Two paragraphs about Caregivers Robots in family.

Reactions to a Remote-Controlled Video-Communication Robot in Seniors’ Homes: A Pilot Study of Feasibility and Acceptance

Adriana M. Seelye, M.S.,1,2 Katherine V. Wild, Ph.D.,1,3

Nicole Larimer, B.A.,3 Shoshana Maxwell, M.P.H.,3

Peter Kearns, B.A.,3 and Jeffrey A. Kaye, M.D.1,3

1Layton Aging & Alzheimer’s Disease Center and 3Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon.

2Department of Psychology, Washington State University, Pullman, Washington.

Portions of this research were presented at the 64th annual meeting of the Gerontological Society of America, November 18–22, 2011, in Boston, Massachusetts.

Abstract Objective: Remote telepresence provided by tele-operated robotics

represents a new means for obtaining important health informa-

tion, improving older adults’ social and daily functioning and

providing peace of mind to family members and caregivers who live

remotely. In this study we tested the feasibility of use and accep-

tance of a remotely controlled robot with video-communication

capability in independently living, cognitively intact older adults.

Materials and Methods: A mobile remotely controlled robot with

video-communication ability was placed in the homes of eight se-

niors. The attitudes and preferences of these volunteers and those of

family or friends who communicated with them remotely via the

device were assessed through survey instruments. Results: Overall

experiences were consistently positive, with the exception of one

user who subsequently progressed to a diagnosis of mild cognitive

impairment. Responses from our participants indicated that in

general they appreciated the potential of this technology to enhance

their physical health and well-being, social connectedness, and

ability to live independently at home. Remote users, who were

friends or adult children of the participants, were more likely to test

the mobility features and had several suggestions for additional

useful applications. Conclusions: Results from the present study

showed that a small sample of independently living, cognitively

intact older adults and their remote collaterals responded positively

to a remote controlled robot with video-communication cap-

abilities. Research is needed to further explore the feasibility and

acceptance of this type of technology with a variety of patients and

their care contacts.

Key words: robotics, tele-operated, aging, technology, video-

communication

Introduction

T he U.S. population is aging at a rapid rate. In the next 25

years, the number of individuals 65 years and older will

double to 72 million.1 Despite the importance most older

adults place on maintaining independence and ‘‘aging in

place,’’2 older adults and those with cognitive impairment face sig-

nificant challenges to living independently. In addition to functional

decline, falls, decreased mobility, sensory impairment, caregiver

burden, and social isolation all pose threats to independent living.3

Social relationships are an important factor for maintaining life

satisfaction and subjective well-being in healthy older adults and

those with cognitive impairments.4 Low social support is predictive

of long-term mortality in older adults5 and can put severe strain on

caregivers.6

Decreasing healthcare personnel and resources,7 rising healthcare

costs,8 and advancing technology have fostered the development of

monitoring and assistive technologies for older adults. Such tech-

nologies are poised to provide novel approaches to enhance older

adults’ physical health, well-being, social connectedness, and ability

to live independently at home. Decreased costs associated with for-

mal healthcare and assisted living placement are additional benefits

of in-home monitoring and intervention technologies. Ubiquitous

sensor networks that provide unobtrusive in-home monitoring of

physical activity,9 complex activity recognition,10 context-based

IADL reminder systems,11,12 home telecare,13 and physically or so-

cially assistive robots14,15 are examples of smart environment as-

sistive technologies.

Given the detrimental effects of social isolation on older adults,

assistive technologies that promote older adults’ interaction with

others have gained recent interest. Two such technologies are socially

assistive robotics (SAR) and tele-operated (remote control) robotics.

SAR provides assistance to human users through nonphysical social

interaction.16 A socially assistive robot is characterized by its physi-

cal nature, personality traits, emotional expression, human–robot

dialog, and user-modeling. SAR devices have been used to decrease

social isolation, increase compliance with medical treatments, and

keep older adults functioning independently longer at home.11,16

Tele-operated remote control robotics are controlled remotely and

generally do not provide the same level of human–robot social in-

teraction to users as SAR. However, given that they are controlled

remotely, tele-operated robotics have the unique capability of al-

lowing a user to be video-monitored by a caregiver or healthcare

provider while living independently. It is important that tele-

operated robots allow users to stay connected with family members

or friends who live outside of the home through mobile

D O I : 1 0 . 1 0 8 9 / t m j . 2 0 1 2 . 0 0 2 6 ª M A R Y A N N L I E B E R T , I N C . � V O L . 1 8 N O . 1 0 � D E C E M B E R 2 0 1 2 TELEMEDICINE and e-HEALTH 755

videoconferencing. These features have the potential to positively

impact social functioning, quality of life, and ability to live

independently.

Only one study to our knowledge has examined older adult and

healthcare provider perceptions of an in-home robotic telepresence

for community-dwelling older adults.17 In this study, participants

reported that a robotic telepresence could help to monitor abilities in

everyday life, enhance safety, reduce travel to healthcare visits, re-

lieve caregiver burden, and facilitate communication. Healthcare

providers had slight concerns that telepresence robots could lead to

older adult isolation and loss of privacy. Overall, tele-operated ro-

botics have the potential to improve older adults’ social and daily

functioning, while providing peace of mind to family members and

caregivers who live remotely. No studies known to us have assessed

the feasibility of in-home tele-operated robotics with older adults

and individuals with cognitive impairment.

In the present study, we expand upon previous research by con-

ducting a pilot study examining the feasibility and acceptance of a

remotely controlled robot with video-communication capability in a

sample of independently living healthy older adults. We were in-

terested in exploring the attitudes and preferences of seniors and

those of family or friends who communicated with them remotely via

the device.

Subjects and Methods PARTICIPANTS

Volunteers in the present study were drawn from a longitudinal

cohort established to understand how various methods of pervasive

home computing and other technologies may support or improve the

health and independence of people as they age. These volunteers

comprise the participants in the ORCATECH Living Laboratory (OLL),

which is a community-based resource of volunteer seniors who have

agreed to allow emerging technologies to be deployed and tested in

their homes. These volunteers undergo semiannual standardized

cognitive, functional, and neurological batteries and report weekly

on changes to their health, medications, and life events. Broadband

Internet connection was installed in each home. Secure Web-based

software allows remote management of longitudinal data streams,

the status of the sensor net, and the participants.

Although all participants were deemed not demented at time of

enrollment (Clinical Dementia Rating scale < 1; Mini-Mental State Examination [MMSE] > 24), mild cognitive impairment (MCI) was not a criterion for exclusion. MCI was defined as objective cognitive

impairment in at least one domain, in the presence of normal general

cognitive function, minimal or no functional decline, subjective

memory complaint, and absence of dementia diagnosis.18 Impair-

ment on neuropsychological testing was defined as a score 1.5

standard deviations or more below the model-derived predicted

mean values stratified by age, education, and sex. Normative data

were based upon 3,268 cognitively normal individuals enrolled in 32

Alzheimer’s Disease Centers.19

Participants were free of medical conditions that would cause

physical disability or likelihood of death within 3 years, the duration

of the initial Living Laboratory recruitment. The eight volunteers for

this project were living alone in their own homes and were able to

identify a remote collateral individual who would be willing to

participate. All volunteers signed written informed consent to par-

ticipate in the project.

TELEPRESENCE ROBOT The VGo robot system (VGo Communications, Nashua, NH) in-

cludes a remote telepresence robot, handheld local controller, 8-h

battery, charging dock and power cord, and a remote driving con-

troller. Technical requirements for the in-home user include 802.11

broadband wireless coverage, unsecured, WEP, or WPA2 security,

and > 384 kilobits per second (Kbps) Internet upload speed. Technical requirements for the remote user include Vista, XP, or MAC, Dual

Core 2.0 GHz, 1MD RAM, > 384 Kbps Internet upload speed, camera, microphone, and speakers.

MEASURES For the purposes of this study two questionnaires were developed

to record participant and collateral responses to their experience with

the device. Based on an Alpha User Feedback Questionnaire utilized

by VGo in the early stages of prototype development, the participant

feedback questionnaire focused on six areas of interest: appearance,

communications experience, driving experience, home experience,

privacy, and applications. The remote user questionnaire was limited

to installation and setup (of computer software), communications

experience, and driving experience. The interviews all started by

asking about the general impressions of the users, followed up by

queries about specific aspects of the device and its operation. All

participants were given the opportunity to make additional com-

ments at the end of the interview.

PROCEDURES Prior to deployment in participants’ homes, the device was in-

stalled in the Oregon Health & Science University Point of Care La-

boratory, a mock apartment set up in the Biomedical Engineering

Department for initial testing. Following successful installation and

manipulation of the system, it was then tested in the home of one of

the authors (N.L.) for final evaluation before use in volunteers’ homes

(see Fig. 1). Minor software and device malfunctions were corrected

through communication with the system’s engineers.

System requirements were reviewed with potential participants

prior to consent and installation. Participants were asked to identify a

family member or friend with whom they communicate on a regular

basis. For Living Laboratory volunteers, wireless coverage and other

technical prerequisites had already been provided as part of their

enrollment in that project. For collateral sources, broadband Internet

access with appropriate upload speed and specified home computer

capabilities were verified.

Once both the participant’s and collateral’s systems were installed,

both were trained in the device’s use. Users were trained in their

home, to answer incoming calls, to make calls, to turn off the device,

and to adjust the volume and on other technical elements. Seniors’

SEELYE ET AL.

7 5 6 TELEMEDICINE and e-HEALTH D E C E M B E R 2 0 1 2

remote collateral participants were trained in initiating calls and

moving the device as needed. Each senior had the device available for

two complete days. During that time they received a daily call from

the Oregon Health & Science University research team and up to two

additional calls daily from the family member or friend who was

trained in use of the device. After the device was removed, both users

and collateral sources were interviewed regarding their impressions

of the device and its potential long-term utility.

Results Eight Living Laboratory participants and their remote collaterals

were enrolled in this study. Table 1 shows participants’ baseline de-

mographics. All participants were cognitively intact at study en-

rollment, although one participant progressed to a diagnosis of MCI

after study completion. Participant and remote collateral responses to

interview questions were reviewed and summarized by a licensed

psychologist (K.V.W.) and a clinical psychology graduate student

(A.M.S.). Recurring observations were tallied, and themes were

identified by consensus.

PARTICIPANT FEEDBACK Table 2 gives for examples of participant feedback. Participants rated

the robot’s appearance favorably. Most participants placed the robot and

docking station in their main living space for the duration of the study.

Communication experience was also rated positively by participants.

Specifically, participants reported that it was easy to hear and answer

calls and turn the robot on and off. The picture and volume were clear

and worked well. Participants reported slight confusion about how to

use the handheld remote, and one person unplugged the robot because

she was worried about a fire. Feedback on driving experience was

mixed. Although most users drove the robot and said it was easy to

operate, they expressed concern that driving hazards were not com-

municated clearly or obviously by the robot. In addition, transitions

from solid flooring to carpeting were problematic. Home experience was

rated positively for relatively easy and nonobtrusive movement of the

robot throughout the home. Participants expressed little concern about

privacy, although they highlighted the importance of having control

and knowledge of who has access to call them through the device. The

majority of participants stated that they would be willing to use the

robot with friends, family members, and healthcare providers.

Table 1. Baseline Demographics of Participants

DEMOGRAPHIC VALUE

Gender

Male 1

Female 7

Age (years)

Mean – SD 77.5 – 8.4

Range 64–92

Education (years)

Mean – SD 12.6 – 3.2

Range 7–18

Race (n)

White 7

Black 1

MMSE

Mean – SD 27.2 – 3.5

Range 19–29

MMSE, Mini-Mental State Examination.

Table 2. Example Participant Feedback

� ‘‘It was nice that my daughter didn’t always have to come over.’’

� ‘‘Gave me a sense of safety.’’

� ‘‘It was like another person. I was sad to see it go.’’

� ‘‘It would be good for checking on a sedentary person.’’

� ‘‘Not sure what the purpose is supposed to be.’’

� ‘‘It was too complicated.overwhelming.’’a

a Participant who progressed to mild cognitive impairment.

Fig. 1. The telecommunication robot in a study participant’s home.

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Additional uses for the robot suggested by participants were to help

people with everyday tasks and chores and to alert a caregiver if user

was in danger or needed medical care.

Overall, participants reported that their experience using the robot

was positive and enjoyable. Its appearance was rated favorably, and

participants kept the robot in their main living spaces and in most

cases were sad to see it go. Participants became more comfortable

operating the robot with increased practice. Only one participant had

a negative experience with the robot. She was confused by its purpose

and function and requested that it be removed from her home. This

individual progressed to a diagnosis of MCI after the study ended.

REMOTE COLLATERAL FEEDBACK Table 3 gives for examples of collateral feedback. Collaterals rated

the ease of installation and setup of the software positively. Com-

munication experience was also rated very favorably. Specifically,

collaterals commented that the calling interface was user-friendly

and the video and sound quality were good. Collaterals particularly

liked having the ability to move the robot around in their loved one’s

environment during calls. Feedback on driving experience was

mixed. For example, some thought it was easy, others thought it

became easier with practice, and others rated it as very difficult.

Consistent with participant feedback, driving hazards were not ob-

vious to collaterals and not clearly communicated in timely fashion.

Overall, collaterals rated their experience with installation and use

and communication positively. Concerns about driving were ex-

pressed. Collaterals liked the mobility of the robot compared with

stationary video-communication technology and commented that

this type of technology would give peace of mind to family members.

Discussion Responses from our participants indicated that in general they

appreciated the potential of the telepresence robotic technology to

enhance their physical health and well-being, social connectedness,

and ability to live independently at home. This finding is consistent

with previous research that has demonstrated that older adults re-

spond positively to technologies that support their values of personal

identity, dignity, independence, and maintenance of social ties.20

Responses from remote collaterals were also positive and indicated

that they appreciated the potential of the technology to increase their

loved one’s safety and social connectedness. This finding is consis-

tent with previous research indicating that assistive technologies that

address safety and social isolation are considered of utmost impor-

tance to caregivers.21 Also, consistent with previous research,22 care

contacts in the present study suggested that an in-home robot might

be even more useful if it provided assistance with everyday tasks and

chores as well as the detection of danger (e.g., falls) and provision of

alerts for medical assistance.

There were nevertheless some reservations among this small

sample about the robot’s practicality. For example, operating the

handheld remote was slightly confusing to some participants, and the

device’s wheels were not durable enough to handle transitions be-

tween rooms with different types of flooring. Consistent with our

results, previous research has shown that barriers to technology ac-

ceptance in this population include devices that are physically ob-

trusive, are difficult to use and interact with, or function

poorly.19,22,23 Longer and more detailed initial training with these

types of technologies might address concerns about operation of

remote controls and increase the users’ sense of self-efficacy and

confidence with the devices. Additionally, advances in user interface

may enhance acceptance of such devices by older adults.

Our single participant who went on to develop MCI was unable to

use the device and requested that it be removed. We are not the first to

find that individuals with MCI have more difficulty with technology

than healthy older adults. DeJoode et al.24 found that cognitively

impaired individuals had more difficulty managing everyday tech-

nology in their homes than intact individuals and that caregiver

assistance is likely important to their uptake and use of new tech-

nology. Seelye et al.23 examined the feasibility of training individ-

uals with MCI to use electronic memory aids to compensate for

memory loss. The authors found that although participants with MCI

enjoyed the challenge of learning to use electronic aids, even seem-

ingly basic devices proved too complicated, and participants stopped

using them after the study ended. It should be noted that the types of

technology examined in these studies were everyday technologies that

were relatively familiar to participants, such as voice recorders and

personal digital assistants. It is possible that the novelty of the robot

was related to our one participant’s negative reaction to it. Introducing

a new technology as early as possible in the MCI process would give

the user time to become familiar with it before cognitive impairment

progressed and might increase acceptance and long-term use.

Conclusions In summary, results from the present study showed that a small

sample of independently living, cognitively intact older adults and

their remote collaterals responded positively to a remote controlled

robot with video-communication capabilities. One participant who

later progressed to a diagnosis of MCI responded negatively to the

robot. Participants expressed little concern about privacy, although

they expressed desire to have control over who had access to contact

them through the device. Possible barriers to acceptance of this de-

vice included difficulties maneuvering it around the environment.

When designing tele-operated remote control robotics for older

adults, attention should be given to device functionality as well as the

unique physical, cognitive, emotional, and social needs of the

Table 3. Example Remote Collateral Feedback

� ‘‘Everyone that’s older should have one.’’

� ‘‘It’s a great tool that would give the family peace of mind.’’

� ‘‘When I felt like checking up on him I could just log on.’’

� ‘‘(It would be useful) to alert health care providers of anything dangerous like elevated heart rate.’’

SEELYE ET AL.

7 5 8 TELEMEDICINE and e-HEALTH D E C E M B E R 2 0 1 2

population. Given that older adults may experience sensory, motor,

and cognitive limitations, user interfaces should be large and intui-

tive to use, operation requirements should be simple and clearly

communicated, and features should be modifiable based on indi-

vidual preferences and lifestyle. Research is needed to further explore

the feasibility and acceptance of this type of technology with cog-

nitively impaired older adults.

Limitations of the present study include the small sample size,

short study duration, and use of only qualitative data. In addition,

we did not control for variables that may affect attitudes toward

technology, such as depressed mood, chronic pain, and significant

life events. Future quantitative studies are needed with larger

samples of healthy older adults and individuals with MCI. Ex-

tended exposure to the device and collection of quantitative data

would provide more robust findings about not only the accept-

ability but also the utility and perceived benefits of remote con-

trolled in-home video-communication in healthy and cognitive

impaired older adults. Additional applications of the device, as

recommended by our participants and their friends or family have

yet to be explored.

Acknowledgments This research was supported by NIA grants P30AG08017,

P30AG024978, and 1R01AG024059 and by VGo Communications.

Disclosure Statement No competing financial interests exist. VGo Communications had

no involvement in study design; collection, analysis, and interpre-

tation of data; writing the report; or the decision to submit the report

for publication.

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Address correspondence to:

Katherine V. Wild, Ph.D.

Layton Aging & Alzheimer’s Disease Center

Oregon Health & Science University

3181 S.W. Sam Jackson Park Road, CR131

Portland, OR 97239

E-mail: [email protected]

Received: January 27, 2012

Revised: March 2, 2012

Accepted: March 3, 2012

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