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

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

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

Development and Demonstration of a Wireless Ultraviolet Sensing Network for Dose Monitoring and Operator Safety in Room Disinfection Applications

The use of mobile ultraviolet-C (UV-C) disinfection devices for the decontamination of surfaces in hospitals and other settings has increased dramatically in recent years. The efficacy of these devices relies on the UV-C dose they deliver to surfaces. This dose is dependent on the room layout, the shadowing, the position of the UV-C source, lamp degradation, humidity and other factors, making it challenging to estimate. Furthermore, since UV-C exposure is regulated, personnel in the room must not be exposed to UV-C doses beyond occupational limits. We proposed a systematic method to monitor the UV-C dose administered to surfaces during a robotic disinfection procedure. This was achieved using a distributed network of wireless UV-C sensors that provide real-time measurements to a robotic platform and operator. These sensors were validated for their linearity and cosine response. To ensure operators could safely remain in the area, a wearable sensor was incorporated to monitor the UV-C exposure of an operator, and it provided an audible warning upon exposure and, if necessary, ceased the UV-C emission from the robot. Enhanced disinfection procedures could then be conducted as items in the room could be rearranged during the procedure to maximise the UV-C fluence delivered to otherwise inaccessible surfaces while allowing UVC disinfection to occur in parallel with traditional cleaning. The system was tested for the terminal disinfection of a hospital ward. During the procedure, the robot was manually positioned in the room by the operator repeatedly, who then used feedback from the sensors to ensure the desired UV-C dose was achieved while also conducting other cleaning tasks. An analysis verified the practicality of this disinfection methodology while highlighting factors which could affect its adoption.</jats:p

Generations Active Together: an example of using physical activity promotion and digital technology to bring together adolescents and older people in Stirling, Scotland

The Generations Active Together (GAT) program, delivered by Active Stirling in central Scotland, is an intergenerational physical activity (PA) program for adolescents in high school and older adults in care homes and community groups. The Generating Older Active Lives Digitally (GOALD) Research Team sought to use GAT to examine how digital technology developed for the purpose of PA and sports-based reminiscence can be used to improve social connectedness for older adults. This paper details the challenges and successes of delivering the GAT program and describes the differences between in-person pre-pandemic delivery of GAT with the attempted digital delivery during the pandemic. The transferable lessons learned from GAT delivery to GOALD project planning and implementation included, but are not limited to, the importance of in-person activities for both generations and using digital technology as a complementary, rather than a replacement tool for PA delivery. CONTRIBUTION TO THE FIELD Intergenerational activities focusing on PA involving adolescents and older adults is possible with attention to reciprocal inputs and benefits for all generations and are potentially more effective and easier to deliver in person. Where in-person PA delivery is impossible, digital-only PA is arguably better than no interaction but requires support in setting up technology to deliver PA effectively. Digital technology is likely to be more effective in supporting intergenerational PA when complemented by in-person interactions. Adolescents and older adults in care homes can engage in beneficial interaction, but attention should be paid to school commitments at this age and stage, as well as the practical aspects of travel and scheduling of this kind of contact

NSAID use and clinical outcomes in COVID-19 patients: a 38-center retrospective cohort study.

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce pain, fever, and inflammation but have been associated with complications in community-acquired pneumonia. Observations shortly after the start of the COVID-19 pandemic in 2020 suggested that ibuprofen was associated with an increased risk of adverse events in COVID-19 patients, but subsequent observational studies failed to demonstrate increased risk and in one case showed reduced risk associated with NSAID use. METHODS: A 38-center retrospective cohort study was performed that leveraged the harmonized, high-granularity electronic health record data of the National COVID Cohort Collaborative. A propensity-matched cohort of 19,746 COVID-19 inpatients was constructed by matching cases (treated with NSAIDs at the time of admission) and 19,746 controls (not treated) from 857,061 patients with COVID-19 available for analysis. The primary outcome of interest was COVID-19 severity in hospitalized patients, which was classified as: moderate, severe, or mortality/hospice. Secondary outcomes were acute kidney injury (AKI), extracorporeal membrane oxygenation (ECMO), invasive ventilation, and all-cause mortality at any time following COVID-19 diagnosis. RESULTS: Logistic regression showed that NSAID use was not associated with increased COVID-19 severity (OR: 0.57 95% CI: 0.53-0.61). Analysis of secondary outcomes using logistic regression showed that NSAID use was not associated with increased risk of all-cause mortality (OR 0.51 95% CI: 0.47-0.56), invasive ventilation (OR: 0.59 95% CI: 0.55-0.64), AKI (OR: 0.67 95% CI: 0.63-0.72), or ECMO (OR: 0.51 95% CI: 0.36-0.7). In contrast, the odds ratios indicate reduced risk of these outcomes, but our quantitative bias analysis showed E-values of between 1.9 and 3.3 for these associations, indicating that comparatively weak or moderate confounder associations could explain away the observed associations. CONCLUSIONS: Study interpretation is limited by the observational design. Recording of NSAID use may have been incomplete. Our study demonstrates that NSAID use is not associated with increased COVID-19 severity, all-cause mortality, invasive ventilation, AKI, or ECMO in COVID-19 inpatients. A conservative interpretation in light of the quantitative bias analysis is that there is no evidence that NSAID use is associated with risk of increased severity or the other measured outcomes. Our results confirm and extend analogous findings in previous observational studies using a large cohort of patients drawn from 38 centers in a nationally representative multicenter database

Exploring the Design, Use and Impact of Companion Pet Robots and Automata for Older Adults and People with Dementia

Some work has been removed from the public version of this thesis, due to copyright restrictions on some under review works. For further details, please use the information provided to find the since published paper or contact the author.Companion robots, socially assistive robots typically possessing zoomorphic features, have shown potential in the care of older adults and people with dementia. Previous research demonstrated reduced agitation, anxiety, loneliness and blood pressure for older adults, and reduced carer burden. However, many literature gaps and methodological flaws remained, and there was limited evidence of real-world adoption into health and care practice. In particular, most research involved Paro, the robot seal costing ~£5000, a prohibitive cost for most intended end-users. Furthermore, contradictory research results, robot failures and variable responses of older people suggested sub-optimal robot design. This thesis therefore aimed to expand the knowledge base on companion robots for older adults, through collaborative action research, bridging the gap between research and practice with real-world benefit. The studies explored feedback in various settings from a collectively large sample of stakeholders essential for real-world implementation: older adults (with and without dementia), family members, care home staff and management, robot developers, health and care professionals and students. All types of stakeholder found companion robots acceptable. The value of user-centred design was demonstrated with significant differences between end-users and developers in perceptions of suitable robot design. Optimum robot design should include soft, furry, familiar, realistic embodiment, with large cute eyes, life simulation, lap-sized frame, interactivity and gaze direction and costing <£250. An effective infection control procedure was developed proven for bacterial infection of robot pets (with varying shell types), in care home settings. Ethical concerns on robot use, as reported in literature, were explored concluding that they were unlikely to pose real-world barriers. Finally, this thesis provides initial support that such affordable devices result in longer term wellbeing outcomes, such as reduced depression, anxiety and agitation for older people. In conclusion, this thesis contributes knowledge on design, use and impact of companion robots for older adults, and the user-centred feedback has informed a new prototype robot pet

Generations Active Together: An Example of Using Physical Activity Promotion and Digital Technology to Bring Together Adolescents and Older People in Stirling, Scotland

The Generations Active Together (GAT) program, delivered by Active Stirling in central Scotland, is an intergenerational physical activity (PA) program for adolescents in high school and older adults in care homes and community groups. The Generating Older Active Lives Digitally (GOALD) Research Team sought to use GAT to examine how digital technology developed for the purpose of PA and sports-based reminiscence can be used to improve social connectedness for older adults. This paper details the challenges and successes of delivering the GAT program and describes the differences between in-person pre-pandemic delivery of GAT with the attempted digital delivery during the pandemic. The transferable lessons learned from GAT delivery to GOALD project planning and implementation included, but are not limited to, the importance of in-person activities for both generations and using digital technology as a complementary, rather than a replacement tool for PA delivery

NSAID use and clinical outcomes in COVID-19 patients: a 38-center retrospective cohort study.

BackgroundNon-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce pain, fever, and inflammation but have been associated with complications in community-acquired pneumonia. Observations shortly after the start of the COVID-19 pandemic in 2020 suggested that ibuprofen was associated with an increased risk of adverse events in COVID-19 patients, but subsequent observational studies failed to demonstrate increased risk and in one case showed reduced risk associated with NSAID use.MethodsA 38-center retrospective cohort study was performed that leveraged the harmonized, high-granularity electronic health record data of the National COVID Cohort Collaborative. A propensity-matched cohort of 19,746 COVID-19 inpatients was constructed by matching cases (treated with NSAIDs at the time of admission) and 19,746 controls (not treated) from 857,061 patients with COVID-19 available for analysis. The primary outcome of interest was COVID-19 severity in hospitalized patients, which was classified as: moderate, severe, or mortality/hospice. Secondary outcomes were acute kidney injury (AKI), extracorporeal membrane oxygenation (ECMO), invasive ventilation, and all-cause mortality at any time following COVID-19 diagnosis.ResultsLogistic regression showed that NSAID use was not associated with increased COVID-19 severity (OR: 0.57 95% CI: 0.53-0.61). Analysis of secondary outcomes using logistic regression showed that NSAID use was not associated with increased risk of all-cause mortality (OR 0.51 95% CI: 0.47-0.56), invasive ventilation (OR: 0.59 95% CI: 0.55-0.64), AKI (OR: 0.67 95% CI: 0.63-0.72), or ECMO (OR: 0.51 95% CI: 0.36-0.7). In contrast, the odds ratios indicate reduced risk of these outcomes, but our quantitative bias analysis showed E-values of between 1.9 and 3.3 for these associations, indicating that comparatively weak or moderate confounder associations could explain away the observed associations.ConclusionsStudy interpretation is limited by the observational design. Recording of NSAID use may have been incomplete. Our study demonstrates that NSAID use is not associated with increased COVID-19 severity, all-cause mortality, invasive ventilation, AKI, or ECMO in COVID-19 inpatients. A conservative interpretation in light of the quantitative bias analysis is that there is no evidence that NSAID use is associated with risk of increased severity or the other measured outcomes. Our results confirm and extend analogous findings in previous observational studies using a large cohort of patients drawn from 38 centers in a nationally representative multicenter database