Abstract
Assistive technologies are important tools for helping older people to live independently. Praminda Caleb-Solly, Associate Professor in Independent Living Systems at Bristol Robotics Laboratory (BRL) and Institute of Bio-Sensing Technologies, University of the West of England, provides an introduction as to how assistive robotics can address care needs.
Between 2000 and 2040, the proportion of the world’s population of those over 60 years old is expected to double from around 11% to 22%, and the absolute number of people aged 60 years and over is expected to increase from 605 million to 2 billion over the same period (World Population Ageing 2009; United Nations, New York, 2010). Ageing results in increased frailty and difficulties in performing activities of daily living activities, which increases the probability of long-term institutional care. Additionally, due to increased ageing-related impairments from conditions such as stroke, arthritis, heart disease and dementia, people are often not able to support themselves in their own homes. However, people do prefer to live in their own homes for as long as possible, staying active members of their local communities and families, rather than having to go into care.
The incidence and prevalence of chronic diseases and disabilities are having a profound impact on all aspects of our economy and society. Providing cost-effective and high-quality support for an ageing population, who have to cope with a range of disabling conditions, is a high priority issue for all governments. The lack of adequate social care provisions in the community and funding cuts have added to the burden on an already over-stretched healthcare system. It was reported that spending on social care had fallen by around £700 million since 2010 in the United Kingdom, 1 and there is a significant rise in people waiting for care home places, home care and home adaptations. 2
Connected and Secure Assistive Robotics Ecosystems
Intelligent robots, integrated with smart home sensors and healthcare databases, can provide the ability to realise autonomous assistive care solutions to support independent living for an ageing population.
Assistive technologies, such as smart home environments, integrated sensors and assistive robotics, are recognised as important tools in helping older people improve their quality of life and live independently for longer. 3 Current research is looking into a range of different ways in which robots might be used, such as assisting older adults with age-related disabilities and long-term conditions, and their carers, in daily tasks, to enable independent living and active ageing. 4
Assistive robots, working in conjunction with smart home sensors, can enable proactive initiatives to prompt and support a person wherever they are in their home, thus offering increased availability, awareness and access, as compared to a static telecare system. The assistance provided by a robot could include lifting and carrying, support with dressing and rehabilitation, or to monitor health with early detection of problems, using an interactive robot to provide guidance for taking remedial action.
In recent years, there have been a number of European research projects that involve the use of robots for providing physical and cognitive assistance to older adults. These include Hobbit – the mutual care robot, 5 a socially assistive robot to support older adults in their home for tasks such as picking up objects and detecting emergency situations; Care-O-Bot, 6 a mobile service robot focussed on the execution of fetch-and-carry tasks to support personnel of nursing homes in their daily tasks; RoboCare, 7 a multi-agent human assistance system composed of a robotic agent, sensors for continuous monitoring and reasoning systems; K-SERA, 8 a social robot that monitors, helps and alerts persons with chronic obstructive pulmonary disorder to facilitate effective self-management of their disease; Florence, 9 a multi-purpose robot with local and remote communication services to improve home care for older persons; and CompanionAble, 10 providing people suffering from mild cognitive impairments (MCI) with a cognitive assistive companion to support their wellbeing.
Researchers at the BRL at the University of the West of England are also leading the way in this field, working on key areas of research that are crucial to ensuring that service robots are useful and usable. Flagship projects in the BRL include CHRIS, 11 investigating cooperative human-robot interactive systems; MOBISERV, 12 an integrated intelligent home environment for the provision of health, nutrition and wellbeing services to older adults; INTRO, 13 an interactive robotics research network for training a new generation of robotic researchers to build intelligent robots that can function in real-world environments; MOBOT, 14 providing intelligent active mobility assistance by integrating sensory processing, proactive autonomy and adaptive interaction; and ReMeDi, 15 a robot system designed to enable medical tele-examination of patients. New projects include I-DRESS 16 and CHIRON, 17 both developing robotic devices to offer physical assistance. The work in the BRL involves understanding how people and robots can interact intuitively, safely and effectively; designing and testing robots that will be acceptable and enjoyable to use; and ensuring that the technology is developed being mindful of ethical and cultural issues. A robot as the interface also has the potential to offer a more social and entertaining interaction experience. The use of voice recognition and speech synthesis, gesture recognition and sensor information from ambient intelligent environments and smart garments enable a robotic assistive system to offer more natural interactions.
Cloud Robotics, Internet of Things and Social Intelligence
A key aspect of the research into assistive robotics is developing contextual and social intelligence for the robot to interact appropriately, safely and reliably in real-time. The aim is to develop robust and intelligent assistive robots by incorporating both environmental and user characteristics and behaviour as part of the overall intelligent control system architecture.
Assistive robots need access to information that is current and gives a dynamic world view of the user in order to provide information and support that is ‘intelligent’ and incorporates learning, otherwise the robot is functioning as a pre-programmed state machine. Drawing on contextual information from environmental and activity sensors instrumented into a smart home, and information about the user’s current physical and emotional state, assistive robots can create value through provision of interventions that are more socially intelligent in regard to how and what advice and support are provided. 18 To create a more holistic service that takes into consideration prioritisation of events based on aspects of health and social circumstance requires an adaptable, intelligent learning system. 19 Building on existing research on intelligent control system architectures, 20 research is being conducted to develop modular infrastructures that can be extended over time, as new functionalities are defined, and people’s conditions, and hence needs, change.
The current research focus in developing assistive robots that can be integrated into a range of contexts, centres on establishing how robotic devices can be appropriated as vital elements of a broader assisted living ecology.
User acceptance and ensuring effectiveness and efficiency of these technologies requires employing participatory design approaches, involving older people, their formal and informal carers, healthcare and social care and service providers, and clinicians. This can only be achieved by adopting a multidisciplinary approach in the conceptualisation, design and deployment of these technologies. In addition to achieving technological feasibility and user acceptance, it is vital to ensure that these technologies are economical to manufacture and maintain. Legal and ethical aspects of the use of autonomous systems are also areas that need more deliberation.
Impact
In 2011, there were over 800,000 older people whose care needs were not being met. 21 By 2020, we will face a shortage of up to two million health and social care workers across Europe. 22 The use of assistive robots has the potential for addressing the growing shortage of health and social care workers.
In a King’s Fund report, Appleby 23 notes that as the demography of the population changes, there will not only be an increased need for social and long-term care, but ‘the boundaries between what constitutes social care and what we consider health care to be, are likely to become increasingly blurred’. This also holds true for assistive technologies; with growing developments in point of care diagnostics and medical devices being developed for home use, the role for assistive robotics could also constitute providing social care, but also monitoring and emergency treatment of acute conditions in a home environment. In the first instance, this could be realised through telerobotic solutions, where specialists provide healthcare services at home via teleoperated robotics devices.
The recent Whole System Demonstrator Programme in the United Kingdom showed that if used correctly, telehealth can deliver a 15% reduction in Accident and Emergency visits, a 20% reduction in emergency admissions, a 14% reduction in elective admissions, a 14% reduction in bed days and an 8% reduction in tariff costs. 24 This represents a significant cost saving. However, telehealth devices that often require physical dexterity and cognitive capacity for effective use will present a considerable barrier for frail older adults with a range of complex ageing-related impairments. The use of autonomous or teleoperated robotic devices could be a viable solution in a number of such scenarios.
The development and provision of assistive robotic devices and services present a substantial business and growth opportunity. The global medical robotic systems market size was valued at US$7,470.7 million in 2014. 25 This also encompasses assistive robots, which also include home-based rehabilitation robotics.
Government Investment
Innovate UK has recently defined a Robotics and Autonomous Systems UK Strategy 26 to capture value in a cross-sector UK RAS innovation pipeline through co-ordinated development of assets and skills. Robotics in health and social care has been identified as a key area for development and investment. The report states, ‘in health and social care collaborative robotics can offer assistance to nurses and staff providing physical lifting capability, automatic cleaning of equipment and improved rehabilitation outcomes. They will enable logistics services that allow staff to concentrate on care’.
To address growing health and social care needs, government agendas are promoting wellbeing and independence for older people and carers within communities to help people maintain their independence at home. The recent Long Term Care Revolution 27 initiative is an example of such a scheme looking to encourage innovative solutions.
There is an unacceptable lag and chasm between research into assistive robotics and getting products and services to users. More extensive real-world user trials and market studies, involving all stakeholder groups in independent and care settings over longer periods of time, need to be conducted as part of clinical studies. Considerably more government support and investment initiatives are needed if the United Kingdom wishes to benefit commercially and socially from this technology.