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Assistive robots for socialization in elderly people: results pertaining to the needs of the users

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Abstract

Background/aim

Technological solutions can support the elderly, improve their quality of life and reduce isolation and loneliness. The Euro-Japan ACCRA (Agile Co-Creation for Robots and Aging) project has the objective of building a reference co-creation methodology for the development of robotic solutions for ageing. The aim of this study is to provide a pilot qualitative analysis of the real needs of elderly people and their caregivers when exposed to conversational activities with robots and to identify priority needs that should be developed from end-user perspectives.

Methods

A qualitative research design was adopted to define a pre-structured questionnaire that was administered to the elderly taking part in the piloting sessions. Three groups of end-users were included: subjects with an age ≥ 60 years, informal caregivers and formal caregivers.

Results

The interviews were carried out in Italy and Japan. A total of 17 elderly and 36 caregivers were recruited. Common needs in the two sites were categorized into 3 groups: Communication; Emotion Detection and Safety. General robot acceptance level is good and perception is positive among participants in the pilot sites.

Conclusion

A positive perception of the elderly on the application of a robotic solution was found and many are the needs that could be addressed by an appropriate and careful robotic development taking into account the real needs and capabilities of the involved subjects.

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Funding

This work was supported by the ACCRA Project, founded by the European Community’s Horizon 2020 Programme (H2020-SCI-PM14-2016)—Grant agreement no. 738251.

Author information

Authors and Affiliations

  1. Department of Medical Sciences, Geriatric Unit, Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, FG, Italy

    Grazia D’Onofrio, Francesca Greco, Antonio Greco & Daniele Sancarlo

  2. The BioRobotics Institute, Scuola Superiore Sant’Anna, Pontedera, Italy

    Grazia D’Onofrio, Laura Fiorini, Raffaele Limosani & Filippo Cavallo

  3. Connectdot Ltd, Kyoto, Japan

    Hiroshi Hoshino & Aiko Matsumori

  4. Academic Center for Computing and Media Studies, Kyoto Bunkyo University, Kyoto, Japan

    Yasuo Okabe & Masahiko Tsukamoto

  5. ICT, Innovation and Research Unit, Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, FG, Italy

    Alessandra Vitanza & Francesco Giuliani

Authors
  1. Grazia D’Onofrio
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  2. Laura Fiorini
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  3. Hiroshi Hoshino
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  4. Aiko Matsumori
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  5. Yasuo Okabe
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  6. Masahiko Tsukamoto
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  7. Raffaele Limosani
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  8. Alessandra Vitanza
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  9. Francesca Greco
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  10. Antonio Greco
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  11. Francesco Giuliani
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  12. Filippo Cavallo
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  13. Daniele Sancarlo
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Corresponding author

Correspondence to Grazia D’Onofrio.

Ethics declarations

Conflict of interest

All authors declare that there are no conflicts of interest.

Statement of human and animal rights

All procedures performed in the study fulfilled the Declaration of Helsinki, and the guidelines for Good Clinical Practice. The approval of the study for experiments using human subjects was obtained from the local Ethics Committees on human experimentation.

Informed consent

All participants were required to sign three consent forms before participation: consent for participation to the research study, consent for sharing the audio–video recorded material and data with other consortium members, and a consent form for using the audio–video recorded material and data for public purposes (publications, dissemination goals).

Appendices

Appendix 1: Conversation interview guide

Interview objectives

  • Understanding the context and the way of life of the person (in order to know what his/her conversation activities are and to situate the context of intervention of the robot).

  • Identifying problems related to loneliness and isolation (slightly or advanced).

  • Identifying needs in terms of conversation.

  • Getting early indications of the potential attractiveness of the robot and its main functionalities.

Interview guide for elderly

figure a

Introduction

Dear Mr./Mrs:…………………………………. Thank you for accepting to participate in this “needs” interview for the ACCRA project. Your collaboration is appreciated! I will shortly explain the interview procedures.

Interview protocol:

  • This interview aims to determine potential issues and needs that you might have come across concerning your conversation activity.

  • This interview aims to determine your perceptions about the usage of technology and robotics for health care and for reducing the loneliness and isolation of the elderly people.

  • The data will be used for the ACCRA project to prepare the robots that fits the elderly needs.

  • This data may be used for future publications including, but not limited to: academic journals, websites and policy papers.

  • This interview will be recorded.

  • The interviewer/researcher conducting this interview will make sure that the data is treated confidentially and that the data will not be traceable to a specific individual to safeguard privacy.

  • If you do not feel comfortable to give answers to a question, you can state this without providing any reason and the interviewer/researcher will skip the question.

  • If you do not feel comfortable to continue the interview any further, you may at any moment discontinue the interview without providing any reasons.

Do you have any questions? Do you understand and accept the above mentioned procedures?

If so, we will start the interview.

First part

  1. 1.

    Context and way of life

    1. (1)

      Are you a person with sensorial and/or cognitive disabilities?


      Probes:

      1. i.

        Have you hearing impairments? Have you difficulties to hear a telephone call, a film on TV or a conversation with your relative/friend?

      2. ii.

        Have you vision impairments? Have you difficulties to watch TV, computer or your smartphone?

      3. iii.

        Have you cognitive impairments? Have you often memory loss? Do you often lose the thread of one’s discourse?

    2. 2)

      Do you succeed to have conversations with people?


      Probes:

      1. i.

        When talking to people, do you pay attention to their body language (ex. facial expression, hand movement, etc.)?

      2. ii.

        Do people get what you are saying?

        1. (a)

          Do people tend to misinterpret what you say?

        2. (b)

          Do you find it hard to express your feelings to others?

        3. (c)

          Do you have difficulty putting your thoughts into words?

        4. (d)

          Do you find it difficult to express your opinions when others do not share them?

        5. (e)

          Do you try to divert or end conversations that do not interest you?

    3. 3)

      What are your feelings about your social status?


      Probes:

      1. i.

        How often do you feel that you lack companionship?

        1. a)

          How often do you feel that there is no one you can turn to?

        2. b)

          How often do you feel alone?

      2. ii.

        How often do you feel that your interests and ideas are not shared by those around you?

      3. iii.

        How often do you feel that you are “in tune” with the people around you?

        1. a)

          How often do you feel left out?

        2. b)

          How often do you feel that your relationships with others are not meaningful?

        3. c)

          How often do you feel isolated from others?

    4. 4)

      Could you indicate the people that you often meet? What have you social interaction with them?


      Probes:

      1. i.

        Is there a special person who is around when you are in need?

        1. a)

          Is there a special person with whom you can share your joys and sorrows?

        2. b)

          Have you a special person who is a real source of comfort to you?

        3. c)

          Is there a special person in your life who cares about your feelings?

      2. ii.

        Does your family try to help you?

        1. a)

          Do you get the emotional help and support you need from your family?

        2. b)

          Can you talk about your problems with your family?

        3. c)

          Is your family willing to help you make decisions?

      3. iii.

        Do your friends try to help you?

        1. a)

          Can you count on your friends when things go wrong?

        2. b)

          Have you friends with whom you can share your joys and sorrows?

        3. c)

          Can I talk about your problems with your friends?

  2. 2.

    Hospital/Nursing home

    1. 5)

      How does this hospital ward/nursing home make you feel?


      Probes:

      1. i.

        What is the atmosphere like?

      2. ii.

        What interactions are there between staff/patients/visitors?

        1. a)

          How are visiting times managed?

        2. b)

          Does the healthcare team take the problems seriously, explain information clearly, and try to understand your experience, and provide viable options?

      3. iii.

        What do you notice about safety issues?

        1. a)

          What does information tell you about the quality of care here?

        2. b)

          Is hospital ward/nursing home accessible to those with disabilities?

Second part

  1. 1.

    First investigation of the interests for a robot

    1. 1)

      Do you have any experiences with technology?


      Probes:

      1. i.

        Do you use computers/smartphones/tablets? Why (not)?

        1. a.

          If you are using:

          • What do you use it for?

            • Calling friends/family

            • For online shopping

            • For watching television shows

          • Did you buy it on your own or did somebody else buy it for you?

            • Why did you get it on your own/somebody else buy it for you?

            • Who did buy it for you?

        2. b.

          If you are not using

          • Why do you not use them?

            • Do you have issues using these equipment?

            • What kind of issues do you experience using them?

          • Are you interested in using computers/smartphones/tablets?

            • What would you like to be able to do?

      2. ii.

        What kind of technology are you most comfortable with?

        1. a.

          Could you mention 3?

        2. b.

          Why are you the most comfortable with these 3?

          • Are you experienced with them?

          • Did somebody explain it to you on how to use them?

          • Were they intuitive for you to use?

    2. 2)

      Are your family/friends experienced with computers/smartphones/tablets?


      Probes

      1. i.

        What do they use?

      2. ii.

        What do you think about the fact that they use it?

      3. iii.

        Have you ever used a computer/smartphone/tablet together with your close ones?


      At this point; show video/pictures about BUDDY with a short explanation on what it can do at the moment.

    3. 3)

      After looking at these video/pictures about BUDDY, what do you think about BUDDY? Could a robot help you with your conversational issues?


      Probes:

      1. i.

        What are your first impressions about the robot?

        1. a.

          Interesting? Strange? Scary? Why do you think that?

        2. b.

          What do you think about the idea of robots in health care?

      2. ii.

        Do you believe that the robot will be able to provide you the necessary help to solve your conversational issues? Why (not)?

        1. a.

          If it would help you:

          • With which issues would it help you? How would it help you?

        2. b.

          If it would not help you, why not?

          • What would should be changed to make it useful for you?

          • Would it be useful for other elderly? Why do you think that?

      3. iii.

        If BUDDY would be here right now, do you think that you will be able to use BUDDY properly? Why (not)?

        1. a.

          Will you be able to give it the proper commands? Why (not)?

        2. b.

          Will you be able to give any input commands (smart phone/touchscreen)? Why (not)?

        3. c.

          What kind of input commands should be used to make it easier for you to communicate with the robot?

      4. iv.

        Would you be interested in training sessions to be able to use BUDDY (alone?)? Why (not)?

        1. a.

          What kind of training sessions would you like to attend? Face-to-face, manual, video training?

    4. 4)

      How would you feel being helped by a robot instead of a human worker?


      Probes:

      1. i.

        Would you feel sad, scared or something else? Why would you feel that way?

      2. ii.

        What positive or negative ideas do you have about having a robot help you with your conversation problems?

      3. iii.

        What advantages or disadvantages could you think of about using robots?

        I will now provide some functions that BUDDY could potentially perform.

    5. 5)

      BUDDY could improve your conversation ability and reduce the isolation risk using cameras and sensors. It could even “see” that you fell down. Based on the situation it could suggest you some exercises or warn a health care worker.

      Probes:

      1. i.

        What do you think of such functions? It could keep track of your conversation ability, living situations and health. Useful or not? Why?

      2. ii.

        How would you feel being monitored by a robot?

        1. a.

          Is it an invasion of privacy? Or do you not mind?

        2. b.

          It weakens the relationships between elderly and health care workers?

        3. c.

          Who should have access to your health data?

    6. 6)

      BUDDY could provide some simple cognitive exercises and keep in touch with your relatives/friends to help you maintain/improve your conversation ability. Would you be willing to do cognitive exercises with a robot? Why (not)?


      Probes:

      1. i.

        Which (lack of) functions would convince you to (not) do exercises with the robot?

      2. ii.

        Would you feel safe doing exercises with a robot?

    7. 7)

      BUDDY could facilitate communication between you and healthcare workers using digital communication (e.g. Skype). What do you think of such function?


      Probes:

      1. i.

        Is it useful? Why (not)?

      2. ii.

        Would communication with family/friends be more interesting? Why (not)?

    8. 8)

      Should BUDDY be able to help you solve your conversation issues? Why (not)?

    9. 9)

      During the entire interview, were you able to think and express your opinions about your conversation issues in daily life and robots in health care? Right now based on your current knowledge, would you be interested in using BUDDY?


      Probes:

      1. i.

        Why would you (not) be interested?

      2. ii.

        Based on the video and your own daily issues, are there other tasks that you would like BUDDY to be able to do, to make it possible for you to live independently longer?

        1. a.

          Should BUDDY be able to carry things?

        2. b.

          Should BUDDY be able to do certain tasks automatically for you?

      3. iii.

        What would be required to make BUDDY (even more) interesting and useful to you?

      4. iv.

        Which (lack of) functions would convince you to (not) use the robot?

Additional elements

  1. 1)

    We are almost at the end of the interview. Are there any comments that you would like to make or want to add that you think might be important?


To finish the interview, I would like to ask the final few questions.

Socio-demographic information

  1. 1)

    What was your previous occupation?

  2. 2)

    What is your highest enjoyed education level?

  3. 3)

    What is your current family situation? Do you have a spouse, children or grand-children?


This is the end of the interview, I would like to thank you for your collaboration!

Interview guide for caregivers

When you are interviewing an informal caregiver, adjust the wording of ‘elderly’ to a more appropriate term: spouse, father (in law)/mother (in law) or loved one.

figure b

Introduction

Dear Mr./Mrs:…………………………………. Thank you for accepting to participate in this “needs” interview for the ACCRA project. Your collaboration is appreciated!

Interview protocol:

  • This interview aims to determine potential issues and needs that you might have perceived among the elderly concerning their conversation activity.

  • This interview aims to determine your perceptions about the usage of technology and robotics for health care.

  • The data will be used for the ACCRA project to prepare the robots that fits the elderly needs and could support you in your work.

  • This data may be used for future publications including, but not limited to: academic journals, websites and policy papers.

  • This interview will be recorded.

  • The interviewer/researcher conducting this interview will make sure that the data is treated confidentially and that the data will not be traceable to a specific individual to safeguard privacy.

  • If you do not feel comfortable to give answers to a question, you can state this without providing any reason and the interviewer/researcher will skip the question.

  • If you do not feel comfortable to continue the interview any further, you may at any moment discontinue the interview without providing any reasons.


Do you have any questions? Do you understand and accept the above mentioned procedures?


If so, we will start the interview.

First part

  1. 1.

    Context and way of life

    1. 1)

      Could you describe what you think the current conversation issues are among the elderly?


      Probe:

      1. i.

        Do they for example have problems: hearing problems, vision problems, writing problems, and problems using the telephone

      2. ii.

        Memory loss, losing the thread of one’s discourse?

    2. 2)

      Could you describe the problems that you have seen among the elderly in regards with their conversation activity?


      Probe:

      1. a.

        Reducing of social interaction. What difficulties do you see? for example Do they have difficulties to call or go out home? What are the problems?

      2. b.

        Do the elderly experience any problems with their social life in their daily life due to their reduced conversation activity?

        1. i.

          For example, how often are they visiting family/friends? Do you notice any variations respect to last year (i.e. reduced times, same times)?

        2. ii.

          How is their participation in events/activities? Do they regularly join and participate in events?

  2. 2.

    Hospital/Nursing home

    1. 3)

      How does this hospital ward/nursing home make you feel?


      Probes:

      1. ii.

        What is the atmosphere like?

      2. iii.

        What interactions are there between staff/patients/visitors?

        1. c)

          How visiting times are managed?

        2. d)

          Does the healthcare team take the problems seriously and explain information clearly, about your loved one?

      3. iv.

        What do you notice about safety issues?

        1. c)

          What does information tell you about the quality of care here?

        2. d)

          Is hospital ward/nursing home accessible to those with disabilities?

Second part

  1. 1.

    First investigation of the interests for a robot

    1. (1)

      Do you have any experience with technology?


      Probe:

      1. a.

        Do you use computers/smartphones/tablets? Why (not)?

        1. i.

          If you are using:

          1. 1.

            What do you use it for?

          2. 2.

            Did you buy it on your own or did somebody else buy it for you?

            1. a.

              Why did you get it on your own/somebody else buy it for you?

            2. b.

              Who did buy it for you?

        2. ii.

          If you are not using

          1. 1.

            Why do you not use them?

            1. a.

              Do you have issues using these equipment?

            2. b.

              What kind of issues do you experience using them?

          2. 2.

            Are you interested in using these equipments?

            1. a.

              What would you like to be able to do?

            2. b.

              Do you have experience with assistive robots?

              1. i.

                If so, what kind of robots?

    2. (2)

      Could you describe your work with the elderly


      Probe:

      1. a.

        It was addressed a little bit before, but could you explain further what kind of work you do with/for the elderly?

        1. i.

          What are your most important tasks?

        2. ii.

          How does an average daily routine look like for you?

      2. b.

        How much direct contact do you have with the elderly? Do you visit the elderly often? Do you attend multiple elderly? Do you work individually or in teams?


      At this point; show video/pictures about BUDDY with a short explanation on what it can do at the moment.

    3. (3)

      After looking at these video/pictures about BUDDY, what do you think about BUDDY? A robot that could help you with your work in helping elderly with mobility issues?

      Probe:

      1. a.

        What are your first impressions about the robot?

        1. i.

          Is BUDDY look interesting, cool, strange or something else?

        2. ii.

          What do you think about the idea of robots in health care?

      2. b.

        Do you believe that the robot will be able to provide you the necessary support to solve elderly’s conversation issues? Why (not)?

        1. i.

          If it would help you, with issues would it help you? How would it help you?

        2. ii.

          In particular, why it would not help you?

          1. 1.

            What should be changed to make it useful for you?

          2. 2.

            Might BUDDY be useful for other healthcare workers or another department? Why do you think that?

      3. c.

        If BUDDY was right here, do you think that you will be able to use BUDDY properly? Why (not)?

        1. i.

          Will you be able to give the proper commands? Why (not)?

        2. ii.

          Will you be able to give or input commands (smart phone/touchscreen)? Why (not)?

        3. iii.

          What kind of input commands should be used to make it easier for you to communicate with the robot?

      4. d.

        Would you be interested in receiving training to be able to use BUDDY? Why (not)?

        1. i.

          What kind of training would you prefer? Face-to-face, manual, video training?

    4. (4)

      How would you feel to use robots to take care of elderly?


      Probe:

      1. a.

        Would you feel happy, sad or anything else? Why would you feel that way?

      2. b.

        What kind of positive or negative ideas do you have about having a robot helping you with your work in elderly care?

      3. c.

        What advantages or disadvantages could you think of about using robots?

      4. d.

        How do you think that the elderly will view robots as a nursing tool?


      I will now provide some functions that BUDDY could potentially perform

    5. (5)

      BUDDY could improve your conversation ability and reduce the isolation risk (using cameras and sensors).


      Probe:

      1. a.

        What do you think of such functions? It could keep track of their conversation activity, living situation and health. Is it useful or not? Why (not)?

      2. b.

        What do you think about the remote monitoring of the elderly?

      3. c.

        How would you feel using robots to monitor the elderly?

        1. i.

          Is it an invasion of privacy?

        2. ii.

          Does it weaken the relationships between elderly and healthcare workers, or between you and elderly?

        3. iii.

          Who should have access to the data?

    6. (6)

      BUDDY could provide some simple cognitive exercises to help elderly maintain/improve their conversation activity. Would you be willing to use or allow robots to do such exercises with the elderly? Why (not)?


      Probe:

      1. a.

        Is it because of safety reasons? Or something else?

      2. b.

        Which (lack of) functions would convince you to (not) do exercises with the robot?

    7. (7)

      BUDDY could facilitate communication between you and the elderly from a distance using digital communication. What do you think of such function?


      Probe:

      1. a.

        Do you think that it is useful? Why (not)?

      2. b.

        Would communication with family or friends be more interesting? Why (not)?

    8. (8)

      Should BUDDY be able to help you solve these issues? Why (not)?

    9. (9)

      During the entire interview, were you able to think and express your opinions about elderly’s conversation issues in daily life and robots in health care? Right now based on your current ideas, would you be interested in using BUDDY to support you in your daily activities?


      Probe:

      1. a.

        Why (not)?

      2. b.

        Based on the video and your own work experience, are there other tasks that you would like BUDDY to be able to do to make it more attractive for you to use BUDDY, whether it’s to make it possible for elderly to live independently longer or help you in your work?

        1. i.

          Should BUDDY be able to carry things?

        2. ii.

          Should BUDDY be able to do certain tasks automatically?

      3. c.

        What would be required to make BUDDY (even more) interesting and useful to you?

      4. d.

        Which (lack of) functions would convince you to (not) to use the robot?

Additional elements

  1. (1)

    We are almost at the end of the interview. Are there any comments that you would like to make or want to add that you think might be important?


    To end the interview, I would like to ask you some final questions

Socio-demographic information

  1. (1)

    What is your highest enjoyed education level?

  2. (2)

    What is your current job position?

  3. (3)

    How many years of work experience do you have in elderly care?


    This is the end of the interview, I would like to thank you for your collaboration.

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D’Onofrio, G., Fiorini, L., Hoshino, H. et al. Assistive robots for socialization in elderly people: results pertaining to the needs of the users. Aging Clin Exp Res 31, 1313–1329 (2019). https://doi.org/10.1007/s40520-018-1073-z

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  • DOI: https://doi.org/10.1007/s40520-018-1073-z

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