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

This is the final version. Available on open access from Wiley via the DOI in this recordBACKGROUND: Robopets are small animal-like robots which have the appearance and behavioural characteristics of pets. OBJECTIVE: To bring together the evidence of the experiences of staff, residents and family members of interacting with robopets and the effects of robopets on the health and well-being of older people living in care homes. DESIGN: Systematic review of qualitative and quantitative research. DATA SOURCES: We searched 13 electronic databases from inception to July 2018 and undertook forward and backward citation chasing. METHODS: Eligible studies reported the views and experiences of robopets from residents, family members and staff (qualitative studies using recognised methods of qualitative data collection and analysis) and the effects of robopets on the health and well-being of care home residents (randomised controlled trials, randomised crossover trials and cluster randomised trials). Study selection was undertaken independently by two reviewers. We used the Wallace criteria and the Cochrane Risk of Bias tool to assess the quality of the evidence. We developed a logic model with stakeholders and used this as a framework to guide data extraction and synthesis. Where appropriate, we used meta-analysis to combine effect estimates from quantitative studies. RESULTS: Nineteen studies (10 qualitative, 2 mixed methods and 7 randomised trials) met the inclusion criteria. Interactions with robopets were described as having a positive impact on aspects of well-being including loneliness, depression and quality of life by residents and staff, although there was no corresponding statistically significant evidence from meta-analysis for these outcomes. Meta-analysis showed evidence of a reduction in agitation with the robopet "Paro" compared to control (-0.32 [95% CI -0.61 to -0.04, p = 0.03]). Not everyone had a positive experience of robopets. CONCLUSIONS: Engagement with robopets appears to have beneficial effects on the health and well-being of older adults living in care homes, but not all chose to engage. Whether the benefits can be sustained are yet to be investigated. IMPLICATIONS FOR PRACTICE: Robopets have the potential to benefit people living in care homes, through increasing engagement and interaction. With the robopet acting as a catalyst, this engagement and interaction may afford comfort and help reduce agitation and loneliness.National Institute for Health Research (NIHR

Social robot interventions for people with dementia:A systematic review on effects and quality of reporting

Background:  Using non-pharmacological interventions is a current approach in dementia care to manage responsive behaviors, to maintain functional capacity, and to reduce emotional stress. Novel technologies such as social robot interventions might be useful to engage people with dementia in activities and interactions as well as to improve their cognitive, emotional, and physical status. Objective:  Assessing the effects and the quality of reporting of social robot interventions for people with dementia. Methofs:  In our systematic review, we included quasi-experimental and experimental studies published in English, French, or German, irrespective of publication year. Searching CINAHL, Cochrane Library, MEDLINE, PsycINFO, and Web of Science Core Collection was supplemented by citation tracking and free web searching. To assess the methodological quality of included studies, we used tools provided by the Joanna Briggs Institute. To assess the reporting of the interventions, we applied CReDECI 2 and TIDieR. Results:  We identified sixteen studies published between 2012 and 2018, including two to 415 participants with mostly non-defined type of dementia. Eight studies had an experimental design. The predominant robot types were pet robots (i.e., PARO). Most studies addressed behavioral, emotion-related, and functional outcomes with beneficial, non-beneficial, and mixed results. Predominantly, cognitive outcomes were not improved. Overall, studies were of moderate methodological quality. Conclusion:  Heterogeneous populations, intervention characteristics, and measured outcomes make it difficult to generalize the results with regard to clinical practice. The impact of social robot interventions on behavioral, emotion-related, and functional outcomes should therefore be assessed considering the severity of dementia and intervention characteristics

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

A systematic review of electronic assistive technology within supporting living environments for people with dementia

Health and social care provision needs to change in order to meet the needs of an increase in the number of people living with dementia. Environmental design, technology and assistive devices have the potential to complement care, help address some of the challenges presented by this growing need and impact on the lived experience of this vulnerable population. This systematic review was undertaken to identify the research on the use of electronic assistive technology within long-term residential care settings. A total of 3229 papers published from the inception of each of the databases up until May 2016 were retrieved from searches in four major databases. Sixty-one were identified to be included in the review. The inclusion criteria were: original peer reviewed journals; an electronic assistive technology intervention; with residents or tenants living with dementia or their family or paid caregivers; in supported living environments or residential care. The data extracted from the included studies focused on the methodology, technology, outcomes and the role of people living with dementia within the research. Overall, an extensive variety of technical interventions were found, with a broad range of methodological heterogeneity to explore their effect. Additionally, wide-spanning outcomes to support the potential of technology solutions and the challenges presented by such intervention were found

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

Assistive technology with context-aware computing and artificial intelligence capabilities can be applied to address cognitive and communication impairments experienced by persons with dementia (PwD). This research aims to provide an overview of current literature regarding characteristics of intelligent assistive technology devices (IATDs) for cognitive and communicative impairments of PwD as well as of the areas of impairment addressed by the IATDS. A multi-faceted systematic search strategy involving three electronic database platforms, two electronic databases and three electronic journals yielded records produced over the past decade. Predefined criteria were applied for inclusion and data extraction. Data was thematically analysed and synthesised. This review demonstrates that the bulk of research involving IATDs over the past decade has focused on cognitive impairments of PwD and has not yet evolved past the conceptual or prototype stages of development. A summary of commercially available IATDs for PwD is provided at the end of this review. This research concluded that IATDs for PwD primarily focus on social robots, especially PARO, and that they address cognitive impairments of attention and affect, as well as social-pragmatic communicative impairments. Few IATDs address the linguistic impairments experienced by PwD. Future research should involve collaboration between computer engineering and health practitioners to address the identified gaps and to contribute to evidence-based decision making for PwD.Mini Dissertation (MAAC)--University of Pretoria, 2019.Centre for Augmentative and Alternative Communication (CAAC)MAACUnrestricte

Technology-based non-pharmacological interventions for stress and distress in dementia care: a systematic review; and, A mixed-method multiple-baseline single-case study exploring the impact of the Tovertafel (Magic Table) on factors impacting staff burnout in an acute dementia care hospital ward

Technology-based non-pharmacological interventions are a fast-growing area of dementia care and are being applied in a variety of care settings. Due to the readily available nature of many technology-based interventions which often have high face validity and are perceived to have very minimal side effects, research can lag behind clinical applications. Current research suggests that these interventions may be beneficial people to with dementia, but the extent of their effectiveness in specific aspects of dementia care and the impact on the wider care system is still being determined. A systematic review of the literature was conducted to review the effectiveness of technology based non-pharmacological interventions on stress and distress in dementia care settings. The term ‘stress and distress’ encompasses behaviour, affect, perception or thought disturbance symptoms in dementia, such as depression, anxiety, agitation, poor sleep and high levels of distress. While there is evidence that technology-based non-pharmacological interventions can be effective in reducing for stress and distress for people with dementia, the findings of the studies included in the review are mixed, meaning that there is not yet a clear indication of which, if any interventions are most effective. These results are discussed in relation to findings from other studies, with recommendations for future research and clinical applications. Current research on technology-based non-pharmacological interventions in dementia care often fails to consider staff as a significant factor in the application of interventions. A mixed method multiple-baseline single-case study methodology was used to assess the impact of the Tovertafel, a technology-based non-pharmacological intervention, on factors related to staff burnout in an acute dementia care ward. The Tovertafel (meaning Magic Table in Dutch) is a digital projection device which provides an interactive and playful recreation activity for people with dementia. The results suggested that the majority of participants demonstrated improvement in factors related to burnout, and a meta-analysis suggested small to medium effect sizes across participants. The thematic analysis of a qualitative staff experience questionnaire established three themes: patient’s positive engagement and response to the Tovertafel; benefits to staff from using the Tovertafel; and opportunities to enhance care with no changes to the normal workload. These results suggest that the Tovertafel may have the potential to improve staff outcomes in relation to burnout factors. Potential directions for future research are discussed

An exploration of factors influencing human responses to short term interaction with a pet robot

Past research has found that intervention with Paro, a seal robot, on healthy adults can improve psychophysiological responses (Mitsui et al. 2001a,b, Kawaguchi et al. 2012). According to Bethel & Murphy (2010), psychophysiological study focuses on understanding human emotion and behaviour during an event through observation, physiological and psychological measures. However, these previous studies of Paro were limited by small participant sizes (less than 10 participants), and did not investigate the effectiveness of Paro in reducing stress such as environmental stress. Furthermore, little is known about the circumstances in which interacting with Paro can help to reduce stress as indicated by changes in psychophysiological responses. Three studies were conducted in laboratory settings, in order to limit any extraneous variables that can affect the psychophysiological responses. This thesis aims to identify factors that can influence psychophysiological responses to short-term interaction with a Paro in the healthy adult population. It also aims to understand how the factors affect the effectiveness of Paro intervention in reducing effects of stress. The psychophysiological responses were measured using self-reports, physiological sensors (skin conductance responses, heart rate, and heart rate variability) and video recording. The stress used in this thesis is induced environmental noise. A study was conducted (n = 76) to explore which features of Paro (active and inactive) and of human behaviour towards the robot (talking and stroking) were responsible for any effects it creates. It was found that interacting with Paro aroused skin conductance responses and its presence during the intervention increased positive moods. At the same time, the positive moods influenced the effectiveness of the Paro intervention in reducing stress. A subsequent study (n = 104) compared the effects of interacting with an active Paro with the effects of stroking a furry bolster, and explored the stress reducing effect of Paro intervention as a pre-stress treatment. The novelty effect of Paro in the intervention was also investigated. It was found that the Paro intervention was not enough to minimize and reduce the impact of induced stress. However, there was a trend that suggests the Paro intervention has more impact in lessening the stress than the bolster intervention as indicated by improvements in physiological responses (such as heart rate and heart rate variability). At the same time, it was found that novelty affected how participants interacted with the Paro (based on video observation during the intervention), but did not change the positive effect of the Paro intervention. A final study (n = 104) explored two intervention formats: either Paro or bolster as preand post-stress intervention. This study also explored the effectiveness of Paro or bolster intervention using a mathematical task. It was found that the Paro intervention was more suitable as a post-stress intervention, as suggested by improvement in physiological responses (heart rate and heart rate variability). However, no improvement in math performance was found in either Paro or bolster interventions. Additionally, in this study and Study 2, the bolster intervention showed the importance of stroking soft fur in reducing stress and negative moods. There are five key findings of this thesis: Large samples of data were obtained from (i) healthy young adults (n = 284). Paro intervention is more effective as (ii) post-stress treatment, in terms of reducing effects of (iii) induced environmental stress in (iv) healthy adults. The thesis also found (v) factors that influenced the changes in psychophysiological responses and the effectiveness of Paro interventions such as stressors and intervention formats

Enhancing the Quality of Care in Long-Term Care Settings

Quality of care in long-term care is a worldwide issue given the growing numbers of dependent older people. This book presents international research, 22 varied papers, exploring quality of care from several different angles. Important themes include: (1) workforce issues, such as staff training and support; job competencies, satisfaction, and intention to stay in work; staff burnout; effects of personal- and work-related factors on quality of care; (2) intervention studies: for depressive symptoms in nursing home residents; adjustment for new residents; social and psychological support; and loneliness and isolation; (3) methodology, including: developing and testing quality indicators; measuring residents' experience of quality; and assessing partnership between staff and families; and (4) older people's experiences, such as dry eyes and using ocular lubricants; associations between length of stay and end of life care; palliative care service use and comfort at end of of life; and causes of infection-related hospitalization. The book concludes with a systematic review of the current evidence base of care home research in Brazil