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The Role of Healthcare Robots for Older People at Home: A Review

Article in International Journal of Social Robotics · November 2014

DOI: 10.1007/s12369-014-0242-2

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Int J of Soc Robotics (2014) 6:575–591
DOI 10.1007/s12369-014-0242-2

The Role of Healthcare Robots for Older People at Home:

A Review
Hayley Robinson · Bruce MacDonald ·
Elizabeth Broadbent

Accepted: 31 May 2014 / Published online: 3 July 2014

© Springer Science+Business Media Dordrecht 2014

Abstract This review aimed to identify the areas of need tional robots, greater educational content and motivational
that older people have, and the available solutions. In par- aspects of appearance and interaction style.
ticular, the robotic solutions are explored and critiqued and
areas for future development identified. The literature was Keywords Healthcare robots · Robotics · Ageing ·
reviewed for factors that influence admission to nursing home Assistive technologies
care, and for technological solutions to these factors. The
main issues facing older people are physical decline, cogni-
tive decline, health management, and psychosocial issues. 1 Introduction
Robots exist that may meet some of the identified issues
but gaps where robots could be developed include deliver- The rising number of older people is an increasing con-
ing interventions to prevent physical decline occurring and cern because of the predicted strain on healthcare services.
robots with multiple functions, including a range of cognitive Although there is no set age marking that a person is ‘old’
stimuli and health education. To reduce barriers to accep- the developed world often adopts the retirement age of 60 or
tance, robots designed to provide physical and healthcare 65 [1]. According to current statistics, the number of people
assistance should have a serious appearance. On the other aged over 65 is predicted to triple between 2000 and 2050
hand animal-like robots can address psychosocial issues and [2]. Already older people outnumber younger cohorts and
function like pets. While smart phones and computers can there is a shortage in formal and informal caregivers of the
offer some solutions, robots may promote adherence due to a elderly [3,4]. For older people, remaining in one’s home later
social presence. Robots are being developed to address areas in life instead of living in an elder care facility is beneficial
of need in older people, including physical, cognitive, med- in terms of overall quality of life, if their needs are ade-
ical and psychosocial issues. However more focus could be quately addressed [5]. Admission to a nursing home facility
placed on developing preventative interventions, multifunc- is rarely a stress free period and the transition into a nurs-
ing home has been associated with distress, depression and
emotional problems for patients and their families as well as
H. Robinson
early mortality [6–11]. The application of ‘ageing in place’
Department of Psychological Medicine, The University and community care has a number of benefits in terms of cost
of Auckland, Auckland, New Zealand effectively meeting the needs of older people and delaying
e-mail: [email protected] nursing home admission [12]. By developing technologies
B. MacDonald
to help older people retain their independence, older people
Department of Electrical and Computer Engineering, may be happier and healthier in their old age provided their
The University of Auckland, Auckland, New Zealand needs are met. At present many technologies exist, including
robotic technologies, designed specifically to help older peo-
E. Broadbent (B)
Department of Psychological Medicine, The University
ple. The aim of this review is to examine the problems older
of Auckland, Private Bag 92019, Auckland, New Zealand people experience that lead to early admission into nursing
e-mail: [email protected] home care and the current solutions, including technologies

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that exist that can help older people retain their independence trust of technology because it may isolate the user further or
and delay admissions. By discussing these problems and the they will not be able to get rid of it. Any new technologies
current assistance that older people receive this review will should address these concerns. One way to do this may be
discuss where current robotic technologies fit into older peo- to identify and resolve these fears by providing access to the
ple’s lives and what direction developments need to head technologies and showing case studies where the technology
towards in the future to ensure that they can offer adequate has been successfully employed.
services and will be acceptable to older users. Developers of robotic technologies must consider not only
the role of the robot but whether an older person will accept
it and use it as they should [15]. Robots may need to be
2 Overview of Healthcare Robots specifically tailored to people who may be sceptical of robot
use or reluctant to use them because of the great jump in
A healthcare robot is a robot with the aim of promoting or technology the robot represents [16]. To do this older people
monitoring health, assisting with tasks that are difficult to need to be included in the development of robots. It has been
perform due to health problems or preventing further health reported that the concerns and needs of older people are not
decline. Health in this sense encompasses not just physical identified in the design process and more research needs to
but mental, emotional and psychosocial problems. Health- be conducted looking at an older person as a user of health-
care robots can have many different functions and can be care robots [17]. Acceptability of the robot is linked to its
categorised as either rehabilitation robots or social robots. functions. If older people view the robot as useful they are
Rehabilitation robots are physically assistive devices that are more likely to rate it as more acceptable [18]. Exploratory
not primarily communicative or perceived as social entities. research has been conducted with older people to maximise
Their job is to perform a physical task or make a task easier usability and gain an idea of what a robot should be capable
for the user. In contrast a social robot is an easily understood of doing for older people. In one study older people indi-
and likable interface for older people to interact with and/or cated that they would like a robot for detecting falls, control-
acts as a companion. Social robots can also help a person ling appliances, cleaning, medication alerts, making calls and
perform a task to improve day-to-day life. Social robots can monitoring location [19]. Most of these tasks point towards
further be categorised into service type robots or companion- maintaining independence and dignity. The loss of indepen-
ship robots. Service type robots are assistive devices and are dence often means residential care, which to an older person
designed to support people living independently by assisting means they are no longer able to care for themselves and
with mobility, completing household tasks, and monitoring their lives will be controlled with little privacy. However, it
health and safety [13]. The robot is classed as social because also may be degrading to an older person to insist they use
the user can interact with it and the robot can determine from a toy-like gadget to help them maintain their independence.
the user’s input how it can assist. Companion robots do not The robot’s appearance influences how people appraise the
assist the user in performing any task but aim to improve qual- abilities of the robot and it can also have profound effects on
ity of life by acting as a companion. Some robots provide both its accessibility, desirability and expressiveness.
companionship and assistance. Robots can potentially help Older people recognize the potential usefulness of a robot
people remain independent by addressing functional, psy- in the home, but are wary about privacy issues and the way
chological and medical monitoring needs in a similar way the robot would operate in the home environment [20]. Most
to existing assistive technologies. Many of these robots will older people would prefer a robot that was not able to wan-
be discussed in terms of how they help address the problems der inside the house and think it should be designed to per-
older people encounter and possible solutions as well as the form specific tasks. Robots are appreciated for their ability to
advantages and disadvantages of the robotic technology. offer improved communication between patients and health-
care professionals, and because they could offer support to
caregivers [21]. Lastly, the social aspect of the robot (i.e. the
3 Barriers to Implementation and Potential Solutions way it communicates) has been reported to be helpful in pro-
moting acceptance of the robot. Research has shown the way
One of the challenges with implementing and designing the robot interacts with the person indicates whether they are
healthcare robots is acceptance. There are many challenges encouraged to further engage with the robot [22]. Research
with acceptance of new technologies and theoretical mod- has shown more socially intelligent robots are better received
els have been developed to determine how factors such as [23,24]. Future research needs to focus on improving the
perceived usefulness, enjoyment, trust and perceived ease of aesthetic design, programming and functions of robots to
use predict intention to use [14]. Other hurdles include the suit this problem. It is very important that the needs of older
complexity of the technology, problem solving when faced people are identified so that robotic technology can be suc-
with a challenge, low self-efficacy in competence to use, mis- cessfully used for healthcare in the future. The rest of this

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review will identify the problems that older people face in the do not result in a fracture, fractures from falls are a significant
community and the technical solutions, including the success source of morbidity and mortality [43]. Even if a fall does
and applicability of healthcare robots. This review will iden- not result in major injury fear of falling can affect quality of
tify gaps in the current solutions and critique current tech- life. Older people who fear falling have reduced confidence,
nology to work towards increased acceptance. To provide limited social activity and more impairment when performing
an overview Table 1 shows robots that are currently being daily activities. Interventions incorporating problem solving,
developed or trialled. Table 2 shows the problems that older role playing, exercise training and changing self-efficacy to
people face and the technological solutions to these problems reduce fear of falling have been found to have positive health
including how robotic technologies meet these needs. benefits [44–46].

4.1.2 Technological Solutions for Older People with

4 Problems that Older People Face in the Community Functional and Physical Decline
and Solutions
At present older people have a number of assistive technolo-
4.1 Physical and Functional Decline gies available to them to help retain independence other than
home help. As the population ages the use of such devices
4.1.1 Contribution to Nursing Home Admission may help reduce the pressure on healthcare services. Such
devices range from simple things to correct physical decline
Physical and functional decline is often a reason why older (glasses, hearing aids), devices that make life better or eas-
people cannot remain independent [25]. Physical decline can ier despite impairment (magnification aids, talking books),
reduce mobility, increase the risk of falls and reduce the abil- devices that assist with mobility (wheelchairs, walking sticks,
ity to perform general tasks around the home. Basic daily mobility scooters) and devices that make daily activities safer
tasks can be divided into two groups: activities of daily liv- and/or easier to perform (bath rails, non slip mats, mechanical
ing (ADLs) that include tasks such as eating, dressing, toi- toilet seats). Finally, a computer with internet capabilities or
leting, walking, and bathing, and instrumental activities of telephones may mean an older person can pay bills or order
daily living (IADLs), which are tasks beyond daily activities items online to be delivered when it becomes difficult to leave
but still need to be accomplished for a person to live indepen- the home.
dently (i.e. managing the home and finances, shopping, and To monitor health and in case of a fall many older people
transportation) [26]. Loss of mobility due to physical decline wear alert bracelets where they can push a button to call for
makes a large contribution to assistance requirements and is emergency help. A mobile phone may also give an older per-
predictive of nursing home admission [27]. son a sense of independence and/or security when they go out,
Usually this kind of assistance is provided from a paid positively impacting autonomy and independence [47,48].
source and/or from friends and family. Research has found More advanced technologies, such as smart homes can offer
that older people who receive help and support from family safety monitoring as well as home monitoring for people
have a lower risk of entering a nursing home [28,29] and who have physical and some cognitive impairment. Smart
that those who receive home visits as part of an elder care home technology has been developed to help older people
programme are less likely to be admitted to formal care [30– function independently and to ensure their safety when alone
32]. When older people are unable to perform daily tasks and [49]. Smart home technology includes a number of features
are not receiving home care, chances of nursing home admis- such as motion-sensing devices for automatic lighting con-
sion increase [33]. For older people loss of independence and trol, motorized locks, door and window openers, motorized
mobility can be difficult to cope with and contribute to poor blinds and curtains, smoke and gas detectors, and tempera-
quality of life [34]. Receiving home help instead of enter- ture control devices [50]. At present a number of smart home
ing formal care is a positive alternative; however it needs to initiatives are being developed and trialled. For example, the
be ensured that the needs of the older person are actually SmartBo project, [51] is a demonstration apartment operated
being met. Unfortunately, research has found that even when by the Swedish Handicap Institute focused on furthering the
assistance is being provided it is often not adequate [35].This development of these technologies. The PROSAFE project
means that an older person may be more likely to develop [52] is another body of research aiming to develop a system
depression [36] and be institutionalized [37–39]. using infrared motion sensors to recognize what a person is
Associated with physical decline and decreased mobility doing to accommodate patients with Alzheimer’s disease.
is increased risk of falls. Falling or fear of falling is a large The Aware Home Research Initiative (AHRI) at Georgia
predictor of nursing home admission [40,41]. About a third of Institute of Technology is working towards enhancing the
older people over 65 years, living independently in the com- quality of life of older people in their own homes and help-
munity, fall each year [42]. Even though the majority of falls ing them maintain independence [53]. Other projects such

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Table 1 Capabilities of robots designed for, tested or applicable to older people

Robot name Country Physical description Functional capabilities

Assistance type
MOVAID Italy Machine-like, no head/face, approx. 2 Heating/delivering, food, changing bed linen,
meters tall kitchen bench cleaning.
AILISA France Machine-like, no head/face, approx. 1 Mobility aid, physiological monitoring, falls
metre monitoring
Ri-man Japan Human-like, head with static face, approx. Lift and carry people, small detection
1.5 metres.
Care-O-bot Germany Human-like, head with static face, approx. Walking and navigation aid, fetch and carry task
1.5 metres tall. objects, controls security and home environment,
monitor health and persons safety, cleaning tasks
(putting items away, setting table, watering plants,
sorting laundry), heating food, telepresence
system, medication reminder
Guido Ireland Machine-like, no head/face, approx 1 Walking and navigation aid
metre.
HRIB Japan Machine-like, no head/face, approx 1 Clam shell like robot which with bath people sitting
metre. inside
Monitoring
Hector Europe Machine-like with a touch screen interface Record daily routines, control home environment,
with a static face, approx. 1.5 meters tall cognitive training, medication reminder, review
daily agenda, fall detection capabilities and
emergency help assessment
Pearl USA Human-like, head capable of facial Reminders for daily activities, guiding around rest
expressions, approx. 1 metre home, appointment reminders, telepresence
system, health monitoring, open/close refrigerator.
Wakamaru Japan Human-like, head capable of facial Security, managing schedules, information service,
expressions, approx. 1 metre. face recognition, conversation, medication
reminder, reporting unusual situations
Hopis Japan Dog-like, fluffy, head has static face, Measuring blood pressure, blood sugar and
approx. 0.3 metres. temperature
Cafero New Zealand Machine-like, no face, approx. 1 metre. Monitor and record vital signs, telepresence system,
cognitive training, entertainment and reminiscence,
activities schedule
IRobiQ Korea Human-like, with a static face, approx. 0.3 Medication reminder, cognitive training,
metres entertainment, telepresence communication, vital
signs monitoring
Ifbot Japan Human-like, with a static face, approx. 0.3 Entertainment, cognitive training, health monitoring
metres
Teddy Japan Bear-like robot, capable of facial Monitor health and speech, medication reminder,
expressions, approx. 0.4 metres record daily routine
Robobear Japan Bear-like robot, capable of facial Monitor health, speech and medication, telepresence
expressions, approx. 0.4 metres system, entertainment
Companionship
Paro Japan Seal-like, fluffy, capable of facial Companionship
expressions, approx. 0.25 metres
AIBO Japan Dog-like, hard surface, capable of facial Companionship, entertainment
expressions, approx. 0.25 metres
NeCoRo Japan Cat-like, fluffy, head capable of facial Companionship
expressions, approx. 0.25 metres
Tama Japan Cat-like, fluffy, head capable of facial Companionship, appointment reminder,
expressions, approx. 0.25 metres entertainment, health monitoring
Wandakun Japan Koala-like robot, fluffy, capable of facial Companionship, entertainment
expressions, approx. 0.3 metres

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Table 1 continued
Robot name Country Physical description Functional capabilities

Huggable USA Bear-like robot, capable of facial Companionship, able to send and receive hugs
expressions, approx. 0.4 metres
Homie USA Dog-like, fluffy, head has static face, Companionship
approx. 0.3 metres.
Icat The Netherlands Cat-like, hard surface, Companionship
capable of facial
expressions, 0.38 metres.

Table 2 Helping older people

Issue to be addressed Current interventions/ technologies Robots with functions to address
remain independent with
developed to meet needs needs
assistive devices, technologies
and robots Functional decline
Mobility Wheelchairs Walkers Canes and Robotic wheelchairs [57] Guido
walking sticks Transportation [58]
services and taxis Mobility
Scooters
AILISA [60] Ri-man [153]
Care-O-bot [61] Pearl [62]
Bathing Home care services. Walk in HRIB (Robotic bathtub; [63]
shower Installation of support
rails Non-slip bath mats
Toileting Home care services Mechanical a

toilet seat [56]

Meal preparation Home care services (e.g. meals on MOVAID [154] Care-O-bot[61]
wheels)
Housework Home care services Roomba (Robot vacuum cleaner)
[57] MOVAID -changing beds
and cleaning kitchen [154] Pearl
[62]
Shopping Home care services Online a

shopping
Physical decline
prevention and
therapy
Addressing sensory Hearing aids Spectacles and a

decline contact lenses Talking books

Magnification aids
Frailty and falling Physical therapy to help prevent AILISA-Falls monitoring [60]
falls [42] Intervention to prevent Hector [107]
fear of falling [44] Falls
monitoring
Monitoring Medic alert bracelets Smart homes AILISA [57] Care-O-bot [61]
security and safety [49] Hector [107] Wakamaru [110]
Prevention Group exercise programmes Stroke rehablitation and exercise
Physical Therapy robot [64]
Cognitive decline
prevention
Group cognitive intervention Hector [107] Cafero[82] IRobiQ
programmes [74,75] Computer [84] Ifbot [56]
cognitive training [79] Video
conferencing intervention [81]

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Table 2 continued
Issue to be addressed Current interventions/ technologies Robots with functions to address
developed to meet needs needs

Health management
Medication Simplifying medication dosage Care-O-bot [61] Hector [107]
management regimes [97] Education Personal Wakamaru[110] IRobiQ [84]
Digital Assistants and memory Teddy [111]
devices [99]
Robobear [108]
Managing illness Internet websites [78] Care-O-bot [61] Hector [107] Pearl
and monitoring Teleconferencing [101] [62] Hopis [56] Cafero [82]
health Telemonitoring [102] IRobiQ [84] Ifbot [56] Teddy
[111]
Robobear [109] Tama [156]
Psychosocial needs
Companionship Pets Family and friends visits Wakamaru [110] Paro [140] AIBO
[141]
NeCoRo [155]
Tama [156]
Wandakun [156]
Huggable [157]
Homie [158]
ICat [159]
Social Organised social activities and IRobiQ [84] Care-O-bot
communication/ clubs Video calling [138] -telepresence [61]
isolation
Telephone Email Hector telepresence [107]
Pearl-telepresence [62]
Cafero-telepresence [82]
IRobiQ-telepresence [84]
Robobear-telepresence [101]
Huggable-send and receive hugs
[157]
Illness information Internet websites [78] a

for older people

and carers
Information about Internet websites [78] a

health care
services
Support groups for Internet websites [78] a

a No papers published on robots older people and

carers
that meet this need

as COACH [54] aim to help people with dementia remain their caregivers, they may be too complex for older users. In
in their own home. COACH is being developed to help peo- addition, people may be reticent to call for help and reluctant
ple perform simple tasks such as hand-washing using artifi- to wear alert bracelet due to stigma [55].
cial technology and cameras to give prompts. Smart phone
applications designed to monitor movement also exist to help 4.1.3 Robotic Technologies to Assist with Functional
keep track of people. For example, iWander is an applica- and Physical Decline
tion designed to track people with dementia and reduce the
amount of stress on caregivers while still giving the person Robotic technologies have largely focused on how a health-
with dementia functional independence [48]. care robot can assist performing day to day tasks for older
One potential problem with these technologies is that people to ensure that they can remain in their own homes.
although they provide peace of mind for an older person and These range from robotic spoons, kettles [56], lawn mowers

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and vacuum cleaners [57], which have varying degrees of ods, smart home methods and fall recognition as well as the
usefulness and necessity, to robots that can help with clean- services that one can access on the internet such as banking
ing, heating food and sorting laundry. Mobility assistance is and shopping. This could be of great advantage to an older
one area that robotics has focused on, Including smart wheel- person especially if the robot is acceptable, simple to use and
chairs, artificial limbs and exoskeletons [58]. Additionally, viewed as useful. It is important that the robot is designed
robots that can help lift and carry people and robotic walk- to address any sensory deficits by having a large screen, text
ers are being developed. For example researchers in Dublin and buttons and a loud clear voice.
have been developing a personal mobility aid that functions Aside from developing robots to help people with their
as a smart walker [59]. The latest prototype, Guido, was current needs, a focus of robotic technologies should be pre-
released in 2004. Guido can assist frail and visually impaired vention of decline and maintenance of health. For example,
individuals by navigating them through the environment and physical exercise interventions that target strength, balance,
informing them of nearby objects. Other robots in develop- flexibility, or endurance are successful at reducing falls and
ment include ALISA [60], Care-O-Bot [61] and Pearl [62], risk of falling as well as reducing functional decline. Such
which can also do other tasks. ALISA is able to monitor phys- interventions have been administered in group settings or
iological symptoms and falls, Care-O-Bot is able to control at home [42,44]. In the future robotic technologies could
home security and the home environment, monitor health, assist in administering interventions to people in an innov-
communicate with healthcare providers and family as well ative way, particularly if older people can develop a close
as doing general tasks such as fetching objects, and using a rapport with the robot. Robots may offer more intensive or
microwave. Lastly, Pearl is able to monitor health, provide accessible rehabilitation options in the home. Robots can help
appointment reminders and has telecommunication capabil- encourage older people who have suffered a stroke to perform
ities. rehabilitation exercises [64]. With multifunction robots in
Other robots are able to help older people with basic daily development, especially those with telepresence capabilities
activities such as bathing. A robot called Harmony in Roll-lo or that can have specific interventions programmed onto their
Bathing [63] (HIRB) has been designed to assist older peo- software, there are many possibilities for interventions to be
ple to bathe. The person sits in the robot, and is enclosed administered to people in their own homes and for older peo-
in a chamber with their head and shoulders left exposed. ple to practise movement and exercise. For example, interac-
The robot then bathes the person by releasing water and soap tive video games focusing on fitness are already being used on
within the chamber. The robot has been trialled in Japan with gaming consoles but could have large implications for health
positive feedback. Residents felt that the robot protected their if administered by a robot with a social entity that aims to care
privacy and dignity while staff reported that it was an eas- for an older person. Research has found that an advantage of
ier, less time consuming method of bathing residents [63]. robotic technologies over other technologies is that people
Although used in an institutional setting HIRB may also be are more motivated to follow instructions. One study found
appropriate for older people living at home receiving care as that people were more likely to perform relaxation exercises
bathing is a particularly difficult task for older people. This if the instructions were administered by a robot in compari-
technology is yet to be trialled with older people in the com- son to a computer tablet [65]. Other research has found that
munity. Despite this it could have advantages in replacing a a robot is a better motivator for people on a weight loss pro-
shower in the home and may reduce the risk of falls and slips gramme and people form a close therapeutic alliance with the
in the bathroom. robot compared to a computer [66]. Research has found that
people develop stronger affinities to robots and interact with
4.1.4 Critique of Robotic Solutions them in a similar style to the way they would interact with
people, resulting in greater usage and greater compliance
The robotic technologies available are a good starting point [67]. Robots therefore offer a good way of administering
for future work. These robots do address many of the phys- health interventions and health maintence for older people
iological and functional needs of older people (helping with but currently do not do this.
daily chores, daily living activities, mobility and safety). At present very little research has been published showing
Multifunctional robots that can perform a variety of tasks the benefits of current healthcare robots in an older person’s
relating to daily needs therefore could be very helpful for home. Most robots have undergone exploratory pilot testing
an older person in the community, provided they perform in nursing homes to see how older people engage with the
adequately. These robots also provide a form of security and robot. When robots are shifted to a person’s home more fac-
communication should help be needed. However, there are tors have to be taken into account. It may not be feasible
areas where healthcare robots could be further developed. to install a large robot with a variety of functions into an
Robots designed to help with functional and physical activi- older person’s home. Not only is cost an issue but also size
ties can combine technologies such as communication meth- and maintenance. There will not be other people around to

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operate or encourage people to use the robot in a private set- 4.2.2 Technological Solutions for Older People
ting. Robotic technologies need to show that they can offer with Cognitive Decline and Caregivers
improvements to daily life compared the person’s current
situation. If the robot poses problems (e.g. technical issues, A lot of information is available to caregivers and older peo-
takes up too much space) then the problems need to be fixed ple on the internet. Lauriks et al. [78] reviewed the needs of
to ensure acceptance. people with dementia and their carers and found that the inter-
net can provide valuable information on diagnosis, condition,
available support services and care options. They identified
a number of useful websites and support groups which help
4.2 Cognitive Decline meet the needs of this population.
Other technologies that have been developed to help stim-
4.2.1 Contribution to Nursing Home Admission ulate people with cognitive decline and prevent further dete-
rioration use interactive software. For example, Astell et al.
Aside from physical decline, cognitive decline and the pro- [79] developed an interactive, multimedia touch screen sys-
gression of dementia is another reason why older people enter tem designed to prompt reminiscing for people with dementia
residential care [68]. According to recent research the preva- and their carers. The authors found that people with demen-
lence of dementia including Alzheimer ’s disease will only tia can use the touch screen system to reminisce, making
increase as the aging population continues to grow [69]. Not interactions with caregivers more enjoyable and easier. Other
only are illnesses such as dementia distressing for older peo- interventions such as ‘Musical Memory Lane’ and the ‘Video
ple, they are likely to contribute to functional disability [70]. Memory Lane’ presented nostalgic music and videos to peo-
The consequences of mild to serious cognitive impairment ple with Alzheimer’s disease. The use of these technologies
are that older people may have trouble with memory and has been observed to have a positive impact on engage-
orientation, creating concern for the individual’s safety and ment, mood and talking and reduce fidgeting [53]. Other
ability to look after themselves. This means that older peo- programmes trialled with older people have found that a cog-
ple with cognitive impairment become reliant on informal nitive intervention administered on a computer resulted in
caregivers (friends and family) in the community [71]. This long term improvements in fluid intelligence and is a suit-
dependence on others may lead to caregiver burden, psycho- able way of helping prevent and treat cognitive deficits [80].
logical issues, physical health problems and increased stress Of interest is the use of technology to administer cognitive
for the caregiver and the family because the older person interventions to people in their own home. Poon et al. [81]
requires a great amount of surveillance [72]. In many cases, conducted a study of increasing cognitive skills in older peo-
the older person has to be admitted to an elder care facility ple via videoconferencing or in a group setting. They found
as their needs cannot be properly addressed in the commu- that both groups had similar cognitive improvements indi-
nity [73]. Technologies in this case should not only focus on cating that videoconferencing was a feasible, effective way
helping a person with cognitive decline maintain their inde- of assessing and improving cognitive skills.
pendence but also preventing further decline and supporting
caregivers of those with cognitive impairments. 4.2.3 Robotic Technologies to Assist with Cognitive Decline
Currently research has found that intellectual stimulation
can have protective effects against dementia [74]. Research Some robots have been developed with software to help stim-
looking at the benefits of cognitive-based interventions has ulate people with brain training exercises to help with cog-
found older people who took part in cognitive training had nitive decline. Cafero [82] is a robot that offers telecommu-
less functional decline in daily tasks, meaning they can nication and health monitoring as well as cognitive training.
remain independent in their own home for longer [75]. This robot has been trialled in nursing homes and dementia
For example, Ball et al. [76] conducted research looking at units [83]. The cognitive stimulation from the games (tai-
the relationship between cognitive training for older people lored separately for dementia and cognitively able patients),
and the effects on independent functioning. They assigned as well as reminiscence material and music on the robot
older people to either ten group training sessions for mem- were aspects that staff and residents thought were beneficial.
ory, reasoning, speed of processing or a no-contact control For the dementia patients it was a way of keeping patients
group. They found that those assigned to intervention groups engaged and stimulated, potentially leading to less disrup-
demonstrated better cognitive functioning than the control tive behaviour, better quality of life and less job stress for
group over a period of two years. Interventions that aim to carers . Other robots such as IRobiQ [84] and Ifbot [56] offer
improve or maintain cognitive functioning may have better cognitive games as well as other services. For older people
chances of delaying nursing home admission especially for without dementia the expected benefits would be similar to
those who show signs of cognitive impairment [77]. other cognitive training programmes. It could be an advan-

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tage to have such software programmed onto the robot so that need to take the medication. Poor medication management
the robot can remind and encourage the user to use the cog- is a problem because it can lead to poor control of chronic
nitive training exercises as well as measure physical health conditions such as hypertension [92,93], heart failure [94]
as part of a holistic health approach. and cholesterol management [95]. This consequently may
result in complications and unplanned admission to hospi-
4.2.4 Critique of Needs and Solutions tal [96]. Overall, interventions that simplify medicine dosing
regimens and are educational can be effective in improving
Little research has been published on robots to assist with adherence to medication in older people [97,98].
cognitive problems in the community. It would be interesting
to note whether a robot would be used for cognitive training 5.1 Technological Solutions for Older People to Manage
or whether it would be passed off as another gadget and rarely Health and Medication
used. Research has found that the personality of the robot can
make a difference to whether people take the robot seriously. A device as simple as a personal digital assistant (PDA),
One study compared a robot that playful to a robot that was [99,100] if properly set up, can serve as a reminder to
serious and asked participants from the general community take medication. However if an older person does not want
to perform an exercise routine. Although people rated the to take their medication then the reminder can easily be
playful robot more positively, they followed the instructions ignored. Technologies should go beyond a reminder system
of the serious robot for longer [85]. Hence older people may but address the reasons why one may not want to take med-
be less willing to interact with a robot if they do not feel ication. Additionally it is important for health providers to
it is a serious device but more like a toy. This may explain know whether a patient is taking a medication and/or possi-
the lack of positive results for robots such as Ifbot [56] and ble side effects so that they can intervene if health problems
Hopis [56]. Another possibility is to include games other arise.
than cognitive programmes. For example, a robot that can To successfully monitor health older people need to reg-
provide other forms of stimulation such as card games, music, ularly consult with their doctor to monitor health informa-
talking books and videos also may help stimulate cognitive tion (e.g. blood pressure, pulse, chronic wounds, etc.). Tech-
awareness in other ways than just brain training. A robot nology is also able to help older people communicate with
that can offer a greater variety of functions may be better health professionals and monitor their health. Video confer-
accepted and could act as a substitute for other technologies encing offers a cost effective means of providing better med-
(e.g. it could act as a radio, television or computer game). In ical care for those with chronic illnesses who need to mon-
the previously cited study [83], music and video were used to itor their condition and consult with physicians [101]. This
stimulate and entertain dementia patients and could be good technology allows patients to sit in the comfort of their own
for older people living in the community. homes while health-care providers conduct routine and com-
prehensive medical monitoring procedures in their offices.
The information from the appointment can be used to monitor
5 Management of Medical Regimes and Health patient adherence to medication, vital signs (e.g. blood glu-
cose levels, oxygen saturation, and pulmonary function tests)
Older people often suffer from a number of chronic illnesses and get an overall picture of the patient’s health. Trials con-
which many can manage successfully themselves in their own ducted with this technology have found improvements with
homes. However many older people need to make sure their medication monitoring and blood pressure control [102].
health and treatments are properly monitored. For example, Online health sources or applications such as “MyChart”
older people who take multiple medications are increasingly and “MyHealth” can also help monitor medication and ensure
likely to have trouble managing their regimes [86]. It has been that doctors have accurate information about their patients.
estimated that rates of adherence in older people range from MyChart allows patients to communicate with their doc-
26 to 59 % [87] but may be as low as 0 % [88]. Older people tor and access necessary records [103]. MyHealth enables
are often intentionally or non-intentionally non-adherent for patients to view customized health information, obtain lab
a number of different reasons. The reasons result from fear test results and renew prescriptions online. Similarly mobile
of addiction to pain relief [89], embarrassing and unpleasant phones have a number of applications relating to healthcare
side effects [90] or insufficient knowledge about the effects and can be used to monitor health and manage chronic disease
of continually altering medication regimes [91]. Older peo- [104]. As of 2010, there were over 7,000 healthcare related
ple may non-intentionally miss or alter medications because apps available at the Apple App Store for patients [105].
of the complexity of the regime, forgetfulness, stress, anxi- Healthcare apps have been shown to improve patients’ adher-
ety. Older people may intentionally miss medication because ence to treatment and assist patients in the management of
they do not feel any negative symptoms and do not feel a disabilities and chronic conditions such as diabetes [106]. For

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example, eCAALYX (Enhanced Complete Ambient Assisted ties and interact with a robot by talking to it and giving
Living Experiment) is an application developed for older peo- instructions. Robotic technologies could incorporate pro-
ple with multiple chronic conditions. The eCAALYX smart- grammes to monitor health that were developed for other
phone app receives input from a BAN (a patient-wearable platforms. Again robotic devices could be useful to promote
smart garment with wireless health sensors) and the global health monitoring and health behaviour, such as diet and
positioning system (GPS) location sensor in the smartphone. exercise because of the additional motivation a robot may
It is able to inform the individual’s healthcare provider over have over other technologies. A robot could be programmed
the Internet about the condition of their patient [47]. to not only remind people to take medications but address
worries about side effects and changes to dosage as well
5.2 Robotic Technologies to Assist Health Monitoring as send information to a health practitioner. Some robots
and Medication Management do have these capabilities (i.e. iRobiQ [84], Hector [107],
Cafero [82] Wakamaru [110]) but because there have been
Health monitoring is a common feature of many health- very few studies published it is difficult to know whether the
care robots. Already robots have been designed to measure robots are having a positive impact on adherence and health
vital signs and send the information to the doctor. Most of monitoring.
these robots also have telecommunication capabilities, which
means that consultations over a video phone can be provided.
In this way robots can combine existing technologies into one 6 Psychosocial Issues
easy and simple interface. Robots such as Cafero [82], Hec-
tor [107] and Pearl [62], are robots that can monitor health 6.1 Contribution to Nursing Home Admission
as well as other services, while some robots such as Hopis
have been specifically designed just to monitor vital signs. Physical health, medical care and assistance with daily activ-
Hopis [56] was able to measure blood sugar, temperature and ities should not be the only priorities for older people liv-
blood pressure however this robot is no longer in production ing in the community. Older people living in the commu-
due to poor sales and low usage. It seems that the problem nity with health issues often have problems retaining strong
with this robot was the fluffy, animal like appearance despite social contacts and maintaining social networks, leading to
the seriousness of the tasks it performed. Although designers loneliness. Social engagement means having the ability to
want robots to be likeable and approachable, older people do maintain many social connections and participate in social
not want to interact with a toy. Other robots such as Ifbot [56] activities. Lack of social networks and isolation is just as
(a toy-like robot that offers cognitive training, entertainment great a risk factor for nursing home admission as functional
and health monitoring) is not in production due to poor sales, status and mental status [28]. Older people who participate
again showing the importance of a non-toy appearance. With in social activities of some kind are less likely to enter nurs-
Ifbot initial testing found that elderly slowly warmed to the ing homes and have decreased mortality levels compared to
robot but after five weeks grew bored with the robot [108]. those who live alone [112]. For older people living in the
Currently robots that perform similar tasks are being used in community loneliness has been linked to higher blood pres-
research trials. Smaller robots such as Robobear [109], Waka- sure, poor sleep, worse cognition over time [27,113,114],
maru [110] and Teddy [111] have so far had good reactions higher prevalence of dementia [115,116] and is an indepen-
from older people even though they are still in the exploratory dent risk factor for depression [117,118]. For some older
phase of research. These robots are able to monitor health and people, having regular social events or even owning a pet
give medication reminders as well as act as a companion. can help reduce loneliness. As older people who live alone
Wakamaru can send a signal to a health provider if it reports may not be able to have people around them all the time,
anything unusual and Robobear is also programmed to play having a pet around may mean that they never feel alone.
games and has telepresence capabilities. It will be interest- Health benefits of owning a pet include reduced mortality
ing to see if these robots are better accepted than Hopis and after cardiac surgery [119], better physical health [120,121]
Ifbot. and well as less emotional distress after bereavement [122]
and reductions in loneliness and depression [123].
5.3 Critique of Needs and Solutions Depression from loneliness, and age related depression
can have a large impact on psychosocial functioning, limiting
Applications available on mobile phones and other simi- the amount people want to engage with others, which has an
lar technologies generally only serve as reminders rather effect on overall physical and mental health [124,125]. It is
than a motivator for health improvement or monitoring. important to address the self-sustaining cycle, in which age-
Robotic technologies may have an advantage over such sys- related depression leads to isolation, which in turn creates
tems because of the way people regard them as social enti- further depression. It is estimated that only 1–2 % of older

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people living independently suffer from major depression but discuss with a human [135]. Furthermore they may prefer to
that at least 10 % experience some symptoms of depression use the robot because they may feel like they are wasting the
associated with physical illness, life changes, or other sources doctor’s time with their problems [136].
of life stress that can easily be treated [126]. Furthermore Technologies that older people do feel competent using
older people who report that they have felt depressed or sad could have positive clinical implications for connecting peo-
over the previous twelve months are at higher risk of nursing ple and providing information. Lekeu et al. [137] demon-
home admission even after other variables were controlled strated that older people with mild dementia are able to
for [127]. This is because depression may enhance disease learn how to use a mobile phone if given access to the right
changes that increase frailty or may lead to poor diet, less technology. Telecommunication or video calling also offer
exercise and increased alcohol use [128,129]. Interventions opportunities for increased contact with family and friends.
that have included psychological and medical components Telecommunication in nursing homes has been found to pro-
have a positive impact of levels of depression [130–132] in mote social contact with family and may be more beneficial
older people in the community. because each party can see one another [138]. Savenstedt
Older people may be at risk from a number of psychoso- et al. [139] showed that a videophone helped reduce family
cial problems. Addressing psychosocial needs may not be as member guilt and increased the amount of contact they had
easy as expanding social communications for older people. with their loved one in a nursing home when regular face-to
Many older people are reluctant to talk about issues that are face visits were not possible [79].
affecting them. Most older people expect their heath to dete-
riorate with time, and as a consequence, they may feel their 6.3 Robotic Technologies for Psychosocial Problems
problems are not worth complaining about. Often older peo-
ple think that depressive symptoms come under the umbrella Future development of healthcare robots should take into
of aging and again do not seek support despite experienc- account, not just older peoples’ functional and healthcare
ing psychological stress. Older people may not acknowledge needs but also connection to the community and the pro-
loneliness or functional deterioration due to stoicism, pride vision of support and information. Some robots exist with
and/or perceived stigma [133]. Older people are less likely to telecommunication abilities so they can be used not just to
bring up problems such as incontinence, poor eyesight, and contact health practitioners but also to contact friends and
failing memory because of embarrassment. Additionally, the family.
person may be unaware of where to seek help or what treat- The presence of the robot as a social entity may help reduce
ment or assistance is available. loneliness. Some robots have been specifically developed to
act as a companion. Companion robots are designed to func-
6.2 Technological Solutions for Older People tion as a pet that older people can interact with and look
for Psychosocial Problems after. They offer users all the benefits of owning a pet in cir-
cumstances where an actual animal may be inappropriate.
Technologies can offer a number of ways to help older people Results from studies using Paro [140] (a fluffy seal robot)
and promote psychological well-being. Firstly technology and AIBO [141] (a dog-like robot) have found that loneli-
has expanded in such a way that there are multiple ways in ness and depression decreases in older people after inter-
which we can communicate with one another. Technologies acting with the robot in nursing home settings [142–145].
to promote social connectedness should be adapted specif- Paro has been available commercially since 2005 and over
ically for older people who may be at a high risk of social 1000 have been sold, with 60–70 % of the robots being used
isolation. Although the telephone, internet and email help by individuals [146]. Shibata et al. [147] sent questionnaires
ensure older people do not become isolated [134,135] they to a sample of Paro owners finding that major reasons for
are not specifically designed to meet older people’s needs. purchase was because participants could not keep pets, the
Computer networking and such support sites appear to be robot cannot get sick and the robot is easy to take care of,
beneficial [53,79]. Older people may fail to use a computer cute and can be hugged. Many participants reported they had
or a mobile phone because the buttons are too small to read previously owned pets but currently could not keep real pets
or require a high level of dexterity. Furthermore many older (reasons included: too old, feeling sad if their pet died, and
people may feel they lack the proficiency to access websites, not knowing who would care for the pet once they died).
online support groups, email or use mobile phones because Similarly research with AIBO owners and analysis of AIBO
the technology is overwhelming. The full amount of infor- internet forums illustrate how people become attached to the
mation that could be useful to older people concerned about robot like a pet, attributing mental states, lifelike essences
health is therefore are not being accessed. Older people may and social rapport to the robot, and other psychological ben-
be more willing to seek information from a healthcare robot efits of being in the company of a pet [148,149]. Research
about health problems that are potentially embarrassing to shows that these robots are easy to interact with and are suit-

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able for older people to have in their own home. There is very ing formal care. As older people experience more health
little learning required and the technology does not seem to problems and suffer cognitive decline, medical manage-
be overwhelming. ment and health monitoring become major concerns and
people may no longer live by themselves. Lastly, even
6.4 Critique of Needs and Solutions if an older person is coping with age related challenges
they may feel lonely, isolated and depressed. Psychological
Technologies offer a number of ways to ensure that peo- health is another reason why people enter formal admission
ple can communicate with one another. For an older person because it may lead to health problems and poor quality of
who is not able to meet with people face to face this may life.
be very important to ensure they feel socially connected to This review has highlighted that there are many techno-
others. Telecommunication capabilities which are offered on logical solutions to help older people remain independent,
many healthcare robots provide another way of communicat- and robotic technologies now seem to be a part of a possible
ing with people, so long as older people feel confident using future. Robotic technologies need to ensure that all aspects
the robot. of health are addressed and the best possible healthcare is
Although communication is important for older people available to older people. Robotic technologies offer many
other psychological needs also need to be addressed to ensure advantages but also there are many barriers to overcome
that they retain high quality of life while still residing in before they successfully integrated into society. One of the
their own homes. Future healthcare robots could focus on main advantages is that robots can be programmed to per-
developing technologies to help provide support for older form many activities and provide information and support,
people as they face age related challenges. Robots could without being too complicated. Robots also are perceived
be developed to provide information for older people and by people as a social entity meaning that they are in a bet-
their carers about various health conditions, how to man- ter position to administer intervention and motivate people
age them, support groups and what health services are avail- to perform certain behaviours. However, many of the cur-
able. As discussed people may feel more comfortable using rent healthcare robots are designed to fix a problem rather
the robot as a source of information rather than having than prevent decline and promote health. There is no rea-
to bring up potentially embarrassing issues with a health son why a robot cannot become a preventative health tool as
practitioner. well as practical help for current issues. However, currently
Although the field of companion robots is expanding robots have not extensively been trialled in the homes of
rapidly, with a number of prototypes in development, they older people so it is not known how realistically the technol-
have yet to be trialled extensively with older populations. ogy will fit into daily life and whether it will have benefits.
Future research should use randomized control designs, have Future research should trial existing robots in the commu-
larger sample sizes and have a longer duration [150,151]. nity as well as developing robots specifically for people to
Research needs to determine whether older people in the have in their own homes. Future research should consider
community interact with companion robots such as Paro and the needs of older people and what software should be on
AIBO in a similar way to people in formal care facilities. the robot as well as the capabilities of the robot. Many older
These robots may not be suitable for all people depending people have reservations about new technology because a
on their preferences and may have a novelty factor such that robot is associated with futuristic advanced technology that
use declines over time. they may not be able to master. People also fear that robots
will become a difficult to use and may further isolate them.
To reduce these barriers to acceptance, research should show
7 Discussion and Future Directions that robots can successfully be used in the home and provide
a positive example for future users. Robot developers also
This review identified the main needs of older people in need to ensure that they are aware of the problems that older
the community to ensure that they can remain living inde- people face, as outlined in this review, and ensure that a robot
pendently in their own homes. If these needs are not ade- will be useful for older people in their own home. If an older
quately addressed the chances of nursing home admission person does not perceive the robot as useful it is unlikely
rise, placing a greater strain on healthcare services. Results that they will use it [152]. This review has identified that the
of this review showed that older people often require help robot’s aesthetic design and size need to be considered to
performing day to day activities as well as physical activ- enhance acceptability.
ities. As older people age their physical condition declines
meaning that injury and falls are a large concern, particu- Acknowledgments We thank Electronics and Telecommunications
Research Institute (ETRI) and Yujin Robot for their valuable contri-
larly if they live by themselves. Older people may become butions and help with the research. We would also like to thank our
forgetful as they grow older which is also a reason for enter-

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colleagues at University of Auckland on the HealthBots research team of the 2005 IEEE International Workshop on Robots and Human
for their ongoing support. Interactive Communication, Nashville, TN, 365–370
21. Boissy P, Corriveauz H, Michaud F, Labontey D, Royer M (2007)
Conflict of interest No conflict of interest. A qualitative study of in-home robotic telepresence for home
care of community-living elderly subjects. J Telemed Telecare 13:
79–84
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154. Dario P, Guglielmelli E, Laschi C, Teti G (1999) MOVAID: a Bruce MacDonald completed a BE (1st class) and Ph.D in the Electri-
personal robot in everyday life of disabled and elderly people. cal Engineering department of the University of Canterbury. He worked
Technol Disabil 10:77–93 with NZ Electricity and the DSIR in Wellington, NZ, then the Computer
155. Libin AV, Cohen-Mansfield J (2004) Therapeutic robocat for nurs- Science Department of the University of Calgary in Canada. In 1995
ing home residents with dementia: preliminary inquiry. Am J he joined the Department of Electrical and Computer Engineering at
Alzheimer’s Dis Other Demen 19:111–116 the University of Auckland. His long term goal is to design intelligent
156. Taggart W, Turkle S, Kidd CD (2005) An interactive robot in a robotic assistants that improve the quality of peoples’ lives, with primary
nursing home: preliminary remarks. In: Proceedings of Toward research interests in human robot interaction and robot programming
Social Mechanisms of Android Science, Stresa, Italy, pp 56– systems, and applications in areas such as healthcare and agriculture. He
61 is the director of the department’s robotics group, principal investigator
157. Stiehl WD, Lieberman J, Breazeal C, Basel L, Cooper R, for the international robotics team at the University of Auckland, and
Knight H, Lalla L, Maymin A, Purchase S (2006) The hug- leads the multidisciplinary HealthBots robotics group, a collaboration
gable: a therapeutic robotic companion for relational, affective with South Korean partners for robots to help older people. He is the
touch. In: Proceedings of the 3rd IEEE Consumer Communi- leader of Faculty of Engineering research theme Technology for Health.
cations and Networking Conference, Las Vegas: NV. pp 1290–
1291
158. Kriglstein S, Wallner G (2005) HOMIE: an artificial companion
for elderly people. In: Proceedings of The CHI’05: Conference Elizabeth Broadbent received her B.E. (Hons) in Electrical and Elec-
on Human Factors in Computing Systems, Portland, Oregon, pp tronic Engineering from the University of Canterbury, Christchurch,
2094–2098 New Zealand, and her M.Sc. and Ph.D. degrees in health psychology
159. Heerink M, Krose B, Evers V, Wielinga B (2006) The influence from the University of Auckland, New Zealand. Elizabeth is currently
of a robot’s social abilities on acceptance by elderly users. In: a Senior Lecturer in Health Psychology at the Faculty of Medical and
Proceedings of the 15th IEEE international symposium on robot Health Sciences, the University of Auckland. Her research interests
and human interactive communication RO-MAN 06 Hatfield, UK, include human robot interaction, with a particular interest in compan-
pp 521–526 ion robots, emotional reactions to robots and perceptions of robots.

Hayley Robinson received her B.A. (Hons) in Psychology from the

University of Canterbury, Christchurch, New Zealand, and her M.Sc.
degree in health psychology from the University of Auckland, New
Zealand. Hayley is currently working on her PhD in Health Psychology
at the University of Auckland. Her research interests are psycholog-
ical benefits with companion robots and interactions with robots that
have the potential to improve both physical and mental health for older
people.

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