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Technology and Health Care 17 (2009) 33–40 33 DOI 10.3233/THC-2009-0537 IOS Press

Caregivers’ requirements for in-home robotic agent for supporting community-living elderly subjects with cognitive impairment

Véronique Faucounaua,∗, Ya-Huei Wua, Mélodie Boulaya, Marina Maestruttib, Anne-Sophie Rigauda and the QuoVADis project aAssistance Publique-Hôpitaux de Paris Hôpital Broca 54-56, Paris, France bGET-INT (TELECOM & Management Sud Paris), Evry Cedex, France

Received 21 January 2009

Accepted 11 February 2009

Abstract. Older people are an important and growing sector of the population. This demographic change raises the profile of frailty and disability within the world’s population. In such conditions, many old people need aides to perform daily activities. Most of the support is given by family members who are now a new target in the therapeutic approach. With advances in technology, robotics becomes increasingly important as a means of supporting older people at home. In order to ensure appropriate technology, 30 caregivers filled out a self-administered questionnaire including questions on needs to support their proxy and requirements concerning the robotic agent’s functions and modes of action. This paper points out the functions to be integrated into the robot in order to support caregivers in the care of their proxy. The results also show that caregivers have a positive attitude towards robotic agents.

Keywords: Old people, caregivers, needs, burden, robot

1. Introduction

For the last few decades, the number of people over the age of 65 in France has been increasing. In 2008, the number of people in this age group is estimated to be around 10.5 million, representing 16.4% of the total population [21]. Most of them want to remain living independently. Nonetheless, barriers to independence are numerous, such as frail physical and/or mental health, housing conditions, lack of transportation facilities, community information and communication services, and low income levels. The most common physical health barriers are low mobility levels, visual or hearing impairments, pain, sensory loss, fall-related injuries, chronic illness and adverse drug reactions, while loneliness, dementia and cognitive impairments are the main mental health issues [22].

In France, 28% of the elderly aged 60 or older receive regular help and support from informal caregivers or family members due to a handicap or a health problem [10]. Thus, ageing-in-place often goes together with an increase in costs for home care, home modifications and transportation. The demographic

∗Corresponding author. Tel.: +33 1 44 08 35 03; Fax: +33 1 44 08 35 10; E-mail: [email protected].

34 V. Faucounau et al. / Caregivers’ requirements for in-home robotic agent

imperative of an ageing population and its impact on the reorganisation of health care systems worldwide create unique opportunities to look at new approaches in delivering health care services. While human caregiving cannot and will not be replaced, assistive technologies that can supplement human caregiving have the potential to improve the quality of life for both older adults and their caregivers [24]. The concept of tele-operated assisted mobile robots to support the provision of home tele-health services is one solution that is worth investigating [5,17,23]. For robots, the functionalities are related to supporting independent living [12] by supporting basic activities (eating, bathing, toileting, getting dressed) and mobility, providing household maintenance, monitoring of those who need continuous attention, and maintaining safety [3,20]. Some authors have also [27,28] studied the companionship that a robot might provide.

Family caregivers play an essential role not only in caring for their proxy but also as privileged witnesses, able to judge a patient’s disabilities or to detect a disease’s complications, such as behavioural disturbances. They play the role of informant for physician and other health care professionals, which is very useful for optimising the well-being of these patients. Furthermore, to gain a better vision of the impact of treatment, experts have emphasised the necessity in clinical trials to involve the assessments of caregivers and to examine the impact of intervention not only on patients but also their caregivers as well: the caregivers thus play the role of “co-cared” [1,11,26,29]. Informal caregivers are a new target in the therapeutic approach, which includes taking them into consideration and encouraging their participation.

Although their role is recognised, there is a lack of studies assessing their needs in getting help to support their proxy. This lack is obvious concerning the potential help supplied by Information and Communication Technology (ICT).

As part of data collection, we participated in the QuoVADis project carried out in the Broca hospital. The project’s goal is to develop a domestic environment with an assistive robot supporting an elder with cognitive impairments. The aim of this study is to determine the needs and requirements of the caregivers in order to develop a system tailored to patients and caregivers.

2. Methods

2.1. Questionnaire

A questionnaire was developed in order to assess the needs and requirements of the caregivers. In this questionnaire, data on socio-demographic factors and the patient-caregiver relationship level were collected. Other items concern 3 domains: needs of the caregivers, functions of the robot and modes of action of the robot.

As to the needs of the caregivers, four areas of needs subdivided into more specific themes [18] were selected and included into the questionnaire:

1) Need for general and personalised information: information on dementia in order to cope with the disease.

2) Need for support with regard to symptoms of dementia: supporting the caregiver in providing instrumental care to the person with dementia; compensating for disabilities such as memory problems in daily life activities.

3) Need for social contact and company for the person with dementia: ways to stay connected with family, friends and social environment.

4) Need for health monitoring and perceived safety: need to be cared for and to feel safe when the disease progresses.

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Table 1 Mean age of female and male caregivers

N Mean (SD) range Female 13 57.20(14.60) 26–85 Male 15 72.08(14.07) 43–87

Other items with regard to the functions of the robot were developed according to a review of the literature [2,18]. The following domains were identified and were addressed by the questionnaire:

1) Cognitive prosthesis: cognitive stimulation, daily-activities cueing/stimulation, medicine and ap- pointment reminder, electronic agenda for planning and time management.

2) Safeguarding: detecting emergencies (fall detection, panic attack detection, sadness/apathy detec- tion, abnormal sound/noise detection, motion sensor)

3) Social interaction: an internet-based videoconferencing system with family, friends and health professionals.

4) Support with regard to symptoms of cognitive impairments: information, online chat and forum for caregivers, pictures and music storage, oral advice for daily activities.

5) Emergency assistance: automatic call for assistance in case of emergency

In addition, issues regarding the robot’s modes of actions were tackled: modes of alert signals; the possibility of turning off the robot; the possibility for the robot to set up a night watch and to go everywhere in the apartment (even the bedroom); the remote control by health professionals; the possibility for the person with dementia to wear a bracelet or a medallion personal help button in order to be detected by the robot.

The body of the questionnaire was composed of closed-ended questions (yes/no questions and multiple choice questions).

2.2. Population

Thirty caregivers were recruited in the Broca hospital. They accompanied the patient to the Broca Memory Clinic. They gave an oral consent after the project was explained to them. They anonymously filled in the questionnaire.

The project was submitted to an Ethical Committee.

3. Results

Table 1 shows age (mean and range) of the interviewed people. Two data values are missing in the female group.

Fifteen persons are 60 years old or more, and 13 persons are less than 60 year old. Regarding educational background, 40% had college and above education, 46.7% of respondents had

high school education, and 13.3% had grade school and below education. A great proportion of the caregivers (90%) are family members (14 spouses, 13 children). More than

half (56.7%) live with their patient. Among the spouses, the majority (78.6%) are between 70 and 90 years old.

Among the caregivers who do not live with their proxy, more than 53.8% have daily contact (by phone or in person) with the patient, and 43.3% spend more than an hour taking care of the patient.

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Table 2 Specific themes of essential needs today and in case of future worsening

Needs Today In case of worsening To stimulate his/her memory/concentration 86.7% 50.0% To stimulate him/her during daily activities 83.3% 43.3% To encourage him/her to communicate, to keep relationships 60.0% 56.7% To leave him/her alone without anxiety 56.7% 60.0% To have more time devoted to activities with my proxy 46.7% 23.3% A better understanding of the patient’s disease, in order to cope with it 46.7% 50.0% To have support in taking care of my proxy 43.3% 70.0% To have more time for me, to stand back in order to do my best 30.0% 63.3%

Table 3 The top 10 functions selected to be served by the robot

Functionalities Responses “yes” (%) Cognitive stimulation program 93.3% Falls detection 93.3% Detection of the inability to get up after a fall 93.3% Automatic help call 93.3% Abnormal positions detection 86.7% Drug intake reminder 86.7% Panic attack detection 83.3% Communication with health professionals 80.0% Appointments reminder 80.0% Sadness/apathy detection 73.3%

3.1. Essential needs

Cognitive and daily stimulations are essential needs for the caregivers, followed by encouragement to communicate, and the possibility to leave their proxy alone without anxiety. When the disease progresses, support for taking care of their proxy is the principal need for the caregivers, followed by the wish to have more time for them and to have the possibility of leaving their proxy alone without anxiety (Table 2).

3.2. Robot’s functions

Regarding the robot’s functions, cognitive stimulation and safeguarding functions (fall detection, detection of the inability to get up after a fall, automatic help call) collected the greatest number of positive responses. Secondarily, the caregivers are interested in the drug intake reminder, the abnormal position detection and the panic attack detection (Table 3).

3.3. Modes of action of the robot

Of the caregivers, 73.3% said that the best way to inform the patient of a programmed event would be an oral signal. A large majority (63.3%) of study participants find it appropriate that the robot follows the person into his/her bedroom.

Most of the caregivers (56.7%) think that the patient would feel uneasy about wearing a bracelet or a medallion personal help button continuously (in order to be detected in emergency situations). In case of emergency, the persons to be informed first would be the emergency rescue service and then the family. In such a situation, 73.3% of the caregivers would like to be informed by a vocal message. Abnormal sounds/noises that should be detected by the robot are at first moans (73.3%) and then screams (53.3%).

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In order to have better control over the robot, 93.3% of the caregivers would like remote control of the robot by a health professional in case of emergency. The possibility for the robot to set up a night watch seems to be a good idea for 86.7% of the caregivers. Finally, a large majority of the participants (60%) find it valuable to have the possibility of switching off the robot.

4. Discussion

4.1. Caregiver burden

Regarding their involvement in caring and assisting their proxy, a majority of the spouses and a lot of children spend an hour or more per day with the patients. Among the persons who spend less than a quarter of an hour to take care of their proxy, half are spouses. The results may not be totally reliable because the help/support definition was not clearly explained. The spouses do not necessarily think that some acts count as support, and we did not ask them if they had servants at home. However, these findings are in accordance with those found in the French surveys “Handicaps, Incapacit és, Dépendances” [1,10] and “Conditions de vie des ménages français” [4].

4.2. Needs

In our group, children express their needs more clearly than spouses. Moreover, they would like their parent to maintain a social life, and as the disease progresses, they would like to have support (psychological and educational) to take care of him/her. The caregivers, the spouses, as well as the children, seem to have a good vision about the evolution of the disease, and they plan for their future needs. In the literature, few authors are interested in studying the needs of caregivers for supporting their proxy at home. However, we found an article tackling caregivers’ perceptions and expectations vis- à-vis ICTs. Rialle et al. [25] investigated the representations, wishes and fears of family caregivers regarding 14 innovative technologies. Opinions towards technologies were much contrasted. The respondents were divided into two opposite clusters: one in favour of a substantial usage of technology for care aiding, the other rather or totally hostile to such a use.

There are obviously gaps in both data and publications that prevent us from understanding the needs these caregivers address.

4.3. Robot’s functions

The function of the robot most demanded by the caregivers is the cognitive stimulation programme that primarily can meet the needs of the person with cognitive impairment. As a consequence of the inability to remember, the patients may forget an appointment or to take medicine correctly. Thus, the robot serving the function of cognitive prosthesis (cognitive stimulation programme, drug intake reminder and appointments reminder) that can help the elder compensate for his/her impairment is welcomed by the caregivers. The robot should serve as a cognitive orthotic, providing the elderly with reminders about their daily activities. In fact, for over a decade, efforts at designing cognitive orthotics have enabled reminders to be provided using the telephone [13], personal digital assistance [9] and pagers [15].

Secondly, the caregivers are massively in favour of the functions of safeguarding systems (fall detection, automatic help call, abnormal positions detection, panic attack detection, sadness/apathy detection) provided by the robot. Use of this type of service has a positive effect on the caregivers’ burden,

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especially regarding their level of anxiety about the safety of their family member [8,16,19]. In the same vein, Rialle et al. [25] found that the most appreciated technologies were those that increase the patient’s safety and the caregiver’s freedom to leave the home, while decreasing the caregiver’s fear of an accident.

Thirdly, the caregivers express their wish to communicate with health professionals via the robot to obtain information on treatment, care and support.

4.4. Modes of action of the robot

The caregivers would like the robot to be able to speak in order to inform the patient of a programmed event.

Most caregivers think that the patient would feel uneasy about wearing a personal emergency system continuously (in order to be detected in emergency situations). Wearing it on one’s body may be perceived as physically and psychologically obtrusive: it could be perceived as uncomfortable and symbolise a growing dependence, which is stigmatising. The respondents are in favour of the possibility to switch off the robot because the continuous activity of the robot could be perceived as obtrusive to personal routines. These findings are in accordance with the concept of obtrusiveness defined by Hensel et al. [14].

Caregivers do not seem to be concerned by privacy: they are not opposed to the presence of the robot in the bedroom despite that the robot has video camera and could transmit the data to third parties, contrary to the findings in the literature [6,7].

In case of emergency, our findings show that the caregivers are interested in a tele-care system that could provide a real opportunity to support and assist elderly people and could alleviate their burden.

4.5. Recommendations

To meet the needs of caregivers and to take into account technical limitations, the robot should include the following functions and modes of action:

– cognitive stimulation programme – drug intake and appointments reminder – falls and abnormal position detection – automatic help call – remote control by health professionals – possibility to switch off the robot

Moreover, the following functions must be adjustable:

– The signals to inform a programmed event should include at least 3 modalities (sound, oral and visual). The switch from one modality to another should be possible, and easily feasible. Moreover, another modality should be considered for the persons with visual or hearing impairments.

– The possibility to keep watch on the patients and to follow them into all rooms. For those who want to protect their intimacy, the access of the robot everywhere in the apartment (especially the bedroom) must be limited.

– The night watch should be activated according to the wishes of the patient and his/her caregiver.

Additionally, the robot must be mutable and adaptable. When patients have cognitive impairment but are more or less autonomous, the robot helps them to manage daily activities (appointments, medicine reminder). When the disease progresses and the impairments become more debilitating, the robot must alleviate the caregivers’ burden and serve as an additional care provider by reinforcing remote tele-care.

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5. Conclusion

The limits of the study are the small size of the sample and the selection bias. The persons who agreed to answer the questionnaire were perhaps those who were the most open to the use of technologies. As a consequence, our population might not be representative and our results cannot be generalised. Be that as it may, our study will contribute to enlighten the means to provide help and support via the ICT.

Our results allow us to suggest a few recommendations for the conception of the system. It is important when developing robots to adhere to the needs addressed by caregivers who are able to judge a patient’s disabilities or to detect disease’s complications. In such a way, the tailored system gains a greater chance of acceptance and use by the target population.

These results will be complemented by evaluation of patients’ needs and by data collected from focus groups that we will conduct in future.

Acknowledgements

This work was carried out as part of QuoVADis project, funded by ANR-07-CNSA-Tecsan.

References

[1] S. Andrieu, H. Bocquet, A. Joel, S. Gillette-Guyonnet, F. Nourhashemi, A. Salva, A. Grand and REAL.FR Group, Changes in informal care over one year for elderly persons with Alzheimer’s disease, Journal of Nutrition, Health & Aging 9 (2005), 121–126.

[2] G. Baltus, D. Fox, F. Gemperle, J. Goetz, T. Hirsch, D. Magaritis, M. Montemerlo, J. Pineau, N. Roy, J. Schulte and S. Thrun, Towards personal service robots for the elderly. (2000) from http://www.cs.cmu.edu/˜thrun/papers/thrun.nursebot- early.pdf.

[3] T. Bickmore and R.W. Picard, Towards Caring Machines, Proceedings of CHI, Vienna, Austria, 2004. [4] P. Breuil-Genier, Aides aux personnes âgées dépendantes: la famille intervient plus que les professionnels, Economie et

statistique 316–317 (1998), 21–43. [5] A. Cesta, S. Bahadori, G. Cortellessa, G. Grisetti, M.V. Giuliani, L. Locchi, G.R. Loene, D. Nardi, A. Oddi, F. Pecora, R.

Rasconi, A. Saggese and M. Scopelliti, The Robocare project cognitive systems for the care of the elderly. In Proceedings of International Conference on Aging, Disability and Independence, 2003.

[6] K.L. Courtney, Privacy and senior willingness to adopt smart home information technology in residential care facilities, Methods of Information in Medicine 47 (2008), 76–81.

[7] G. Demiris, B.K. Hensel, M. Skubic and M. Hantz, Senior residents’ perceived need of and preferences for “smart home” sensor technologies, International Journal of Technology Assessment in Health care 24 (2008), 120–124.

[8] A.S. Dibner, Personal emergency response systems: communication technology aids elderly and their families, Journal of Applied Gerontology 9 (1990), 504–510.

[9] M. Dowds and K. Robinson, Assistive technology for memory impairment: Palmtop computers and TBI. In Braintree Hospital Traumatic Brain Injury Neurorehabilitation Conference, 1996.

[10] N. Dutheil, Les aides et les aidants des personnes âgées. Etudes et résultats, Drees, n◦ 208. 2001. [11] H. Feldman, S. Gauthier, J. Hecker, B. Vellas, B. Emir, V. Mastey and P. Subbiah, Donepezil MSAD Study Investigators

Group. Efficacy of donepezil on maintenance of activities of dailiy living in patients with moderate to severe Alzheimer’s disease and the effect on caregiver burden, Journal of the American Geriatrics Society 51 (2003), 737–744. Erratum in: Journal of the American Geriatrics Society 51 (2003), 1331.

[12] J. Forlizzi, C. DiSalvo and F. Gemperle, Assistive Robotics and an Ecology of Elderly Living Independently in Their Homes, Journal of HCI Special Issue on Human-Robot Interaction 19 (2004), 25–59.

[13] R.H. Friedman, Automated telephone conversation to access health behaviour and deliver behaviour interventions, Journal of Medical Systems 22 (1998), 95–101.

[14] B. Hensel, G. Demiris and K. Courtney, Defining obtrusiveness in home telehealth technologies: a conceptual framework, Journal of the American Medical Informatics Association: JAMIA 13 (2006), 428–431.

[15] N.A. Hersh and L. Treadgold, Neuropage: the rehabilitation of memory dysfunction by prosthetic memory and cueing, Neurorehabilitation 4 (1994), 187–197.

40 V. Faucounau et al. / Caregivers’ requirements for in-home robotic agent

[16] B. Johnston, L. Wheeler, J. Deuser and K.H. Sousa, Outcome of the Kaiser permanent tele-home health research project, Archives of Family Medicine 9 (2000), 40–45.

[17] N. Katevas, Mobile Robotics in Health Care Services, IOS Press, Amsterdam, The Netherlands, 2001. [18] S. Lauriks, A. Reinersmann, H.G. Van der Roest, F.J. Meiland, R.J. Davies, F. Moelaert, M.D. Mulvenna, C.D. Nugent

and R.M. Dröes, Review of ICT-based services for identified unmet needs in people with dementia, Ageing Research Reviews 6 (2007), 223–246.

[19] C. Montgomery, Personal response system in United States, Home Health Care Services Quarterly 13 (1992), 201–222. [20] E.D. Mynatt, I. Essa and W. Rogers, Increasing the opportunities for aging in place. Proceedings of CUU Conference

on Universal Usability New York: ACM, 2000, 65–71. [21] A. Pla, Bilan démographique 2007 : des naissances toujours très nombreuses. Insee première n◦ 1170. 2008. [22] L. Plouffe, Canadian Perspectives on Older Adult User Needs: ICT. Research for Independent Living, EC Workshop,

Brussels, Nov 24–25 2005, from http://ftp.jrc.es/EURdoc/eur22352en.pdf. [23] M.E. Pollack, L. Brown, D. Colbry, C. Orosz, B. Peintner, S. Ramakrishnan, S. Engberg, J.T. Matthews, J. Dubar-Jacob,

C.E. McCarthy, S. Thrun, M. Montemerlo, J. Pineau and N. Roy, Pearl: A mobile robotic assistance for the elderly. In Proceedings AAAI Workshop on Automation as Caregiver, 2002.

[24] M.E. Pollack, Intelligent Technology for an Aging Population: The Use of AI to Assist Elders with Cognitive Impairment, AI Magazine 26 (2005), 9–24.

[25] V. Rialle, C. Ollivet, C. Guigui and C. Hervé, What Do Family Caregivers of Alzheimer’s Disease Patients Desire in Smart Home Technologies? Contrasted results of a wide survey, Methods of Information in Medicine 47 (2008), 63–69.

[26] S. Sörensen, P. Duberstein, D. Gill and M. Pinquart, Dementia care: mental health effects, intervention strategies and clinical applications, Lancet Neurology 5 (2006), 961–973.

[27] W. Taggart, S. Turkle and C. Kidd, An interactive robot in a nursing home: Preliminary remarks. In Towards Social Mechanisms of Android Science, Cognitive Science Society, Stresa, Italy, 2005.

[28] K. Wada, T. Shibata, T. Saito and K. Tanie, Effects of Robot Assisted Activity to Elderly People who Stay at a Health Service Facility for the Aged. Proceedings of the 2003 IEEE/RSJ International Conference on Intelligent Robots and Systems, Las Vegas, Nevada, 2003.

[29] B. Winblad, A. Wimo and O. Amkvist, Outcome measures in Alzheimer’s disease: do they go far enough? Dementia and Geriatric Cognitive Disorders 11 (2000), 3–10.