Pet robots and dementia care; achieving implementation within long-term care facilities

Research Project Title

Recommendations for implementing pet robots in long-term care facilities for residents with dementia

Key Words

Animal-assisted technology, pet robot, social robot, long-term care, nursing home, care home, dementia care, psychosocial health, implementation, strategies

Challenge

Pet therapy involves the use of trained animals to support individuals1, 2, and has shown to benefit the psychosocial health of people living with dementia2. Pet robots are a technology-based substitute for pet therapy. Research shows that pet robots demonstrate promise in improving the psychosocial health of older adults, including people living with dementia. Benefits include improving mood, engagement and reducing agitation3-5. Overall, larger studies are needed to confirm their effectiveness. The cost of pet robots has been cited as a barrier to their adoption in care settings6. As technology is advancing quickly, lower-cost options have emerged in the recent years. However, there have been no studies that consolidated the impact of low-cost pet robots for people with dementia. As such, little is known about their potential to improve the psychosocial health of people living with dementia.

It is also important to concurrently pursue knowledge on the implementation of pet robots to support the translation of research findings into real-world practice for dementia care. However, there have been no previous studies investigating the multi-level barriers and facilitators to implementing pet robots.

Research Project

The overall aim of this research is to develop recommendations for implementing pet robots as part of a dementia care plan within long-term care facilities.

There are 6 key phases to the research design:
1) Literature review (scoping review) to understand the impacts of low-cost pet robots.
2) Analysing consumer reviews on low-cost pet robots (n=1327).
3) Literature review to understand barriers and facilitators to implementing social robots.
4) Individual, in-depth interviews with healthcare professionals and organisational leaders (n=22) from 8 nursing homes in the Republic of Ireland.
5) Consultation with key stakeholders (n=5).
6) Conducting a two-round international modified Delphi study (n=56).

Based on these research findings, implementation recommendations will be proposed.

Key Objectives & Findings

The three core objectives of the study and findings are set out below:

1. To understand the potential of using low-cost pet robots as a psychosocial intervention for older adults and people with dementia.
First, we reviewed the literature7 and identified 8 articles that evaluated the use of 2 low-cost pet robots with older adults and people with dementia. This included a robotic cat and dog, which costs between €110-130 (as of December 2020). These studies were conducted in the UK and USA. Some of the positive impacts of using pet robots included improvements to mood, communication, and social interaction. Some studies also reported that the use of pet robots provided companionship and led to improvements in mental wellbeing. However, issues and concerns associated with the use of pet robots were also reported. For instance, some older adults misperceived pet robots as live animals, or became attached to them. They also led to anxiety or agitation among a few participants, who attempted to harm the pet robot. Some care staff and researchers also had concerns about the hygiene and infection control of the pet robots.

Next, we reviewed 15 online consumer websites, and identified 1,327 reviews that described experiences and perceptions of using a low-cost robotic cat with older adults and people with dementia8. Reviewers (individuals who wrote the reviews on the consumer websites) were mostly family members of older adults and people with dementia. Many (n=357) described positive perceptions about the robotic cat’s lifelikeness and features, while some (n=105) felt that it felt and looked mechanical. Most (n=874) described that its use led to positive emotions among older adults and people with dementia, such as improved mood and expressions of affection. For instance, one reviewer shared “I would say this week has been his calmest, happiest, most relaxed, enjoyable week in possibly three or more years! Because of this life-like, mechanical companion designed exactly for people like him”. Reviewers also expressed that it provided the older adult and or person with dementia an opportunity to participate in various activities, such as grooming or talking to it. Nevertheless, some reviewers (n=70) expressed that it caused anxiety for those who saw it and treated it as being real.

Overall, these findings were similar with other larger studies9-13 that used other higher-cost pet robots. This suggests that low-cost robotic pets show promise in addressing the psychosocial needs of older adults and people with dementia.

2. To understand barriers and facilitators to implementing pet robots for older adults and people with dementia.
We reviewed the literature to identify and consolidate information from 53 articles that reported on the barriers and facilitators to implementing social robots, including pet robots14, 15. Most studies (n=37) were conducted within 13 countries in Europe. Other countries included Australia, the United Kingdom, the United States, New Zealand, Japan and Mexico. Most studies were conducted in participants’ homes and long-term care facilities. We found that previous research studies have been disproportionately focused on examining barriers and facilitators relating to the characteristics of social robots (including pet robots), such as their design and ease of use, while little is known about other contextual factors, such as external policies, that can influence their implementation. No previous studies have been conducted to explicitly examine the multi-level determinants to implementing social robots, including pet robots.

After this, we used a qualitative approach to further understand this topic by interviewing healthcare professionals and organisational leaders from 8 nursing homes in the Republic of Ireland16, 17. Multi-level barriers and facilitators to the implementation of pet robots were identified.  Some barriers included cost, lack of funding, resources and knowledge, infection control mandates and potential disruptions to workflow. Some facilitators identified included relative advantages compared to other existing interventions, national guidelines, and alignment with care processes.

3. To identify, contextualise and gain consensus on strategies for implementing pet robots in nursing homes for dementia care.
Achieving this objective involved 2 main sequential steps18. Step 1 was to identify and contextualise implementation strategies. Findings of barriers and facilitators to implementing pet robots (Objective 2) were mapped onto a taxonomy of implementation strategies19, 20, which allowed us to identify a list of potentially relevant strategies. These strategies were contextualised to the context of this study, using findings from our previous studies and through consultation with 2 healthcare professionals, 1 academic researcher and 1 organisational leader, and with a Patient and Public Involvement member from the Alzheimer Society of Ireland.

Step 2 was to gain consensus from a panel of experts. A two-round modified Delphi study will be conducted with 3 groups of key stakeholders to identify the strategies that are important and critical for implementing pet robots in long term care facilities as part of a care plan for residents with dementia. This process is ongoing and is expected to be completed by end of Summer 2022.

Recommendations

The findings from this research have provided further knowledge on how pet robots can be adopted as a part of dementia care in nursing homes. First, we identified low-cost pet robots as promising technology to support the psychosocial health of older adults and people living with dementia. More high-quality effectiveness studies are required to confirm their positive impacts. Next, we identified barriers and facilitators to implementing pet robots. Findings show that barriers and facilitators occur different levels. Therefore, multilevel factors, such as organisational factors and external factors, should be thoroughly considered to support the adoption of pet robots. Data collection and analysis for our final study to identify the most relevant implementation strategies is still ongoing. The findings from this study will have practical implications for long-term care facilities that would like to embed pet robots as part of their routine dementia care.

Research Project Outputs:

Findings and research outputs, once complete, will be made available through this research project webpage. Please see peer-reviewed publications related to this project within the reference list below.

Timeline

October 2019 – October 2022

Research Team

Ms Wei Qi Koh, National University of Ireland Galway
Dr Elaine Toomey, Lecturer in Physiotherapy, School of Allied Health, University of Limerick
Professor Dympna Casey, Head of the School of Nursing and Midwifery, National University of Ireland Galway

Funding & Support

The research presented was carried out as part of the Marie Curie Innovative Training Network (ITN) action, H2020-MSCA-ITN-2018,under grant agreement number 813196.

Reference List:

1. Perkins A.  The benefits of pet therapy. Nursing made Incredibly Easy 2020;18(1): 5-8

2. Klimova B, Toman J, Kuca K. Effectiveness of the dog therapy for patients with dementia-a systematic review. BMC psychiatry 2019;19(1):1-7.

3. Abbott R, Orr N, McGill P, et al. How do "robopets" impact the health and well-being of residents in care homes? A systematic review of qualitative and quantitative evidence. International Journal of Older People Nursing 2019;14(3) https://doi.org/10.1111/opn.12239 [Accessed 24 May 2022]

4. Hung LL, Liu C, Woldum E, et al. The benefits of and barriers to using a social robot PARO in care settings: a scoping review. Bmc Geriatrics 2019;19(1) https://doi.org/10.1186/s12877-019-1244-6   [Accessed 24 May 2022]

5. Pu LH, Moyle W, Jones C, et al. The Effectiveness of Social Robots for Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Studies. Gerontologist 2019;59(1):E37-E51. doi: 10.1093/geront/gny046

6. Hung L, Liu C, Woldum E, et al. The benefits of and barriers to using a social robot PARO in care settings: a scoping review. BMC Geriatrics 2019;19(1):1-10.

7. Koh WQ, Ang FXH, Casey D. Impacts of low-cost robotic pets for older adults and people with dementia: scoping reviewJMIR rehabilitation and assistive technologies 2021;8(1):e25340. [Accessed 24 May 2022]

8. Koh WQ, Whelan S, Heins P, et al. The Usability and Impact of a Low-Cost Pet Robot for Older Adults and People With Dementia: Qualitative Content Analysis of User Experiences and Perceptions on Consumer Websites. JMIR aging  2022;5(1):e29224. [Accessed 24 May 2022]

9. Moyle W, Jones CJ, Murfield JE, et al. Use of a robotic seal as a therapeutic tool to improve dementia symptoms: a cluster randomized controlled trial. Journal of the American Medical Directors Association 2017;18(9):766-73.

10. Jøranson N, Pedersen I, Rokstad AMM, et al. Effects on symptoms of agitation and depression in persons with dementia participating in robot-assisted activity: a cluster-randomized controlled trial. Journal of the American Medical Directors Association 2015;16(10):867-73.

11. Jøranson N, Pedersen I, Rokstad AMM, et al. Change in quality of life in older people with dementia participating in Paro activity: A cluster‐randomized controlled trial. Journal of advanced nursing 2016;72(12):3020-33.

12. Gustafsson C, Svanberg C, Müllersdorf M. Using a robotic cat in dementia care: a pilot study. Journal of gerontological nursing 2015;41(10):46-56.

13. Kramer SC, Friedmann E, Bernstein PL. Comparison of the effect of human interaction, animal-assisted therapy, and AIBO assisted therapy on long-term care residents with dementia. Anthrozoös 2009;22(1):43-57.

14. Koh WQ, Felding SA, Budak KB, et al. Barriers and facilitators to the implementation of social robots for older adults and people with dementia: a scoping review. BMC geriatrics 2021;21(1):1-17. [Accessed 24 May 2022]

15. Koh WQ, Felding SA, Toomey E, et al. Barriers and facilitators to the implementation of social robots for older adults and people with dementia: a scoping review protocol. Systematic reviews 2021;10(1):1-6. [Accessed 24 May 2022]

16. Koh WQ, Toomey E, Casey D. Exploring Barriers and Facilitators to the Implementation of Pet Robots for People With Dementia in Nursing Homes: A Qualitative Research Protocol. International Journal of Qualitative Methods 2021;20:16094069211047059. [Accessed 24 May 2022]

17. Koh, W.Q., Toomey, E., Flynn, A. & Casey, D. (2022). Determinants of implementing of pet robots in nursing homes for dementia care. BMC Geriatrics, 22(1), 457. [Accessed 7 June 2022]

18. Koh, W. Q., Casey, D., Hoel, V., & Toomey, E. (2022). Strategies for implementing pet robots in care homes and nursing homes for residents with dementia: protocol for a modified Delphi study. Implementation Science Communications, 3(1), 58. [Accessed 7 June 2022]

19. Powell BJ, McMillen JC, Proctor EK, et al. A Compilation of Strategies for Implementing Clinical Innovations in Health and Mental Health. Medical Care Research and Review 2011;69(2):123-57. doi: 10.1177/1077558711430690

20. Waltz TJ, Powell BJ, Fernández ME, et al. Choosing implementation strategies to address contextual barriers: diversity in recommendations and future directions. Implementation Science 2019;14(1):1-15.

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