Ask the Expert
Beyond Science Fiction: The Practical Applications of Robotics in Healthcare
According to the US Census, one in five people will be age 65 years or older in 2030; and the number of older Americans is projected to be 88.5 million by 2050. As the world population continues to age at an unprecedented rate, there will be a substantial demand on healthcare staff and resources. As such, many healthcare facilities have turned to robot technologies to support overextended staff. Healthcare robotics is still in its early stages while evidence to support its utility is being gathered from single-site studies that tend to focus on a specific population (eg, use of telemedicine robots in rural communities, use of rehabilitation robots in stroke patients).
One of the most recent studies to assess the viability of robotics in a long-term care setting is a randomized, controlled trial that evaluated the psychosocial effects of a companion robot named Paro in 40 nursing home residents in New Zealand. The robot, designed to look like a baby harp seal, can appear to recognize people and its environment because it responds to tactile, auditory, and postural cues. Over 12 weeks, the investigators measured cognitive status, loneliness, depression, and quality of life in the intervention group, which interacted with the Paro robot for an hour twice a week, and the control group, which participated in regular activities, such as crafts, during the same time. At follow-up, the investigators observed significant decreases in measures of loneliness in the intervention group compared with the control group. Additionally, Paro was compared with a resident dog. The investigators found that a greater number of residents interacted with the robot than the dog, indicating that Paro may be able to address some of the unmet needs of older people that a resident animal may not.
Clinical Geriatrics® (CG) had the opportunity to discuss the Paro robot study and other implications for the use of robotics in healthcare with the study’s four authors: Hayley Robinson, MSc, doctorate student; Elizabeth Broadbent, BE, MSc, PhD, department of psychological medicine; Bruce MacDonald, BE, PhD, department of electrical and computer engineering; and Ngaire Kerse, MBChB, PhD, department of general practice and primary healthcare, University of Auckland, New Zealand. The following answers represent the team’s collective responses.
CG: What do the results of your study reveal about the potential of companion robots in long-term care settings?
This study shows that companion robots can make a beneficial impact on the social environment by facilitating communication and reducing loneliness. There is a place for companion robots in long-term care. While not everyone wanted to interact with the robot, the majority were interested and enjoyed being with it. Staff commented that the robot helped to reduce agitation in some residents, and Paro provided them with something to discuss and care for. The robot is not designed to replace live pets in such settings, as both have benefits and downsides. One benefit of a robot is that it will sit with an older person and engage with them for a long time, whereas an animal will often move away after a short time to see other things.
What are some other types of robots that are currently being used or in development for use in healthcare settings around the world?
Some robots help people with functional tasks that would otherwise be difficult to perform. They include robotic systems that help surgeons perform minimally invasive surgery (eg, da Vinci); rehabilitation robots (eg, RoboTherapist 3D, which has been designed to help stroke patients); and medication delivery robots (eg, TUG). Robotic technologies, such as smart wheelchairs (eg, Guido Simplex) and exoskeletons (eg, Hybrid Assistive Limb, or HAL), have also been designed to provide physical assistance.
Service-type robots are programmed to perform a variety of functions related to independent living, including assistance with basic activities, such as eating, bathing, toileting, dressing, mobility (including navigation), household maintenance, and monitoring of health and safety. Other robots can remind people to take medication, provide telemedicine, or take vital signs, such as blood pressure. For example, MOVAID can help with heating/delivering food, changing bed linens, and kitchen cleaning; Harmony in Roll-lo Bathing has been designed to assist older people with bathing; and iRobiQ can take blood pressure and remind people to take medication. Some robots provide videoconferencing, including some designed specifically for older people (eg, Giraff), or for hospital consultations by remote doctors (eg, RP-VITA).
What value are robots adding to patient care?
Robots may help facilitate “aging in place,” whereby a robotic aid is able to help people maintain their independence and autonomy. By helping people with daily tasks and monitoring health, a robot may delay the admission to an eldercare institution. In addition, robots have the potential to improve quality of life of both the residents and staff in eldercare facilities. As retirement homes experience increasing demands as a result of the growing aging population in the setting of nursing shortages, the provision of assistance from robots will be highly valued if appropriately developed. Some of the robots can measure vital signs, provide entertainment and stimulation, and may be a means to communicate with family and friends. Other robots can be useful in providing mobility assistance. Pet-like robots can provide comfort and facilitate social interaction and communication among residents and staff.
Please discuss the current evidence base supporting the use of robots in healthcare settings.
The use of robots in healthcare is relatively new. Many robots are still in development and so only pilot studies have been performed with a few small sample sizes to evaluate acceptance and feasibility. Most studies have been cross-sectional or short-term longitudinal studies, and the results suggest that many people are open to the idea of robots and will use them if they are useful, easy to use, and provide some advantages in terms of accuracy and independence.
In your opinion, will robots replace human caregivers? Please explain why or why not.
Throughout the course of this research, many people have questioned whether robots are going to replace humans. For staff, this is a particular concern, and for family and friends of patients or even those receiving care, there is the worry that there will be a lack of human companionship. However, these robots are not being designed to replace human contact, but actually to facilitate it. This is illustrated by our results with Paro. For example, when a staff member would come in and bring a cup of tea to a resident, he or she would say, “Hello, how are you?” and then “Goodbye.” In contrast, when the resident had Paro, the staff member would stop and say hello to both the resident and to Paro, stroke Paro, and then comment to the resident about it; they would have a little laugh together. Other robots are being designed with telecommunication capabilities, which means that residents can talk to friends and family easily. Finally, robots that help with daily tasks enable staff caring for older persons to spend less time doing the tasks themselves and more time talking to their residents.
Do you think that using robots will be necessary to keep up with the demands on the healthcare system posed by the aging population?
Many technologies are commonplace, and cell-phones and computers are ubiquitous. The use of e-health is becoming more and more common, and it is only natural that the use of technology will continue to increase in the future. The trials that have been conducted in New Zealand have shown that healthcare robots with a variety of functions are well received. A number of the robots used in these trials have now been purchased for use in another rural part of the country to try and improve the quality of care for older people who do not live close to healthcare services. With advances in robotics, we think that robots will be able to supplement existing care, and hopefully be able to improve quality of life in a cost-effective manner.
The authors report no relevant financial relationships.