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