I, Caregiver: Do Robots Have a Place in Elder Care?

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According to the Alzheimer's Association, more than five million Americans are living with Alzheimer's disease. In the absence of any medical breakthroughs to prevent, slow or stop the disease, that number is predicted to rise to 13 million by 2025.

The last two generations have produced far fewer children than our grandparents' generation. This translates into a lack of people who can provide care for our ever-growing aging population. Additionally, as people live longer they often need more care for a longer period of time than in the past. This includes nearly all elders; not just those with Alzheimer's.

To ease this crunch, companies are experimenting with robots that can be programmed to complete a number of household and caregiving tasks, as well as call 9-1-1 in an emergency.

Robotic pets: furry and functional

The Front Porch Center for Innovation and Wellbeing, where researchers identify and test new elder care technologies, has conducted a significant amount of analysis of animal-based therapy for aging adults.

"We tested two PARO robot pets for a pilot project at the Sunny View Care Center and Memory Care Unit in the San Francisco Bay Area," says Davis Park, director of the Front Porch Center. "The purpose of the pilot is to gauge resident reaction when interacting with the life-like robot."

The pilot ended last month and the initial findings suggest that engaging with the pet robot reduced pacing and anxiety, and helped calm older residents. "The robots were even used in place of psychotropic drugs," Parks said. "The average amount of time people spent with the robots was up to 25 minutes, which is usually enough time for people to pay attention to it and become socially engaged, whether they're talking to PARO or engaging with people around them."

More robotic pets are becoming available. Polly the Talking Parrot has received rave reviews from several family caregivers on Alzheimer's sites. Polly repeats in a high-pitched parrot voice whatever she hears—twice—mimicking the actions of a real parrot. While repeating, Polly moves her beak and flaps her wings. Her head turns and she shifts from side-to-side with her legs. The people I've heard from have said the life-like Polly was well worth the investment.

Should robots replace real caregivers?

The medical community may accept robotic pets without worry; and I would agree. But the idea of robotic care represents a slippery slope.

Susan (Claffey) Madlung, gerontologist and Clinical Educator for Regional Programs and Home Health Re-Design at Vancouver Coastal Health was surprised to be asked about robots, though she said she shouldn't be, "given these times of advanced technology and limited resources (human as well as financial)." Madlung continued:

"Social isolation of seniors is a significant concern amongst gerontologists and caregivers alike. Robot care, in my mind, would only compound that issue. It will be a long time and the aging of several generations before seniors would feel comfortable and competent with this type of approach to care. Although robots might seem like a good response to the growing need for caregivers, I could see this as being quite detrimental to the emotional and psychosocial well being of anyone, not just seniors. Human need humans."

Daniel C. Potts, M.D., neurologist and Medical Director for Dementia Dynamics, a training program for dementia caregivers, is uncertain about robots. Potts says, "I have mixed feelings about the use of robotics in eldercare. On the positive side, I certainly realize that our 21st century lifestyle has made in-person caregiving more challenging, especially for children caring for aging parents.

"I also feel that technologies that allow remote monitoring to occur, such as medication systems that monitor med dosing, reminder systems for appointments, etc., can be very useful and reduce some of the anxieties of remote caregiving. Furthermore, I feel that some of the robotic systems that help with some of the rote, physical tasks of caregiving, like lifting and turning may prove to be of great use in some cases. I have also heard of the Japanese baby seal robot that has been associated with reduced cortisol levels in autistic persons and dementia patients, suggesting reduced stress levels in response to holding and interacting with it.

"Having said this, I am concerned, in general, with the level of personal disconnection in our society today, especially between the younger generations and elders. I think this is weakening our culture. Story and personal sharing is so important for all of us, an essential for human life. Relationship is critical to maturity, and I think it becomes even more important as we age. If we think that we can provide adequate care and support to an aging population through technology alone, we are misguided.

"Nothing can take the place of human touch, eye contact, warmth, reminiscence, presence, compassion and empathy—bearing one another's burdens through real relationships. So I think we have to be careful that we use technology wisely. But in summary, I think it will prove to be helpful in certain situations. In general, I think we have a society which seeks to avoid pain rather than being transformed through it."

Protecting the human element as we embrace the future of caregiving

Potts' commentary gave me food for thought. I'd considered that some people may rely on robots too much and not give needed personal attention to their elders. However, I hadn't considered that a robot could provide people with a type of barrier against personally witnessing too much of the decline of a loved one.

When I'm asked about the future of robotic care, I always say that, while there is certainly a place for it, I think we need to guard against dehumanizing caregiving. I'm happy to say that both Madlung and Potts stated much the same idea in their own words.

No machine will ever replace human touch or the warmth of human love. When our loved ones are at their most vulnerable, those are the elements that are most needed for their wellbeing. As with most things, balance and caution should be used if we are to successfully blend robotic assistance with human care.

Carol Bradley Bursack

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Over the span of two decades, author, columnist, consultant and speaker Carol Bradley Bursack cared for a neighbor and six elderly family members. Her experiences inspired her to pen, "Minding Our Elders: Caregivers Share Their Personal Stories," a portable support group book for caregivers.

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8 Comments

Very interesting article, with opposing and contrasting points of view.

While I wouldn't normally be in favor of an animated machine, if it can help someone suffering from the ravages and infirmities of old age and/or dementia, and do so safely, then I think it should be considered. It would at least be another technological method by which technology can help elders and not be focused so much on the young who are the primary purchasers of so many technogadgets.

And once again I disagree with Madlung, who I think has a rigid scientific and not even clinical or humane approach to the entire issue. Everytime I read something she's written, I think she really doesn't have a clear conception of the difficulties and challenges of elder care. She seems to be just to be a research scientist who doesn't have much human interaction herself. I certainly would never consider her as a candidate for our medical team.

How she can conclude that robot interaction would compound social isolation is unclear. At some point, someone with dementia may even believe that the robot is human. And regardless of personality changes, inability to recognize family, hostility and aggression, the robot will still be there, without becoming hurt, angry or hostile as we humans can easily become.

Notwithstanding that those quoted are only an infinitismal representation of the medical community, that discipline hasn't been one to embrace nonmedicine changes with open arms. How long has it taken for alternative medicine to be accepted as something other than quack treatment? How long has cancer treatment been focused on the slash and burn approach?

Potts at least recognizes both sides of the issue, but his statement that "technologies that allow remote monitoring to occur, such as medication systems that monitor med dosing, reminder systems for appointments, etc., can be very useful and reduce some of the anxieties of remote caregiving" to me reflects a very amateurish and simplistic approach to the complexities of caregiving.

I wonder how many Depends he's changed? I wonder how many times he's gotten up in the middle of the night to drive to an elder's home because he/she can't be reached and the possibility of a fall or worse is on the caregivier's mind? How many times has he come home exhausted and conflicted because of the physical stress of being chauffeur for all the medical appointments?

He does make a valid point about disconnection in today's society. But I question whether robotics in elder care would increase that, substitute for it, or actually enhance interpersonal reaction with the family by lessening some of the trauma the family undergoes.

I'll be interested to read what others write on this issue.
Dr. Potts is right -- When an elder is reminiscing, how is a robot ever going to smile and laugh and add its own memories, as would a loving caregiver who's heard the story many times before but is kind enough not to say so?
Also, if I could get a robot that looked exactly like the actor Adrian Paul from Highlander I would buy him in a heartbeat.LOL