Assistive Social Robots in Elderly Care a Review

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Assistive social robots in elderly

care: A review

ARTICLE in GERONTECHNOLOGY · APRIL 2009

DOI: 10.4017/gt.2009.08.02.002.00

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3 AUTHORS, INCLUDING:

Joost Broekens

Delft University of Technology

66 PUBLICATIONS 475 CITATIONS

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Marcel Heerink

Windesheim University

36 PUBLICATIONS 634 CITATIONS

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Available from: Marcel Heerink

Retrieved on: 29 March 2016

https://www.researchgate.net/profile/Marcel_Heerink?enrichId=rgreq-31c15c60-56bc-48f9-bd11-9fbc5f59e5a6&enrichSource=Y292ZXJQYWdlOzIyOTA1ODc5MDtBUzo5Nzc0ODQzMDg4NDg2N0AxNDAwMzE2NDUwMDkz&el=1_x_7https://www.researchgate.net/profile/Joost_Broekens?enrichId=rgreq-31c15c60-56bc-48f9-bd11-9fbc5f59e5a6&enrichSource=Y292ZXJQYWdlOzIyOTA1ODc5MDtBUzo5Nzc0ODQzMDg4NDg2N0AxNDAwMzE2NDUwMDkz&el=1_x_7https://www.researchgate.net/profile/Joost_Broekens?enrichId=rgreq-31c15c60-56bc-48f9-bd11-9fbc5f59e5a6&enrichSource=Y292ZXJQYWdlOzIyOTA1ODc5MDtBUzo5Nzc0ODQzMDg4NDg2N0AxNDAwMzE2NDUwMDkz&el=1_x_4https://www.researchgate.net/publication/229058790_Assistive_social_robots_in_elderly_care_A_review?enrichId=rgreq-31c15c60-56bc-48f9-bd11-9fbc5f59e5a6&enrichSource=Y292ZXJQYWdlOzIyOTA1ODc5MDtBUzo5Nzc0ODQzMDg4NDg2N0AxNDAwMzE2NDUwMDkz&el=1_x_3https://www.researchgate.net/publication/229058790_Assistive_social_robots_in_elderly_care_A_review?enrichId=rgreq-31c15c60-56bc-48f9-bd11-9fbc5f59e5a6&enrichSource=Y292ZXJQYWdlOzIyOTA1ODc5MDtBUzo5Nzc0ODQzMDg4NDg2N0AxNDAwMzE2NDUwMDkz&el=1_x_3https://www.researchgate.net/publication/229058790_Assistive_social_robots_in_elderly_care_A_review?enrichId=rgreq-31c15c60-56bc-48f9-bd11-9fbc5f59e5a6&enrichSource=Y292ZXJQYWdlOzIyOTA1ODc5MDtBUzo5Nzc0ODQzMDg4NDg2N0AxNDAwMzE2NDUwMDkz&el=1_x_3https://www.researchgate.net/publication/229058790_Assistive_social_robots_in_elderly_care_A_review?enrichId=rgreq-31c15c60-56bc-48f9-bd11-9fbc5f59e5a6&enrichSource=Y292ZXJQYWdlOzIyOTA1ODc5MDtBUzo5Nzc0ODQzMDg4NDg2N0AxNDAwMzE2NDUwMDkz&el=1_x_3https://www.researchgate.net/publication/229058790_Assistive_social_robots_in_elderly_care_A_review?enrichId=rgreq-31c15c60-56bc-48f9-bd11-9fbc5f59e5a6&enrichSource=Y292ZXJQYWdlOzIyOTA1ODc5MDtBUzo5Nzc0ODQzMDg4NDg2N0AxNDAwMzE2NDUwMDkz&el=1_x_3https://www.researchgate.net/publication/229058790_Assistive_social_robots_in_elderly_care_A_review?enrichId=rgreq-31c15c60-56bc-48f9-bd11-9fbc5f59e5a6&enrichSource=Y292ZXJQYWdlOzIyOTA1ODc5MDtBUzo5Nzc0ODQzMDg4NDg2N0AxNDAwMzE2NDUwMDkz&el=1_x_3https://www.researchgate.net/publication/229058790_Assistive_social_robots_in_elderly_care_A_review?enrichId=rgreq-31c15c60-56bc-48f9-bd11-9fbc5f59e5a6&enrichSource=Y292ZXJQYWdlOzIyOTA1ODc5MDtBUzo5Nzc0ODQzMDg4NDg2N0AxNDAwMzE2NDUwMDkz&el=1_x_3https://www.researchgate.net/publication/229058790_Assistive_social_robots_in_elderly_care_A_review?enrichId=rgreq-31c15c60-56bc-48f9-bd11-9fbc5f59e5a6&enrichSource=Y292ZXJQYWdlOzIyOTA1ODc5MDtBUzo5Nzc0ODQzMDg4NDg2N0AxNDAwMzE2NDUwMDkz&el=1_x_3https://www.researchgate.net/publication/229058790_Assistive_social_robots_in_elderly_care_A_review?enrichId=rgreq-31c15c60-56bc-48f9-bd11-9fbc5f59e5a6&enrichSource=Y292ZXJQYWdlOzIyOTA1ODc5MDtBUzo5Nzc0ODQzMDg4NDg2N0AxNDAwMzE2NDUwMDkz&el=1_x_3https://www.researchgate.net/publication/229058790_Assistive_social_robots_in_elderly_care_A_review?enrichId=rgreq-31c15c60-56bc-48f9-bd11-9fbc5f59e5a6&enrichSource=Y292ZXJQYWdlOzIyOTA1ODc5MDtBUzo5Nzc0ODQzMDg4NDg2N0AxNDAwMzE2NDUwMDkz&el=1_x_3https://www.researchgate.net/?enrichId=rgreq-31c15c60-56bc-48f9-bd11-9fbc5f59e5a6&enrichSource=Y292ZXJQYWdlOzIyOTA1ODc5MDtBUzo5Nzc0ODQzMDg4NDg2N0AxNDAwMzE2NDUwMDkz&el=1_x_1https://www.researchgate.net/profile/Marcel_Heerink?enrichId=rgreq-31c15c60-56bc-48f9-bd11-9fbc5f59e5a6&enrichSource=Y292ZXJQYWdlOzIyOTA1ODc5MDtBUzo5Nzc0ODQzMDg4NDg2N0AxNDAwMzE2NDUwMDkz&el=1_x_7https://www.researchgate.net/institution/Windesheim_University?enrichId=rgreq-31c15c60-56bc-48f9-bd11-9fbc5f59e5a6&enrichSource=Y292ZXJQYWdlOzIyOTA1ODc5MDtBUzo5Nzc0ODQzMDg4NDg2N0AxNDAwMzE2NDUwMDkz&el=1_x_6https://www.researchgate.net/profile/Marcel_Heerink?enrichId=rgreq-31c15c60-56bc-48f9-bd11-9fbc5f59e5a6&enrichSource=Y292ZXJQYWdlOzIyOTA1ODc5MDtBUzo5Nzc0ODQzMDg4NDg2N0AxNDAwMzE2NDUwMDkz&el=1_x_5https://www.researchgate.net/profile/Marcel_Heerink?enrichId=rgreq-31c15c60-56bc-48f9-bd11-9fbc5f59e5a6&enrichSource=Y292ZXJQYWdlOzIyOTA1ODc5MDtBUzo5Nzc0ODQzMDg4NDg2N0AxNDAwMzE2NDUwMDkz&el=1_x_4https://www.researchgate.net/profile/Joost_Broekens?enrichId=rgreq-31c15c60-56bc-48f9-bd11-9fbc5f59e5a6&enrichSource=Y292ZXJQYWdlOzIyOTA1ODc5MDtBUzo5Nzc0ODQzMDg4NDg2N0AxNDAwMzE2NDUwMDkz&el=1_x_7https://www.researchgate.net/institution/Delft_University_of_Technology?enrichId=rgreq-31c15c60-56bc-48f9-bd11-9fbc5f59e5a6&enrichSource=Y292ZXJQYWdlOzIyOTA1ODc5MDtBUzo5Nzc0ODQzMDg4NDg2N0AxNDAwMzE2NDUwMDkz&el=1_x_6https://www.researchgate.net/profile/Joost_Broekens?enrichId=rgreq-31c15c60-56bc-48f9-bd11-9fbc5f59e5a6&enrichSource=Y292ZXJQYWdlOzIyOTA1ODc5MDtBUzo5Nzc0ODQzMDg4NDg2N0AxNDAwMzE2NDUwMDkz&el=1_x_5https://www.researchgate.net/profile/Joost_Broekens?enrichId=rgreq-31c15c60-56bc-48f9-bd11-9fbc5f59e5a6&enrichSource=Y292ZXJQYWdlOzIyOTA1ODc5MDtBUzo5Nzc0ODQzMDg4NDg2N0AxNDAwMzE2NDUwMDkz&el=1_x_4https://www.researchgate.net/?enrichId=rgreq-31c15c60-56bc-48f9-bd11-9fbc5f59e5a6&enrichSource=Y292ZXJQYWdlOzIyOTA1ODc5MDtBUzo5Nzc0ODQzMDg4NDg2N0AxNDAwMzE2NDUwMDkz&el=1_x_1https://www.researchgate.net/publication/229058790_Assistive_social_robots_in_elderly_care_A_review?enrichId=rgreq-31c15c60-56bc-48f9-bd11-9fbc5f59e5a6&enrichSource=Y292ZXJQYWdlOzIyOTA1ODc5MDtBUzo5Nzc0ODQzMDg4NDg2N0AxNDAwMzE2NDUwMDkz&el=1_x_3https://www.researchgate.net/publication/229058790_Assistive_social_robots_in_elderly_care_A_review?enrichId=rgreq-31c15c60-56bc-48f9-bd11-9fbc5f59e5a6&enrichSource=Y292ZXJQYWdlOzIyOTA1ODc5MDtBUzo5Nzc0ODQzMDg4NDg2N0AxNDAwMzE2NDUwMDkz&el=1_x_2


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R e v i e w

Joost Broekens PhDDelft University of Technology, Delft, the NetherlandsE: [email protected]

Marcel Heerink MScUniversity of Applied Sciences, Amsterdam, The Netherlands

E: [email protected]

Henk Rosendal PhD

University of Applied Sciences, Leiden, The NetherlandsE: [email protected]

J. Broekens, M. Heerink, H. Rosendal. Assistive social robots in elderly care: areview. Gerontechnology 2009; 8(2):94-103; doi: 10.4017/gt.2009.08.02.002.00. Assistivesocial robots, a particular type of assistive robotics designed for social interactionwith humans, could play an important role with respect to the health and psycho-logical well-being of the elderly. Objectives Assistive social robots are believedto be useful in eldercare for two reasons, a functional one and an affective one.Such robots are developed to function as an interface for the elderly with digital

technology, and to help increase the quality of life of the elderly by providingcompanionship, respectively. There is a growing attention for these devices inthe literature. However, no comprehensive review has yet been performed to in-vestigate the effectiveness of such robots in the care of the elderly. Therefore, wesystematically reviewed and analyzed existing literature on the effects of assistivesocial robots in health care for the elderly. We focused in particular on the com-panion function. Data Sources A systematic search of MEDLINE, CINAHL, Psy-cINFO, The Cochrane Library databases, IEEE, ACM libraries and finally GoogleScholar was performed for records through December 2007 to identify articlesof all studies with actual subjects aimed to assess the effects of assistive socialrobots on the elderly. This search was completed with information derived frompersonal expertise, contacts and reports. Study Selection and Data ExtractionSince no randomized controlled trials (RCT)’s have been found within this fieldof research, all studies reporting effects of assistive robotics in elderly popula-tions were included. Information on study design, interventions, controls, andfindings were extracted for each article. In medical journals only a few articleswere found, whereas about 50 publications were found in literature on ICT androbotics. Data Synthesis The identified studies were all published after 2000 in-dicating the novelty of this area of research. Most of these publications containthe results of studies that report positive effects of assistive social robots on healthand psychological well-being of elders. Solid evidence indicating that these ef-fects can indeed be attributed to the actual assistive social robot, its behavior andits functionality is scarce. Conclusions There is some qualitative evidence as well

as limited quantitative evidence of the positive effects of assistive social robotswith respect to the elderly. The research designs, however, are not robust enoughto establish this. Confounding variables often cannot be excluded. This is partlydue to the chosen research designs, but also because it is unclear what researchmethodology is adequate to investigate such effects. Therefore, more work onmethods is needed as well as robust, large-scale studies to establish the effectsof these devices.

Key words: Assistive robotics, companion robot, Aibo, Paro, Huggable, iCat

Assistive social robots in elderly care: a review


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A s s i s t i v e s o c i a l r o b o t s

Because of the graying of our western popu-lation, there is a growing necessity for newtechnologies that can assist the elderly intheir daily living. There are two main ar-

guments for this. First, it is expected thatwestern countries will face a tremendousshortage on staff and qualified healthcarepersonnel in the near future1. Second, peo-ple prefer more and more to live in their ownhomes as long as possible instead of beinginstitutionalized in sheltered homes, or nurs-ery homes when problems related to age-ing appear. To address these issues, we notonly need sufficient health care personnel,

but also the presence and appliance of high-tech devices2. ICT-technology and roboticsare developing quickly nowadays, resultingin products that have the potential to playan important role in assisting the elderly3. Inorder to use new technology in an effectiveand efficient way, robust information withrespect to their effects is needed, especiallywhen used in health-care.

In this review we focus on health- and psy-chological well-being-related effects of as-sistive social robots on the elderly. Robotresearch in eldercare concerns assistive ro-bots that can be both rehabilitation robotsand social robots (Figure 1). The first typeof research features physical assistive tech-nology that is not primarily communicativeand is not meant to be perceived as a socialentity. Examples are smart wheelchairs4, ar-tificial limbs and exoskeletons5. The field ofsocial robotics concerns systems that can beperceived as social entities that communi-cate with the user. Of course there are also

projects with social robots aimed at reha-bilitation6 and vice versa.

Studies on social robots in eldercare fea-

ture different robot types. First, there arerobots that are used as assistive deviceswhich we will refer to as service type robots.Functionalities are related to the supportof independent living by supporting basicactivities (eating, bathing, toileting and get-ting dressed) and mobility (including navi-gation), providing household maintenance,monitoring of those who need continuousattention and maintaining safety. Examples

of these robots are ‘nursebot’ Pearl7, theDutch iCat (although not especially devel-oped for eldercare) and the German Care-o-bot8. Also categorized as such could be theItalian Robocare project, in which a robot isdeveloped as part of an intelligent assistiveenvironment for elderly people9. The socialfunctions of such service type robots existprimarily to facilitate interfacing with the ro-

bot. Studies typically investigate what differ-ent social functions can bring to the accept-ance of the device in the living environmentof the elder, as well as how social functionscan facilitate actual usage of the device.

Second, there are studies that focus on thepet-like companionship a robot might pro-vide. The main function of these robots isto enhance health and psychological well-being of elderly users by providing com-panionship. We will refer to these robotsas companion type robots. Examples arethe Japanese seal-shaped robot Paro10, theHuggable11 (both specifically developed forexperiments in eldercare) and Aibo (a robotdog by Sony, see below). Social functionsimplemented in companion robots are pri-marily aimed at increasing health and psy-

chological well-being. For example, studiesinvestigate whether companion robots canincrease positive mood in elderly living innursery homes.

However, not all robots can be categorizedstrictly in either one of these two groups.For example, Aibo is usually applied as aFigure 1. Categorization of assistive robots for elderly


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companion type robot, but can also beprogrammed to perform assistive activi-ties12 and both Pearl and iCat can providecompanionship.

This review aims to provide a first overalloverview of studies that investigate the ef-fects of assistive social robots on the healthand well-being of the elderly. Since themajority of the assistive social robot stud-ies with actual elderly people as subjectsinvolve the robots Aibo, Paro, iCat and‘nursebot’ Pearl, these robots are brieflyhighlighted next.

AIBO

Aibo is an entertainment robot developedand produced by Sony (Figure 2a)13. It iscurrently out of production. It has program-

mable behavior, a hard plastic exterior andhas a wide set of sensors and actuators. Sen-sors include a camera, touch sensors, in-frared and stereo sound. Actuators includefour legs, a moveable tail, and a moveablehead. Aibo is mobile and autonomous. Itcan find its power supply by itself and it isprogrammed to play and interact with hu-mans. It has been used extensively in studieswith the elderly in order to try to assess the

Figure 2. Assistive social robots; (a) Aibo, (b) Pearl, (c) Robocare with screen, (d) Robocare withoutscreen, (e) Care-o-bot I, (f) Care-o-bot II, (g) Care-o-bot III, (h) Homie, (i) iCat, (j) Paro and (k) Hug- gable


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effects on the quality of life and symptomsof stress. In this article we will review thesestudies.

PARO

Paro is a soft seal robot (Figure 2j )10,14. It hasbeen developed by the Intelligent SystemsResearch Institute (ISRI) of the National In-stitute of Advanced Industrial Science andTechnology (AIST) in Japan, and is producedby Intelligent System Co. Ltd. It is developedto study the effects of Animal Assistive Ther-apy with companion robots, and is targetedat the elderly. It has programmable behavior

as well as a set of sensors. Sensors include atouch sensor over the complete body, an in-frared sensor, stereoscopic vision and hear-ing. Actuators include eyelids, upper bodymotors, front paw and hind limb motors.Paro is not mobile. It has been used exten-sively in studies with the elderly to assessthe effects of robot therapy.

ICATThe iCat has been developed and is pro-duced by Philips Electronics (Figure 2i )15.Its design aim is to be a research platformfor human-robot interaction. It is made ofhard plastic and has a cat-like appearance.Furthermore, it has a face that is able to ex-press emotions. Studies typically investigatehow users perceive the iCat as interface tonew technology. The iCat is not particularlyaimed at being a companion (i.e., affectiveassistance) but more at functional assistance(classified as service type). However, it is in-cluded in this study as some studies involv-ing the elderly typically measure accept-ance under the influence of different socialiCat behaviors. Therefore the iCat stronglyrelates to social interaction between the eld-erly and robots as well.

PEARL

Of the four most-cited and studied robots,Pearl is targeted most heavily on functionalassistance. Pearl is the second generationof nursebots developed by Carnegie Mel-lon University (Figure 2b)7,16. It is a mobilerobot that can help the elderly to navigate

through the nursing facility. It does have auser-friendly interface with a face, and canalso provide advice and cognitive supportfor the elderly.

Other eldercare robots that have only brieflybeen included in this review are the Care-o-bot (Figure 2e)8 and Robocare (Figure 2c)9.Their effects have been measured, but notdirectly related to health or psychologicalwell-being. Finally, for the Huggable (Fig-ure 2k )11, a good example of a companionrobot, we did not find any publications onuser studies at the time of collecting the data

for the review. Many of the health- and psy-chological well-being-related effects on theelderly have been found in studies with thefour devices described above (Table 1).

METHODOLOGY

The data collection process consisted ofthree steps (Figure 3). First, a systematicsearch of MEDLINE, CINAHL, PsycINFO,

The Cochrane Library databases, IEEE, ACMlibraries and finally Google Scholar was per-formed for records through December 2007to identify articles of all studies with actualsubjects aimed to assess the effects of assis-tive social robots on the elderly. These da-tabases were searched using the followingsearch terms: Companion robot, Aibo, Paro,iCat, Pearl, nursebot, Care-o-bot, Homie,Huggable and Robocare combined in allpossible ways with elderly, assistive robot-ics, health care or health and care. This par-ticular use of search terms ensured that nostudy involving companion robots and eld-erly was missed. Further, our use of particu-lar robot names in combination with theiruse in the area of health care ensured thatwe also included all studies with robots thatare often used as companion robot, but that

do not employ this exact term in the article.The search was restricted to publications inEnglish, with no limitations on dates of pub-lication or venue. All three researchers inde-pendently screened the initial set of results.Studies were selected for inclusion if they ac-tually reported studies that related assistivesocial robotics to elderly people. This first


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step in the data collection process resulted inan initial list of 229 studies (Figure 3a).

Second, this list of potentially relevant full-

text articles was reviewed by all three ofthe reviewers separately according to themain criterion for this review: the publica-tion delivers empirical data on the effects ofassistive robotics in health care for the eld-erly. Key criterion for inclusion was that thestudy involved real elderly subjects. Sincethis is a relatively new field, we preferreda complete overview of the field and there-fore included all study-designs in this review.

This selection process resulted in a list of 68studies (Figure 3b).

Third, disagreements about the inclusion ofarticles were resolved in a face to face dis-cussion and a study was included in the finallist of to be reviewed publications (Figure 3c)if two out of three researchers agreed to in-clude it.

Subsequently, the final set of 43 studieswere reviewed with respect to the robust-ness of evidence, the chosen study design,the number of patients involved, the out-come measures, the period of follow-up,and the results.

RESULTS

In total, 43 citations were included in our re-view (Table 1). For each study, we report onresearch design, type of assistive social robot,main outcome measures used in the studyto measure the effects of the intervention,number of participants in the study, whetheror not the results were positive, negative ormixed and the time period the study spanned.We also included our main observations.

A variety of effects or functions of assistivesocial robots have been studied, including (i)

increased health by decreased level of stress,(ii) more positive mood, (iii) decreased lone-liness, (iv) increased communication activitywith others, and (v) rethinking the past. Most

studies report positive effects (Table 1). Withregards to mood, companion robots are re-ported to increase positive mood, typicallymeasured using evaluation of facial expres-sions of elderly people as well as question-naires. Further, elderly people are reportedto become less lonely with the interventionof companion robots as measured with lone-liness measurement scales. With regards tohealth status, companion robots are report-

ed to alleviate stress (for instance, measuredby stress hormones in urine) and increaseimmune system response. Some studies re-port a decrease on existing dementia meas-urement scales. One study explicitly reportsthat a companion robot (the My Real Baby inthis case) elicited memories about the past.Many studies report positive findings withregards to social ties between the elderly in

homes (measured by the frequency of con-tact between the elderly) as well as betweenthe elderly and family. Typically, the com-panion is the topic of conversation.

With regards to the perception of the com-panion robot, narrative records present in alarge portion of these studies show that mostelderly actually report liking the robots (ortheir controls, such as a pet toy).

Four patterns emerge that limit the strengthof the evidence for the positive effects re-ported. The first pattern is that the majority ofstudies are with the Aibo and Paro compan-ion robots. This means that little has beenpublished on experimentation with differentforms of assistive social robots. This is inter-esting, as it has been concluded that form

and material does matter a lot to the accept-ance and effects of assistive social robots23,42.

Second, the majority ofthe studies are done in

Japan. As it has beenshown that robot per-ception is culturally de-Figure 3. Flow diagram outlining the review process


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pendent17 results should therefore not begeneralized too easily to other cultures.

Third, practically all of the studies are done

with elderly people in nursery homes, notwith elderly people still living in their ownhouse, even though there is a growingnumber of elderly people that get support intheir own home. We do not know if the ef-fects of social assistive robots are the samein these two cases.

Fourth, and most importantly, the researchmethods used to derive effects are not ro-

bust from a methodological point of view.Good control conditions are rare. Whenpresent, the results are often difficult to in-terpret because the control condition, suchas a fake Paro, has an effect that is similarto the effect of the experimental condition,or because the number of participants istoo small to conclude much.10,18,22. Somestudies are even contradictory in terms of

their outcome18,23

. Also, many studies arenot long-term enough to exclude noveltyeffects. Further, the exact way of interact-ing with the elderly is often not described inenough detail to make it possible to repeatthe study. Therefore, we should be carefulto conclude that the cause of any effect isreally due to the robot, since a Hawthorneeffect (a temporary change to behavior inresponse to a change in the environment)can not be excluded in several studies. No-table exceptions to this are recent studiesby Kidd et al.42 and Wada and Shibata14 where participants could play with the ro-bot without intervention by the researchers.Other exceptions to this are studies that in-vestigate robot acceptance and design cri-teria that include a larger number of partici-pants and generally allow subjects to play

with the robot by themselves without inter-vention of the researchers24-29. However, itshould be noted that this latter type of re-search is aimed at extracting requirementsfor robot design and understanding robotacceptance and as such does not focus onphysical and mental health as treatment ef-fects of robots.

CONCLUSION

Many different studies report positive re-actions of the elderly to assistive social ro-bots. As a wide variety of research designs

has been used, and many of these studiesindicate a positive effect of companion ro-bots on the elderly, we conclude that thereis some evidence that companion type ro-bots have positive effects in health care forthe elderly with respect to at least mood,loneliness and social connections with oth-ers. However, the strength of this evidenceis limited, since (i) most studies have beendone in Japan, with (ii) a limited set of com-

panion robots, i.e., Aibo and Paro, and (iii)research designs are not robust enough, usu-ally not described in enough detail to repeat,and confounding causal variables cannot beexcluded. However, as several studies men-tion subjective reports from elderly peopleindicating that they like the companion ro-bots, we conclude that it is worth-while toinvest in research methods that are able to

attribute the causality of the beneficial ef-fects to the robot as well as invest in robust,large-scale cross-cultural studies to betterestablish the effects of these devices.

FUTURE RESEARCH

Given the large number of studies that showpositive effects of either the robot or itsplacebo version, such as a non-functionalrobot or a pet toy, we believe this type ofdevices hasmerits in elder care. Further, andof importance, the elderly seem to be opento this kind of technology25-28.

We consider it necessary to address themethodological problems, or at the veryleast vagueness regarding methodology of-ten encountered in these studies. It is a lit-tle unfair to judge so harsh these studies, as

they attempt to do something quite difficultand novel: experiment with a novel form oftreatment in a real life situation without hav-ing the benefit of being able to set up rand-omized blind trials, as the placebo version ofthe robot is also perceptually different. Thisis obviously not the case with drug-research,for example. However, we surely think that


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several of the experimental design issuesneed to, and can be improved.

First, it is absolutely necessary to have a

control group that is not in contact with theexperimental group. Secondly, researchersneed to start replicating results of each oth-er, and for this to be possible they need tohave access to the methods used, the samecontrol conditions and preferably the samerobots. This implies that all studies shoulddescribe their research design and methodsclearly and in such a way that the researchcan be completely repeated somewhere

else. Third, studies must be long-term. Thenovelty value of something that enters thelife of an elderly person may take some timeto wear off. Fourth, many studies attempt to

derive statistically significant results from fartoo small a number of subjects. This is prob-lematic, because of sample group selectionbias and lack of statistical power.

In summary, we need large-scale experi-ments that are rigorously set up, and an ad-equate methodology by which these stud-ies are done and compared to each other.Further, we need more variation in the formand function of these robots to figure outwhat parts actually contribute to the benefi-cial effects. Setting up a large scale, inter-national (for instance, EU-based) program

to establish the merits of these, and related,devices could be of great importance for theelderly as well as for health care in general.

AcknowledgementPart of this work has been conducted whilethe first author worked as a researcher at theTelematica Instituut, Enschede, the Netherlands.

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Assistive Social Robots in Elderly Care a Review

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