robot and the interactive contextualized feedback helped capture and maintain users’ attention during engagement; however, it did not significantly improve their positive affective states. Additionally, the presence of either a static or a proactive robot reduced apathy-related behaviors by facilitating purposeful activities, thus, motivating behavioral engagement.

Robotic assistance for people with dementia: a viable option for the future?

INTRODUCTION

Demographic changes in society and fewer personnel working in healthcare services have resulted in an increase in the speed of development of safe, reliable robotic assistance technologies for patients with neurological diseases. This paper aims to advocate for the frailty of patients in light of the economic need for robotic assistance, discuss potential hazards, and outline related factors that influence positive outcomes.

AREAS COVERED

This article reviews the state of the art and perspectives regarding the use of robotics in older adults with dementia. We focus on current trends in the development of robotic technologies for these patients and discuss the potential hazards associated with the implementation of such cutting-edge technology in daily practice.

EXPERT OPINION

We envisage a gradual increase in the usage of robot-based devices for the management and support of patients with cognitive deficits. In particular, the introduction of artificial intelligence will enhance the functionality of these technologies, but also increase potential hazards resulting from human-robot interactions. The development of such technology must consider whether neurological syndromes are static or progressive. Progressive syndromes pose the biggest challenge since the functionality of robotic devices must adapt to patients changing cognitive and motor performance profiles.

Assistive Robots for the Social Management of Health: A Framework for Robot Design and Human-Robot Interaction Research

There is a close connection between health and the quality of one's social life. Strong social bonds are essential for health and wellbeing, but often health conditions can detrimentally affect a person's ability to interact with others. This can become a vicious cycle resulting in further decline in health. For this reason, the social management of health is an important aspect of healthcare. We propose that socially assistive robots (SARs) could help people with health conditions maintain positive social lives by supporting them in social interactions. This paper makes three contributions, as detailed below. We develop a framework of social mediation functions that robots could perform, motivated by the special social needs that people with health conditions have. In this framework we identify five types of functions that SARs could perform: (a) changing how the person is perceived, (b) enhancing the social behavior of the person, (c) modifying the social behavior of others, (d) providing structure for interactions, and (e) changing how the person feels. We thematically organize and review the existing literature on robots supporting human-human interactions, in both clinical and non-clinical settings, and explain how the findings and design ideas from these studies can be applied to the functions identified in the framework. Finally, we point out and discuss challenges in designing SARs for supporting social interactions, and highlight opportunities for future robot design and HRI research on the mediator role of robots.

Measuring the impact of age, gender and dementia on communication-robot interventions in residential care homes

AIM

The primary aim of this study was to examine the impact of age, gender and the stage of dementia on the results of an assistive technology intervention that make use of communication robots (com-robots). The intervention was designed to improve the social participation and interactions of nursing home residents. While our previous study showed that the overall effects of com-robot intervention were positive, it was unknown what impact age, gender and the stage of dementia of participants had on such an intervention.

METHODS

This was a non-randomized, multicenter quasi-experimental intervention study conducted in residential care homes in Japan. Two types of com-robots were introduced for 8 weeks after baseline evaluation. The World Health Organization's ICF was used for evaluating any changes present after the 8-week intervention. In total, 78 residents (68 women, 10 men, 86.5 ± 7.7 years old) participated in the study. The Degree of Daily Life Independence Score for People with Dementia (DDLIS-PD) was employed for measuring the stage of dementia.

RESULTS

The results showed that the older participants aged ≥80 benefited more from the intervention than the younger cohort did (P < 0.05). A greater improvement was shown among those with a more advanced stage of dementia than those at a less advanced stage (P < 0.05), when using DDLIS-PD.

CONCLUSIONS

The overall findings support the use of com-robots within the context of a care team for older people with moderate dementia, and those who are aged ≥80 years. Geriatr Gerontol Int 2020; 20: 373-378.

Positive Emotions, More Than Anxiety or Other Negative Emotions, Predict Willingness to Interact With Robots

Like early work on human intergroup interaction, previous research on people's willingness to interact with robots has focused mainly on effects of anxiety. However, existing findings suggest that other negative emotions as well as some positive emotions also have effects. This article systematically examines the roles of positive and negative emotions in predicting willingness to interact with robots, using an integrative analysis of data across five studies that use diverse interaction conditions and several types of robots. We hypothesize and find that positive emotions account for more variance than negative emotions. Practically, the findings suggest new strategies for interventions, aimed at increasing positive emotions to increase willingness to engage in intergroup interaction. No existing work has examined whether positive emotions are stronger predictors than negative emotions for willingness for human intergroup interaction, an important topic for future research.

Review of outcome measures in PARO robot intervention studies for dementia care

The aim of this study was to describe interventions for PARO, as well as the outcomes evaluated and found following use of PARO, and to identify outcome measures in PARO intervention studies for older adults with dementia. Multiple databases (Web of Science, PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Cochrane, and Scopus) were searched and eight studies were included in the systematic review. The review demonstrated that interventions using PARO can be beneficial for improving QOL, affect, social interaction, and reducing NPS and psychotropic or pain medication use. This study identified three domains of outcome measures used to assess the effects of interventions using the PARO robot: quality of life, biological and physiological conditions, and medical treatment.

The benefits of and barriers to using a social robot PARO in care settings: a scoping review

BACKGROUND

Given the complexity of providing dementia care in hospitals, integrating technology into practice is a high challenge and an important opportunity. Although there are a growing demand and interest in using social robots in a variety of care settings to support dementia care, little is known about the impacts of the robotics and their application in care settings, i.e., what worked, in which situations, and how.

METHODS

Scientific databases and Google Scholar were searched to identify publications published since 2000. The inclusion criteria consisted of older people with dementia, care setting, and social robot PARO.

RESULTS

A total of 29 papers were included in the review. Content analysis identified 3 key benefits of and 3 barriers to the use of PARO. Main benefits include: reducing negative emotion and behavioral symptoms, improving social engagement, and promoting positive mood and quality of care experience. Key barriers are: cost and workload, infection concerns, and stigma and ethical issues. This review reveals 3 research gaps: (a) the users' needs and experiences remain unexplored, (b) few studies investigate the process of how to use the robot effectively to meet clinical needs, and (c) theory should be used to guide implementation.

CONCLUSIONS

Most interventions conducted have been primarily researcher-focused. Future research should pay more attention to the clinical needs of the patient population and develop strategies to overcome barriers to the adoption of PARO in order to maximize patient benefits.

Effects of Assistive Robot Behavior on Impressions of Patient Psychological Attributes: Vignette-Based Human-Robot Interaction Study

Background

As robots are increasingly designed for health management applications, it is critical to not only consider the effects robots will have on patients but also consider a patient’s wider social network, including the patient’s caregivers and health care providers, among others.

Objective

In this paper we investigated how people evaluate robots that provide care and how they form impressions of the patient the robot cares for, based on how the robot represents the patient.

Methods

We have used a vignette-based study, showing participants hypothetical scenarios describing behaviors of assistive robots (patient-centered or task-centered) and measured their influence on people’s evaluations of the robot itself (emotional intelligence [EI], trustworthiness, and acceptability) as well as people’s perceptions of the patient for whom the robot provides care.

Results

We found that for scenarios describing a robot that acts in a patient-centered manner, the robot will not only be perceived as having higher EI (P=.003) but will also cause people to form more positive impressions of the patient that the robot cares for (P<.001). We replicated and expanded these results to other domains such as dieting, learning, and job training.

Conclusions

These results imply that robots could be used to enhance human-human relationships in the health care context and beyond.

The Effectiveness of Social Robots for Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Studies

Background and Objectives

Social robots may promote the health of older adults by increasing their perceived emotional support and social interaction. This review aims to summarize the effectiveness of social robots on outcomes (psychological, physiological, quality of life, or medications) of older adults from randomized controlled trials (RCTs).

Research Design and Methods

A mixed-method systematic review of RCTs meeting the study inclusion criteria was undertaken. Eight databases were electronically searched up to September 2017. Participants' characteristics, intervention features, and outcome data were retrieved. The mean difference and standardized mean difference with 95% confidence intervals (CI) were synthesized to pool the effect size.

Results

A total of 13 articles from 11 RCTs were identified from 2,204 articles, of which 9 studies were included in the meta-analysis. Risk of bias was relatively high in allocation concealment and blinding. Social robots appeared to have positive impacts on agitation, anxiety, and quality of life for older adults but no statistical significance was found in the meta-analysis. However, results from a narrative review indicated that social robot interactions could improve engagement, interaction, and stress indicators, as well as reduce loneliness and the use of medications for older adults.

Discussion and Implications

Social robots appear to have the potential to improve the well-being of older adults, but conclusions are limited due to the lack of high-quality studies. More RCTs are recommended with larger sample sizes and rigorous study designs.

"She Had a Smile on Her Face as Wide as the Great Australian Bite": A Qualitative Examination of Family Perceptions of a Therapeutic Robot and a Plush Toy

Background and Objectives

Recent years have seen social robotic pets introduced as a means of treating behavioral and psychological symptoms of dementia, and many show promising potential. In this study, we sought to explore family members' perceptions of the Japanese-developed baby harp seal, Paro (version 9), and a look-alike, nonrobotic Plush Toy, when used by their relative with dementia for 15 min, 3 afternoons per week for 10 weeks.

Research Design and Method

The study employed a descriptive qualitative approach, which was nested within a larger cluster randomized controlled trial. A convenience sample of 20 family members (n = 10 each from the Paro and Plush Toy conditions) with relatives in 9 long-term care facilities in Queensland, Australia, completed individual semi-structured interviews (telephone or face-to-face). Inductive, data-driven thematic analysis of the data was undertaken with the assistance of the qualitative management software, ATLAS.ti®.

Results

Family members of long-term care residents with dementia expressed positive perceptions of the Paro, perceiving that it improved mood, reduced agitation, and provided opportunity for communication for their relative. Negative perceptions of the Plush Toy were given by family members, primarily because of its lack of movement and engagement.

Conclusion

Family members were keen for their older relative with dementia to use a social robot that moved and engaged with them, and Plush Toys that were static and unresponsive were perceived as being unimportant in improving quality of life. However, the current cost of Paro was identified by family members as a major limitation to use.

Using a therapeutic companion robot for dementia symptoms in long-term care: reflections from a cluster-RCT

OBJECTIVES

We undertook a cluster-randomised controlled trial exploring the effect of a therapeutic companion robot (PARO) compared to a look-alike plush toy and usual care on dementia symptoms of long-term care residents. Complementing the reported quantitative outcomes , this paper provides critical reflection and commentary on individual participant responses to PARO, observed through video recordings , with a view to informing clinical practice and research.

METHOD

A descriptive, qualitative design with five participants selected from the PARO intervention arm of the trial. The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000508673).

RESULTS

The five participants and their responses to PARO are presented in terms of three issues: i.) Different pre-intervention clinical presentations and different responses; ii.) Same individual, different response - the need for continual assessment and review; and iii.) The ethics of giving and retrieving PARO. Implications for clinical practice and future research are discussed in relation to each issue.

CONCLUSION

The findings suggest that one approach does not fit all, and that there is considerable variation in responses to PARO. A number of recommendations are discussed to aid the delivery of psychosocial interventions with PARO in practice, as well as to guide future research.

Pet robot intervention for people with dementia: A systematic review and meta-analysis of randomized controlled trials

This study aims to systematically evaluate the efficacy of Pet robot intervention (PRI) for people with dementia. Two waves of electronic searches of the PubMed, EMBASE, Web of Science, Cochrane library, IEEE Digital Library and PsycINFO databases were conducted. In total, eight articles from six randomized controlled trials (RCTs) met the eligibility criteria and were included in this systematic review. The results of the meta-analysis showed a statistically significant decrease in behavioral and psychological symptoms of dementia (BPSD), especially agitation and depression, in people with dementia who were treated with PRI. Both individual and group format PRI significantly ameliorated BPSD. However, there were no significant improvements in cognitive function or quality of life. The results of the meta-analysis suggest that PRI may be suitable as a treatment option for BPSD in people with dementia and should be considered as a useful tool in clinical practice.