Rethinking Care: Robots’ Role In the Dementia Journey

Could a robot be a companion to someone living with dementia?

Dr. Lilian Hung is an associate professor at the University of British Columbia’s School of Nursing and holds the Canada Research Chair in Senior Care. She is also the founder of the Innovation in Dementia and Aging (IDEA) Lab, where her interdisciplinary team studies how emerging technologies, including robots, can improve quality of life for older adults. Mario Gregorio, an educator and advocate who was diagnosed with vascular neurocognitive disorder in 2008, serves as a mentor to IDEA Lab researchers and an advisor on numerous accessibility committees. 

In this conversation with Being Patient’s Mark Niu, Hung and Gregorio discuss how robots and other technologies are being developed to support people living with dementia — from cognitive stimulation and emotional support to questions surrounding privacy and trust.

Being Patient: Dr. Hung, what is your specialty at UBC?

Dr. Lilian Hung: The lab that we have in UBC is called Innovation in Dementia and Aging. We bring [together] students from interdisciplinary [fields], like engineering, psychology, nursing, medicine. They come together and work with [people] like Mario. They work on technology and see how it can support older adults. A lot of these technologies are really at the forefront, like virtual reality and social robots.

Being Patient: Mario, how do you fit into this picture?

Mario Gregorio: I am their guinea pig in their projects. Lillian will bring in some innovative robotic devices from her meetings abroad. She asks our patients, partners, or mentors, “What do you think? How does it work?” And we explore the pros and cons. People toss out ideas and try to figure out: How can we use it for people with dementia in long-term care?

As part of my mentorship with the students, I help them write grants and do some community projects, like Memory Cafe, and [figure out] how we integrate them in the community. I also work with other accessibility advisory committees, focused on older adults in the community. But most of the time, I really enjoy working with the digital format that our IDEA Lab is working on with robotic devices.

Being Patient: There are all sorts of technologies that can make life easier for people living with dementia. Why do you think robots are a good fit?

Hung: Because I think that the robots could [provide] support in many ways. They could support cognitive stimulation. Your brain needs exercise; the robot will engage people to have conversations. They use the creativity to interact with the robot, so it gets them using the brain. It also serves with memory and helps to remind the person [if] they need to take medications. 

We know a lot of older people might be socially isolated, so [it’s helpful to have] something that they could talk to [and] feel like the robot’s not going to judge them. It’s programmed to be positive. The tiny robot that we have [can] connect to ChatGPT. Using verbal commands just makes things a little bit easier.

Gregorio: We need to face the fact that manpower is a very challenging issue in the medical care service. Robotic devices do not aim to replace manpower in the medical service. We like to think of it as a support system where [caregivers] might be able to take respite. People with dementia can [spend] a little bit of time interacting with the robot. [They] could be playing games, telling jokes, or any other activities that might help them during [their caregivers’] off time.

We do have some of our robotic devices, like the telepresence robot, where if the patient is in Vancouver and their daughter is in Australia, they can talk. Sometimes some dementia patients will not understand or will not execute commands if they do not know the person that is talking to them.

Being Patient: Mario, you were diagnosed 17 years ago?

Gregorio: Yes, that’s correct.

Being Patient: And from that time, having worked with various robots, how do you think it has helped you along the way? If you didn’t have robots at that time, would things be much more difficult for you?

Gregorio: At this time, I looked at robots and [was] fascinated by their potential. There are certain robotic devices or AI technology that helps me in advocacy or mentorship with the students.

These robotic devices — there’s a future in it. Two examples of those would be our Paro robotic device as a companion robot, and the one that we recently [tested] called Lovot, which is also a companion robot that helps [patients] in their time-out period. When I say time-out period, it’s when they have nothing to do, or sometimes they just need something to be connected with. I think [it] is very important for people with dementia to have something to be connected with.

Being Patient: What have you seen in the robots’ interactions with people who have dementia or any kind of cognitive issues? Has anything been surprising to you?

Gregorio: One time, we took the robots to one of these long-term care homes, and were surprised [by] the reception that the residents in the home gave to our Lovots. They look at it as something that is there according to their needs.

These robotic devices do not ask for anything, and yet they are interactive. They sort of look at you and then look at the temperature of your emotion. If you’re happy, [they] will sound happy. Sometimes these Lovots will ask to be picked up and hugged, just like your cat or your dog.

“I think [it] is very important for people with dementia to have something to be connected with.”

Hung: What was surprising to me is, when [we talk to] patients with dementia, they don’t normally say much, or they are quite withdrawn. But when they have these robots in their hands, they will talk to the robot. [The patients] use a lot of creativity. They don’t only ask a question, they would also provide an answer. They will [pretend to] speak for the robot. [They] interpret whatever the robot provides as a signal.

They exercise their brain in terms of using creativity to interact with the robot. That is a really important thing because if people don’t talk, that’s when they will start to lose their language. Their language can decline very quickly, and they lose the ability to be able to speak. Having something like that to keep up with their language skills [is] really important.

[You also use] social skills when you’re having a conversation with or interacting with the robot. If you don’t use it, you lose it, so to be able to maintain those skills is very important.

Being Patient: Tell me about artificial intelligence and the ability for these robots to learn and adapt to the patients. How good are they at adapting? Do you see the potential for them getting much smarter, to be able to do more things?

Gregorio: These robots are designed to be interactive. It’s a learning experience. It adapts the way it looks at you, it will look at you and create responses according to your feelings or emotions at that time.

We are not there yet in the sense it can be something to be trusted to really know you. But it does map you, in the sense that it sort of creates a profile and remembers [it].

Hung: It’s able to be personalized using machine learning. That makes the conversation a lot more personal.

Being Patient: What about the fears and concerns around privacy? Tell me about those trust issues of having a robot with you at all times. Does everybody that you’ve seen trust it?

Gregorio: That’s an interesting question. If you leave [the Lovot robot] at home, then it will map your premises, and if there’s an intruder in that house, it will send you a message on your cell phone, telling you somebody’s out there.

I agree that there is the issue of privacy, and this is a prime concern. How do you make it private? This is one of the challenges of robotic devices. How can we trust it? Personally, I don’t. Because of the frightening issue of AI, it’s ubiquitous, and it is something that we need some sort of safeguard. At the same time, we need to focus on the benefits of what these robotic devices can [do to] help people with dementia. Because [often] they have been estranged from their family or their friends, and they lead a little bit of an isolated existence.

Hung: It’s a top priority for researchers these days, to think about the ethics [of] using these robots. Having the user be engaged in the whole design of this robot, like trying to understand what might be the priority needs of the users, and what’s okay and what’s not okay.

“It’s able to be personalized using machine learning. That makes the conversation a lot more personal.”

Being Patient: Lillian, what do you want to work on next with robots? What are some of the questions that you’re hoping to answer in your next experiments?

Hung: We’re working on ethics and having users support co-design [of the robots]. When they design something, I’m hoping to work with the people in the ecosystem to test it [and] adjust it to make it better so that we can have something that’s beneficial for people.

I think that sometimes people are worried about [AI’s] potential harm, especially for populations that are vulnerable, like people with dementia. I think it’s important that we get in the space to do the research. If we don’t do the research, we do not know how we can do this in an ethical and safe way that can be beneficial for people.

Being Patient: What do you hope a robot will be able to do in the future for those with neurocognitive disorders?

Gregorio: My ideal robot will be a robot that will wake me up in the morning and start telling me a small joke to start my day. And then, at the same time, remind me about simple processes [like] going to the washroom, going to bed, and taking a bath. And then it will look at me and then tell me, “Your blood pressure today is this much,” and “Your diabetic A1C is this much.”

In other words, something that would help [remind me] of the things that I need to do for that day, be able to tell me about the state of my health, and also be my coach in my activities — telling me, “Hey, you walked 8,000 steps yesterday. Let’s do 10,000 today.” Something that would motivate me.

Being Patient: Are we close to that, though?

Hung: It sounds like that’s a high expectation but we already have the technology. People wear these sensor rings [which provides that] health data already. But there’s a difference from wearing a ring or having a phone [app], compared to having a robot. The [robot has a] physical presence, is able to use verbal commands, links [to] existing technologies, and [is] more accessible for the person with dementia to use – I think that’s the future.