The Age of the Robot: Mental health in older people

Dr Jordan Abdi is a Foundation Trainee at the Kings College Hospital Trust in London. He has been working with a team of researchers in the burgeoning field of socially assistive robots, and how the technology can be used in clinical settings. Jordan has worked with London City Hall, the European Commission, the G7 and the G20 summits to help develop the future policy directions on issues including the rise of robots and their impact on workers. He will be speaking at the upcoming BGS Spring Meeting, 10-12 April in Cardiff.

As of 2019, the ‘robot revolution’ promises to solve the ever-growing skilled-personnel shortage across industries. In healthcare, socially assistive robot technology promises to assume new roles to meet the growing demand of our ageing population. Growth in numbers of older people is compounded by a proportional decrease in the number of social and healthcare providers. In 2015, there were seven workers for every older person across the globe, however by 2030 the number is projected to fall to below five. It is in this context that we look to robots.

At present, physically or surgically assistive robots dominate the healthcare sector’s robot usage. From increasingly sophisticated wheelchairs to robotic limbs, the future of robotic healthcare is often defined in these terms. However, a smart walking stick cannot combat the increase in mental health conditions recognised in older people. It is here that socially assistive robots are gaining headway. Much of the excitement surrounding these robots centres on their ability to solve the challenges facing social care, by assisting with activities of daily living, monitoring and improving physical health and improving the overall wellbeing of its users.

As of yet however, I remain unconvinced that socially assistive robots will have any significant impact on care for older people in the near future. Loneliness, for instance, remains one of the growing and under-recognised difficulties facing older people. Over half of people over the age of 75 live alone and 17% of older people see family, friends or neighbours less than once a week. A meta-analysis in 2015 showed that the impact of loneliness and isolation carries the same mortality risk as smoking 15 cigarettes a day. Although socially assistive robots have been shown to reduce loneliness, they have only done so in small, weak studies that did not account for important confounders. For example, several studies across cultural spheres have shown that when socially assistive robots are used in group settings, they improve the sociability of the subjects, which is maintained even when the robot is taken away. There have been three major studies that have assessed the impact SAR have on loneliness and two of them were conducted in group settings, which makes it difficult to ascertain whether the reduced loneliness scores of the participants was due to the robot itself or through indirectly increasing the sociability of the subjects.

In order to achieve a successful application of socially assistive robots in this setting, future research needs to be more conscious of the outcome measures chosen and its translation into care. Many studies use surrogate measures such as frequency of laughter, or performance in particular games, and while these may be desired outcomes, it is not clearly demonstrated how they meet quantifiable needs of the population being studied. For example, a Japanese study involved a robot staying at home with the participants for 8 weeks and assessed its impact using cognitive tests and saliva samples. While the study demonstrated an improvement in cognitive scores and a reduction in saliva cortisol, it did not assess whether living with a robot for 8 weeks had any impact on loneliness.

I have been researching socially assistive robots for 5 years, and am fascinated by the new frontiers these robots have created in medical and social care. The dramatic impact that our ageing population will have on society is widely reported and there exists no real solution to the challenges this demographic change will present. The potential for this technology to completely revolutionise care is attainable if we focus on the needs of the older population. More collaboration between healthcare professionals, social care workers and robotic engineers is vital in bridging the gap between concept and delivery. The scope for socially assistive robot technology in health and social care is limited only by our imagination and it is our responsibility to realise a smart future.