Infection prevention and control challenges of using a therapeutic robot

Implementing Robotic Pets in Continuing Care Settings: A Scoping Review of Barriers and Facilitators

BACKGROUND

Robotic pets are a unique technological innovation found among facility-based continuing care (CC) settings for older adults living with or without dementia. While researchers have reported positive outcomes for older adults who interact with robotic pets, unintended negative consequences may occur if robotic pets are not implemented properly. We examine the current evidence describing barriers and facilitators of implementing robotic pets for older adults residing in CC facilities to inform implementation practices.

METHODS

A scoping review was conducted following the methodological framework outlined by Arksey and O'Malley. Five databases and the CADTH Gray Matters tool were used to identify relevant articles and gray literature. Our inclusion criteria followed the Population, Concept, Context (PCC) framework: Population: older adults living with or without dementia; Concept: barriers and facilitators to implementing robotic pets to older adults; Context: CC facilities. Two reviewers independently screened all titles, abstracts, and full-text articles and extracted the data. Two reviewers also organized barriers and facilitators into the theoretical domains framework (TDF) domains, which map onto the capability, opportunity, and motivation behavioral Change Wheel (COM-B).

RESULTS

We identified 518 unique articles from our database and gray literature search, 42 of which met our inclusion criteria. Barriers and facilitators were identified across all 14 domains of the TDF and all six components of the COM-B. Domains mentioned in ≥ 50% of the articles include environmental context and resources, beliefs about consequences, and social influences. Common facilitators include knowledge of the benefits of robotic pets and how to use robotic pets, while common barriers include concerns over infantilization and hygiene.

CONCLUSIONS

Our findings will help inform care providers of the barriers and facilitators to implementing robotic pets within CC settings with the goal of improving the quality of life of older adults.

Animal-assisted and robotic animal-assisted interventions within dementia care: A systematic review

BACKGROUND

Animal-assisted interventions and robotic animal interventions are becoming increasingly popular to support the care of people with dementia and may have the potential to improve a range of psychosocial outcomes. This review aims to identify, describe, and compare animal-assisted and robotic animal interventions delivered to people with dementia, their characteristics, effectiveness, and the proposed mechanisms underlying any potential impact.

METHODS

A systematic literature search was conducted in MEDLINE, AMED, EMBASE, PsycINFO, OVID Nursing, PubMed, CINAHL and Web of Science. Random-effects meta-analyses of randomised controlled trials (RCTs) were conducted to summarise studies that evaluated common outcomes (agitation, depression, quality of life). A narrative approach was used to synthesise other findings.

RESULTS

Fifty-one studies were included: 18 RCTs; 12 non-randomised trials, 13 cohort studies, 7 qualitative studies and one mixed-methods study. Meta-analyses were conducted for a small number of RCTs, with effectiveness of animal-assisted interventions demonstrated for agitation. Narrative findings suggested animal-assisted and robotic animal interventions may be promising in improving depression, agitation, and quality of life. Three potential mechanisms of action were identified for both animal-assisted and robotic animal interventions, namely enhancing social connections, providing engaging and meaningful activities, and the affect-generating aspect of the human-animal bond. A fourth mechanism was identified for animal-assisted interventions only: promoting physical activity. Robotic animals appear to have a place in complex human-animal relationships, but a greater understanding of robotic animal interventions is required to harness the benefits that may be derived from their use.

CONCLUSION

Delivering these interventions appear promising in improving psychosocial outcomes for people with dementia. As most included studies had methodological limitations, these findings are preliminary, but contribute to the body of evidence providing an understanding in terms of intervention characteristics and mechanisms of action. When developing intervention guidance, attention should be given to potential mechanisms and fundamental characteristics such as session content, delivery format and facilitator role.

Nurses' perception towards care robots and their work experience with socially assistive technology during COVID-19: A qualitative study

This study aimed to explore nurses' perceptions towards care robots and their work experiences in caring for older adults who use socially assistive technology. This qualitative descriptive study included 18 nurses who cared for older adults with dementia or living alone at home. Interviews via Zoom were conducted, and the collected data were analyzed using inductive content analysis. The three themes were identified: (1) perceived benefits, (2) perceived challenges, and (3) improvements needed to enhance the quality of care. The participants perceived that the care robot and socially assistive technology were useful in caring for older adults during COVID-19. However, they noted that the limited capabilities of the technology and an increased workload negatively impacted the quality of care for older adults. The findings of this study indicated that socially assistive technology and care robots have potential benefits in assisting older adults with dementia or living alone.

Robotic Psychology: A PRISMA Systematic Review on Social-Robot-Based Interventions in Psychological Domains

Current technological advancements have allowed robots to be successfully employed in the healthcare sector. However, the recently acquired ability of social robots to process social information and act according to it has potentially made them very well suited to support or conduct psychological interventions. The present paper carried out a systematic review of the available literature regarding social-robot-based interventions in psychological domains using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The inclusion criteria were: (i) publication date until 2020; (ii) being an empirical study, master thesis, or project report; (iii) written in English or Italian languages (the two languages spoken by the authors); (iv) published in a scholarly peer-reviewed journal or conference proceedings, or were Ph.D. or master’s theses; and (v) assessed “social robot”-based intervention in psychological domains. Overall, the review showed that three main areas may benefit from social-robot-based interventions: social skills, mood, and wellbeing (e.g., stress and anxiety levels). Interestingly, social robots seemed to have a performance comparable to, and sometimes even better than, human operators. The main, but not exclusive, target of robot-based interventions in the psychological field was children with autism spectrum disorder (ASD). As evidence is, however, still limited and in an embryonic state, deeper investigations are needed to assess the full potential of social robots for the purposes of psychological intervention. This is relevant, considering the role that social robots could have in overcoming barriers to access psychological assessment and therapies.

The effect of PARO robotic seals for hospitalized patients with dementia: A feasibility study

Robotic seals have been studied in long-term care settings; though, no studies of patients with dementia in the acute care setting have been reported. The purpose of this study was to evaluate the feasibility of PARO interventions for hospitalized patients with dementia, determine physiological effects and describe social-affective interactions. Using a prospective descriptive design with pre-post PARO intervention physiological measurements, we studied 55 participants who received up to five 15-min PARO interventions. The PARO was favorably accepted for 212 (95%) of the 223 PARO interventions. Differences in pre- and post-physiological measures for mean arterial pressure, pulse, respiration, oxygenation, stress, and pain levels were evaluated using Wilcoxon Signed Rank test with statistically significant pre and post differences (p=<0.05); however, the differences were not clinically significant. Participants (95%) demonstrated beneficial PARO interactions with the most frequent interactions being speaking and petting. The PARO shows promise for enhancing social and affective responses for hospitalized patients with dementia.

Formal caregivers' perceptions and experiences of using pet robots for persons living with dementia in long-term care: A meta-ethnography

AIM

To explore the formal caregivers' perceptions and experiences of using pet robots for persons living with dementia residing in long-term care settings and the factors influencing their perceptions by evaluating, integrating, and synthesizing findings from relevant international research articles using a meta-ethnography.

DESIGN

Noblit and Hare's interpretative meta-ethnography.

DATA SOURCES

Eight articles, published between 2013-2018, were identified following a systematic search of four databases (Scopus, ProQuest Central, EBSCO, and Google Scholar) between June 2019-February 2020.

REVIEW METHODS

Two researchers independently appraised the selected articles. Noblit and Hare's seven steps and a meta-ethnography reporting guidance were used. Reciprocal translation was used to obtain a line of argument synthesis.

RESULTS

Three overarching themes were identified: a beneficial tool but not for everybody, a tool that has limitations but could be overcome, and a positive experience if appropriately introduced and sustained.

CONCLUSION

This meta-ethnography contributes to the understanding of current potential benefits and limitations of pet robots for persons living with dementia residing in long-term settings. It also identifies several factors, as perceived by caregivers, that may influence their acceptability, adoption, and routine use in practice.

IMPACT

Although for the past two decades pet robots have been used as a psychosocial intervention for persons living with dementia in long-term care settings, there is a dearth of literature on the perception of formal caregivers and their experience of such interventions. While pet robots can have emotional, social, behavioural, and practical benefits, there are several technological, organizational, and contextual challenges and limitations that constrain their routine use. The solutions synthesized in this review can be of benefit to robot designers, facility managers, policy makers, and other health care professionals interested in introducing pet robots in long-term care settings.

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.

What Makes a Social Robot Good at Interacting with Humans?

This paper discusses the nuances of a social robot, how and why social robots are becoming increasingly significant, and what they are currently being used for. This paper also reflects on the current design of social robots as a means of interaction with humans and also reports potential solutions about several important questions around the futuristic design of these robots. The specific questions explored in this paper are: “Do social robots need to look like living creatures that already exist in the world for humans to interact well with them?”; “Do social robots need to have animated faces for humans to interact well with them?”; “Do social robots need to have the ability to speak a coherent human language for humans to interact well with them?” and “Do social robots need to have the capability to make physical gestures for humans to interact well with them?”. This paper reviews both verbal as well as nonverbal social and conversational cues that could be incorporated into the design of social robots, and also briefly discusses the emotional bonds that may be built between humans and robots. Facets surrounding acceptance of social robots by humans and also ethical/moral concerns have also been discussed.

Living well in older age: what can we learn from the Japanese experience?

Japan has the most aged population in the world. Not only do people live longer in Japan, they also age better. While the ageing population reflects a success story driven by lifestyle factors and health promotion initiatives, it also results in challenges for policymakers, families and older people. Other countries with ageing population profiles, such as the UK, can learn from the Japanese experience. In this article, the authors focus on the potential of health promotion strategies, social connections and technology to enhance well-being in older age.

Robotic technology for palliative and supportive care: Strengths, weaknesses, opportunities and threats

BACKGROUND

Medical robots are increasingly used for a variety of applications in healthcare. Robots have mainly been used to support surgical procedures, and for a variety of assistive uses in dementia and elderly care. To date, there has been limited debate about the potential opportunities and risks of robotics in other areas of palliative, supportive and end-of-life care.

AIM

The objective of this article is to examine the possible future impact of medical robotics on palliative, supportive care and end-of-life care. Specifically, we will discuss the strengths, weaknesses, opportunities and threats (SWOT) of this technology.

METHODS

A SWOT analysis to understand the strengths, weaknesses, opportunities and threats of robotic technology in palliative and supportive care.

RESULTS

The opportunities of robotics in palliative, supportive and end-of-life care include a number of assistive, therapeutic, social and educational uses. However, there are a number of technical, societal, economic and ethical factors which need to be considered to ensure meaningful use of this technology in palliative care.

CONCLUSION

Robotics could have a number of potential applications in palliative, supportive and end-of-life care. Future work should evaluate the health-related, economic, societal and ethical implications of using this technology. There is a need for collaborative research to establish use-cases and inform policy, to ensure the appropriate use (or non-use) of robots for people with serious illness.

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.