Emotions and stigma: Social robots from the perspectives of older adult end-users

Post by Jaya Kailley

This blog post summarizes results from the peer-reviewed journal article “Older adult perspectives on emotion and stigma in social robots” published in Frontiers in Psychiatry (2023).

Social robots: Tools to support the quality of life of older adults

Canada’s older adult population is rapidly growing (1), and tools such as social robots may be able to support the health and quality of life of older adults. Social robots are devices that can provide support to users through interaction. They can be used for health monitoring, reminders, and cognitive training activities (2), and they have been shown to decrease behavioural and psychological symptoms of dementia, improve mood, decrease loneliness, decrease blood pressure, and support pain management (3–6).

End-user driven approaches to improve social robot adoption

 Despite their benefits, social robots are not readily adopted by older adults. Issues raised in the literature include a lack of emotional alignment between end-users and devices (7,8) and the perception of stigma around social robot use (3,9). To address these barriers and improve the design of future devices, it is important to better understand user preferences for social robots, rather than relying only on expert opinion (10).

Older adult perspectives on social robot applications, emotion and stigma

The Neuroscience, Engagement, and Smart Tech (NEST) lab at Neuroethics Canada explored the topics of emotion and stigma in social robots from the perspectives of older adults, people living with dementia, and care partners. This project was co-designed with a Lived Experience Expert Group (LEEG, or “League”). We conducted online workshops where participants had an opportunity to share their thoughts on what a social robot should be able to do, what kind of emotional range it should be capable of displaying, how much emotion it should display, and considerations around using a social robot in various public contexts (Figure 1).

Figure 1 – Results from the SOCRATES workshops.

Participants expressed that they would want a social robot to interact with them and provide companionship. They also suggested that a robot could be a medium to connect with others; for example, a robot could facilitate electronic communication between two people.

Emotional display was something that most participants desired in a social robot, but there were different preferences for how much emotion a robot should display. Participants mentioned that a social robot displaying negative emotions could be stressful for the user, but a social robot displaying only positive emotions could appear artificial. One participant suggested that to get around this issue, a social robot could have a dial to set the level of interactivity that the user desired. Ideas for displays of emotions raised included facial expressions, body movements, or noises. Participants also explained how having a robot that aligned its emotions with the user could facilitate connection between the robot and user.

Participants also discussed considerations around using a robot in front of other people. Some participants voiced concern about attracting negative attention from an audience and feeling judged, while others suggested that a social robot could help to educate and raise awareness about dementia and how technologies can provide support to older adults.

Looking to the future

One key part of the neuroethics field today is co-created research (11), which involves engaging end-users in the creation of interventions meant to support their wellbeing. The results from this study highlight that social robots should have advanced interactive abilities and emotional capabilities to ensure that users can feel connected to these devices. Since older adults have different preferences for emotional range, customizability should be prioritized in the design of future devices. The results for considerations around using a robot in public suggest that social robot marketing may have a significant impact on the way assistive technologies are perceived in the future. Highlighting these devices as support and using them to educate the public about dementia may reduce the stigma around these technologies. These key findings should be incorporated into the design and implementation of future social robots to improve social robot adoption among older adults.

References

1.         Infographic: Canada’s seniors population outlook: Uncharted territory | CIHI [Internet]. [cited 2022 Jun 16]. Available from: https://www.cihi.ca/en/infographic-canadas-seniors-population-outlook-uncharted-territory

2.         Getson C, Nejat G. Socially assistive robots helping older adults through the pandemic and life after COVID-19. Robotics. 2021 Sep;10(3):106.

3.         Hung L, Liu C, Woldum E, Au-Yeung A, Berndt A, Wallsworth C, et al. The benefits of and barriers to using a social robot PARO in care settings: A scoping review. BMC Geriatr. 2019 Aug 23;19(1):232.

4.         Petersen S, Houston S, Qin H, Tague C, Studley J. The utilization of robotic pets in dementia care. Journal of Alzheimer’s Disease. 2017 Jan 1;55(2):569–74.

5.         Robinson H, MacDonald B, Broadbent E. Physiological effects of a companion robot on blood pressure of older people in residential care facility: A pilot study. Australasian Journal on Ageing. 2015;34(1):27–32.

6.         Latikka R, Rubio-Hernández R, Lohan ES, Rantala J, Nieto Fernández F, Laitinen A, et al. Older adults’ loneliness, social isolation, and physical information and communication technology in the era of ambient assisted living: A systematic literature review. J Med Internet Res. 2021 Dec 30;23(12):e28022.

7.         Prescott TJ, Robillard JM. Are friends electric? The benefits and risks of human-robot relationships. iScience. 2021 Jan 22;24(1):101993.

8.         Pu L, Moyle W, Jones C, Todorovic M. The effectiveness of social robots for older adults: A systematic review and meta-analysis of randomized controlled studies. The Gerontologist. 2019 Jan 9;59(1):e37–51.

9.         Koh WQ, Felding SA, Budak KB, Toomey E, Casey D. Barriers and facilitators to the implementation of social robots for older adults and people with dementia: a scoping review. BMC Geriatr. 2021 Jun 9;21:351.

10.       Bradwell HL, Edwards KJ, Winnington R, Thill S, Jones RB. Companion robots for older people: importance of user-centred design demonstrated through observations and focus groups comparing preferences of older people and roboticists in South West England. BMJ Open. 2019 Sep 1;9(9):e032468.

11.       Illes J. Reflecting on the Past and Future of Neuroethics: The Brain on a Pedestal. AJOB Neuroscience. 2023 Mar 31;1–4.

Jaya Kailley is a directed studies student under the supervision of Dr. Julie Robillard in the NEST Lab, and she is pursuing an Integrated Sciences degree in Behavioural Neuroscience and Physiology at the University of British Columbia. She currently supports research projects that aim to include end-users in the process of social robot development. Outside of work, Jaya enjoys playing the piano, drawing, and reading fiction novels.

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On COVID-19: Exploring the Experiences of the Dementia Community during the Pandemic

This blog post discusses some of the key findings from the article “The Impact of a Global Pandemic on People Living with Dementia and their Care Partners: Analysis of 417 Lived Experience Reports , paper here).

It is without question that the COVID-19 pandemic has greatly impacted our daily lives. From new health policies to months being on lockdown, we have had to adapt to the rapidly changing circumstances within the last year and a half. Remember when every day necessities were becoming scarce and the difficulty in trying to find a roll of toilet paper? More importantly, as the pandemic progressed, there were increased concerns surrounding available hospital beds and ventilators [1,2] and the allocation of resources including vaccines and therapies to combat the virus [2,3]. While the entire world has had a handful of shared experiences, some have been more vulnerable to the virus and the regulations set in place. 

During the earlier days of the pandemic, we learned that older adults were at a higher risk of contracting the virus, especially those living in long-term care facilities, including people living with dementia. They were restricted from going out, attending regular health care services, receiving home support, or accessing community supports and social networks. Families and care partners also had difficulties in caring for their loved ones, as some were unable to physically visit them in a long-term care home. As this continues to be an unprecedented time, it is important to understand the experiences and needs of the dementia community.

What we did

With an ongoing collaboration with the Alzheimer Society of British Columbia, we at the Neuroscience, Engagement, and Smart Technology (NEST) Lab developed a survey to explore the lived experiences of people living with dementia and their care partners during the pandemic. In this survey, we touched on four different themes including (1) information and resource needs, (2) caring for someone living with dementia during the COVID-19 pandemic, (3) mental health and well-being needs, and (4) the use of technology for social connection during the pandemic. We distributed the survey between June and August 2020 and received 417 responses (395 care partners and 22 people living with dementia).

What we found

Information and resource needs

Figure 1 shows the locations from which our participants were receiving their information about COVID-19. With so many sources of information during the pandemic, our participants found that the information they accessed were helpful in terms of maintaining their own health (74% of care partners, 86% people living with dementia) and a period of social distancing (70%, 77%). They found that the information they accessed was either somewhat or very stressful (29%, 23%), neither stressful or reassuring (23%, 23%), or somewhat or very reassuring (48%, 54%). In terms of needs, care partners wished to have learned more about care options including long-term care and respite care, while people living with dementia wanted to learn more about self-care during the pandemic. 

Figure 1. “Where have you been receiving information about the COVID-19 pandemic?”

Caring for someone living with dementia

The focus of this section in our survey was to identify the main concerns of care partners during the pandemic. While there was concern for every care partner scenario described in the survey, the five major concerns were having more responsibilities as a care partner, access to therapy and/or a vaccine for COVID-19 in the future, having the person they care for be infected with COVID-19, the person that they care for having difficulty understanding COVID-19 and the health regulations set in place, and having themselves be infected with COVID-19. Figure 2 presents other areas of concern for these care partners.

Figure 2. Care partner concerns.

Mental health and well-being 

An increased period of social distancing and being on lockdown affected the mental health and well-being of those living with dementia and their care partners. People living with dementia were restricted in their home, not being able to go out to get groceries, attend regular health care services, or even access community supports. With this in mind, we uncovered that the pandemic had increased our participants’ stress overall (58%, 62%), and they had felt left out (63%, 81%), isolated (74%, 81%), and lacked companionship (70%, 76%). To manage this stress and maintain their well-being, participants said that they spent time talking to friends and family, walking around the neighbourhood, watching television, and engaged in household activities. 

Technology and social connection

As many in-person activities were suspended and some transitioned to a virtual setting, we were interested in whether people living with dementia and their care partners were utilizing technology for social connection. Even though there were increased feelings of isolation and lack of companionship during the pandemic, our participants were able to socialize and connect with others through a cell phone/smartphone, on devices such as laptops and tablets, as well as home phones. However, only 19% of care partners and 36% of people living with dementia felt that using technology to connect with others felt the same as interacting with them in person. There is something to be said about the quality and impact of having in-person interactions and the impact it can have on one’s mental well-being. 

What now?

Our survey took the opportunity during a challenging time to explore the real life experiences of people living with dementia and their families and care partners. With this, we were able to identify some actionable priorities for services such as those provided by the Alzheimer Society of B.C. to better support the dementia community during a pandemic. Since the publication of our results, the Alzheimer Society of B.C. already implemented some of the suggestions and findings in their service delivery. Moving forward, there will be plans to implement long-term changes to address the needs of this community and to better manage the care for older adults and people living with dementia. 

The authors of this work were Mallorie Tam, Dr. Jill Dosso, and Dr. Julie Robillard. Special acknowledgement to the Alzheimer Society of B.C. for their support and collaboration on the project. 

Press coverage of the study: https://vancouversun.com/health/seniors/people-with-dementia-experienced-more-stress-loneliness-during-covid-19-says-ubc-study

References

1. Emanuel EJ, Persad G, Upshur R, Thome B, Parker M, Glickman A, Zhang C, Boyle C, Smith M, Phillips JP (2020) Fair allocation of scarce medical resources in the time of Covid-19. N Engl J Med 382, 2049–2055.
2. Smith EE, Couillard P, Fisk JD, Ismail Z, Montero-Odasso M, Robillard JM, Vedel I, Sivananthan S, Gauthier S (2020) Pandemic dementia scarce resource allocation. Can Geriatr J 23, 216-218.
3. Neurology Today, COVID-19: Prepare for Care-Rationing—Know Your Hospital Policies, https://journals.lww.com/neurotodayonline/blog/breakingnews/pages/post.aspx?PostID=932, Last updated April 8, 2020, Accessed July 21, 2020.

Dementia Technology Policies: Benefits Are Clear – But What About the Harms?

This blog post discusses some of the key findings from the article “Prioritizing Benefits: A Content Analysis of the Ethics in Dementia Technology Policies” published in the Journal of Alzheimer’s Disease (2019, paper here).

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A new era of dementia care

From tracking devices to social robots, technology is rapidly transforming the scope of dementia care. Persons living with dementia and their caregivers can now choose from a wide range of innovative technologies to assist with everyday activities, symptom management, and more. With potential benefits such as increased autonomy and enhanced safety for persons living with dementia (1), new technologies are continuously being developed and entering the market.

Despite the excitement of innovation, the promising benefits of dementia technology must not be the only ethical implication to consider. Although monitoring technologies such as video surveillance can keep older adults safe, this may be at the cost of compromising privacy and independence. While companion robots may show potential in enhancing well-being and connection in older adults (2), this often comes with an expensive price tag. These diverse ethical implications are important for older adults to consider so they adopt technology that best aligns with their needs and values.

The question is, how are these ethical implications communicated to the dementia community through public policies?

The guidance of public policies

Alzheimer associations around the world create public-facing policies to guide the adoption and use of technology in dementia care. Given the wide array of ethical implications in need of consideration, policies play a critical role in raising the ethical issues of care technology to the dementia community. However, we found that the quality and ethical content of these policies can greatly vary, particularly around what ethical implications are being most and least discussed with the public (3).

What we found: Policies prioritize benefits

In the Neuroscience, Engagement, and Smart Tech (NEST) Lab, we analyzed the ethical content of 23 international policies using the four principles of biomedical ethics (4): beneficence, non-maleficence, autonomy, and justice (Fig. 1).

Fig. 1. The four principles of biomedical ethics adapted from Beauchamp and Childress (4).

What we found was that nearly all policies (96%) discussed the benefits of using technology such as increased independence, improved social contact, and enhanced quality of life for the person affected by dementia (3). However, this near-perfect score was not matched by the other ethical principles that raise the potential risks and harms associated with using dementia care technology (Fig. 2)

Fig. 2. Prevalence of policy documents based on the four principles of biomedical ethics.

Themes of justice, for example, were discussed in 74% of the policies, followed by themes of non-maleficence at 52% and autonomy at only 43% (Fig. 2). This lack of comprehensive discussion surrounding the risks and potential harms of dementia care technology is critical for users. Understanding ethical considerations such as cost, privacy, and consent are imperative for people affected by dementia to make well-informed decisions about their care.

Reshaping dementia technology policies

As dementia care technology continues to rapidly develop, so should policies that shape their adoption and use. To maximize the current and future benefits of dementia technologies, policies need to be reworked so that they are in the best interest of the dementia community. Important to this is the inclusion of not just benefits, but the potential risks and harms associated with dementia care technology. Persons with dementia, caregivers, and family members need to be actively engaged in the policy-making process to ensure patient-centred guidance in public policies.

A guide to adopting new technology in dementia care

Based on our findings, we disseminated a public resource to guide the adoption of new technologies in dementia care. Here are 10 questions for older adults to consider when adopting a new technology:

Acknowledgements to Dr. Julie Robillard for her leadership in this project and research members Tanya Feng and Mallorie Tam for their substantial contributions. This work was supported by the Canadian Consortium on Neurodegeneration in Aging and AGE-WELL NCE.

References

1. Meiland F, Innes A, Mountain G, Robinson L, van der Roest H, García-Casal JA, et al. Technologies to Support Community-Dwelling Persons With Dementia: A Position Paper on Issues Regarding Development, Usability, Effectiveness and Cost-Effectiveness, Deployment, and Ethics. JMIR Rehabil Assist Technol. 2017 Jan 16;4(1):e1.
2. Pike J, Picking R, Cunningham S. Robot companion cats for people at home with dementia: A qualitative case study on companotics. Dementia. 2021 May 1;20(4):1300–18.
3. Robillard JM, Wu JM, Feng TL, Tam MT. Prioritizing Benefits: A Content Analysis of the Ethics in Dementia Technology Policies. J Alzheimers Dis. 2019;69(4):897–904.
4. Beauchamp T, Childress J. Principles of Biomedical Ethics: Marking Its Fortieth Anniversary. Am J Bioeth. 2019 Nov;19(11):9–12.

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Julia Wu, BSc is a Research Assistant in the Neuroscience, Engagement and Smart Tech (NEST) Lab at the University of British Columbia and BC Children’s and Women’s Hospital. Her research interests include mental health and innovative approaches to improving patient experience and person-centred care in health care systems.