The Utilization of Robotic Pets in Dementia Care “She Had a Smile on Her Face as Wide as the Great Australian Bite”: A Qualitative Examination of Family Perceptions of a Therapeutic Robot and a Plush Toy Change in quality of life in older people with dementia participating in Paro-activity: a cluster-randomized controlled trial. A Pilot Randomized Trial of a Companion Robot for People With Dementia Living in the Community. Antipsychotic Drug Use and Mortality in Older Adults with Dementia The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Effects on Symptoms of Agitation and Depression in Persons With Dementia Participating in Robot-Assisted Activity: A Cluster-Randomized Controlled Trial. The psychosocial effects of a companion robot: a randomized controlled trial. Effect of a human-type communication robot on cognitive function in elderly women living alone Use of a Robotic Seal as a Therapeutic Tool to Improve Dementia Symptoms: A Cluster-Randomized Controlled Trial. Evaluation of the results of a randomized controlled trial: how to define changes between baseline and follow-up. Efficacy of pain treatment on mood syndrome in patients with dementia: a randomized clinical trial. Therapeutic effects of dog visits in nursing homes for the elderly. Exploring the effect of companion robots on emotional expression in older adults with dementia: a pilot randomized controlled trial.
Background : Behavioral problems may affect individuals with dementia , increasing the cost and burden of care . Pet therapy has been known to be emotionally beneficial for many years . Robotic pets have been shown to have similar positive effects without the negative aspects of traditional pets . Robotic pet therapy offers an alternative to traditional pet therapy . Objective : The study rigorously assesses the effectiveness of the PARO robotic pet , an FDA approved biofeedback device , in treating dementia-related symptoms . Methods : A r and omized block design with repeated measurements guided the study . Before and after measures included reliable , valid tools such as : RAID , CSDD , GDS , pulse rate , pulse oximetry , and GSR .  Participants interacted with the PARO robotic pet , and the control group received st and ard activity programs .  Five urban secure dementia units comprised the setting . Results : 61 patients , with 77 % females , average 83.4 years in age , were r and omized into control and treatment groups . Compared to the control group , RAID , CSDD , GSR , and pulse oximetry were increased in the treatment group , while pulse rate , pain medication , and psychoactive medication use were decreased . The changes in GSR , pulse oximetry , and pulse rate over time were plotted for both groups . The difference between groups was consistent throughout the 12-week study for pulse oximetry and pulse rate , while GSR had several weeks when changes were similar between groups . Conclusions : Treatment with the PARO robot decreased stress and anxiety in the treatment group and result ed in reductions in the use of psychoactive medications and pain medications in elderly clients with dementia Background and Objectives Recent years have seen social robotic pets introduced as a means of treating behavioral and psychological symptoms of dementia , and many show promising potential . In this study , we sought to explore family members ' perceptions of the Japanese-developed baby harp seal , Paro ( version 9 ) , and a look-alike , nonrobotic Plush Toy , when used by their relative with dementia for 15 min , 3 afternoons per week for 10 weeks . Research Design and Method The study employed a descriptive qualitative approach , which was nested within a larger cluster r and omized controlled trial . A convenience sample of 20 family members ( n = 10 each from the Paro and Plush Toy conditions ) with relatives in 9 long-term care facilities in Queensl and , Australia , completed individual semi-structured interviews ( telephone or face-to-face ) . Inductive , data -driven thematic analysis of the data was undertaken with the assistance of the qualitative management software , ATLAS.ti ® . Results Family members of long-term care residents with dementia expressed positive perceptions of the Paro  , perceiving that it improved mood , reduced agitation , and provided opportunity for communication for their relative . Negative perceptions of the Plush Toy were given by family members , primarily because of its lack of movement and engagement . Conclusion Family members were keen for their older relative with dementia to use a social robot that moved and engaged with them , and Plush Toys that were static and unresponsive were perceived as being unimportant in improving quality of life . However , the current cost of Paro was identified by family members as a major limitation to use AIM The aim of this study was to investigate effects of robot-assisted group activity with Paro on quality of life in older people with dementia . BACKGROUND Nursing home residents with severe dementia often experience social withdrawal and lower quality of life , which are suggested to be enhanced by non-pharmacological interventions . DESIGN A cluster-r and omized controlled trial . Ten nursing home units were r and omized to robot-assisted intervention or control group ( treatment as usual ) .  METHODS Data were collected between March 2013-September 2014 . 27 participants participated in group activity for 30 minutes twice a week over 12 weeks , 26 participated in the control group .  Change in quality of life was assessed by local nurses through the Quality of Life in Late-Stage Dementia scale at baseline , after end of intervention and at 3 months follow-up . The scale and regular psychotropic medication were analysed stratified by dementia severity . Analysis using mixed model , one-way anova and linear regression were performed . RESULTS An effect was found among participants with severe dementia from baseline to follow-up showing stable quality of life in the intervention group compared with a decrease in the control group . The intervention explained most of the variance in change in the total scale and in the subscales describing Tension and Well-being for the group with severe dementia . The intervention group used significantly less psychotropic medication compared with the control group after end of intervention . CONCLUSION Pleasant and engaging activities facilitated by nursing staff , such as group activity with Paro , could improve quality of life in people with severe dementia . The trial is in adherence with the CONSORT statement and is registered at www . clinical trials.gov ( study ID number : NCT01998490 ) [ corrected ] OBJECTIVES To investigate the affective , social , behavioral , and physiological effects of the companion robot Paro for people with dementia in both a day care center and a home setting . DESIGN A pilot block r and omized controlled trial over 12 weeks . Participants were r and omized to the intervention ( Paro ) or control condition  ( st and ard care ) . SETTING Two dementia day care centers and participants ' homes in Auckl and , New Zeal and . PARTICIPANTS Thirty dyads ( consisting of a care recipient with dementia and their caregiver ) took part in this study . All care recipients attended dementia day care centers at Selwyn Foundation and had a formal diagnosis of dementia . INTERVENTION Thirty-minute unstructured group sessions with Paro at the day care center were run 2 to 3 times a week for 6 weeks . Participants also had Paro at home for 6 weeks . MEASUREMENTS At the day care centers , observations of the care recipients ' behavior , affect , and social responses were recorded using a time sampling method . Observations of interactions with Paro for participants in the intervention were also recorded . Blood pressure and salivary cortisol were collected from care recipients before and after sessions at day care . In the home setting , level of cognition , depressive symptoms , neuropsychiatric symptoms , behavioral agitation , and blood pressure were measured at baseline , 6 weeks , and 12 weeks . Hair cortisol measures were collected at baseline and at 6 weeks . RESULTS Observations showed that Paro significantly improved facial expressions ( affect ) and communication with staff ( social interaction ) at the day care centers . Subanalyses showed that care recipients with less cognitive impairment responded significantly better to Paro . There were no significant differences in care recipient dementia symptoms , nor physiological measures between the intervention and control group . CONCLUSION Paro shows promise in enhancing affective and social outcomes for certain individuals with dementia in a community context . Larger r and omized controlled trials in community setting s , with longer time frames , are needed to further specify the context s and characteristics for which Paro is most beneficial Context Recent reports suggest that antipsychotics are associated with increased risk for death in patients with dementia . Contribution This large , population -based study from Canada assessed the risk for death after dispensation of antipsychotics in older adults with dementia . New use of antipsychotics compared with nonuse was associated with increased risk for death at 30 days . Conventional agents were associated with higher risks than were atypical agents . Caution Sensitivity analyses showed that unmeasured confounders might diminish or erase observed associations . Implication Both conventional and atypical antipsychotics may be associated with an increased risk for death in elderly persons with dementia . The Editors Various challenging behavioral and psychological symptoms commonly develop in older adults with dementia and predispose them and their caregivers to poor outcomes ( 1 ) . Nonpharmacologic strategies are recommended as first-line management for these symptoms ( 2 ) , but they may be difficult to implement in clinical practice ( 3 ) . For many reasons , antipsychotic medications are routinely prescribed in this setting ( 4 , 5 ) . Conventional antipsychotics , such as haloperidol , have been available since the 1950s . Meta-analyses of clinical trials evaluating conventional antipsychotics to treat agitation in dementia show that these agents have modest efficacy and important adverse effects compared with placebo ( 6 , 7 ) . In the past decade , use of newer atypical antipsychotics has been rapidly increasing in clinical practice because these agents were thought to produce fewer adverse effects than conventional agents ( 2 ) . A Canadian study found that the prevalence of antipsychotic use in older adults increased from 2.2 % in 1993 to 3.0 % at the end of 2002 . In that study , atypical antipsychotics , which were unavailable in 1993 , accounted for 82.5 % of all antipsychotics dispensed in 2002 ( 8) . Short-term r and omized , controlled trials ( RCTs ) have studied the role of atypical antipsychotics in the management of behavioral and psychological symptoms of dementia ( 2 , 9 ) . An RCT involving 421 out patients with Alzheimer disease and psychosis , aggression , or agitation concluded that the adverse effects of these newer drugs offset their advantages ( 10 ) . As a result , improvements in behavioral symptoms with antipsychotic drug treatment do not necessarily lead to improvements in overall quality of life for patients or their caregivers ( 11 ) . In April 2005 , the U.S. Food and Drug Administration ( FDA ) issued a public health advisory that the use of atypical antipsychotics to treat elderly patients with dementia was associated with an increased risk for death compared with placebo ( 12 ) . In June 2005 , Health Canada issued a similar warning and additional data ( 13 ) . These warnings stem from review s of RCTs that involve the atypical agents risperidone , olanzapine , quetiapine , and aripiprazole . The mortality rate was approximately 1.6 to 1.7 times higher than with placebo and was greater with antipsychotics than with placebo in 15 of the 17 trials review ed by the U.S. FDA ( 12 ) . The warnings extend to all currently available atypical antipsychotics . Other publications have provided support for these warnings and have raised further safety concerns about older conventional antipsychotics ( 1416 ) . Important questions remain unanswered . Although RCTs provide the best evidence of treatment efficacy and harm , the individual RCTs in this case had low event rates . Reliable estimates of the mortality risk were generated only when data were combined by meta- analysis ( 14 ) . Furthermore , these RCTs were generally short in duration and could not provide information about the long-term effect of antipsychotics on mortality ( 14 , 17 ) . Finally , these trials provide estimates of harm primarily for atypical antipsychotics . Relatively few data are available on harms associated with older conventional antipsychotics . Studies suggest that important differences may exist in the safety profiles of conventional and atypical agents ( 15 , 16 , 18 , 19 ) . Using population -based data , we sought to determine the risk for all-cause mortality in older adults with dementia who received atypical antipsychotics , conventional antipsychotics , or no antipsychotic .  Because important baseline differences exist among these groups , we used propensity score matching to improve their comparability . We also evaluated the effect of duration of treatment with antipsychotics on the risk for death . Methods Data Sources Ontario is Canada 's most populous province . During our study , Ontario had a population of approximately 12 million people , of whom 1.4 million were 65 years of age or older . A universally funded health program covers nearly all physician services , medications , and hospital services for patients 65 years of age or older in Ontario . Information from 4 administrative health care data bases was linked to develop the study cohort : pharmacy records from the Ontario Drug Benefit program , hospitalization records from the Canadian Institute for Health Information Discharge Abstract Data base , physician billing information for inpatient and outpatient services from the Ontario Health Insurance Plan , and basic demographic information and vital statistics from the Registered Persons Data base . We used encrypted unique identifiers that are common among data bases to link anonymous information on demographic characteristics and health services utilization for patients in our study . Little basic information on patients is missing in these data bases . For example , the coding accuracy of drug cl aims in the Ontario Drug Benefit program data base is excellent , with an error rate of only 0.7 % ( 20 ) . The study was approved by the ethics review board of Sunnybrook and Women 's College Health Sciences Centre , Toronto , Ontario , Canada . Dementia Cohort We identified a cohort of all Ontario residents 66 years of age or older with a diagnosis of dementia ( in the Ontario Health Insurance Plan or Discharge Abstract Data base ) between 1 April 1997 and 31 March 2002 . To focus on antipsychotic drug treatment for behavioral and psychological symptoms of dementia , we excluded patients who had evidence of other psychotic disorders ( such as schizophrenia ) or were receiving palliative care services . To reduce the potential for selection bias , we studied only new users of antipsychotics and excluded those who had received antipsychotics in the year before cohort entry ( 21 ) . Exposure to Antipsychotics We identified new use of antipsychotics if any agent available through the Ontario Drug Benefit program was dispensed after cohort entry . Cohort entry ( that is , the index date ) was defined as the date of the first dispensed antipsychotic drug . Available atypical drugs included olanzapine , quetiapine , and risperidone , and available conventional drugs included chlorpromazine , flupenthixol , fluphenazine , haloperidol , loxapine , pericyazine , perphenazine , pimozide , thioridazine , and trifluoperazine . Clozapine was rarely used in Ontario during the study period , and we therefore excluded patients who were receiving this medication . Other atypical antipsychotics ( such as aripiprazole and ziprasidone ) are not licensed for use in Canada . We decided that exposure to an antipsychotic was discontinued ( and we censored follow-up ) if the patient did not refill his or her antipsychotic prescription within an interval composed of the days of drug supply plus a grace period of 20 % . For example , we censored follow-up for a patient who did not refill his or her 60-day antipsychotic prescription within 72 days . We also censored follow-up for patients who switched from atypical to conventional antipsychotics ( or vice versa ) . However , we continued follow-up for patients who switched from 1 atypical antipsychotic to another , because data suggest no statistically significant difference in the risk for death associated with individual drugs in this class ( 13 , 14 , 16 ) . We applied the same rules to conventional antipsychotics .  All-Cause Mortality The primary outcome was all-cause mortality , as recorded in the Registered Persons Data base ( for patients who were not hospitalized at the time of death ) or the Discharge Abstract Data base ( for patients who died while hospitalized ) . To assess the influence of the duration of antipsychotic exposure on the outcome , we evaluated the risk for death at 30 , 60 , 120 , and 180 days after the initial dispensing of antipsychotic medication . Cohort Matching We stratified the dementia cohort to support separate analyses among persons living in the community and those residing in long-term care at cohort entry . Studies have demonstrated that rates of antipsychotic prescribing are substantial among older adults newly admitted to long-term care facilities ( 4 ) . Furthermore , long-term care residents typically carry a greater burden of comorbid disease and are more vulnerable to adverse drug events than are their counterparts in the community ( 22 , 23 ) . Our first objective was to determine the risk for death among older adults with dementia who received atypical antipsychotics compared with those who were not exposed to any antipsychotic .  Because antipsychotic use was not r and omly assigned in the study cohorts , we addressed potential confounding and selection biases by developing a propensity score for antipsychotic use . We then applied this score to match users of atypical antipsychotics with nonusers in the dementia cohort . The rationale and methods underlying the use of a propensity score for a proposed causal exposure variable are described elsewhere ( 24 ) . Recent studies provide guidance on the selection of variables to include in the propensity score ( 25 , 26 ) . We developed a logistic regression model by using 42 covariates describing patient characteristics . Tables 1 and 2 list many of the characteristics included in the propensity score . After a structured and iterative assessment of the balance of measured covariates Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVES To examine effects on symptoms of agitation and depression in nursing home residents with moderate to severe dementia participating in a robot-assisted group activity with the robot seal Paro . DESIGN A cluster-r and omized controlled trial . Ten nursing home units were r and omized to either robot-assisted intervention or a control group with treatment as usual during 3 intervention periods from 2013 to 2014 . SETTING Ten adapted units in nursing homes in 3 counties in eastern Norway . PARTICIPANTS Sixty residents ( 67 % women , age range 62 - 95 years ) in adapted nursing home units with a dementia diagnosis or cognitive impairment ( Mini-Mental State Examination score lower than 25/30 ) . INTERVENTION Group sessions with Paro took place in a separate room at nursing homes for 30 minutes twice a week over the course of 12 weeks . Local nurses were trained to conduct the intervention . MEASUREMENTS Participants were scored on baseline measures ( T0 ) assessing cognitive status , regular medication , agitation ( BARS ) , and depression ( CSDD ) . The data collection was repeated at end of intervention ( T1 ) and at follow-up ( 3 months after end of intervention ) ( T2 ) . Mixed models were used to test treatment and time effects . RESULTS Statistically significant differences in changes were found on agitation and depression between groups from T0 to T2 . Although the symptoms of the intervention group declined , the control group 's symptoms developed in the opposite direction . Agitation showed an effect estimate of -5.51 , CI 0.06 - 10.97 , P = .048 , and depression -3.88 , CI 0.43 - 7.33 , P = .028 . There were no significant differences in changes on either agitation or depression between groups from T0 to T1 . CONCLUSION This study found a long-term effect on depression and agitation by using Paro in activity groups for elderly with dementia in nursing homes . Paro might be a suitable nonpharmacological treatment for neuropsychiatric symptoms and should be considered as a useful tool in clinical practice OBJECTIVES To investigate the psychosocial effects of the companion robot , Paro , in a rest home/hospital setting in comparison to a control group . DESIGN R and omized controlled trial . Residents were r and omized to the robot intervention group or a control group that attended normal activities instead of Paro sessions . Sessions took place twice a week for an hour over 12 weeks . Over the trial period , observations were conducted of residents ' social behavior when interacting as a group with the robot . As a comparison , observations were also conducted of all the residents during general activities when the resident dog was or was not present . SETTING A residential care facility in Auckl and , New Zeal and . PARTICIPANTS Forty residents in hospital and rest home care . MEASUREMENTS Residents completed a baseline measure assessing cognitive status , loneliness , depression , and quality of life . At follow-up , residents completed a question naire assessing loneliness , depression , and quality of life . During observations , behavior was noted and collated for instances of talking and stroking the dog/robot . RESULTS In comparison with the control group , residents who interacted with the robot had significant decreases in loneliness over the period of the trial . Both the resident dog and the seal robot made an impact on the social environment in comparison to when neither was present . Residents talked to and touched the robot significantly more than the resident dog . A greater number of residents were involved in discussion about the robot in comparison with the resident dog and conversation about the robot occurred more . CONCLUSION Paro is a positive addition to this environment and has benefits for older people in nursing home care .  Paro may be able to address some of the unmet needs of older people that a resident animal may not , particularly relating to loneliness Summary Background Considering the high prevalence of dementia , it would be of great value to develop effective tools to improve cognitive function . We examined the effects of a human-type communication robot on cognitive function in elderly women living alone . Material / Methods In this study , 34 healthy elderly female volunteers living alone were r and omized to living with either a communication robot or a control robot at home for 8 weeks . The shape , voice , and motion features of the communication robot resemble those of a 3-year-old boy , while the control robot was not design ed to talk or nod . Before living with the robot and 4 and 8 weeks after living with the robot , experiments were conducted to evaluate a variety of cognitive functions as well as saliva cortisol , sleep , and subjective fatigue , motivation , and healing . Results The Mini-Mental State Examination score , judgement , and verbal memory function were improved after living with the communication robot ; those functions were not altered with the control robot . In addition , the saliva cortisol level was decreased , nocturnal sleeping hours tended to increase , and difficulty in maintaining sleep tended to decrease with the communication robot , although alterations were not shown with the control . The proportions of the participants in whom effects on attenuation of fatigue , enhancement of motivation , and healing could be recognized were higher in the communication robot group relative to the control group . Conclusions This study demonstrates that living with a human-type communication robot may be effective for improving cognitive functions in elderly women living alone OBJECTIVES To test the effects of individual , nonfacilitated sessions with PARO ( version 9 ) , when compared against a look-alike plush toy and usual care , on the emotional and behavioral symptoms of dementia for people living in long-term care facilities . DESIGN Parallel , 3-group , cluster-r and omized controlled trial conducted between June 14 , 2014 , and May 16 , 2015 . SETTING Twenty-eight long-term care facilities operated by 20 care organizations located in South-East Queensl and , Australia . PARTICIPANTS Four hundred fifteen participants aged ≥60 years , with a documented diagnosis of dementia . INTERVENTION Stratified by private/not-for-profit status and r and omized using a computer-generated sequence , 9 facilities were r and omized to the PARO group ( individual , nonfacilitated , 15-minute sessions 3 times per week for 10 weeks ) ; 10 to plush toy ( same , but given PARO with robotic features disabled ) ; and 9 to usual care . Treatment allocation was masked to assessors . MEASUREMENTS Primary outcomes were changes in levels of engagement , mood states , and agitation after a 10-week intervention , assessed by coded video observations ( baseline , weeks 1 , 5 , 10 , and 15 ) and Cohen-Mansfield Agitation Inventory-Short Form ( baseline , weeks 10 and 15 ) . Analyses followed intention-to-treat , using repeated measures mixed effects models . Australian New Zeal and Clinical Trials Registry ( ACTRN12614000508673 ) . RESULTS Video data showed that participants in the PARO group were more verbally [ 3.61 , 95 % confidence interval ( CI ) : 6.40 - 0.81 , P = .011 ] and visually engaged ( 13.06 , 95 % CI : 17.05 - 9.06 , P < .0001 ) than participants in plush toy . Both PARO ( -3.09 , 95 % CI : -0.45 to -5.72 , P = .022 ) and plush toy ( -3.58 , 95 % CI : -1.26 to -5.91 , P = .002 ) had significantly greater reduced neutral affect compared with usual care , whilst PARO was more effective than usual care in improving pleasure ( 1.12 , 95 % CI : 1.94 - 0.29 , P = .008 ) . Videos showed that PARO was more effective than usual care in improving agitation ( 3.33 , 95 % CI : 5.79 - 0.86 , P = .008 ) . When measured using the CMAI-SF , there was no difference between groups . CONCLUSIONS Although more effective than usual care in improving mood states and agitation , PARO was only more effective than a plush toy in encouraging engagement OBJECTIVE The most common way to evaluate the effect of an intervention is to compare the  intervention and nonintervention groups regarding the change in the outcome variable between baseline and follow-up ; however , there are many different ways to define " changes . " The purpose of this article is to demonstrate how different definitions of " change " used in the analysis can influence the results of a study . STUDY DESIGN AND SETTING Two different r and omized controlled trials were used as examples . RESULTS The results of the analyses showed that for continuous outcome variables , analysis of covariance seems to be the most appropriate because it corrects for the phenomenon of regression to the mean . For dichotomous outcome variables , multinomial logistic regression analysis with all possible changes over time as outcome seems to be the most appropriate , especially because of its straightforward interpretation . CONCLUSION A different definition of " change " can lead to different results in the evaluation of the effect of an intervention BACKGROUND Depression is common in nursing home ( NH ) patients with dementia , and often clustered with anxiety and other mood symptoms . An association between pain and depressive symptoms has been reported , but the impact of pain management on depression and other mood symptoms has not been investigated . OBJECTIVE Secondary analyses of a cluster r and omized clinical trial examine the response of dementia-related mood symptoms to a Stepwise Protocol of Treating Pain . METHOD Three-hundred fifty-two patients with moderate and severe dementia and significant behavioural disturbances , related to 60 clusters ( i.e. clusters defined as single independent NH units ) in 18 NHs of Western Norway , were included . All patients in the intervention group received individual daily pain treatment with paracetamol , extended release morphine , buprenorphine transdermal patch or pregabaline for 8 weeks , with additional follow-up assessment 4 weeks after completion of the intervention . Clusters r and omized to control received usual treatment . A mood cluster consisting of depression , anxiety , sleep disorders , apathy and appetite items from the Neuropsychiatric Inventory-Nursing Home ( NPI-NH ) was the primary outcome . RESULTS Analysed by Mann-Whitney U-tests , Stepwise Protocol of Treating Pain conferred significant benefit in treatment of the NPI-NH mood cluster ( F = 13.4 , df = 1;299 , p < 0.001 ) and depression ( F = 2.0 , df = 1;301 , p = 0.025 ) . Further analyses highlighted improvements in apathy ( F = 5.3 , df = 1;300 , p = 0.017 ) , night-time behaviours ( F = 3.1 , df = 1;301 , p = 0.050 ) , and appetite items ( F = 11.6 , df = 1;301 , p = 0.005 ) , but not irritability ( p = 0.092 ) and anxiety ( p = 0.125 ) . CONCLUSION Mood symptoms including depression significantly improved with pain treatment , emphasizing the importance of more rigorous treatment of pain in agitated people with dementia . Findings have potentially immediate clinical relevance BACKGROUND Previous studies have suggested that visiting dogs can have positive effects on elderly people in nursing homes . We wanted to study the effects of biweekly dog visits on sleep patterns and the psychiatric well-being of elderly people . METHODS A total of 100 residents ( median age : 85.5 years ; [ 79 ; 90 ] ) from four nursing homes were r and omly assigned to receive biweekly visits for 6 weeks from a person accompanied by either a dog , a robot seal ( PARO ) , or a soft toy cat .  Sleep patterns were measured using actigraphy technology before , during ( the third and sixth week ) , and after the series of visits . The participants were weighed and scored on the Geriatric Depression Scale , the Gottfries-Bråne-Steen Scale , and the Mini-Mental State Examination  before and after the visit period . RESULTS We found that sleep duration ( min ) increased in the third week when visitors were accompanied by a dog rather than the robot seal or soft toy cat ( dog : 610 ± 127 min ; seal : 498 ± 146 min ; cat : 540 ± 163 min ; F2,37 = 4.99 ; P = 0.01 ) . No effects were found in the sixth week or after the visit period had ended . We found that visit type had no effect on weight ( F2,88 = 0.13 ; P > 0.05 ) , body mass index ( F2,86 = 0.33 ; P > 0.05 ) , Geriatric Depression Scale ( F2,82 = 0.85 ; P > 0.05 ) , Gottfries-Bråne-Steen Scale ( F2,90 = 0.41 ; P > 0.05 ) , or Mini-Mental State Examination ( F2,91 = 0.35 ; P > 0.05 ) . Furthermore , we found a decrease in the Geriatric Depression Scale during the experimental period ( S = -420 ; P < 0.05 ) , whereas cognitive impairment worsened as shown by a decrease in Mini-Mental State Examination score ( S = -483 ; P < 0.05 ) and an increase in the Gottfries-Bråne-Steen Scale ( t = 2.06 ; P < 0.05 ) . CONCLUSION Visit type did not affect the long-term mental state of the participants . The causal relationship between sleep duration and dog-accompanied visits remains to be explored This pilot study aim ed to compare the effect of companion robots ( PARO ) to participation in an interactive reading group on emotions in people living with moderate to severe dementia in a residential care setting . A r and omized crossover design , with PARO and reading control groups , was used . Eighteen residents with mid- to late-stage dementia from one aged care facility in Queensl and , Australia , were recruited . Participants were assessed three times using the Quality of Life in Alzheimer 's Disease , Rating Anxiety in Dementia , Apathy Evaluation , Geriatric Depression , and Revised Algase W and ering Scales .  PARO had a moderate to large positive influence on participants ' quality of life compared to the reading group . The PARO intervention group had higher pleasure scores when compared to the reading group . Findings suggest PARO may be useful as a treatment option for people with dementia ; however , the need for a larger trial was identified
Background and Objectives Social robots may promote the health of older adults by increasing their perceived emotional support and social interaction .
This review aims to summarize the effectiveness of social robots on outcomes ( psychological , physiological , quality of life , or medications ) of older adults from r and omized controlled trials ( RCTs ) .