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

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

3 Results

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.