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the long view

A robot sidles up to an elderly man in a wheelchair. “Hi John,” the robot says. “Ready for some exercise?”

John keeps staring at the floor, so the robot takes a different tack. “How about a game of 21 Questions. What’s your favourite dessert?” The man’s face lights up. "Apple pie,” he says.

Robots such as this may be coming soon to a nursing home near you. To meet the shortage of nurses and healthcare aides, engineers are scrambling to develop robots programmed to respond to older adults’ mental, physical and social needs.

Paro, a “therapeutic robot” shaped like a baby harp seal, has already received regulatory approval as a medical device used to lower stress in people with dementia. Japanese developers, meanwhile, have come up with bulkier robots designed to provide personal care, such as helping patients out of bed.

But the next step, engineers say, is to program robots to engage older adults in mental and physical activities – and help break the ice in nursing homes by encouraging residents to interact with each other.

The goal is not to replace human caregivers, said Goldie Nejat, an associate professor of mechanical engineering at the University of Toronto, and Canada Research Chair in Robots for Society. But as we continue to live longer, Canada’s health-care system is struggling to keep up with the demand for elder care. “We do have a health-care need.”

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Dr. Goldie Nejat with some elder-care robot prototypes.Liz Do/University of Toronto

Nejat is developing robots that she hopes will help older Canadians maintain their independence at home, assist those living in remote areas and supplement care for groups of patients in residential facilities.

Older adults living alone often skip meals, especially if they suffer from depression. Prototypes known as “socially assistive robots” can help with this. Nejat is working on a robot that can seek out its owner at meal times and say, “Let’s go to the kitchen together.” The robot offers a selection of recipes and asks the owner to pick a favourite dish. Cooking alongside an interactive robot, she said, provides motivation to prepare a meal “and then actually eat it.”

Socially assistive robots can also mitigate elder isolation by sparking conversations among nursing-home residents and initiating bingo or trivia games, she said. Before long, “they’re playing together and interacting with each other – and of course the robot becomes a topic of interaction as well.”

Elder-care robots will be inexpensive compared with the cost of human labour, she added. One of her mobile prototypes, which stands just over four feet tall, should be ready for mass production in a few years, at an estimated cost of $2,000 – about the price of a high-end laptop.

Robots have potential to not only assist people directly, but also to reduce the risk of caregiver burnout, said Lorraine Mion, a professor of nursing at Ohio State University who specializes in geriatric care.

Older adults with physical or cognitive disabilities often lose interest in activities they used to enjoy. Time after time, she’s heard caregivers say things such as “I can’t get Dad to get outside” or “Mom won’t even watch TV anymore.” Apathy increases the risk of further mental and physical decline, and “it’s a real burden for families.”

But a robot never tires of nudging a patient to try something new, nor does it get distressed or frustrated when a patient shoots down one suggestion after another.

Mion and her colleague, Nilanjan Sarkar, a mechanical engineering professor at Vanderbilt University, have evaluated socially assistive robots in residential care facilities as part of research funded by the U.S. National Institutes of Health.

Adults with an average age of 80 participated in robot-led exercises, such as moving arms to music while seated in a chair, math quizzes and games such as 21 Questions. In surveys of more than 40 participants, about 95 per cent gave the experience a positive review, Sarkar said.

The robots are designed to be highly responsive to patients’ cues, he explained. Equipped with cameras, they use algorithms to analyze a person’s gaze and interest level. The robot, he said, "is like a good coach who is not bound to one activity, whether someone likes it or not.”

Robots with artificial intelligence may conjure nightmares of humanoid machines run amok, such as the rampaging “hosts” on the HBO series Westworld. On the other hand, who doesn’t love Pixar’s plucky trash compactor, WALL-E?

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A robot being studied for use in elder care by researchers at Vanderbilt University.Ashwaq Zaini Amat / Vanderbilt University/Vanderbilt University

People tend to prefer robots that are neither too mechanical-looking, nor eerily human, Mion said. Previous research has shown that people are most receptive to robots that have features such as eyes, a mouth and nose, as well as human-like gestures. But if a robot looks like it has human skin, “People feel uneasy with it.”

In the end, she said, acceptance of elder-care robots will depend on the individual. Some might say, “This is too invasive – get this thing out of here.” But others may regard them as their best bet to avoid moving to a nursing home.