By Alexandra Krassikova
There is no escaping technology in our day and age. Technology penetrates all domains of our lives: smartboards help students learn, the automated transit system gets us home, and Netflix keeps us entertained. The healthcare field is no exception. Thinking about healthcare, some technological advances that come to mind are surgical robots, three-dimensional printed organs, and nanotechnology.
However, not all technology used in healthcare is so futuristic. In long-term care (LTC) facilities, an emerging technological intervention is socially assistive robots (SARs). And, as you will soon see, they are cuddlier than they sound.
In 2010, the Long-Term Care Homes Act, 2007 (1) came into force in Ontario. This provincial legislation emphasized the creation of welcoming environments for residents and the provision of reasonable, person-centered care in LTC facilities. The Act also redefined admission requirements for LTC homes: to qualify for long-term care, a person must be in continuous need of professional and personal care, and assistance with activities of daily living such as walking, dressing, and eating.
Currently, LTC facilities are facing challenges in providing high quality care as older adults entering LTC need assistance more than ever. As of 2019, 90% of residents in Ontario LTC facilities have varying levels of cognitive impairment, and 64% have a diagnosis of dementia (2). Dementia is an umbrella term used to describe a range of diseases that are commonly characterized by a decline in cognitive functioning, loss of memory, and loss of independence (3).
Furthermore, persons with dementia and cognitive impairment are at higher risk of experiencing depression, anxiety, apathy, irritability, and agitation, compared to the general aging population (4). Unfortunately, these conditions can be mistaken as natural signs of aging and are often untreated (5). Technology can offer a simple solution here for those needing treatment and can be used preventatively for individuals at risk.
Socially assistive robotics is a novel field focused on using robots to assist individuals through social interactions, often as a form of animal-assisted therapy. The most commonly used SAR is Paro, a baby harp seal (6). Paro is an adaptive robot that can recognize voices, respond to words, and react to user interactions such as stroking. Although Paro is the most common SAR, other adaptive robots include NeCoRo and Bandit, catlike and doglike robots, respectively (7).
A study conducted by Jøranson and colleagues (9) in Norway looked at the effects of using Paro on agitation and depression in individuals with dementia living in LTC facilities. Study participants were placed in groups of up to six people for sessions lasting 30 minutes, twice a week, for 12 weeks. Participants would interact with one other and with Paro by talking, petting, smiling, and singing.
Even three months after the intervention ended, researchers found a positive, long-term effect on agitation and depression in the individuals who interacted with Paro (9). The positive outcomes of this and other studies (7) demonstrate that SARs can be used to improve the psychological state of persons with dementia and their overall functioning.
Some limitations to using SARs in LTC settings include technical barriers like robot malfunction, the limited capabilities of current SARs, and prejudice towards robot use in healthcare (10). There is also a lack of high quality, reliable studies implementing SAR interventions (7). Additionally, further research on ethical considerations is required as SARs become more advanced (10).
Using SARs can be a novel, efficient, and cost-effective way to improve psychological functioning in LTC residents and in persons with dementia. On the contrary, using medication to treat psychological conditions in persons with dementia is associated with an increase in falls, fractures, and death (11); further, there is only limited evidence of efficacy in using medication to treat these symptoms in this population (12).
To avoid the adverse outcomes associated with prescribed medication, many alternative interventions have been proposed as first-line treatments, including touch therapy, music therapy, massage, and exercise (13,14). Consider SARs as another such intervention. Several studies have demonstrated the positive effect of using SARs (15) and with further research, robots like Paro may further demonstrate their worth. In time, SARs can potentially be programmed to assist in daily activities like reminding individuals to take medication; to monitor cognitive and functional changes; and to recognize their user’s mood changes.
Aging is an inevitable process that none of us can escape. Therefore, ensuring that older adults are aging in comfort should be a priority ― the search for novel, creative interventions such as Paro must continue.
With careful and thoughtful design, SARs has great potential to improve the quality of life of older adults. Perhaps in the not-so-distant future, SARs can help redefine the experience of aging and become an essential part of care provided to residents in LTC facilities.
Featured illustration by Willow Yang for rehabINK.
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To refer to this article, it can be cited as:
Krassikova A. Technology in long term care: How socially assistive robots will seal the deal? rehabINK. 2020;8. Available from: https://rehabinkmag.com
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- Long-Term Care Homes Act, 2007, SO 2007, c 8 [Internet]. CanLii; [cited 2020 Jan 15]. Available from: http://canlii.ca/t/53mxp>
- Ontario Long Term Case Association. This is long-term care 2019 [Internet]. Toronto, Ontario: Ontario Long Term Care Association; 2019 April [cited 2020 Jan 15]. Available from: https://www.oltca.com/OLTCA/Documents/Reports/TILTC2019web.pdf
- Alzheimer’s Association. What is Dementia? [Internet]. Alzheimer’s Association; [cited 2020 Jan 15]. Available from: https://www.alz.org/alzheimers-dementia/what-is-dementia
- Lyketsos CG, Lopez O, Jones B, Fitzpatrick AL, Breitner J, DeKosky S. Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. Jama. 2002 Sep 25;288(12):1475-83.
- Ontario Ministry of Health and Long-Term Care. Mental health: Depression [Internet]. Ontario Ministry of Heath and Long-Term Care; 2015 [cited 2020 Jan 15]. Available from: http://health.gov.on.ca/en/public/publications/mental/depression.aspx
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- Kales HC, Gitlin LN, Lyketsos CG. Assessment and management of behavioral and psychological symptoms of dementia. British Medical Journal. 2015 Mar 2;350:h369.
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- Alnajjar F, Khalid S, Vogan A, Nouchi R, Kawashima R. Emerging Cognitive Intervention Technologies to Meet the Needs of an Aging Population: A Systematic Review. Frontiers in Aging Neuroscience. 2019;11:291.