Michael Cantor, M.D., J.D.

When most people think about robots they picture a walking android from the movies, a vacuum cleaner or maybe an industrial robot. Companion robots are the newest type of robots to move in with their human owners. These interactive devices are evolving to meet the increased needs of seniors, worsened by the COVID-19 pandemic, including loneliness, lack of support for aging in place and poor connectivity with healthcare teams.

During the pandemic many seniors were locked down and limited contact with others to reduce the risk of infection. This isolation triggered a second pandemic of loneliness, anxiety and depression. An AARP survey done last year found that about 2/3 of older adults felt more anxious due to the pandemic, and about 50% reported feeling social isolation, defined as the absence of regular contact with others. The implications of the increase in social isolation and loneliness include significant negative impacts on physical health as documented in a growing scientific literature. Years of research demonstrate a clear correlation between loneliness and increased healthcare costs and utilization.

This epidemic of loneliness is increasing the use of technology to provide companionship and activities, either through the presence of the robot or use of videoconferencing and messaging technologies. Robotic pets are being used in long-term care facilities and assisted living to combat loneliness, and insurance companies are beginning to pay the costs. The robots offer comfort, support and a feeling of connection; the conversational agents in robots allow for engagement that was previously not possible. Robots can provide mindfulness exercises, make jokes and play music, and even share exercise videos that keep isolated seniors moving at home.

And that’s good, because more seniors are at home, alone, than ever before. Many seniors were already reluctant to move to assisted living facilities and nursing homes, and COVID-related deaths and strictly enforced isolation within those settings have increased the resistance to congregate housing as an alternative to aging in place, despite the prospect of community and better care. The housing market also plays a role: baby boomers, who represent the largest number of homeowners in America, are opting to stay in their homes rather than move.

In addition to increasing the use of technology to support aging in place and combat social isolation, the pandemic has spurred significant increases in technologies supporting delivery of home-based health care. Video visits with healthcare professionals are more common than ever before, and the significant growth of house calls programs for chronic care, and hospital-at-home programs for acute care and rehabilitation are demonstrating the increased recognition that it may be better to bring the care to the patient rather than bringing the patient to the care. Families and community support agencies have turned to use of video conferencing technology. There has also been a growth in the use of computer tablets adapted to meet the needs of seniors for access to entertainment and other services in addition to communication technology.  Some seniors who were uncomfortable with technology prior to the pandemic have adapted, and technology itself has evolved to become more user-friendly, even for those largely unfamiliar with computers and tablets.

Robots can go even further than tablets or other devices offering video calls or remote patient monitoring.  They can act as “conversational sensors” that proactively engage with seniors and gather data through discussion. They can integrate the data from vital signs and activities and gauge functional status and mood, and serve as an early warning system to alert caregivers to pain or loss of appetite. When an early change in clinical status occurs, the robot can send messages to the care team to alert them that they should check in on the older adult. And the care team can use the robot to transmit messages directly and avoid phone tag.  These proactive outreaches can avoid delays in care and reduce the risk of emergency room visits and hospitalizations.

Robots as “conversational sensors” can also assess the needs of seniors and provide access to services.  They can help seniors age in place by supporting the instrumental activities of daily living like taking medications, accessing transportation, ordering food and groceries, utilizing home delivery, and more broadly, linking seniors to their community.  ‘

As experience with use of robots continues to grow and the technology evolves, robots will become even more effective at addressing loneliness, acting as connections to the healthcare system, and supporting seniors who want to age in place. Although the COVID-19 pandemic did not create the need for this support, robots are helpful tools to address these gaps in our ability to support healthy aging.

Michael Cantor, M.D., J.D., is chief medical officer of Intuition Robotics, developer of empathetic digital companion technologies.