who needs friends…when robots may be the answer?
Post on 23-Jul-2016
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Ed i to r ia l
Who needs friends…when robots may be the answer?
No doubt many of you will have seen reported in
the press the case of a son advertising for a com-
panion for his 88-year-old father. The father had
moved into a nursing home to be nearer to his
family but his son was concerned that his father
would be lonely and so was looking for company
and a ‘friend’ to go to the local pub with his father
to have a drink and a chat. He was even prepared to
pay the person and had been astonished at the
response to his advertisement. At present, the
candidates are being assessed for their suitability.
However, the fact that such extreme proposals
are needed does raise the serious issue regarding
how lonely many old people can become. Help the
Aged has reported that something like 1.25 million
old people feel isolated and lonely with 300 000
who have not spoken to family or friends for at
least a month. In addition, three quarters of a
million cannot leave their homes more than once a
week and 29% have to rely on family and friends
for any outdoor activity with 200 000 feeling to-
tally trapped in their house or residential or nursing
home. With this in mind, the charity has launched
a campaign to combat isolation and loneliness and
this is called ‘1 is the sadness number’. Age Concern
has also found that unfortunately most of these old
people will be men who lack the contacts and social
skills of women and therefore are more vulnerable
to isolation. They also lack other skills such as being
able to shop or cook for themselves as they were
part of a generation where such tasks were more
commonly carried out by their wives. Learning
such new skills in old age is highly problematical
and at present there is no provision for these defi-
ciencies to be rectified.
In the United States, the elderly population is
growing dramatically, particularly those living
alone. In 1987, the number was 8.5 million, but by
2020 this is expected to rise to 13.3 million. More
than three quarters or 6.5 million of these are
women and the proportion of women living alone
becomes progressively more likely as they become
older. In those over the age of 85 years, 52% of
women live alone compared with 29% for men.
Unfortunately, one of the most common causes of
this situation is the death of their husbands, with
this affecting 77% of women between the ages of
65 and 74 and 88% of those over 75 years. It is
curious to note that men who live alone are more
likely to have divorced their partner or in fact to
have never married. A confounding factor is that
women also have a greater life expectancy than
men.
Max Stek and colleagues (Am J Psychiatry 2005;
162: 178–180) have studied the impact of depres-
sion and perceived loneliness in a large group of
85 year olds, using the 15-item Geriatric Depres-
sion Scale and Loneliness scale. They found that
depression was present in 23% of the subjects but
when depression and loneliness was analysed sep-
arately, there was no significant effect on mortality.
However, when taken together, mortality risk in-
creased by a factor of 2.1, giving support to the
view that isolation can lead to a potential down-
ward spiral of quality of life.
Unfortunately, many older adults regard loneli-
ness as a factor that naturally leads to depression
and is to be expected as part of the ageing process.
A group of researchers studied a group of adults
aged 70 and older to see whether depressive
symptoms could negatively affect active life
expectancy (ALE), or the number of years free of
disability (Am J Geriatr Psych 2008; 16: 435–432).
They found that depressive symptoms reduced ALE
by 6.5 and 3.2 years in men aged 70 and 85,
respectively, and by 4.2 years and 2.2 years in a
similar age group of women, and these remained
significant at all ages and for both genders. They
suggested that depressive symptoms could be a
serious threat to independent living older people
and appropriate diagnosis and treatment could
significantly improve their quality of life.
Dr Robert Wilson, Professor of Neuropsychology
at Rush University Medical Centre has proposed
that a significant risk factor for Alzheimer’s disease
is loneliness (Arch Gen Psychiatry 2007; 64: 234–
240). He and his colleagues recruited 823 elderly
people who were free of dementia symptoms at the
start of the study and they were assessed for lone-
liness using a 5-item scale at baseline and every
year thereafter until death when their brains were
examined for pathological changes associated with
Alzheimer’s disease and the presence of cerebral
infarctions. He found that 76 subjects developed
clinically identifiable symptoms of the disease and
the risk of this was more than double in those who
were lonely. He argued that in those adults sus-
ceptible to Alzheimer’s disease, there is a possibility
of both physical and emotional impacts and per-
haps ‘loneliness affects the brain so that as people
get older they are more susceptible to the age-re-
lated decline in neural pathways’.
� 2008 The Author
Journal compilation � 2008 The Gerodontology Association and Blackwell Munksgaard Ltd, Gerodontology 2008; 25: 65–66 65
A further study has also been carried out on
loneliness in long-term residential and nursing
homes using the premise that ‘animal-assisted
therapy’ can help allay this condition. Professor
William Banks of the St Louis School of Medicine
reported on the ability of a living dog and a robotic
dog to overcome loneliness in old people (J Am Med
Dir Assoc 2008; 9: 173–177). Using a modified
Lexington Attachment to Pets Scale, he found that
the residents of the home exhibited high levels of
attachment to both the real and the robotic dog
over a 7-week study period. There was no
difference on ‘general attachment’ or ‘people
substituting’. However, he could not explain the
mechanism by which the robotic dog reduced
levels of loneliness in this group of elderly people.
At a meeting of the British Computer Society in
2007, Dr Kevin Doughty suggested that with the
changing demographics leading to the potential
shortage of carers, older people may have to rely on
‘virtual care’. The types of help he proposed ranged
from motion-activated lights to a robotic compan-
ion who could be programmed to talk and enter-
tain the elderly. He also pointed out that this would
reduce the number of older people going into res-
idential care homes, the number ending up in
hospital and the need for other people such as
family, friends and members of the support ser-
vices. He stated that the Japanese have already
used robots to help homes dispense medicines to
older people and to carry disabled elderly to the
bathroom so that they could have a bath. The robot
is also able to identify eight different kinds of
smells, can tell the direction a voice is coming from
and uses visual tools to follow a human face. As
Japan is heading towards a reduction of 16% in its
workforce by 2025, Takao Kobayashi for the Ma-
chine Industry Memorial Foundation suggested in
May 2008 that the country could save 2.1 trillion
yen of elderly insurance payments by using robots.
However, the key element in the use of robots to
help and provide care for older people will be their
acceptance by the carers and the old people
themselves. One finding may be that such help is
no substitute for the real thing.
We have to be careful that we do not impose
‘friends’ on older adults as some may seek solitude
and are perfectly happy being alone and may even
look for social isolation.
A real friend is one who walks in when the rest of the world
walks out.
Walter Winchell, 1879–1972
James P Newton
Editor
� 2008 The Author
66 Journal compilation � 2008 The Gerodontology Association and Blackwell Munksgaard Ltd, Gerodontology 2008; 25: 65–66
66 Editorial
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