![Page 1: Effects from robot-assisted group activity in nursing homes€¦ · Effects from robot-assisted ... •Shift towards stimulating social, personal and physical resources in people](https://reader034.vdocuments.us/reader034/viewer/2022050110/5f47d87aea29b00d4211f3e4/html5/thumbnails/1.jpg)
Norwegian University of Life Sciences 1
Effects from robot-assisted
group activity in nursing
homes– a cluster-randomized controlled trial
Nina Jøranson, PhD Candidate
PhD I. Pedersen, PhD A.M.M. Rokstad, Prof. C. Ihlebæk
![Page 2: Effects from robot-assisted group activity in nursing homes€¦ · Effects from robot-assisted ... •Shift towards stimulating social, personal and physical resources in people](https://reader034.vdocuments.us/reader034/viewer/2022050110/5f47d87aea29b00d4211f3e4/html5/thumbnails/2.jpg)
Background• Resident challenges due to poor quality of life and
symptoms of depression and agitation
–Medication has little effect.
• Shift towards stimulating social, personal and physical
resources in people with dementia.
• Development of social robots in recent years – developed
to assist people socially and emotionally.
• Aiming to provide
–social
–psychological
–physiological
Effects from Paro-groups in nursing homes Norwegian University of Life Sciences
benefits
through
interactions.
![Page 3: Effects from robot-assisted group activity in nursing homes€¦ · Effects from robot-assisted ... •Shift towards stimulating social, personal and physical resources in people](https://reader034.vdocuments.us/reader034/viewer/2022050110/5f47d87aea29b00d4211f3e4/html5/thumbnails/3.jpg)
Effects from Paro-groups in nursing homes Norwegian University of Life Sciences
• Effect on reduced loneliness (Robinson et al 2013)
• Effect on reduced apathy (Valenti-Solér et al, 2015)
• Effect on increased utterances and positive
expressions (Takayanaki et al, 2014)
• Improved clinical QoL (Moyle et al 2013)
• Reduced levels of stress hormones
– in urine samples, long term (Wada/Shibata 2008)
– reduced blood pressure (Robinson et al 2015a)
• Increased social interaction and interactions
among participants (Wada et al, 2004, Klein & Cook, 2012, Robinson et al, 2015b)
Previous research on Paro
![Page 4: Effects from robot-assisted group activity in nursing homes€¦ · Effects from robot-assisted ... •Shift towards stimulating social, personal and physical resources in people](https://reader034.vdocuments.us/reader034/viewer/2022050110/5f47d87aea29b00d4211f3e4/html5/thumbnails/4.jpg)
Methods
![Page 5: Effects from robot-assisted group activity in nursing homes€¦ · Effects from robot-assisted ... •Shift towards stimulating social, personal and physical resources in people](https://reader034.vdocuments.us/reader034/viewer/2022050110/5f47d87aea29b00d4211f3e4/html5/thumbnails/5.jpg)
Study design• Cluster-RCT: 5 control group
• 10 nursing homes units 5 Paro group activity
• 3 intervention periods (during 2013 and 2014)
• 6 participants in each Paro-group.
• n = 60 (30 participants in each group).
• Inclusion criteria:
– Age > 65 years
– Dementia diagnosis/cognitive impairment (MMSE <25/30)
– To intervention group: Show interest in Paro during
recruitment.
Registered at www.ClinicalTrials.gov and approved by the Norwegian Committees for Medical and Health Research Ethics.
Effects from Paro-groups in nursing homes Norwegian University of Life Sciences
![Page 6: Effects from robot-assisted group activity in nursing homes€¦ · Effects from robot-assisted ... •Shift towards stimulating social, personal and physical resources in people](https://reader034.vdocuments.us/reader034/viewer/2022050110/5f47d87aea29b00d4211f3e4/html5/thumbnails/6.jpg)
Paro activity group
• 5-6 participants, 30 min twice a week through 12 weeks.
• Activity performed in a separate room in NH.
• Staff leading the sessions, trained in advance and
supervised.
• Semi-structured activity,
naturally occurring activities
with Paro during the sessions.
• Paro distributed for 2 rounds.
Effects from Paro-groups in nursing homes Norwegian University of Life Sciences
![Page 7: Effects from robot-assisted group activity in nursing homes€¦ · Effects from robot-assisted ... •Shift towards stimulating social, personal and physical resources in people](https://reader034.vdocuments.us/reader034/viewer/2022050110/5f47d87aea29b00d4211f3e4/html5/thumbnails/7.jpg)
Assessments
• The Brief Agitation Rating Scale (BARS) – symptoms on
agitation (range 9-63).
• The Cornell Scale for Symptoms of Depression in
Dementia (CSDD) – symptoms on depression (0-38)
• The Quality of Life in Late-Stage Dementia (QUALID) –
assessment on quality of life (11–55)
• Assessments conducted at baseline, post intervention and
at follow-up (3 months after).
• Occurring and change in behaviors from video recordings
in weeks 2 and 10 - analyzed by an ethogram.
Effects from Paro-groups in nursing homes Norwegian University of Life Sciences
![Page 8: Effects from robot-assisted group activity in nursing homes€¦ · Effects from robot-assisted ... •Shift towards stimulating social, personal and physical resources in people](https://reader034.vdocuments.us/reader034/viewer/2022050110/5f47d87aea29b00d4211f3e4/html5/thumbnails/8.jpg)
Ethogram
8Effects from Paro-groups in nursing homes Norwegian University of Life Sciences
![Page 9: Effects from robot-assisted group activity in nursing homes€¦ · Effects from robot-assisted ... •Shift towards stimulating social, personal and physical resources in people](https://reader034.vdocuments.us/reader034/viewer/2022050110/5f47d87aea29b00d4211f3e4/html5/thumbnails/9.jpg)
Analysis of behaviors
9
• 18 predefined behaviors, both positive and negative.
• Time recorded in seconds, converted to % of time.
• , 9 of these included in analysis, mainly positive, such
as:
• Observe Paro / other participants/nurse / other things
• Conversation with/ without having Paro on the lap.
• Smiles/laughter towards Paro / other participants.
• Physical contact with Paro
• Active physical contact with Paro
Effects from Paro-groups in nursing homes Norwegian University of Life Sciences
![Page 10: Effects from robot-assisted group activity in nursing homes€¦ · Effects from robot-assisted ... •Shift towards stimulating social, personal and physical resources in people](https://reader034.vdocuments.us/reader034/viewer/2022050110/5f47d87aea29b00d4211f3e4/html5/thumbnails/10.jpg)
Results
![Page 11: Effects from robot-assisted group activity in nursing homes€¦ · Effects from robot-assisted ... •Shift towards stimulating social, personal and physical resources in people](https://reader034.vdocuments.us/reader034/viewer/2022050110/5f47d87aea29b00d4211f3e4/html5/thumbnails/11.jpg)
Participants at baselineParo-group Control
group
p-
value
Sample of participants n = 30 n = 30
Mean age (±SD) 83,9 (±7.2) 84,1 (±6.7) .922
Women 70 % 63,3 % .584
CDR-rating 1 (mild)
2 (moderate)
3 (severe)
7.4 %
48.1 %
44.4 %
7.6 %
46,2 %
46,2 %
.449
Mean agitation (BARS) 22.4 (±7.7) 23,2 (±11.4) .759
Mean depression (CSDD/Cornell) 9.0 (±4,9) 6.9 (±4.7) .116
Mean quality of life (QUALID) 23.5 (±5.9) 22.9 (±8.5) .754
Included in analysis n = 27 n = 26
Effects from Paro-groups in nursing homes Norwegian University of Life Sciences
Characteristics at baseline
![Page 12: Effects from robot-assisted group activity in nursing homes€¦ · Effects from robot-assisted ... •Shift towards stimulating social, personal and physical resources in people](https://reader034.vdocuments.us/reader034/viewer/2022050110/5f47d87aea29b00d4211f3e4/html5/thumbnails/12.jpg)
Occurring behaviors in week 2
and stratified on CDR-groups
12Effects from Paro-groups in nursing homes
05
1015202530354045505560
All CDR 1/2 CDR 3
• Observing Paro
mean % (SD)
– CDR 1/2: 58,3% (10,8)
– CDR 3: 39,2% (24,3)
p = .019*
• Observing other things
– CDR 1/2: 8,0% (5,8)
– CDR 3: 22,5% (23,5)
p = .042*
* Statistical significant at 0.05-level
Norwegian University of Life Sciences
*
*
![Page 13: Effects from robot-assisted group activity in nursing homes€¦ · Effects from robot-assisted ... •Shift towards stimulating social, personal and physical resources in people](https://reader034.vdocuments.us/reader034/viewer/2022050110/5f47d87aea29b00d4211f3e4/html5/thumbnails/13.jpg)
Change in behaviors on group
level - week 2 to week 10
13
0
5
10
15
20
25
30
35
40
45
50
Week 2 Week 10
• Conversation with Paro
mean % (SD)
From 9,0% (5,5) to 6,7%
(5,5)
p = .014*
• Smiling/laughter - others
From 0,8% (0,8) to 1,5%
(1,4)
p = .011*
Norwegian University of Life SciencesEffects from Paro-groups in nursing homes
*
*
![Page 14: Effects from robot-assisted group activity in nursing homes€¦ · Effects from robot-assisted ... •Shift towards stimulating social, personal and physical resources in people](https://reader034.vdocuments.us/reader034/viewer/2022050110/5f47d87aea29b00d4211f3e4/html5/thumbnails/14.jpg)
Results – symptoms of agitation
Mixed-model analysis:
Estimate (95% CI) change
from baseline to follow-up:
- 5.5 (0.1 – 11.0)
Adjusted:
- 5.4 (0.1 – 10.7), p = .044*
= Control group
= Paro-group
16
18
20
22
24
26
28
Baseline Postintervention
Follow-up
Mean values - BARS:
* statistical significant at 0.05 level
p = .048*
Effects from Paro-groups in nursing homes Norwegian University of Life Sciences
![Page 15: Effects from robot-assisted group activity in nursing homes€¦ · Effects from robot-assisted ... •Shift towards stimulating social, personal and physical resources in people](https://reader034.vdocuments.us/reader034/viewer/2022050110/5f47d87aea29b00d4211f3e4/html5/thumbnails/15.jpg)
Results – symptoms of depression
Mean values - Cornell: Mixed-model analysis:
Estimate (95% CI) change
from baseline to follow-up:
- 3.90 (0.4 – 7.3)
Adjusted:
- 3.99 (0.7 – 7.3), p = .019*
= Control group
= Paro-group
4
5
6
7
8
9
10
11
12
Baseline Post interventionFollow-up
* statistical significant at 0.05 level
p = .028*
Effects from Paro-groups in nursing homes Norwegian University of Life Sciences
![Page 16: Effects from robot-assisted group activity in nursing homes€¦ · Effects from robot-assisted ... •Shift towards stimulating social, personal and physical resources in people](https://reader034.vdocuments.us/reader034/viewer/2022050110/5f47d87aea29b00d4211f3e4/html5/thumbnails/16.jpg)
Results – quality of life according
to dementia severity
Mean QUALID: Mixed model analysis:
20,4
23,1 23
21 21,1
23,2
25,9
27,9
30,9
26,826,4
24,5
BASELINE AFTER INTERVENTION
FOLLOW-UP
CDR 1/2
CDR 3
Paro
• CDR 3 (severe):
Estimate (95% CI) change from
baseline to follow-up :
7.92 (2.16-13.69)
• CDR 1/2 (mild/moderate):
Estimate (95% CI) change from
baseline to follow-up:
0.06 (-5,56 - 5,68), p = .983
p = .008*
Control
Effects from Paro-groups in nursing homes Norwegian University of Life Sciences
* statistical significant at 0.05 level
![Page 17: Effects from robot-assisted group activity in nursing homes€¦ · Effects from robot-assisted ... •Shift towards stimulating social, personal and physical resources in people](https://reader034.vdocuments.us/reader034/viewer/2022050110/5f47d87aea29b00d4211f3e4/html5/thumbnails/17.jpg)
Conclusions
![Page 18: Effects from robot-assisted group activity in nursing homes€¦ · Effects from robot-assisted ... •Shift towards stimulating social, personal and physical resources in people](https://reader034.vdocuments.us/reader034/viewer/2022050110/5f47d87aea29b00d4211f3e4/html5/thumbnails/18.jpg)
Main findings and conclusions• Social and psychological benefits
– Increased social interactions and increased mood.
• Physiological benefits
–Paro seems to have a calming effect
• A stress-reducing effect (increased oxytocin).
• Engaging activity affect behaviors positively.
• All benefits seem to affect quality of life in older people
with severe dementia.
• Paro-intervention might have influenced staff towards
increased attention during the course of the intervention,
resulting in effects at follow-up.Norwegian University of Life SciencesEffects from Paro-groups in nursing homes 18
![Page 19: Effects from robot-assisted group activity in nursing homes€¦ · Effects from robot-assisted ... •Shift towards stimulating social, personal and physical resources in people](https://reader034.vdocuments.us/reader034/viewer/2022050110/5f47d87aea29b00d4211f3e4/html5/thumbnails/19.jpg)
Practical implications
Norwegian University of Life SciencesEffects from Paro-groups in nursing homes 19
• Paro seems to promote health in those who enjoy Paro.
• Paro seems to be a feasible and effective activity in
nursing homes.
• Activity with Paro require little verbal instructions and has
low level of complexity = successful interventions.
• Increased social interactions
as added value.
• A possible non-pharmacological
tool towards nursing home
residents with dementia..
![Page 20: Effects from robot-assisted group activity in nursing homes€¦ · Effects from robot-assisted ... •Shift towards stimulating social, personal and physical resources in people](https://reader034.vdocuments.us/reader034/viewer/2022050110/5f47d87aea29b00d4211f3e4/html5/thumbnails/20.jpg)
Thank you for your attention!