Use of robotics in healthcare is steadily rising with new applications ranging from exoskeletons and prosthetics to surgical and nano robotics for precise operations and drug delivery. In fact, healthcare robotics is expected to become a US$ 32.5 Bn industry by 2027 with a CAGR of around 21.3% from 2020 to 2027.
The COVID-19 pandemic further highlighted the need for robots as integral members of our healthcare workforce.
Robots were used for maintaining hospital sanitization through disinfection robots, fetching medicines and as telepresence robots to keep patients’ company when isolation was necessary for their safety and recovery.
The application domain of healthcare robotics is only going to expand as sensors and actuators become smaller and more precise, and artificial intelligence is used to expand the robot’s learning and interaction capabilities. Despite their vast applications a primary demographic that robots can benefit are ageing adults.
The Case for Introducing Robots in Healthcare:
Countries like Japan, USA, Italy, and Denmark are facing a change in their population demographics as the figures skew in favor of the ageing population.
In the USA alone, the number of people over the age of 65 will make 21% of the population by 2030 as opposed to just 15% in 2018.
This shift in demographics places substantial burden on healthcare facilities and care providers which may include medical workers as well as family members.
Most people prefer to age-in-place instead of leaving their lives behind to age in a care facility. However, ageing imposes a significant challenge on a person’s ability to live independently owing to declining health which can affect mobility, memory and may lead to social isolation.
Additionally, for a majority ageing in place the primary caregiver is also an ageing partner or an adult child. Therefore, taking care of another dependent may impose mental and physical side effects on the caregiver as well.
Caring for elderly in nursing or community homes also poses a challenge due to a shortage of healthcare workers with respect to demand. Research suggests that the addition of each patient to a nurse leads to 23% increase in nurse burnout.
Furthermore, the cost of accessing these care benefits can add significant financial stress to patients or their families. Therefore, digital twin healthcare robotics can play a significant role in supporting the quality of life for ageing adults, allowing them to age with dignity and reducing the stress on care providers.
There is an abundance of literature available outlining the different services that robots may provide when caring for an elderly person. Some of these roles are discussed below.
Robotic Involvement in Activities of Daily Living to Improve Quality of Life:
Activities of daily living (ADL) include tasks such as mobility, eating, drinking, dressing, hygiene, and sleep. These tasks are necessary to meet the basic physiological needs of a person. Additionally, robots can support instrumental activities of daily living which are not essential to the person’s survival but significantly add to the quality of life. These activities include tasks such as cooking and house cleaning.
Robots such as Cruzr and Pepper have been deployed at hospitals, private and nursing homes to monitor individuals especially during the COVID19 pandemic. The robots were equipped with sensors to monitor vitals such as blood pressure, oxygen saturation and body temperature and therefore can perform temporal monitoring of the individual’s health. This allows robots to provide elderly with the requisite health monitoring while keeping the caregivers aware of any emergency that may arise.
Additionally, robots can be used to set reminders for medicines, meals, and doctor appointments, sometimes even allow the elderly to virtually attend these appointments through telemedicine robots, reducing the need for a caregiver to be physically present to provide care. This can be critical during pandemics such as the COVID-19 where reducing human-to-human contact can be pivotal in ensuring the health and safety of the elderly without compromising care. Post COVID-19 these robots can continue to perform interventions, as deemed necessary, significantly reducing the burden on the care provider.
Furthermore, some robots have also been designed to provide physical support to the elderly.
- My Spoon has been designed to help individuals with motor control disabilities to eat or get dressed, with minimal dependance on their caregiver.
- RIBA (Robot for Interactive Body Assistance) is capable of moving patients in and out of bed and wheelchair significantly reducing physical harm to the care provider when performing such strenuous tasks.
Similarly, there are countless examples of robots that can assist elderly in activities of daily living and instrumental daily living such as
- HERB- a robot butler that can cook, clean and perform other household functions,
- Care-O-bot 3, that can facilitate elderly by fetching objects for them and can alert the police in case of emergency, and
- Cody which is designed to give baths to the elderly. 2
These examples of robots facilitating elderly with everyday tasks ranging from health monitoring and recovery to physical tasks that can become a significant chore with age are just scratching the surface of the potential that robots hold with mediating a decline in elderly health or ability to live independently because of it.
Breakthroughs and Potential in Managing Social Isolation, Depression, and Mental Health:
Social healthcare robotics are designed to facilitate interaction between humans-robot and human-human can be significantly helpful in providing emotional and psychological support to the elderly. Unlike robots designed to facilitate activities of daily living, where the appearance of the robot is primarily motivated by robot function, robots designed to provide emotional support can vary in form factor ranging from animal inspired (PARO, AIBO) to humanoid robots such as Pepper.
Depending on their form factor the support that these robots can provide also varies significantly. For e.g., studies done with the PARO robot which is designed as a therapy robot discuss the positive effect on mood of the elderly, alleviation of loneliness as well as increased interaction among the study participants.
Humanoid robots such as Pepper have been used to guide exercise programs for the elderly in care homes and have resulted in longer compliance by the elderly in continuing their routines after the robot intervention ended when compared with simple video tutorials. Robots such as Pepper and CRUZR are also capable of reducing social isolation for the elderly by keeping them connected with their relatives through video call. However, one of their primary roles in providing healthcare and emotional support for the elderly is by acting as a mediator or a liaison between human-human interaction.
People with dementia and Alzheimer’s are affected by memory loss and may need to be reminded of the same thing multiple times. This persistent repetition can be exhausting for the care provider who may have other responsibilities and can therefore respond with short replies that express their frustration. This too can have a significant toll on the elderly’s wellbeing who cannot remember repeating the question and or receiving a response earlier.
In these situations, robots can become exemplary mediators as unlike their human counterparts their sole goal can be to facilitate the elderly. Robots bring additional advantages of being patient and unjudgmental about the elderly’s condition or requests for repetition.
As a result of these benefits social and emotional support for the elderly through robots is a topic under significant investigation by researchers, roboticists, and cognitive scientists, who can see the robots benefitting the elderly by preventing social isolation, providing therapeutic support and other necessary interventions.
The Challenges of Robot Adoption and Deployment:
Despite the enormous potential that robots hold in providing support to the elderly, a fully autonomous robot capable of replacing a nurse or a human caregiver is still some time away. This can be attributed to three separate categories of challenges that are faced in robot adoption and deployment.
Improvements in artificial intelligence, sensors, actuators, embedded computing as well as control strategies have significantly advanced the capabilities of robots. Robots are now capable of learning new techniques through transfer learning and inverse-reinforcement learning to adapt their behaviors according to user needs. However, their ability to sense nuances in human behaviors is still limited and significant research is required to mitigate this gap.
There are still limitations on compute power required to allow a single robot to perform all the support functions needed to care for an ageing individual. Furthermore, issues of robot safety, reliability and long-term learning are also domains that need to be addressed before fully autonomous healthcare robots can be expected to replace human caregivers.
Robot commercialization is an additional challenge. Financial barriers to robot adoption for elderly care can be significant. A Paro robot can cost up to $6000, and a Pepper robot can incur a cost of around $23000. Additional costs are incurred for maintenance and training for the system.
Such steep costs can render robots inaccessible for many or diminish the cost effectiveness when considered against their value. Furthermore, there is a need to run mass trials with end users to verify robot safety and operation before successful commercialization and adoption of these healthcare robotics become possible.
The biggest concerns that arise from using robotics for elderly care are ethical concerns regarding deception, social substitution and user privacy and dignity. Robots that can express emotions or carry interactions that suggest concern for the elderly when this concern is purely simulated can mislead the elderly into thinking that the robot genuinely cares about them. Similarly, robots capable of providing emotional support and carrying interaction with the elderly may have the negative consequence where instead of facilitating human social interaction they end up substituting for it.
Furthermore, robots equipped with sensors such as cameras and microphones can also lead to a violation of the individual’s privacy where elderly is unaware that their data is being collected even in a situation, they may want to keep private. Lastly, elderly may feel that their dignity is compromised by relying on a mechanical object to take care of them.
Conclusion and future outlook:
Despite these challenges, the value that healthcare robotics can add to the system and care of the elderly is undeniable. The COVID-19 pandemic has highlighted several roles in which robots can presently facilitate elderly to live a more independent life and age with dignity in private homes or in care facilities, by providing both physical and non-physical support. The benefits of robot intervention also include alleviation of stress of care provision on care providers and healthcare workers.
To overcome challenges to robot adoption, there is a need to devise policies that can accelerate robot commercialization and facilitate mass long-term testing to generate the requisite data for verifying robot usability. Additionally, engaging end-robot users and other stakeholders in the design of the robot can also lead to valuable dialogue when privacy outweighs concerns over safety, security and vice-versa.
Such a process of co-designing with the end user can also help tackle challenges with robot deception and social isolation as detailed description of robot behavior is developed with the end user.