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Research: Decreasing Delirium

News Story

College of Health Professions professors Lin Drury, PhD, and Sharon Wexler, PhD, are studying how robotic pets can improve the mental well-being of hospitalized older adults.

In 2010, only 13 percent of the US population was over 65. By 2030, that number will grow by a huge margin. As the populous baby boomer generation ages into retirement, the US Census Bureau projects (PDF) that approximately 20 percent of the population will be over 65.

This major population shift will call for fundamental adjustments in a number of different industries, but few will be affected as drastically as health care and health care services. This increase in numbers, combined with rapidly changing technological advances, will continue to necessitate major innovation over the next decade.

Understanding both the current landscape and the changes on the horizon, College of Health Professions Professors Sharon Wexler, PhD, and Lin Drury, PhD, have embarked on a series of research studies dealing with using technology to promote and enhance the well-being and older adults. One of their most promising projects centers around using robotic animals to enhance care for hospitalized older adults, which they have already found has a positive impact on decreasing delirium.

"We had done a study with avatar service animals on a tablet that would see and hear and talk to the patient—the avatar was a cartoon cat or dog that would carry on a conversation through talk to text with a patient in their home 24/7," said Drury. "If the patient wasn't responding, the avatar would reach out to the patient."

Drury and Wexler found success using the avatars, but ran into a number of problems. Primarily, they required strong internet connectivity, and could easily be undone by spotty WiFi. Not to mention, the avatars themselves did not exist in the physical realm.

"We started looking what kind of service animals we could use that don't require internet access, we found these robots that are loaded with sensors, so you can put the animal in the patient's arms, so they stroke and cuddle it in the way you would a real animal. The robot responds through a few scripted sequences—wags its tail, purrs, licks its paws, does things animals would do in a real interactive way," said Drury.

The robots are relatively inexpensive and significantly easier than the avatars from a troubleshooting standpoint—rather than an elaborate IT strategy, they only require a simple battery change—so Wexler and Drury have been able to substitute avatar use with robots for a number of patients.

"Because of the issues with the avatars we've decided to try these relatively simple robots, and see if the outcomes would be anything similar. The good news is that people are really liking the robots," said Drury.

Wexler notes that although they've only enrolled a quarter of the patients into the program, they've already been able to observe its impact.

"So far it is having a dramatic effect on depression and loneliness in hospitalized older adults, and we're seeing a decrease in the rate of delirium. Delirium is a major problem for hospitalized older adults—it's a major quality of life issue, and is a tremendous source of morbidity and mortality in hospitalized patients," said Wexler.

"With delirium, you don't know what's going on, you don't necessarily know what you're doing. It leads to things like people trying to crawl out of bed and falling," said Drury.

Delirium, generally defined as a period of acute confusion—a sudden loss of sense of place and time which can sometimes accompany old age—is one of the most significant issues facing senior citizens today. As the duo notes, having a robotic animal in one's care—which may harken back to caring for a child or a pet—helps orient patients to the present, thus decreasing the rate of these types of harmful episodes.

Taking care of an older loved one often requires help from a devoted extended family: children, grandchildren, siblings, cousins, and so on. From a research standpoint, Wexler and Drury have certainly not shied away from assigning roles and responsibilities to the extended CHP family.

"We have undergraduate and graduate students involved in the research," said Wexler. "We have undergraduate nursing students, accelerated nursing students, master's nursing students and computer science students, and a PhD nursing student. We have a commitment to working with students at all levels, and we feel like it's an important part of the study."

Together, with significant help from the students involved with the research, Wexler and Drury hope to continue to build upon their work. Namely, they'd like to incorporate some of the positive technologies of the avatar into the next iteration of robots.

"Our next plan is to apply for an even larger grant from the National Institutes of Health (NIH), and going to try to combine the technology from our previous avatar project, and combine it with the technology of the robot," said Wexler. "So you'd have this fuzzy robot, but it would also be able to see you, hear you, talk with you, notify the nurses if you were in trouble, the way the avatar could."

As the years march on, the demand for these types of technologies and servicesas well as information on how they affect patientswill only continue to grow. And although the baby boomer generation may start resisting the reality of aging into septua- and octogenarians, at least they'll be accompanied by some pretty good dogs.