Ethical perceptions towards real-world use of companion robots with older people and people with dementia: Survey opinions among younger adults

Background: Use of companion robots may reduce older people’s depression, loneliness and agitation. This benefit has to be contrasted against possible ethical concerns raised by philosophers in the field around issues such as deceit, infantilisation, reduced human contact and accountability. Research directly assessing prevalence of such concerns among relevant stakeholders, however, remains limited, even though their views clearly have relevance in the debate. For example, any discrepancies between ethicists and stakeholders might in itself be a relevant ethical consideration while concerns perceived by stakeholders might identify immediate barriers to successful implementation. Methods: We surveyed 67 younger adults after they had live interactions with companion robot pets while attending an exhibition on intimacy, including the context of intimacy for older people. We asked about their perceptions of ethical issues. Participants generally had older family members, some with dementia. Results: Most participants (40/67, 60%) reported having no ethical concerns towards companion robot use when surveyed with an open question. Twenty (30%) had some concern, the most common being reduced human contact (10%), followed by deception (6%). However, when choosing from a list, the issue perceived as most concerning was equality of access to devices based on socioeconomic factors (m=4.72 on a scale 1-7), exceeding more commonly hypothesized issues such as infantilising (m=3.45), and deception (m=3.44). The lowest-scoring issues were potential for injury or harm (m=2.38) and privacy concerns (m=2.17). Over half (39/67 (58%)) would have bought a device for an older relative. Cost was a common reason for choosing not to purchase a device. Conclusions: Although a relatively small study we demonstrated discrepancies between ethical concerns raised in the philosophical literature and those likely to make the decision to buy a companion robot. Such discrepancies, between philosophers and ‘end-users’ in care of older people, and in methods of ascertainment, are worthy of further empirical research and discussion. Our participants were more concerned about economic issues and equality of access, an important consideration for those involved with care of older people. On the other hand the concerns proposed by ethicists seem unlikely to be a barrier to use of companion robots

Longitudinal Diary Data: Six Months Real-world Implementation of Affordable Companion Robots for Older People in Supported Living

Companion robots have potential for improving wellbeing within aged care, however literature focuses on shorter-term studies often using relatively expensive platforms, raising concerns around novelty effects and economic viability. Here, we report ecologically valid diary data from two supported living facilities for older people with dementia or learning difficulties. Both sites implemented Joy for All robot animals and maintained diaries for six months. Entries were analysed using thematic analysis. We found robot use increased over the six months, changing from short, structured sessions to mainly permanent availability. Thus previously reported concerns on novelty were not warranted. Both sites reported positive outcomes including reminiscence, improved communication and potential wellbeing benefits (reduced agitation/anxiety). Incidences of negative response included devices described as ‘creepy.’ Devices appeared sufficiently robust for prolonged daily use with multiple users. Overall, we provide insight into real-world implementation of affordable companion robots, and longitudinal development of use

Embedding Recovery to Transform Inpatient Mental Health Care: The 333 Model

Objective: The 333 model is a radical redesign of acute mental health care. Time-limited inpatient pathways for assessment (≤3 days), treatment (≤3 weeks), and recovery (≤3 months) replaced traditional geographical-sector wards. By making beds available, 333 aspired to improve access, deliver early treatment, and shorten hospital stays—generating savings through reductions in beds and out-of-area placements (OAPs). This article compares the model’s performance against national benchmarking and internal targets. Methods: The complement of general adult beds (2011–2016) was mapped out. Patient flow data (April 2015–March 2017) were extracted from the National Health Service data warehouse and compared with 2016 NHS benchmarking and 333 targets. Results: Between 2012 and 2016, beds were reduced by 44% compared with 17% nationally. OAPs due to bed unavailability became extremely rare. More than 74% (N=2,679) of patients who were admitted to the assessment unit between 2015 and 2017 were discharged back to the community, minimizing fragmentation of care. Median length of stay was one-sixth as long as the national rate, but readmission rates were higher than the national mean because of the model’s innovative approach to managing treatment of patients with personality disorders. Bed occupancy was below the national average, with beds available every night for 2 years. Conclusions: With its recovery-focused approach, 333 has reduced length of stay and ensured that a stay on any ward is meaningful and adds value. The article demonstrates that bed and OAP reduction and the delivery of safe care can be achieved simultaneously

Microbial contamination and efficacy of disinfection procedures of companion robots in care homes

Background Paro and other robot animals can improve wellbeing for older adults and people with dementia, through reducing depression, agitation and medication use. However, nursing and care staff we contacted expressed infection control concerns. Little related research has been published. We assessed (i) how microbiologically contaminated robot animals become during use by older people within a care home and (ii) efficacy of a cleaning procedure. Methods This study had two stages. In stage one we assessed microbial load on eight robot animals after interaction with four care home residents, and again following cleaning by a researcher. Robot animals provided a range of shell-types, including fur, soft plastic, and solid plastic. Stage two involved a similar process with two robot animals, but a care staff member conducted cleaning. The cleaning process involved spraying with anti-bacterial product, brushing fur-type shells, followed by vigorous top-to-tail cleaning with anti-bacterial wipes on all shell types. Two samples were taken from each of eight robots in stage one and two robots in stage two (20 samples total). Samples were collected using contact plate stamping and evaluated using aerobic colony count and identification (gram stain, colony morphology, coagulase agglutination). Colony counts were measured by colony forming units per square centimetre (CFU/cm2). Results Most robots acquired microbial loads well above an acceptable threshold of 2.5 CFU/cm2 following use. The bacteria identified were micrococcus species, coagulase negative staphylococcus, diptheriods, aerobic spore bearers, and staphylococcus aureus, all of which carry risk for human health. For all devices the CFU/cm2 reduced to well within accepted limits following cleaning by both researcher and care staff member. Conclusions Companion robots will acquire significant levels of bacteria during normal use. The simple cleaning procedure detailed in this study reduced microbial load to acceptable levels in controlled experiments. Further work is needed in the field and to check the impact on the transmission of viruses

Lipid-lowering with inclisiran: areal-world single-centre experience

Objective The reduction in circulating low-density lipoprotein cholesterol (LDL-c) is the primary aim of lipid-lowering therapies as a method of atherosclerotic cardiovascular disease risk reduction. Inclisiran is a new and potent lipid-lowering drug that is shown to be effective in reducing LDL-c in randomised controlled trials, however, real-world data of its use are not yet known. We sought to analyse the early effects of this drug in a tertiary centre lipid and cardiovascular risk clinic. Methods We performed a retrospective analysis of the first 80 patients who received a single dose of inclisiran at our lipid clinic between 1 December 2021 and 1 September 2022. Data were collected using electronic healthcare records. Baseline blood tests were taken prior to start of treatment and were repeated at 2 months follow-up. Data on adverse events were also recorded. Results At 2 months after treatment initiation, mean baseline LDL-c fell from 3.5±1.1 mmol/L by 48.6% to 1.8±1.0 mmol/L and total cholesterol from 5.7±1.3 mmol/L by 33.3% to 3.8±1.1 mmol/L (both p<0.0001). Mean high-density lipoprotein-c rose by 7.7% to 1.4±0.4 mmol/L (p=0.02) and median triglycerides fell by 31.3% to 1.1 mmol/L (IQR 0.9–2) (p=0.001). Adverse events (injection site reaction, fatigue and headache) were recorded in three patients and all had self-resolved by time of follow-up. Conclusion Inclisiran use in line with National Institute for Health and Care Excellence guidelines led to significant lowering of LDL-c at 2 months, with efficacy similar to that reported in trials with good tolerability

Companion robots for older people: importance of user-centred design demonstrated through observations and focus groups comparing preferences of older people and roboticists in South West England.

Companion robots for older people: importance of usercentred design demonstrated through observations and focus groups comparing preferences of older people and roboticists in South West England. BMJ Open 2019;9:e032468. doi:10.1136/ bmjopen-2019-032468 ► Prepublication history and additional material for this paper are available online. To view these files, please visit the journal online (http://dx.doi. org/10.1136/bmjopen-2019- 032468). Received 25 June 2019 Revised 05 September 2019 Accepted 09 September 2019 For numbered affiliations see end of article. Correspondence to Hannah Louise Bradwell; hannah.bradwell@plymouth. ac.uk Original research © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Abstract Objective Companion robots, such as Paro, may reduce agitation and depression for older people with dementia. However, contradictory research outcomes suggest robot design is not always optimal. While many researchers suggest user-centred design is important, there is little evidence on the difference this might make. Here, we aimed to assess its importance by comparing companion robot design perceptions between older people (end users) and roboticists (developers). Design Older people and roboticists interacted with eight companion robots or alternatives at two separate events in groups of two to four people. Interactions were recorded, participants’ comments and observations were transcribed, and content was analysed. Subsequently, each group participated in focus groups on perceptions of companion robot design. Discussions were recorded and transcribed, and content was analysed. Participants and settings Seventeen older people (5 male, 12 female, ages 60–99) at a supported living retirement complex, and 18 roboticists (10 male, 8 female, ages 24–37) at a research centre away-day. Results We found significant differences in design preferences between older people and roboticists. Older people desired soft, furry, interactive animals that were familiar and realistic, while unfamiliar forms were perceived as infantilising. By contrast, most roboticists eschewed familiar and realistic designs, thinking unfamiliar forms better suited older people. Older people also expressed desire for features not seen as important by developers. A large difference was seen in attitude towards ability to talk: 12/17 (71%) older people but only 2/18 (11%) roboticists requested speech. Older people responded positively towards life-simulation features, eye contact, robot personalisation and obeying commands, features undervalued by roboticists. These differences were reflected in preferred device, with ‘Joy for All’ cat chosen most often by older people, while roboticists most often chose Paro. Conclusion The observed misalignment of opinion between end users and developers on desirable design features of companion robots demonstrates the need for user-centred design during development

Personality dimensions emerging during adolescence and young adulthood are underpinned by a single latent trait indexing impairment in social functioning.

BACKGROUND: Personality with stable behavioural traits emerges in the adolescent and young adult years. Models of putatively distinct, but correlated, personality traits have been developed to describe behavioural styles including schizotypal, narcissistic, callous-unemotional, negative emotionality, antisocial and impulsivity traits. These traits have influenced the classification of their related personality disorders. We tested if a bifactor model fits the data better than correlated-factor and orthogonal-factor models and subsequently validated the obtained factors with mental health measures and treatment history. METHOD: A set of self-report questionnaires measuring the above traits together with measures of mental health and service use were collected from a volunteer community sample of adolescents and young adults aged 14 to 25 years (N = 2443). RESULTS: The bifactor model with one general and four specific factors emerged in exploratory analysis, which fit data better than models with correlated or orthogonal factors. The general factor showed high reliability and validity. CONCLUSIONS: The findings suggest that a selected range of putatively distinct personality traits is underpinned by a general latent personality trait that may be interpreted as a severity factor, with higher scores indexing more impairment in social functioning. The results are in line with ICD-11, which suggest an explicit link between personality disorders and compromised interpersonal or social function. The obtained general factor was akin to the overarching dimension of personality functioning (describing one's relation to the self and others) proposed by DSM-5 Section III