Using a therapeutic companion robot for dementia symptoms in long-term care: reflections from a cluster-RCT

ABSTRACT Objectives: We undertook a cluster-randomised controlled trial exploring the effect of a therapeutic companion robot (PARO) compared to a look-alike plush toy and usual care on dementia symptoms of long-term care residents. Complementing the reported quantitative outcomes , this paper provides critical reflection and commentary on individual participant responses to PARO, observed through video recordings , with a view to informing clinical practice and research. Method: A descriptive, qualitative design with five participants selected from the PARO intervention arm of the trial. The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000508673). Results: The five participants and their responses to PARO are presented in terms of three issues: i.) Different pre-intervention clinical presentations and different responses; ii.) Same individual, different response – the need for continual assessment and review; and iii.) The ethics of giving and retrieving PARO. Implications for clinical practice and future research are discussed in relation to each issue. Conclusion: The findings suggest that one approach does not fit all, and that there is considerable variation in responses to PARO. A number of recommendations are discussed to aid the delivery of psychosocial interventions with PARO in practice, as well as to guide future research.

[1]  Roger Bemelmans,et al.  Socially assistive robots in elderly care: a systematic review into effects and effectiveness. , 2012, Journal of the American Medical Directors Association.

[2]  Claire Glenton,et al.  Use of qualitative methods alongside randomised controlled trials of complex healthcare interventions: methodological study , 2009, BMJ : British Medical Journal.

[3]  K. Sink,et al.  Pharmacological Treatment of Neuropsychiatric Symptoms of Dementia , 2005 .

[4]  S. Slaughter,et al.  Consent and Assent to Participate in Research from People with Dementia , 2007, Nursing ethics.

[5]  B. Draper,et al.  Use of a Robotic Seal as a Therapeutic Tool to Improve Dementia Symptoms: A Cluster-Randomized Controlled Trial. , 2017, Journal of the American Medical Directors Association.

[6]  Christianna S. Williams,et al.  Attitudes, stress, and satisfaction of staff who care for residents with dementia. , 2005, The Gerontologist.

[7]  Sandra Petersen,et al.  The Utilization of Robotic Pets in Dementia Care , 2016, Journal of Alzheimer's disease : JAD.

[8]  Wendy Moyle,et al.  “She Had a Smile on Her Face as Wide as the Great Australian Bite”: A Qualitative Examination of Family Perceptions of a Therapeutic Robot and a Plush Toy , 2019, The Gerontologist.

[9]  Gianluca Baio,et al.  Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials. , 2014, The British journal of psychiatry : the journal of mental science.

[10]  J. Cohen-Mansfield,et al.  The impact of a restraint-reduction program on nursing home residents. , 1994, Geriatric nursing.

[11]  Lukman Thalib,et al.  Effect of an interactive therapeutic robotic animal on engagement, mood states, agitation and psychotropic drug use in people with dementia: a cluster-randomised controlled trial protocol , 2015, BMJ Open.

[12]  W. Moyle,et al.  Exploring the effect of companion robots on emotional expression in older adults with dementia: a pilot randomized controlled trial. , 2013, Journal of gerontological nursing.

[13]  J. Gaugler,et al.  Alzheimer's disease and nursing homes. , 2014, Health affairs.

[14]  J. Wattis,et al.  The scope for qualitative methods in research and clinical trials in dementia. , 2004, Age and ageing.

[15]  Clive Ballard,et al.  Improving quality of life for people with dementia in care homes: making psychosocial interventions work. , 2012, The British journal of psychiatry : the journal of mental science.

[16]  J. Johnston,et al.  The Effects of Incident and Persistent Behavioral Problems on Change in Caregiver Burden and Nursing Home Admission of Persons With Dementia , 2010, Medical care.

[17]  J. Alsop,et al.  The mixed randomized trial: combining randomized, pragmatic and observational clinical trial designs. , 2016, Journal of comparative effectiveness research.

[18]  C. Cornman,et al.  The influence of caregivers and behavioral and psychological symptoms on nursing home placement of persons with Alzheimer’s disease: A matched case–control study , 2016, SAGE open medicine.

[19]  D. Basic,et al.  The Rowland Universal Dementia Assessment Scale (RUDAS) and the Folstein MMSE in a multicultural cohort of elderly persons , 2006, International Psychogeriatrics.

[20]  C. Ritchie,et al.  Dementia trials and dementia tribulations: methodological and analytical challenges in dementia research , 2015, Alzheimer's Research & Therapy.

[21]  S. Zuidema,et al.  Prevalence of neuropsychiatric symptoms in a large sample of Dutch nursing home patients with dementia , 2007, International journal of geriatric psychiatry.

[22]  Alzheimer’s Association,et al.  2016 Alzheimer's disease facts and figures , 2016, Alzheimer's & Dementia.

[23]  D. Faraoni,et al.  Randomized controlled trials vs. observational studies: why not just live together? , 2016, BMC Anesthesiology.

[24]  J. Greene,et al.  Assessing the Gold Standard--Lessons from the History of RCTs. , 2016, The New England journal of medicine.

[25]  J. Weuve,et al.  2016 Alzheimer's disease facts and figures , 2016 .

[26]  Takanori Shibata,et al.  Comparison of Verbal and Emotional Responses of Elderly People with Mild/Moderate Dementia and Those with Severe Dementia in Responses to Seal Robot, PARO , 2014, Front. Aging Neurosci..

[27]  S. Parveen,et al.  Psychosocial interventions for people with dementia: An overview and commentary on recent developments , 2019, Dementia.

[28]  C. Ihlebæk,et al.  Effects on Symptoms of Agitation and Depression in Persons With Dementia Participating in Robot-Assisted Activity: A Cluster-Randomized Controlled Trial. , 2015, Journal of the American Medical Directors Association.

[29]  J. Ware,et al.  Pragmatic trials--guides to better patient care? , 2011, The New England journal of medicine.

[30]  P. Reed,et al.  End-of-life care practice recommendations for assisted living residences and nursing homes serving individuals with dementia , 2008 .

[31]  D. Gerritsen,et al.  Only 10% of the psychotropic drug use for neuropsychiatric symptoms in patients with dementia is fully appropriate. The PROPER I-study , 2016, International Psychogeriatrics.

[32]  Jon Nicholl,et al.  Rethinking pragmatic randomised controlled trials: introducing the “cohort multiple randomised controlled trial” design , 2010, BMJ : British Medical Journal.

[33]  W. Moyle,et al.  Care staff perceptions of a social robot called Paro and a look-alike Plush Toy: a descriptive qualitative approach , 2018, Aging & mental health.

[34]  Wendy Moyle,et al.  Assessing engagement in people with dementia: a new approach to assessment using video analysis. , 2015, Archives of psychiatric nursing.

[35]  P. Braun,et al.  Residential aged care in Australia 2005-06: a statistical overview , 2007 .

[36]  Martin Knapp,et al.  Dementia UK: Update , 2014 .

[37]  M. Rapoport,et al.  Pharmacological treatments for neuropsychiatric symptoms of dementia in long-term care: a systematic review , 2012, International Psychogeriatrics.

[38]  T. Partonen,et al.  Comparison of verbal and emotional responses of elderly people with mild/moderate dementia and those with severe dementia in responses to seal robot, PARO , 2014 .

[39]  J. T. van der Steen,et al.  Characteristics Associated with Quality of Life in Long-Term Care Residents with Dementia: A Cross-Sectional Study , 2016, Dementia and Geriatric Cognitive Disorders.

[40]  Gary Mitchell,et al.  Ethical considerations of doll therapy for people with dementia , 2014, Nursing ethics.

[41]  E. Mordoch,et al.  Use of social commitment robots in the care of elderly people with dementia: a literature review. , 2013, Maturitas.

[42]  P. Videbech,et al.  Behavioral Responses of Nursing Home Residents to Visits From a Person with a Dog,a Robot Seal or aToy Cat , 2016 .