Psychosocial health issues among older adults, such as depression and social isolation are an important cause of morbidity and premature mortality for older adults(1, 2). In particular, older adults with dementia are at a higher risk of developing these issues(3). Even though people with dementia may want to remain socially connected and be involved in activities that are personally meaningful(4), disease related impairments such as impaired cognition and emotional control can reduce their capacities and confidence. The stigma surrounding dementia and age discrimination amplifies the isolating effects of disease related impairments and can have disempowering, dehumanizing and marginalizing effects on people with dementia(5). Consequently, they are predisposed to heightened risk of depression and a further decline in cognition and function(6). As the world’s population is ageing rapidly, these issues are expected to be amplified. It is therefore important to look into effective interventions to promote psychosocial wellbeing of older adults, including people with dementia. Technological innovations have been viewed as solutions to deliver effective psychosocial interventions(7), and one such example would be the use of social robots. Social robots are defined as ‘useful robots with social intelligence and skills to allow interaction with people in a socially acceptable manner(8). According to Góngora and colleagues(9), there are four classifications of social robots: pet robots, humanoid robots, telepresence robots and socially assistive robots.
The effectiveness of social robots on the psychosocial health of older adults has been evaluated in the literature. A recent systematic review of 11 randomised controlled studies, of which 80% of the 1042 participants had dementia or mild cognitive impairment, was conducted by Pu et al(10). Social robots were found to improve social engagement between participants and staff, and positively affect physiological indicators of participants through improved sleep, improved oxygenation and improved cardiac status, as well as reduced use of psychotropic drugs for people with severe dementia. Likewise, a scoping review was conducted to map the key benefits of PARO, a robotic seal, for older people with dementia in care settings based on 29 included studies(11). The findings were congruent to the findings from the systematic review. The first benefit was reduced negative emotions and behavioural symptoms in people with dementia, which includes decreased agitation, less use of psychotropic medications, reduction in wandering behaviour, reduced staff stress and caregiver burn out. Secondly, it helped to improve mood, as caregivers highlighted that users had brighter facial expressions, improved quality of sleep and reduced use of pain medication. Thirdly, it helped to improve visual and verbal social engagement, and was used to facilitate conversations between care home residents and staff. The findings from both reviews elucidate evidence on positive trends on the effects of social robots on the psychosocial health of older adults, including people with dementia.
After the effectiveness of interventions have been evaluated, the next phase is to examine their implementation in a real world setting(12), where conditions for implementing an intervention differ from a research setting. Contexts for research (i.e.: clinical) trials are dependent on research supported resources, have specified timeframe, and are transient in nature since interventions are usually discontinued after a trial ends(13). In contrast, factors that influence implementation in real practice, such as competing demands on the care provider, may not be reflected in a research trial(14). Despite positive findings with regards to the effects of social robots for older adults, little is known about how to ensure that these interventions are implemented in practice. Papadopoulos and colleagues conducted a systematic review of twelve articles to identify enablers and barriers to the implementation of socially assistive humanoid robots (SAHR) in health and social care(15). The authors found that facilitators include participants’ enjoyment, intuitiveness and ease of use of the SAHR, personalisation of SAHR services to users’ needs, as well as familiarity towards the SAHR. On the other hand, barriers to implementation were limited capabilities of the robot, as well as negative preconceptions about stigma and dehumanisation of care. The authors reported these determinants were identified through single articles due to heterogeneity in study designs, therefore their findings may not be generalisable. It is also worth noting that the construct of ‘implementation’ was not included in the search strategy. Instead, broader constructs of ‘social robots’ and ‘context of implementation’ were used. Furthermore, the term ‘implementation’ was not included in the titles or abstracts of any of the included articles. Rather, terms such as ‘service evaluation’, ‘usability’, ‘social acceptance’, ‘acceptability’, and ‘feasibility’ were used. This suggests variations in terminologies used to describe implementation in existing studies.
Rationale
The recent systematic review by Papadopoulos et al(15) has provided important insights relating to the implementation of SAHRs. Our review differs in that it encompasses a broader scope to allow inquiry into the implementation of all variants of social robots. Given the variations in terminologies that has been used to describe implementation, this broader scope of evidence synthesis is necessary to establish the breadth of evidence base and to identify knowledge lapses in this field. In addition, our review places a greater focus on the conceptual aspects of implementation. This will be reflected through our search strategy and the use of the Consolidated Framework of Implementation Research (CFIR) to frame our findings. A scoping review is an ideal method for evidence synthesis to meet these goals, since it allows for broad exploration of literature(16, 17). Moving forward, the findings from this review would facilitate a better understanding of factors that are affecting the implementation of social robots for older adults in real practice, and to identify research gaps.
Objectives
The objectives of this scoping review are to synthesise variants in terminologies that have been used to describe barriers and facilitators affecting implementation of social robots, for older adults, including people with dementia and to systematically map out existing research literature to answer these research questions:
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What are the terminologies that have been used to describe implementation?
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What are the barriers affecting implementation of social robots for older adults, including people with dementia?
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What are the facilitators affecting implementation of social robots for older adults, including people with dementia?