Older adults in rural communities who have chronic health conditions are often isolated from social support and medical clinics. Robots may be able to assist with day to day healthcare and provide companionship. This paper presents four case studies of older adults who had chronic health conditions in a rural community. They were given a healthcare robot in their homes for a period of three months to a year. The robot reminded people to take medications, had entertainment and memory games, and skype. Rates of hospitalizations, primary care visits, and phone calls to the medical practitioners before the study began were compared to rates during the study period. Participants also completed questionnaires about their quality of life, mental health, medication adherence, and robot attitudes and were interviewed. The results showed a decrease in primary care visits and phone calls to the practitioners while the robot was present and increases in quality of life were observed. Despite encountering technical issues, patients were mostly positive and accepting of the robot, acknowledging its benefits as a companion.

Robots have been proposed to reduce the costs of the provision of healthcare in rural settings, but as yet little research has tested this. This study investigated the feasibility and cost-effectiveness of a robot measuring routine vital signs in a family medicine clinic in a rural setting. The length of patient consultations was compared before (N = 85 patients) and after a robot was deployed in the clinic (N = 48 patients). A Cafero touchscreen robot took the patient's vital signs prior to the consultation and transferred the results to the medical professional's computer. Time-savings were calculated in New Zealand dollar terms and compared to the costs of the robot and its maintenance. Results showed that consultation lengths were cut by 18% on average (3 minutes and 13 seconds). If 20% of the clinics' annual consultations were augmented with the robot this translates to a total annual savings of NZ$19075. The annual cost of the robot was calculated to be NZ$9400 overs 5 years. Present value calculations of Benefit Cost result in a Benefit Cost ratio of 2.3. These results support the cost-effectiveness of the robot in a rural medical clinic. Further research is needed to improve the services provided by the robot and test it in a larger trial.

Background: Although family photos are often used in the psychosocial care for people with dementia, little is known about the use and effectiveness of generic photos. This systematic literature review explored psychosocial interventions using generic photos for people with dementia, and the effects they have on their social interaction and/or mood and/or quality of life. In addition, it was investigated whether these interventions made use of technology in its implementation. Methods: A systematic search on the following databases was performed: PubMed, Embase, APA PsychInfo, Cinahl, Web of Science, Scopus and Cochrane Central. Inclusion and exclusion criteria were based on the PICO model (Population, Intervention, Comparison, Outcome), and quality assessment was undertaken using the Weight of Evidence Framework. Narrative synthesis was undertaken to summarize study characteristics- settings and designs, type of psychosocial interventions identified, type of photos and technology used, outcome measures, and results. Results: A total of 2,035 results were found, however after title, abstract and full-text screening, a total of 8 studies were included. The most common psychosocial intervention using generic photos was found to be reminiscence therapy, followed by art-viewing activities. In studies that used technology, it was reported that viewing digitalized photos were either similar or better to conventional printed photos. Despite photos being generic, it was found that generic photos could still hold personal significance to the person with dementia. Some positive and significant effects were found for the outcomes social interaction, mood and quality of life, though no study evaluated all three outcomes. Two studies were rated as having high overall quality, 4 were rated as fair, and 2 studies had a low quality assessment rating. Conclusion: Studies found using generic photos were limited, showing varying outcomes and methodological quality. Firm conclusions on the effectiveness of interventions using generic photos are not possible. However, the use of generic photos in psychosocial interventions is a promising area for future research. Researchers should consider studies with better methodological quality and larger samples; and qualitative studies where the intention is to get better insight into successful implementation and impact mechanisms of such psychosocial interventions. Trial registration: n/a.

Background: To address the lack of social interaction and meaningful activities for persons with dementia (PWD) in nursing homes an artistic Photo-Activity was designed. The present study aims to develop a digital version of the Photo-Activity and to investigate its implementation and impact on nursing home residents with advanced dementia, and their (in)formal carers.Methods: First, within a user-participatory design, a digital-app version of the Photo-Activity will be developed and pilot-tested, in co-creation with (in)formal carers and PWD.Next, the feasibility and effectiveness of the Photo-Activity versus a control activity will be explored in a randomized controlled trial with nursing home residents (N=90), and their (in)formal carers. Residents will be offered the Photo-Activity or the control activity by (in)formal carers during one month. Measurements will be conducted by independent assessors at baseline (T0), after one month (T1) and at follow up, two weeks after T1 (T2). Qualitative and quantitative methods will be used to investigate the effects of the intervention on mood, social interaction and quality of life of the PWD, sense of competence of informal carers, empathy and personal attitude of the formal carers, and quality of the relationship between the PWD, and their (in)formal carers. In addition, a process evaluation will be carried out by means of semi-structured interviews with the participating residents and (in)formal carers.Finally, an implementation package based on the process evaluation will be developed, allowing the scaling up of the intervention to other care institutions.Discussion: Results of the trial will be available for dissemination by Spring 2023. The digital Photo-Activity is expected to promote meaningful connections between the resident with dementia, and their (in)formal carers through the facilitation of person-centered conversations.Trial registration: Netherlands Trial Register:NL9219; registered (21 January 2021); NTR (trialregister.nl)

Introduction: The use of digital assistive technologies by and for people living with dementia is promising for supporting social health and advocated as a partial solution to growing prevalence worldwide. A state-of-the-art position paper published in 2017 identified challenges regarding digital assistive technologies, around five themes: development, usability, (cost-)effectiveness, implementation and ethics. This systematic review summarizes progress on the challenges found in 2017, and persisting or emerging challenges. Methods: A systematic review of systematic reviews was conducted, focused on studies published after 2016. The inclusion criteria required that the target group included, at least in part, people with dementia living in the community and that the technologies aimed to support social health. For the five themes, literature searches were conducted in Medline, CINAHL, PsycINFO, and Embase databases. Results: A total of 112 reviews were included, covering various applications such as smart homes, care robots, exergaming and everyday technologies. No applications of artificial intelligence were included. The challenges included personalization of applications (development); limited use of standardized methods (usability); insufficient quantity and quality of randomized controlled trials (cost-effectiveness); overly high expectations of assistive technologies (implementation); and the need for more equitable access to technologies (ethics). Conclusion: Much research has been conducted since the 2017 state of the art position paper. While some challenges identified at that time remain relevant, others have been addressed, and new challenges have emerged. Future research should prioritize emerging artificial intelligence applications; the development of integrated assistive technologies; evaluation using robust methods and meaningful outcomes; and the promotion of more accessible and inclusive technologies.

To enhance social interaction of residents living with dementia and their (in)formal carers in nursing homes, we examined the effects of a digital, person-centred, Photo-Activity (PA) versus a conversation activity (control). An explorative randomized controlled trial was conducted in 81 resident-informal carer (IC) dyads and 51 formal carers (FC) with three measurements (pre/post-test, 2-week follow-up). Intervention effects were tested using Mann–Whitney U’s, and ANCOVA’s with pre-test scores as covariates. Interaction effects were examined between dementia severity (DS; less/more) and condition (PA/control). A post-test effect was observed in social interaction (INTERACT-subscale: Mood [p = 0.037, ηp² = 0.07]), with PA residents showing better mood than controls. Residents with less DS showed more positive effects of PA than residents with more DS (interaction effects: INTERACT-subscales Mood [p = 0.017, ηp² = 0.092], Stimulation Level [p = 0.011, ηp² = 0.106], and Need for Prompting [p = 0.013, ηp² = 0.099]). Higher QUALIDEM Positive Affect scores were observed in the PA group, post-test (p = 0.025, ηp² = 0.082), and follow-up (p = 0.042, d = 0.39). PA FC showed less empathy (IRI; p = 0.006, ηp² = 0.185;) than controls, but reported getting to know the residents better (p = 0.035, r = 0.299). PA improved mood and positive affect of residents with dementia and led to FC knowing the residents better. Less empathy was observed in FC providing PA, requiring further investigation.