Attitudes of the elderly living independently towards the use of robots to assist with activities of daily living

Abstract

BACKGROUND:

Robots are gaining attention as a potential solution to aging.

OBJECTIVE:

The purpose of this study is to explore the attitude of robot assistance in Activities of Daily Living (ADLs) among elderly people living independently.

METHODS:

The one-on-one interview, buddy robot video and questionnaire survey were used to analyze mean, median, range, and the test results of non-parametric statistical methods such as Wilcoxon sign-rank test statistic and one-sample Wilcoxon sign-rank test statistic, so as to explore the attitude of the elderly living independently towards robot-assisted ADLs and the acceptance of the use of robots in 32 ADLs.

RESULTS:

The results showed that there were significant differences in the attitudes, usability and ease of use of elderly people towards robot assistance before and after watching the Buddy Robot video and they had a more positive attitude after watching the video. According to the results, the elderly was more receptive to the use of robots in activities such as “reminding to carry objects” and “reminding to take medicine”, while they were less receptive to the use of robots in the group or private activities such as “playing mahjong” and “taking a bath”.

CONCLUSIONS:

The results showed that the elderly had a positive attitude towards the use of robot-assisted ADLs, and there were differences in the acceptance of robot-assisted ADLs. The results are helpful to understand the assistance needs and attitudes of the elderly, and provide a reference for the design of assistive robots that meet user needs, and ultimately improve the ability of the elderly to live independently at home.

Keywords

Assistance robots acceptance the aged user needs human–robot interaction

1 Introduction

As elderly people age, they tend to prefer to stay at home and live independently [1 –4], because living at home can bring them a sense of security and comfort [5]. Elderly people living independently at home need to engage in some basic domestic tasks of housework and cleaning [6, 7]. However, as the elderly age, they are likely to face some setbacks in their daily activities [7 –9]. When the elderly are unable to carry out these activities of daily living (ADLs), they need external assistance to cope with the needs of such activities [10]. As a promising field, robots are a potential solution to problems related to aging and ADLs assistance, which have attracted much attention in recent years [11 –18].

Robots can assist elders in carrying out some ADLs, enabling them to live independently in their own homes [6 , 20], and improving the quality of life. For example, as mobility assistances [21] or vacuum cleaners [22], robots can help users, especially elderly users, complete some tasks they do not want to do [23] or family chores that they are incapable of doing [24], so as to enhance their sense of independence [25]. Moreover, robots can assist the elderly in preparing meals [26], helping them carry heavy things or grab things beyond their reach [27]. In addition to making up for elderly users’ deficiency in the ability of ADLs [24], robots can also reduce the time and energy of ADLs for elderly users, so that they have more time to do what they like [28, 29]. Venkatesh and Davis [30] pointed out that robotics needs to be considered useful by the elderly, and it should meet their actual needs and preferences. However, the inclusion of robots in the lives of the elderly has not been extensively studied [18]. Therefore, we also need to understand the attitudes of elderly users living independently towards the use of robot assistance in ADLs in terms of activities of daily domestic living, and the specific ADLs in which they would require assistance and be comfortable with robot assistance.

In order to ensure the application of robots, the attitude of end users is very important. Some studies have shown that elders believe that new technologies such as robots may only be useful to others or to their future selves [31]. Xu and Ng [32] used prototype robots as experimental materials to study the attitudes of multiple generations of the same family towards robots. They found that family members of all ages hope that robots can help with household chores. However, they did not conduct research on the attitudes towards robots of single ethnic groups, especially elderly family members. Ezer and Fisk [33] suggested that the elderly prefer to use robots for activities with less physical contact, such as home monitoring, as well as tasks such as object manipulation and information management, and that they prefer to be assisted by humans in leisure and recreational activities [34]. Although robots can help the elderly to carry out daily physical activities and movements at home [35], which is of great significance to improving the health and quality of life of the elderly. However, there is still little understanding about the attitude of the elderly living independently towards the use of robots to assist with ADLs. According to Ajzen [36], attitudes in specific situations can better explain and predict users’ behaviors and needs. Therefore, it is necessary to understand the attitude of those aged people who live independently towards the use of robots to assist with ADLs, so as to provide a reference for the development and design of future assistive robots.

With the rapid development of technology, robot-assisted technology can meet the needs of ADLs of the elderly [37]. However, there are still few studies on integrating robot-assisted technology into the daily life of the elderly [18]. Therefore, the purpose of this study is to explore the attitude of the elderly living independently towards the use of robots to assist with ADLs. Specifically, we attempt to discuss the ADL programs that may require assistance and the attitudes and acceptance of robot-assisted ADLs among old people living independently.

The research is important for the early stages of the development of assisted robotics for the elderly. The understanding of the needs and attitude of the elderly towards robots to assist in their ADLs, so as to facilitate the development and design of the robot for the elderly to meet their daily life needs and enhance their ability to live independently. The study is novel in several ways. First, the subjects of this study are not elderly people living in nursing homes [38], apartments, condominiums, relatives’ homes or living with their children [32], but elderly people living independently in their own homes. This kind of elderly group is a typical one that needs to be paid attention to. Secondly, the application of mixed methods (One-on-one interviews, robot video display, questionnaire survey) is different from previous studies, which lack robot demonstration and related daily auxiliary interaction scenes [24 , 39]. It makes the exploration of the research more in-depth and comprehensive. Thirdly, this study focuses on Taiwanese in Asia, which is different from most previous studies in which users in Europe [40 –43] and the United States [6, 44] are the subjects of study, thus enriching people’s understanding of the elderly in other regions.

2 Methods

2.1 Participants

The recruitment and experimental development of the participants in the study were conducted at the Yongjian Evergreen Promotion Association of Taipei. A total of 36 elders living independently participated in the experiment. The participants were aged between 61 and 88 (M = 72, SD = 6.104), including 15 males and 21 females, as shown in Table 1. Seven of them participated in the first phase of one-on-one interviews. The experiment in the second phase (watching the demonstration video on robots and filling out questionnaires) was attended by 29 elders, 6 of them, also participated in the one-on-one interviews after the experiment. Before the experiment in the second phase, this study conducted a population statistic of all participants, including a basic survey on their experiences in computer operation and experiences in robot use. It was found that participants had a high level of education, including 19 (65.5%) with a bachelor’s (or college) degree or above, 8 (27.6%) with a high school diploma, 1 with a junior high school diploma, and 1 with a primary school diploma. In terms of computer experience, 3 of them (10.3%) said they had no experience in using computer, 11 (37.9%) said their computer experience was elementary (basic operation), 10 (34.5%) stated to have intermediate computer using experience (browsing web pages), and 5 (17.2%) claimed to have advanced experience in using computer (skilled operations). With regard to the robot using experience, most of them (21,72.4%) said they had no experience with robots, with only two elderly people claiming that they had operated a robot, while other six said they had seen robots on TV and in newspapers. All the elderly volunteered to participate in this study and signed a written informed consent before participating in this study. All elders who participated in the study received a coupon worth NT$100 (supermarket vouchers).

Table 1
Participants

Process Total (n) Males (n) Females (n) Range M SD

1st interview participants 7 3 4 65–88 75.71 8.674

Questionnaire participants 29 12 17 61–81 71.10 5.115

2nd interview participants 6 2 4 68–76 71.17 3.312

Process	Total (n)	Males (n)	Females (n)	Range	M	SD
1st interview participants	7	3	4	65–88	75.71	8.674
Questionnaire participants	29	12	17	61–81	71.10	5.115
2nd interview participants	6	2	4	68–76	71.17	3.312

Note: Interviewees in the second interview also participated in the questionnaire.

2.2 Measures

2.2.1 Buddy robot

We chose a public video of Buddy Robot [45], because the video showed the situation in which Buddy Robot assisted ADLs, including accompanying the elderly, answering video calls, managing home appliances, etc., which was very consistent with proposed study. With a total height of 60cm and a movable head and lower limbs, Buddy has a variety of functions, including a wake-up call and a reminder to the elderly to take medicine. The video has Chinese subtitles to ensure that participants can understand it when they watch it.

2.2.2 One-on-one interview

One-on-one interviews in this study are mainly divided into two stages. In the first stage, the purpose of interviews is mainly to understand the specific ADL programs (including the possible need for assistance) of the elderly living independently in their daily life, so as to prepare the follow-up experimental questionnaire. The main questions of the interview are as follows:

What do you usually do at home?

Can you describe the daily activities of your day from getting up in the morning to going to bed in the evening?

Which ADLs do you think are difficult to complete by yourself?

What ADLs do you want others (or other things) to help you with?

What activities do you think that may require assistance in your daily life in the future?

The second stage of the interview was conducted after the experiment, mainly to understand the views of the elderly on the assistance provided by the robot after watching the video. The following are the interview questions:

Do you think using robots can help you better carry out your daily activities?

How would you like to use a robot in your home?

If robot technology is mature, would you use a robot to assist your ADLs? Why?

2.2.3 Questionnaire

The robot assistance attitude questionnaire and the robot assistance acceptance questionnaire of ADLs were used. The robot assistance attitude questionnaire was based on the Technology Acceptance Model (TAM) [46] and the Almere Model [47]. The questionnaire contained a total of 15 items, covering three constructs of perceived ease of use (6 items), perceived usefulness (6 items), and attitude (3 items). Each item was scored by the Likert 5-point Scale (1 = completely disagree, 3 = uncertain, 5 = completely agree). The questionnaire was based on theories in existing literature [46, 47]. We referred to relevant literature [46 –48] and modified the questionnaire according to the attributes of the research subjects. Scholars in related fields were invited to revise the questionnaire. Therefore, the questionnaire developed for this study met the criteria for content validity. Moreover, in order to better reflect the culture (or language and living situation) familiar to the elderly subjects in Taiwan and improve the readability of questionnaire, we invited the Director General of Yongjian Evergreen Promotion Association of Taipei and two elderly staff to revise the questionnaire. The questionnaire was then finalized and filled out by the elderly subjects before and after watching the video. We calculated the internal consistency reliability Crohnbach’s Alpha [49] of the questionnaires filled in before and after watching the video. The α values of perceived ease of use, perceived usefulness, attitude, and the overall questionnaire before watching the video were 0.723, 0.704, 0.728, and 0.845, respectively. The α values of perceived ease of use, perceived usefulness, attitude, and the overall questionnaire after watching the video were 0.717, 0.709, 0.704, and 0.769, respectively, which were more than 0.7. This suggests that there is good internal consistency reliability. In order to have a more comprehensive understanding of the acceptance of robot-assisted users in each ADL, we developed a robot assistance acceptance scale (Table 4) questionnaire for ADLs based on the results of the interview in the first stage, which was arranged to be filled by the elderly after watching the video. Likert 5-point Scale was also used, which showed good internal consistency reliability (α= 0.907).

Table 4
Acceptance of robot assistance in ADLs by the elderly

Items M SD Range Mdn P-value^*

Preparing breakfast 3.41 0.733 2–4 4.00 0.007

Watching TV 3.31 0.850 2–5 3.00 0.061

Karaoke 3.48 0.738 2–5 4.00 0.003

Grocery shopping 3.45 0.572 2–4 3.00 0.001

Friends get-together 3.24 0.786 2–4 3.00 0.108

Eating 3.28 0.797 2–5 3.00 0.074

Using social software 3.62 0.677 2–5 4.00 0.000

Using phones 3.72 0.528 3–5 4.00 0.000

Walking 3.69 0.660 2–5 4.00 0.000

Bathing 2.90 1.012 1–5 3.00 0.572

Using computer 3.93 0.458 3–5 4.00 0.000

Reminding to carry items 4.07 0.371 3–5 4.00 0.000

Reminding to take medicine 4.07 0.371 3–5 4.00 0.000

Dancing 3.48 0.634 2–4 4.00 0.001

Emergency call 4.00 0.463 3–5 4.00 0.000

Playing Tai Chi 3.62 0.622 2–5 4.00 0.000

Reminding where things are 4.07 0.258 4-5 4.00 0.000

Playing Mahjong 3.31 0.806 2–5 3.00 0.050

Cleaning 4.07 0.371 3–5 4.00 0.000

Reminder of important things 4.14 0.351 4-5 4.00 0.000

Walking stairs 3.69 0.541 3–5 4.00 0.000

Preparing lessons 3.90 0.618 2–5 4.00 0.000

Looking for things 4.14 0.441 3–5 4.00 0.000

Washing and drying beddings 3.97 0.499 3–5 4.00 0.000

Cooking 3.90 0.557 2–5 4.00 0.000

Inspection and maintenance of home appliances 3.97 0.566 3–5 4.00 0.000

Assisting movements 3.90 0.618 2–5 4.00 0.000

Shopping 3.62 0.622 2–5 4.00 0.000

Laundry 3.90 0.489 3–5 4.00 0.000

Drying clothes 3.90 0.557 3–5 4.00 0.000

Chopping vegetables 3.59 0.682 2–5 4.00 0.000

Photo archiving 3.97 0.499 3–5 4.00 0.000

Items	M	SD	Range	Mdn	P-value^*
Preparing breakfast	3.41	0.733	2–4	4.00	0.007
Watching TV	3.31	0.850	2–5	3.00	0.061
Karaoke	3.48	0.738	2–5	4.00	0.003
Grocery shopping	3.45	0.572	2–4	3.00	0.001
Friends get-together	3.24	0.786	2–4	3.00	0.108
Eating	3.28	0.797	2–5	3.00	0.074
Using social software	3.62	0.677	2–5	4.00	0.000
Using phones	3.72	0.528	3–5	4.00	0.000
Walking	3.69	0.660	2–5	4.00	0.000
Bathing	2.90	1.012	1–5	3.00	0.572
Using computer	3.93	0.458	3–5	4.00	0.000
Reminding to carry items	4.07	0.371	3–5	4.00	0.000
Reminding to take medicine	4.07	0.371	3–5	4.00	0.000
Dancing	3.48	0.634	2–4	4.00	0.001
Emergency call	4.00	0.463	3–5	4.00	0.000
Playing Tai Chi	3.62	0.622	2–5	4.00	0.000
Reminding where things are	4.07	0.258	4-5	4.00	0.000
Playing Mahjong	3.31	0.806	2–5	3.00	0.050
Cleaning	4.07	0.371	3–5	4.00	0.000
Reminder of important things	4.14	0.351	4-5	4.00	0.000
Walking stairs	3.69	0.541	3–5	4.00	0.000
Preparing lessons	3.90	0.618	2–5	4.00	0.000
Looking for things	4.14	0.441	3–5	4.00	0.000
Washing and drying beddings	3.97	0.499	3–5	4.00	0.000
Cooking	3.90	0.557	2–5	4.00	0.000
Inspection and maintenance of home appliances	3.97	0.566	3–5	4.00	0.000
Assisting movements	3.90	0.618	2–5	4.00	0.000
Shopping	3.62	0.622	2–5	4.00	0.000
Laundry	3.90	0.489	3–5	4.00	0.000
Drying clothes	3.90	0.557	3–5	4.00	0.000
Chopping vegetables	3.59	0.682	2–5	4.00	0.000
Photo archiving	3.97	0.499	3–5	4.00	0.000

Note: ^*one-sample Wilcoxon sign-rank tests. Abbreviation: M, Mean. SD, standard deviation. Mdn, Median. Range, Maximum-Minimum.

2.3 Data analysis

The researcher transcribed the interview data of the study through the online platform of a professional transcription company (https://www.iflyrec.com/), and then checked the transcribed results against the recorded contents verbatim. The data were analyzed by IBM SPSS Statistics version 25. The average score of each item was calculated to obtain the construct score. We conducted a descriptive statistical analysis on standard deviation, mean, median, and range. In addition, due to the small sample size of the questionnaire, we used non-parametric statistical analysis method, mainly including Wilcoxon sign-rank test statistic and one-sample Wilcoxon sign-rank test statistic.

3 Results

3.1 ADLs of the elderly living independently

The researchers conducted one-on-one interviews with 7 participants at the Yongjian Evergreen Promotion Association of Taipei, focusing on the ADLs of elders living independently and ADLs for which they may need assistance. According to the interview results verified verbatim by the professional transcription company and researchers, this study collated a total of 19 ADLs for which elders living independently may require assistance (ADLs that elders find difficult to perform on their own and hope to have assistance for, or ADLs for which they may need assistance in the future), including cooking, cleaning (e.g., sweeping the floor, wiping the floor), laundry, walking stairs, and reminding to take medicine, as shown in Table 2. Some of these ADLs were only mentioned by 1 elder, and some were mentioned by a few of them.

Table 2
ADLs for which the Elderly Living Independently in Taiwan May Require Assistance

Items

Preparing breakfast^* Walking stairs Washing and drying beddings Using phones^*

Watching TV^* Walking^* Karaoke^* Friends get-together^*

Reminding where things are Drying clothes Eating Shopping

Playing Mahjong Grocery shopping^* Laundry Bathing^*

Cooking^* Dancing^* Reminding to take medicine Playing Tai Chi^*

Looking for things (e.g. looking for medicine) Inspection and maintenance of home appliances (e.g. washing machine, TV) Emergency call Chopping vegetables

Preparing lessons (e.g. preparing materials for community courses) Cleaning (e.g. sweeping the floor) Reminding to carry items (e.g. mobile phone, wallet) Assisting movements (e.g. helping elderly cross streets)

Using social software^* (e.g. Line) Using computer^* (e.g. searching information, playing music) Reminder of important things (e.g. reminding elderly to turn off gas when leaving home) Photo archiving (e.g. transferring photos from phone to computer)

Items
Preparing breakfast^*	Walking stairs	Washing and drying beddings	Using phones^*
Watching TV^*	Walking^*	Karaoke^*	Friends get-together^*
Reminding where things are	Drying clothes	Eating	Shopping
Playing Mahjong	Grocery shopping^*	Laundry	Bathing^*
Cooking^*	Dancing^*	Reminding to take medicine	Playing Tai Chi^*
Looking for things (e.g. looking for medicine)	Inspection and maintenance of home appliances (e.g. washing machine, TV)	Emergency call	Chopping vegetables
Preparing lessons (e.g. preparing materials for community courses)	Cleaning (e.g. sweeping the floor)	Reminding to carry items (e.g. mobile phone, wallet)	Assisting movements (e.g. helping elderly cross streets)
Using social software^* (e.g. Line)	Using computer^* (e.g. searching information, playing music)	Reminder of important things (e.g. reminding elderly to turn off gas when leaving home)	Photo archiving (e.g. transferring photos from phone to computer)

Note: ^*refers to ADLs mentioned twice or more in interview questions 1 and 2.

This study also collated the ADLs of elders living independently in Taiwan including dancing, bathing, playing Taichi (Taichi is a physical exercise that combines physical movement, deep breathing and meditation) and walking. For example, from the statement of “sometime I use computer to search for the specific meaning of words that I heard from TV news which I don’t understand (Female, 65 years old)”, ADLs of watching TV and using computers were summarized. During the interview, this study also found that some elders considered themselves to be in good shape and could deal with a lot of things without help, but may require assistance in the future when their body functions deteriorate. For example, an elderly person said that “I sweep and wipe the floor when I get up in the morning. I think this will require assistance in the future (when my health deteriorates). No one can stand a messy home (Female, 66 years old)”. In order to understand more about the acceptance of robot assistance in ADLs, this study extracted a total of 13 daily activities mentioned twice or more (mentioned by 2 or more of the 7 interviewers in their daily activities), among which watching TV was mentioned the most by 5 interviewees, followed by Karaoke, preparing breakfast, eating breakfast and using social application (such as Line) which were mentioned 3 times. In the end, this study formed a project of ADLs for which elders living independently in Taiwan may require assistance, as shown in Table 2, with a total of 32 items, for the preparation of the follow-up questionnaire.

3.2 The attitude of the elderly living independently towards the assistance of robots

With regard to the attitudes of elders living independently in Taiwan towards the assistance provided by robots in ADLs, this study conducted a questionnaire survey. The questionnaire results before and after the elderly watching the video (Table 3) show that the average scores and medians of the constructs are all above 3 (3 is neutral), suggesting that the elderly changed their attitude after watching the video. The average score and median of perceived usefulness construct of the elderly after watching the video reached 4, which is greatest increase among all constructs. Moreover, the median of the Attitude construct also reached 4, suggesting that the minimum and maximum values of all constructs increased after the elderly watched the video. According to the One-sample Wilcoxon Sign Rank Test, the elderly’s perceived ease of use towards robots before watching the video was insignificant (p = 0.253 > 0.05), while their perceived usefulness and attitude towards robots were significant. After watching the video demonstrating the assistance provided by robots on ADLs, the elderly changed perceived ease of use towards robots. Both average score and medians increased, reaching a significant level (p = 0.000). In other words, watching the video could improve the elderly’s perceived ease of use. Moreover, the Wilcoxon Signed Ranks Test found that the elderly’s scores on all constructs before and after watching the video were significant (p < 0.05).

Table 3
Scores of questions on the questionnaire regarding the attitudes of elders living independently in Taiwan towards robot assistance in ADLs before and after watching the robot video

Code Pre Post Z P-value^b

M SD Range Mdn P-value^a M SD Range Mdn P-value^a

PEOU 3.086 0.456 2.00–3.83 3.333 0.253 3.477 0.458 2.33–4.00 3.667 0.000 –3.069 0.002

ATT 3.552 0.506 2.67–4.33 3.667 0.000 3.989 0.467 2.67–4.67 4.00 0.000 –3.154 0.002

PU 3.523 0.410 2.67–4.00 3.500 0.000 4.017 0.384 3.17–4.67 4.00 0.000 –3.991 0.000

Code	Pre	Post	Z	P-value^b
PEOU	3.086	0.456	2.00–3.83	3.333	0.253	3.477	0.458	2.33–4.00	3.667	–3.069	0.002
ATT	3.552	0.506	2.67–4.33	3.667	0.000	3.989	0.467	2.67–4.67	4.00	–3.154	0.002
PU	3.523	0.410	2.67–4.00	3.500	0.000	4.017	0.384	3.17–4.67	4.00	–3.991	0.000

Note: a, One-Sample Wilcoxon Signed Ranks Test; b, Wilcoxon sign-rank test. Abbreviation: PEOU, Perceived ease of use. ATT, Attitude. PU, Perceived Usefulness. M, Mean. SD, standard deviation. Range, Minimum -Maximum. Mdn, Median.

The positive attitude was also identified in the one-on-one interviews with the elderly after watching the robot video. For example, a 73-year-old male senior said: “Because of the age, I become forgetful sometimes, such as forgetting to take medicine and many other things. The robot can remind me and help me remember these things.” However, during the interview, it was also found that those who are currently in good health think that robot assistance may not be needed at present, but will be required in the future when their body functions deteriorate. For example, a 68-year-old senior said: “I don’t need the robot at the moment. If I have trouble with my mobility or have a stroke in the future, I might need it.” A 76-year-old female said: “I can still deal with things myself at the moment. But if I do need it one day in the future, of course I’m willing to use robots to help with my daily life, like one of those in the video. It can remind me to take medicine, and talk to me. I may feel lonely just by myself, and I’m happy to use robots.” The attitude towards robot assistance can also be driven by curiosity, as a 69-year-old female said: “I like trying new things because I’m curious. So I might buy a robot to give it a try.”

3.3 Acceptance of the elderly to use robots in ADLs

According to the results of the Questionnaire on Acceptance of Robot Assistance in ADLs completed by the elderly after watching the video, elders living independently in Taiwan are likely to accept robot assistance in most ADLs with positive attitudes. As shown in Table 4, among the 32 items of ADLs, the average scores on the acceptance of robot assistance in most activities (31 items) exceeded 3 (3 stands for neutral), indicating that elder people are open to the use of robots in these ADLs. The only item with an average score of less than 3 was the more intimate activity “bathing”. In addition, the average scores of the six activities “reminding to carry items”, “reminding to take medicine”, “cleaning”, “reminding where things are”, “reminder of important things” and “looking for things” all exceeded 4 (Agree), while the score of “emergency call” was 4, which indicates that the elderly have a positive attitude towards the use of robot assistance in these 7 activities.

This study calculated the median value of each ADL. The results show that the median of 26 daily activities was 4, and only 6 activities including “grocery shopping”, “friends get-together”, “eating”, “bathing”, “playing Mahjong” and “Watching TV” had a median of 3. In order to learn more about how well the elderly accept robot assistance in their daily activities, this study conducted a one-sample Wilcoxon sign-rank test to compare the medians in the robot-acceptance questionnaire against the number 3 (3 stands for neutral), and the results show that compared with the neutral attitude, the elderly obviously prefer using robots to assist in these activities. The p-value of a total of 27 ADLs was less than 0.05, indicating a statistical significance. This shows to a certain extent that elderly people are acceptable to use robot assistance in most daily activities and hold a relatively positive attitude.

4 Discussion

With the gradual increase of the aging population, more and more elderly people tend to live independently in their own homes. However, with the deterioration of their physical functions [7–9 , 50], the operation and execution of many ADLs require assistance, and robots are an auxiliary scheme with good development potential [51]. As pointed out in [52], research on home-based technology is limited and more studies on acceptability are needed. Therefore, through a combination of qualitative (interview) and quantitative (questionnaire) methods, this study investigated the attitudes of the elderly living independently in Taiwan towards the use of robot assistance in ADLs, which mainly included exploring the attitude of elderly people towards using robots for ADLs assistance, and the acceptance of elderly people using robot assistance in various ADLs. The results of the study will help people (such as the families of the elderly) understand the ADLs of Taiwanese elderly people living independently, help them understand the attitudes and needs of robot assistance in ADLs by elders living independently, and provide reference for the design (such as functional design) of robots, especially home-assistive robots, so as to develop robots that meet the needs of elderly people living independently, and ultimately improve the ability of elders to live independently at home.

Overall, the elderly are more likely to accept the assistance in such activities. The elderly living independently with robot assistance in most ADLs expressed an acceptable, positive attitude. Especially for ADLs that needed reminding (such as reminding to take medicine), they showed a positive acceptance attitude. This may be due to the gradual decline of memory and other things in older people as they grow older [8, 50], they are more receptive to be assisted in such activities. Just as the difficulty mentioned by an elderly person in the interview of the first phase, “I tend to forget things. When I go out, I spend hours finding my purse, and then my phone once my purse is found, but then I will need to go back finding my purse again after locating my phone... I basically spend the whole day trying to find things, either this thing or that thing. I wish my wife could help me. She’s good at finding things, but she finds it boring to find them for me”. Our research also find that compared with cleaning and other housework activities, elders are less likely to accept robot assistance for activities that are more group demanding or intimate, such as friends get-together, play Mahjong and bating. Beer and Prakash [53] have similar findings. Through three different scenarios of mobile manipulator robot operation demonstration, this study found that the elderly hold an open attitude to robot-assisted housework tasks. These studies further demonstrate that for complex and tedious physical tasks, the elderly are more inclined to external assistance, while they are more dependent on themselves to complete the personal and emotional enjoyment tasks that are private and collective. Therefore, the development and design of products such as robots for the elderly with high acceptability should fully consider the physiological and psychological characteristics of the elderly [54] and the categories of ADLs.

Experience is an activity that creates an experience. From the psychological level, the experience is the subject’s internal response to external stimuli. External stimuli to a product experience can be diverse, including the product’s function, shape, and form of presentation. These external stimuli act on people’s visual, auditory and other cognitive systems, affecting people’s cognitive feelings of the product. In this study, the video demonstration of a robot-assisted environment affected the perception of the elderly living independently to a certain extent. The analysis of the attitude questionnaire data of the elderly living independently before and after watching the video revealed that the median and average scores of all constructs have increased after the elderly watched the video, and their perceived usefulness, ease of use, and attitude towards robots have become more positive, especially the changes in their perceived usefulness and perceived ease of use were significant. This indicates that contact such as scenario-based video demonstration can further enhance the elderly’s positive attitude towards robots and other new technological products, and to some extent, it also indicates that the elderly’s attitude towards robot technology may be improved with the passage of time. This finding is consistent with the research results of Koay and Syrdal [55]. The study, which experimented with human-robot interactions in a physical setting over a five-week period, found that people’s attitudes toward robots improved over time. In addition, similar findings have been verified by Stafford and Macdonald [56]. Therefore, in the early stage of the design of robots and other products, diversified product experiences such as robot video display and user experience test of robot products can be tried to improve the attitude of elderly users towards robots, so as to provide a reference for the development and design of robots with higher acceptance in the future.

Robots are considered by users to be useful and relevant to their needs [47 , 56–58]. Therefore, robots need to meet the needs of users [47 , 59]. User needs may be related to users’ perception of the robot’s usefulness, which is one of the important factors affecting the acceptance of new technology [46]. As Beer and Prakash [53] pointed out, the first impression and attitude of elderly users towards robots in the early stage are often influenced by the capabilities of robots. Questionnaire research before and after watching the video shows that the elderly living independently have a more positive attitude towards the perceived usefulness of the assistive robot, which may be related to the participants’ inherent cognition of the robot’s multifunction and the multi-function demonstration of the robot in the video. The Buddy Robot video adopted in the study was consistent with the research theme, which also deepened participants’ understanding of robots and robot-assisted daily activities to a certain extent. In addition, the robot in the video easily realizes the assistance in ADLs through simple voice interaction, which may have some positive effects on the perceived usefulness, perceived ease of use and attitude of the elderly. All these indicate that the elderly users may care about the practicability and ease of use of the robot.

In addition, the elderly not only focus on the usefulness and ease of use of robots at present, but also may focus on the usefulness and ease of use of robots in the future. For example, some people said in the interview that they did not plan to use robots for ADLs assistance at present, because they thought they were in good health and could handle many things by themselves, and that they would only use robots for assistance when they were older and could not handle things independently, as a 68-year-old elderly person said, “If I had trouble with my mobility or had a stroke, I may need the assistance of robots, but I don’t need it now”. This finding is consistent with the research of Wu, Cristancho-Lacroix [31] that the elderly people believe that new technologies such as robots may only be useful for them in the future. In addition, some elderly said that if they had a robot, they may try to use it, but they also stressed that it would not be because that they were physically unwell, but simply because they were curious about new things. From this point of view, for these elderly people, those who use assistive robots may be people who are limited by their mobility or unable to live independently. However, such a view may be one of the obstacles for robots to be widely accepted. The “misunderstanding” of these participants on robots hinders their acceptance of robot technologies [60, 61], making them refuse to accept robot technologies and even robot assistance. Therefore, the development and design of robots should not only consider the usefulness and ease of use of robots at present, but also consider the acceptance of healthy or physically handicapped elderly people at present and in the future, as the elderly may encounter various challenges related to physical and cognitive decline [9]. Gandhi and Goyal [62], based on the physical characteristics of the visually impaired and the elderly, developed “Jet-I-U”, a bionic machine device designed to support their daily tasks. It can be said that we need to pay more attention to the disabled or handicapped elderly, whose needs for health care, rehabilitation, and assistance can be supported by the rapid development of robots and other advanced technology [63].

Our study has the following limitations. First, the analysis data of this study are only based on the Taiwanese elders in Asia, which to some extent limits the applicability of our findings to other countries. In the follow-up studies, attempts to break the geographical limitations of research subjects and conduct cross-regional and cross-cultural studies will be meaningful. Second, although the video demonstration method adopted in the study was novel, it was not the optimal method. In future studies, it should be tried to conduct face-to-face interactive tests between real robots and elderly people. Of course, Video demonstration is certainly effective, as it has been widely used as an effective medium for visualization and user testing for a long time [64], and also in some studies [64 –67] where new discoveries were made.

5 Conclusion

Robot technology is the future development trend. Under the background of population aging, it is necessary to understand the acceptance of elderly users towards robots for the design of robots. This study took the elderly people living independently in Taiwan as the research subjects, and explored their attitude towards the use of robot assistance in ADLs. Through the one-on-one interviews in the first phase, this study has collated a list of 32 ADLs for which the elderly living independently in Taiwan may require assistance. Through the questionnaire on attitudes towards robot assistance in ADLs completed by participants before and after watching the robot video, the questionnaire on the acceptance of robot assistance in these 32 ADLs, and the one-on-one interviews in the second phase, it is found that the attitudes of the elderly people to robot assistance, their perception of usefulness and perception of ease of use are significantly different before and after watching the video, and the results suggest that the Taiwanese elderly living independently hold a positive and open attitude towards the use of robot assistance in ADLs. In addition, the study also show that the elderly are more likely to accept the use of robots in activities such as “reminding to carry items”, “reminding to take medicine”, “reminding where things are”, “reminder of important things” and “looking for things “. For those activities such as “friends get-together”, “playing Mahjong” and “bathing” that are more group demanding or intimate, as well as activities with higher autonomy requirements such as “eating”, “watching TV” and “grocery shopping”, the use of robot assistance is less accepted. The results of the study will help people understand the ADLs of elderly people living independently, and help them understand the elders’ attitudes and needs of robot assistance in ADLs, which can provide reference for robot designers to design more acceptable robots that meet the needs of elderly people living independently, and ultimately improve the ability of elders to live independently at home.

Footnotes

Acknowledgments

We are very grateful to the staff of Yongjian Evergreen Promotion Association of Taipei for their selfless help in this study, as well as to all the elderly participants for their assistance.

Conflict of interest

The authors declare no conflict of interest.

References

Lawler

. Aging in place: coordinating housing and healthcare provision for Americas growing elderly population. 2001. Washington, DC, Neighborworks. 2015.

Gitlin

. Conducting research on home environments: Lessons learned and new directions. Gerontologist. 2003;43(5):628–37.

Broekens

, Heerink

, Rosendal

. Assistive social robots in elderly care: a review. Gerontechnology. 2009;8(2):94–103.

Kunstler

. Therapeutic recreation in naturally occuring retirement community (NORC): Benefiting” aging in place”. Therapeutic Recreation Journal. 2002;36(2):186.

Gillsjö

, Schwartz-Barcott

. A concept analysis of home and its meaning in the lives of three older adults. International Journal of Older People Nursing. 2011;6(1):4–12.

Mitzner

, Chen

, Kemp

, Rogers

. Identifying the Potential for Robotics to Assist Older Adults in Different Living Environments. Int J Soc Robot. 2014;6(2):213–27.

Rogers

, Meyer

, Walker

, Fisk

. Functional limitations to daily living tasks in the aged: A focus group analysis. Hum Factors. 1998;40(1):111–25.

Hedden

, Gabrieli

JDE

. Insights into the ageing mind: A view from cognitive neuroscience. Nat Rev Neurosci. 2004;5(2):87–96.

Moro

, Lin

, Nejat

, Mihailidis

. Social Robots and Seniors: A Comparative Study on the Influence of Dynamic Social Features on Human-Robot Interaction. Int J Soc Robot. 2019;11(1):5–24.

10.

Wiener

, Hanley

, Clark

, Van Nostrand

. Measuring the activities of daily living: Comparisons across national surveys. Journal of gerontology. 1990;45(6):229–37.

11.

Begum

, Huq

, Wang

, Mihailidis

. Collaboration of an assistive robot and older adults with dementia. Gerontechnology. 2015;13(4):405–19.

12.

Heerink

, Kröse

, Wielinga

, Evers

. Studying the acceptance of a robotic agent by elderly users. International Journal of Assistive Robotics and Mechatronics. 2006;7(3):33–43.

13.

Bemelmans

, Gelderblom

, Jonker

, de Witte

. Socially Assistive Robots in Elderly Care: A Systematic Review into Effects and Effectiveness. Journal of the American Medical Directors Association. 2012;13(2):114–20.

14.

Meng

, Lee

. Design issues for assistive robotics for the elderly. Adv Eng Inform. 2006;20(2):171–86.

15.

Lukasik

, Tobis

, Wieczorowska-Tobis

, Suwalska

. Could Robots Help Older People with Age-Related Nutritional Problems? Opinions of Potential Users. Int J Environ Res Public Health. 2018;15(11):10.

16.

Dautenhahn

, Woods

, Kaouri

, Walters

, Koay

, Werry

, editors. What is a robot companion-friend, assistant or butler? 2005 IEEE/RSJ international conference on intelligent robots and systems; 2005: IEEE.

17.

Cavallo

, Aquilano

, Carrozza

, Dario

. Robot-era project: The vision of 3d service robotics. Gerontechnology. 2012;11(2):364.

18.

García-Soler

, Facal

, Díaz-Orueta

, Pigini

, Blasi

, Qiu

. Inclusion of service robots in the daily lives of frail older users: A step-by-step definition procedure on users^′ requirements. Arch Gerontol Geriatr. 2018;74:191–6.

19.

Pollack

. Intelligent technology for an aging population - The use of AI to assist elders with cognitive impairment. Ai Magazine. 2005;26(2):9–24.

20.

Fausset

, Kelly

, Rogers

, Fisk

. Challenges to aging in place: Understanding home maintenance difficulties. Journal of Housing for the Elderly. 2011;25(2):125–41.

21.

Dubowsky

, Genot

, Godding

, Kozono

, Skwersky

, Yu

, et al. editors. PAMM-A robotic aid to the elderly for mobility assistance and monitoring: a” helping-hand” for the elderly. Proceedings 2000 ICRA Millennium Conference IEEE International Conference on Robotics and Automation Symposia Proceedings (Cat No 00CH37065); 2000: IEEE.

22.

Sung

, Grinter

, Christensen

. Domestic Robot Ecology An Initial Framework to Unpack Long-Term Acceptance of Robots at Home. Int J Soc Robot. 2010;2(4):417–29.

23.

Beer

, Smarr

C-A

, Chen

, Prakash

, Mitzner

, Kemp

, et al. editors. The domesticated robot: design guidelines for assisting older adults to age in place. Proceedings of the seventh annual ACM/IEEE international conference on Human-Robot Interaction; 2012: ACM.

24.

Bugmann

, Copleston

, editors. What can a personal robot do for you? Conference Towards Autonomous Robotic Systems; 2011; Springer, Berlin, Heidelberg.: Springer.

25.

Lindenberger

, Lovden

, Schellenbach

, Li

, Kruger

. Psychological principles of successful aging technologies: A mini-review. Gerontology. 2008;54(1):59–68.

26.

Bovbel

, Nejat

. Casper: An assistive kitchen robot to promote aging in place. Journal of Medical Devices. 2014;8(3).

27.

Pigini

, Facal

, Garcia

, Burmester

, Andrich

, editors. The proof of concept of a shadow robotic system for independent living at home. International Conference on Computers for Handicapped Persons; 2012: Springer.

28.

Broadbent

, Kuo

, Lee

, Rabindran

, Kerse

, Stafford

, et al. Attitudes and reactions to a healthcare robot. Telemed e-Health. 2010;16(5):608–13.

29.

Baltes

, Baltes

. Psychological perspectives on successful aging: The model of selective optimization with compensation. 1990:21-34.

30.

Venkatesh

, Davis

. A theoretical extension of the Technology Acceptance Model: Four longitudinal field studies. Management Science. 2000;46(2):186–204.

31.

, Cristancho-Lacroix

, Fassert

, Faucounau

, de Rotrou

, Rigaud

. The Attitudes and Perceptions of Older Adults With Mild Cognitive Impairment Toward an Assistive Robot. J Appl Gerontol. 2016;35(1):3–17.

32.

, Ng

JSL

, Tan

, Huang

. Needs and attitudes of Singaporeans towards home service robots: a multi-generational perspective. Universal Access in the Information Society. 2015;14(4):477–86.

33.

Ezer

, Fisk

, Rogers

, editors. More than a servant: Self-reported willingness of younger and older adults to having a robot perform interactive and critical tasks in the home. Proceedings of the human factors and ergonomics society annual meeting; 2009: SAGE Publications Sage CA: Los Angeles, CA. 136–140.

34.

Smarr

C-A

, Mitzner

, Beer

, Prakash

, Chen

, Kemp

, et al. Domestic robots for older adults: Attitudes, preferences, and potential. Int J Soc Robot. 2014;6(2):229–47.

35.

Martinez-Martin

, Cazorla

. A Socially Assistive Robot for Elderly Exercise Promotion. IEEE Access. 2019;7:75515–29.

36.

Ajzen

. The theory of planned behavior, organizational behavior and human decision processes, vol, 50. Cited in Hansen. 1991:93–114.

37.

Zsiga

, Toth

, Pilissy

, Peter

, Denes

, Fazekas

. Evaluation of a companion robot based on field tests with single older adults in their homes. Assistive Technology. 2018;30(5):259–66.

38.

Campbell

. Dementia care: could animal robots benefit residents? Nursing & Residential Care. 2011;13(12):602–4.

39.

Takayama

, Ju

, Nass

, editors. Beyond dirty, dangerous and dull: what everyday people think robots should do. 2008 3rd ACM/IEEE International Conference on Human-Robot Interaction (HRI); 2008: IEEE.

40.

, Fassert

, Rigaud

. Designing robots for the elderly: Appearance issue and beyond. Arch Gerontol Geriatr. 2012;54(1):121–6.

41.

Gnambs

, Appel

. Are robots becoming unpopular? Changes in attitudes towards autonomous robotic systems in Europe. Comput Hum Behav. 2019;93:53–61.

42.

Kleanthous

, Christophorou

, Tsiourti

, Dantas

, Wintjens

, Samaras

, et al. editors. Analysis of elderly users’ preferences and expectations on service robot’ s personality, appearance and interaction. International Conference on Human Aspects of IT for the Aged Population; 2016: Springer.

43.

Y-h

, Wrobel

, Cornuet

, Kerhervé

, Damnée

, Rigaud

A-S

. Acceptance of an assistive robot in older adults: a mixed-method study of human–robot interaction over a 1-month period in the Living Lab setting. Clinical interventions in aging. 2014;9:801.

44.

Mitzner

, Boron

, Fausset

, Adams

, Charness

, Czaja

, et al. Older adults talk technology: Technology usage and attitudes. Comput Hum Behav. 2010;26(6):1710–21.

45.

Buddy. BUDDY-the Emotional Robot (EN/FR): BUDDY; 2018 [cited 2019 5.24]. Available from: https://www.youtube.com/watch?v=1Z3kwsUjrbo.

46.

Davis

. Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS quarterly. 1989:319-40.

47.

Heerink

, Krose

, Evers

, Wielinga

. Assessing Acceptance of Assistive Social Agent Technology by Older Adults: the Almere Model. Int J Soc Robot. 2010;2(4):361–75.

48.

, CHEN

, CAO

. Analysis on Factors of Perception and Their Influence on Receiving Interactive Message Among Users Based on TAM Model. Digital Library Forum. 2015;129(2):36–42.

49.

Santos

JRA

. Cronbach’s alpha: A tool for assessing the reliability of scales. Journal of extension. 1999;37(2):1–5.

50.

Granata

, Pino

, Legouverneur

, Vidal

, Bidaud

, Rigaud

. Robot services for elderly with cognitive impairment: Testing usability of graphical user interfaces. Technol Health Care. 2013;21(3):217–31.

51.

Hall

, Backonja

, Painter

, Cakmak

, Sung

, Lau

, et al. Acceptance and perceived usefulness of robots to assist with activities of daily living and healthcare tasks. Assistive Technology. 2019;31(3):133–40.

52.

Simonet

, Noyce

. Domotics, Smart Homes, and Parkinson’s Disease. Journal of Parkinson’s disease. 2021.

53.

Beer

, Prakash

, Smarr

, Chen

, Hawkins

, Nguyen

, et al. Older users’ acceptance of an assistive robot: Attitudinal changes following brief exposure. Gerontechnology. 2017;16(1):21–36.

54.

Kim

S-C

, Lee

B-K

, Kim

C-Y

. Usability evaluation of communication service robot for the elderly. J Back Musculoskelet Rehabil. 2019;32(2):313–9.

55.

Koay

, Syrdal

, Walters

, Dautenhahn

, editors. Living with robots: Investigating the habituation effect in participants’ preferences during a longitudinal human-robot interaction study. Robot and Human interactive Communication, 2007 RO-MAN 2007 The 16th IEEE International Symposium on; 2007: IEEE.

56.

Stafford

, MacDonald

, Jayawardena

, Wegner

, Broadbent

. Does the robot have a mind? Mind perception and attitudes towards robots predict use of an eldercare robot. Int J Soc Robot. 2014;6(1):17–32.

57.

Stafford

, MacDonald

, Broadbent

, editors. Identifying specific reasons behind unmet needs may inform more specific eldercare robot design. International Conference on Social Robotics; 2012; Springer, Berlin, Heidelberg.: Springer.

58.

Broadbent

, Stafford

, MacDonald

. Acceptance of Healthcare Robots for the Older Population: Review and Future Directions. Int J Soc Robot. 2009;1(4):319–330.

59.

Forlizzi

, DiSalvo

, Gemperle

. Assistive robotics and an ecology of elders living independently in their homes. Human-Computer Interaction. 2004;19(1):25–59.

60.

Blackman

. Care robots for the supermarket shelf: a product gap in assistive technologies. Ageing Soc. 2013;33:763–81.

61.

Porter

, Benson

, Matsuda

. Older homebound women: negotiating reliance on a cane or walker. Qualitative health research. 2011;21(4):534–48.

62.

Gandhi

, Goyal

. The Jet-IU:Abiomimetic assistive robot for the visually impaired and elderly. International Journal of Hybrid Intelligent Systems. 2020(Preprint):1-15.

63.

Martinez-Martin

, Escalona

, Cazorla

. Socially assistive robots for older adults and people with autism: An overview. Electronics. 2020;9(2):367.

64.

Walters

, Lohse

, Hanheide

, Wrede

, Syrdal

, Koay

, et al. Evaluating the Robot Personality and Verbal Behavior of Domestic Robots Using Video-Based Studies. Advanced Robotics. 2011;25(18):2233–54.

65.

Lohse

, Hanheide

, Wrede

, Walters

, Koay

, Syrdal

, et al., editors. Evaluating extrovert and introvert behaviour of a domestic robot—a video study. RO-MAN 2008-The 17th IEEE International Symposium on Robot and Human Interactive Communication; 2008: IEEE.

66.

Walters

, Syrdal

, Dautenhahn

, te Boekhorst

, Koay

. Avoiding the uncanny valley: robot appearance, personality and consistency of behavior in an attention-seeking home scenario for a robot companion. Autonomous Robots. 2008;24(2):159–78.

67.

Woods

, Walters

, Koay

, Dautenhahn

, editors. Methodological issues in HRI: A comparison of live and video-based methods in robot to human approach direction trials. ROMAN 2006-The 15th IEEE International Symposium on Robot and Human Interactive Communication; 2006: IEEE.

Attitudes of the elderly living independently towards the use of robots to assist with activities of daily living

Abstract

BACKGROUND:

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSIONS:

Keywords

1 Introduction

2 Methods

2.1 Participants

Table 1 Participants Process Total (n) Males (n) Females (n) Range M SD 1st interview participants 7 3 4 65–88 75.71 8.674 Questionnaire participants 29 12 17 61–81 71.10 5.115 2nd interview participants 6 2 4 68–76 71.17 3.312

2.2.1 Buddy robot

2.2.2 One-on-one interview

2.2.3 Questionnaire

3 Results

3.1 ADLs of the elderly living independently

4 Discussion

5 Conclusion

Footnotes

Acknowledgments

Conflict of interest

References

Table 1
Participants

Process Total (n) Males (n) Females (n) Range M SD

1st interview participants 7 3 4 65–88 75.71 8.674

Questionnaire participants 29 12 17 61–81 71.10 5.115

2nd interview participants 6 2 4 68–76 71.17 3.312