Did you ever see Robot and Frank? The charming 2012 film features Frank Langella as an elderly ex-cat burglar in the early stages of dementia whose son buys him a domestic robot to act as a caretaker. While the concept of robot caretakers for the elderly seems like the stuff of science fiction movies, the critical need for care workers to deal with dementia patients worldwide has provided robotics developers with a strong incentive for making that dream a reality.
With over 5.2 million Alzheimer’s patients in the United States alone and millions more worldwide, the cost of caring for Alzheimer's Disease and other dementias is already $203 billion and is expected to climb over $1.2 trillion by 2050 if no treatment advances are made. With the lack of trained care workers, family members are forced to provide care on their own. In 2012 alone, more than 15 million Americans acted as caregivers for Alzheimer's patients and the estimated 17 billion hours of unpaid care they provide was valued at $216 billlion.
But can robots make a difference? The latest issue of Geropsych: the Journal of Gerontopsychology and Geriatric Psychiatry is dedicated to exploring some of the complex issues associated with the development and deployment of caretaker robots, both in terms of what has already been developed and some of the prospects for the future.
Certainly, robotics applications for patient needs have already been developed. These include:
- Rehabilitation robots are mainly used in physical rehabilitation. The best-known example is Cyberdyne’s HAL system of robotic prosthetics for people with motor problems
- Service robots are closer to the common perception of robots providing direct care. One intriguing example developed for use in some German nursing homes is the Care-o-bot developed by Fraunhofer IPA. The latest version of the Care-o-bot handles drinks, plays memory games with residents, helps them with documentation, and even chants with residents. This robot has an omnidirectional platform that lets it navigate obstacles, travel along narrow passages, and autonomously plan the best path for traveling through a room. Another service robot being tested in German nursing homes, Casero, can carry one hundred kilos making it ideal for heavy tasks such as carrying laundry baskets and monitoring corridors to discourage wandering residents.
- Telepresence robots such as Giraff and VGo allow robots to act as “avatars” for nursing home residents and caregivers to interact with people over long distances by conveying the sense of personal presence. Combined with telephony and long-range remote control, telepresence devices permit nursing home caregivers to monitor residents and staff members and even attend conferences in other countries.
- One final category, focusing more on addressing psychological rather than physical needs, is the emotional robot, a.k.a. the companion robot. Most similar to the type of robot seen in Robot and Frank, companion robots are intended to interact with people for social and therapeutic purposes. Examples of companion robots developed in recent years include Aibo, Yumel, PLEO, and Huggable. While largely seen as expensive toys, such robots have become incorporated into the new field of “robotherapy” in treating different kinds of special needs patients. And that includes dementia patients though the benefits of robotherapy are still being weighed.
To explore the effectiveness of companion robots with dementia patients, Japanese manufacturing giant AIST developed an advanced interactive robot known as “Paro”. The Paro robot is designed to resemble a baby harp seal with touch sensors over its body and whiskers as well as sensors to respond to vision, hearing, and temperature. Used in nursing homes in Japan and Europe since 2003, Paro includes proactive and reactive behaviour routines that allow it to respond in a baby-like manner and to develop an emotional bond with patients. Along with responding to being stroked, Paro can also respond to the sound of its name and can learn new routines depending on the wishes of the user.
Along with being certified as the “World’s most therapeutic robot” by the Guinnness Book of Records, Paro has also been the focus of considerable research examining its effectiveness with nursing home residents. In one of the papers included in the special Geropsych issue, a team of researchers compared Paro’s effectiveness in treatment centres in Denmark, Germany and the United Kingdom. Since all three countries represent societies where the social and political costs associated with an aging demographic are likely to become a critical problem in the coming years, the use of robots to care for the elderly has been eagerly adopted. Denmark started using Paro in 2004 and now has hundreds of the robot seals across the country. While Paro is less widely used in Germany and the United Kingdom, enough research has been carried out to allow direct comparisons to be made across countries.
How Paro is used with geriatric patients usually depends on the available social and treatment programs. At the simplest level, patients can interact with Paro directly and research has already shown that this type of interaction can relieve stress and boost oxytocin levels in the bloodstream. Paro can also be used as part of treatment programming to increase social stimulation. Even patients suffering from advanced dementia are able to interact with companion robots and can find the novel experience stimulating. Since Paro provides sensory feedback to the patient’s interacting, this can shape how patients respond.
To ensure that Paro robots are used properly, the Danish Technological Institute (DT!) has a one-day certification course for caregivers. The course covers ethics of Paro use, as well as approved means of using Paro, whether for amusement and/or companionship (making it similar to Animal Assisted Activity, or AAA in many ways). Paro can also be used as a therapeutic tool to provide sensory stimulation though this can vary depending on the dementia symptoms and overall cognitive abilities of the patient.
As the central distributor for Europe, DTI can control how Paro is used by only making the robots available to people who have completed the course. DTI also maintains a research project to collect data on Paro use and how patients respond. According to one recent survey, caregivers use Paro for 1-3 hours each week, usually as a tool for stimulating or entertaining patients. Not all patients like using Paro however, and some even dismiss it as a “childish toy” that has no meaning for them. Other patients can rely on the robot for verbal communication and stimulating memories and feelings. It can also promote an emotional bond by giving a dementia patient something to care for, much in the same way a live animal would. Some caregivers have also reported that Paro can help reduce aggressive behaviour as well as discouraging patients from “wandering off” at times.
Since a robot such as Paro is hardly inexpensive (approximately 5000 euros or $7500 US), its use is usually limited to nursing homes or geriatric care units where one robot can be shared by many dementia patients. Though some robots can be purchased through fundraising drives or by corporate sponsors, how extensively they can be used with geriatric patients usually depends on available funding. As a result, countries like the United States can be expected to lag behind Europe and other countries with better funding for dementia care.
There are also ethical issues involved in using robots to care for dementia patients. Does using robots such as Paro make patients more infantile and reduce human interaction? For that matter, does using robots that look like animals represent a form of deception? Even the very use of terms like “companion robot” or “emotion robot” can be misleading for patients who are incapable of “switching” between the ideas that robots such as Paro are just robots and whether they are actually alive. There is also the question of improving robot technology which will make companion robots with more lifelike features available in just a few years.
Though early optimism about a “robot in every home” a la the Jetsons never really materialized, the prospect of robot companions being used to help deal with the surge of new dementia patients we will be seeing in the coming years seems closer than ever. Despite being machines, emotional robots have infinite patience, never take offence, and never get tired despite the constant demands that lead to burnout in human caregivers. While prototypes such as Paro and Care-o-bot suggest that more can be accomplished as robotics become more advanced, important questions about how these robots are used and whether they can take the place of human interaction are still being researched with few clear answers so far.
About the only real conclusion that can be made is that the rise in new dementia patients will definitely overwhelm geriatric care programs worldwide over the next twenty years. Whether robots can help dementia patients function better and preserve their dignity in the time they have remaining may well be even more important than we currently realize. How well we can handle the social problem we will be facing in the next thirty years will likely depend on whether we are willing to embrace new technological options as they develop.