Effectiveness of Care Robots, and the Intermediaries’ Role between and among Care Robots and Older Adults*

Abstract Background : Older people are frequent Emergency Department (ED) users who present with complex issues that are linked to poorer health outcomes post-index visit, often have increased ED length of stay and tend to have raised healthcare costs. Encouraging evidence suggests that ED teams involving health and social care professionals (HSCPs) can contribute to enhanced patient flow and improved patient experience by improving care decision-making and thus promoting timely and effective care. However, the evidence supporting the impact of HSCPs teams assessing and intervening with older adults in the ED is limited and identifies important methodological limitations, highlighting the need for more robust and comprehensive investigations of this model of care. This study aims to evaluate the impact of a dedicated ED-based HSCP team on the quality, safety, clinical and cost-effectiveness of care of older adults when compared to usual care. Methods : The study is a single-site randomised controlled trial whereby patients aged ≥65 years who present to the ED of a large Irish hospital will be randomised to the experimental group (ED-based HSCP assessment and intervention) or the control group (usual ED care). The recruitment target is 320 participants. The HSCP team will provide a comprehensive functional assessment as well as interventions to promote a safe discharge for the patient. The primary outcome is ED length of stay (from arrival to discharge). Secondary outcomes include: rates of hospital admissions from the ED, ED re-visits, unplanned hospital admissions and healthcare utilisation at 30-days, four and six-month follow-up; patient functional status and quality of life (at baseline and follow-up); patient satisfaction; costs-effectiveness in terms of costs associated with ED-based HSCP compared to usual care; and perceptions on implementation by ED staff members. Discussion : This is the first randomised controlled trial testing the impact of HSCPs working in teams in the ED on the quality, safety, clinical and cost-effectiveness of care for older patients. The findings of the study will provide important information on the effectiveness of this model of care for future implementation. Trial registration : ClinicalTrials.gov, NCT03739515; registered on 12 th November 2018. Protocol version 1. URL: https://clinicaltrials.gov/ct2/show/NCT03739515

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Investigating the effectiveness of care delivery at an acute geriatric community hospital for older adults in the Netherlands: a protocol for a prospective controlled observational study

BMJ Open ◽

10.1136/bmjopen-2019-033802 ◽

2020 ◽

Vol 10 (3) ◽

pp. e033802

Author(s):

Marthe E Ribbink ◽

Janet L Macneil-Vroomen ◽

Rosanne van Seben ◽

Irène Oudejans ◽

Bianca M Buurman

Keyword(s):

Older Adults ◽

The Netherlands ◽

Community Hospital ◽

Care Delivery ◽

Functional Decline ◽

Transitions Of Care ◽

Multiple Chronic Conditions ◽

Hospitalised Patients ◽

Ethics Research ◽

Effectiveness Of Care

IntroductionHospital admission in older adults with multiple chronic conditions is associated with unwanted outcomes like readmission, institutionalisation, functional decline and mortality. Providing acute care in the community and integrating effective components of care models might lead to a reduction in negative outcomes. Recently, the first geriatrician-led Acute Geriatric Community Hospital (AGCH) was introduced in the Netherlands. Care at the AGCH is focused on the treatment of acute diseases, comprehensive geriatric assessment, setting patient-led goals, early rehabilitation and streamlined transitions of care.Methods and analysisThis prospective cohort study will investigate the effectiveness of care delivery at the AGCH on patient outcomes by comparing AGCH patients to two historic cohorts of hospitalised patients. Propensity score matching will correct for potential population differences. The primary outcome is the 3-month unplanned readmission rate. Secondary outcomes include functional decline, institutionalisation, healthcare utilisation, occurrence of delirium or falls, health-related quality of life, mortality and patient satisfaction. Measurements will be conducted at admission, discharge and 1, 3 and 6 months after discharge. Furthermore, an economic evaluation and qualitative process evaluation to assess facilitators and barriers to implementation are planned.Ethics and disseminationThe study will be conducted according to the Declaration of Helsinki. The Medical Ethics Research Committee confirmed that the Medical Research Involving Human Subjects Act did not apply to this research project and official approval was not required. The findings of this study will be disseminated through public lectures, scientific conferences and journal publications. Furthermore, the findings of this study will aid in the implementation and financing of this concept (inter)nationally.Trial registration numberNL7896; Pre-results.

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Assistive Care Robots and Older Adults: Employing a Care Ethics Lens

Canadian Journal of Bioethics ◽

10.7202/1077637ar ◽

2021 ◽

Vol 4 (1) ◽

pp. 101

Author(s):

Rachel Hewitt

Keyword(s):

Older Adults ◽

Care Ethics ◽

Care Robots

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The impact of frailty Screening of Older adults with muLtidisciplinary assessment of those At Risk during emergency hospital attendance on the quality, safety and cost-effectiveness of care (SOLAR): a randomised controlled trial.

Trials ◽

10.1186/s13063-021-05525-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Aoife Leahy ◽

Rachel McNamara ◽

Catriona Reddin ◽

Gillian Corey ◽

Ida Carroll ◽

...

Keyword(s):

Older Adults ◽

At Risk ◽

Cost Effectiveness ◽

Older People ◽

Geriatric Medicine ◽

Research Centre ◽

Medical Assessment ◽

Assessment Unit ◽

Effectiveness Of Care ◽

The Impact

Abstract Background Older people account for 25% of all Emergency Department (ED) admissions. This is expected to rise with an ageing demographic. Older people often present to the ED with complex medical needs in the setting of multiple comorbidities. Comprehensive Geriatric Assessment (CGA) has been shown to improve outcomes in an inpatient setting but clear evidence of benefit in the ED setting has not been established. It is not feasible to offer this resource-intensive assessment to all older adults in a timely fashion. Screening tools for frailty have been used to identify those at most risk for adverse outcomes following ED visit. The overall aim of this study is to examine the impact of CGA on the quality, safety and cost-effectiveness of care in an undifferentiated population of frail older people with medical complaints who present to the ED and Acute Medical Assessment Unit. Methods This will be a parallel 1:1 allocation randomised control trial. All patients who are ≥ 75 years will be screened for frailty using the Identification of Seniors At Risk (ISAR) tool. Those with a score of ≥ 2 on the ISAR will be randomised. The treatment arm will undergo geriatric medicine team-led CGA in the ED or Acute Medical Assessment Unit whereas the non-treatment arm will undergo usual patient care. A dedicated multidisciplinary team of a specialist geriatric medicine doctor, senior physiotherapist, specialist nurse, pharmacist, senior occupational therapist and senior medical social worker will carry out the assessment, as well as interventions that arise from that assessment. Primary outcomes will be the length of stay in the ED or Acute Medical Assessment Unit. Secondary outcomes will include ED re-attendance, re-hospitalisation, functional decline, quality of life and mortality at 30 days and 180 days. These will be determined by telephone consultation and electronic records by a research nurse blinded to group allocation. Ethics and dissemination Ethical approval was obtained from the Health Service Executive (HSE) Mid-Western Regional Hospital Research Ethics Committee (088/2020). Our lay dissemination strategy will be developed in collaboration with our Patient and Public Involvement stakeholder panel of older people at the Ageing Research Centre and we will present our findings in peer-reviewed journals and national and international conferences. Trial registration ClinicalTrials.gov NCT04629690. Registered on November 16, 2020

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Personal Care Robots for Older Adults: An Overview

Asian Social Science ◽

10.5539/ass.v13n1p11 ◽

2016 ◽

Vol 13 (1) ◽

pp. 11 ◽

Cited By ~ 4

Author(s):

S H Hosseini ◽

K M Goher

Keyword(s):

Older Adults ◽

Personal Care ◽

Care Robots

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Older Adult Preferences for Robot Care Providers

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/1541931218621238 ◽

2018 ◽

Vol 62 (1) ◽

pp. 1032-1036

Author(s):

Rachel E. Stuck ◽

Emily M. McDonald ◽

Wendy A. Rogers

Keyword(s):

Older Adults ◽

Older Adult ◽

Care Provider ◽

Care Providers ◽

Adult Care ◽

Care Robots ◽

The World ◽

Technology Intervention ◽

Human Care ◽

Insight Into

As the population of older adults increases throughout the world, there is increased demand for specialized interventions for older adults who receive assistance from care providers. Robot care providers are a potential technology intervention to support this population. Although previous research has explored older adults’ perceptions of robot care providers, the studies primarily included independently functioning older adults. This study explored the perceptions of robot care providers from older adults who are currently receiving assistance from a human care provider to gain insight into their understanding of successful care, and how robot care providers can be designed to effectively care for older adults. The results suggest that in the care provider context, older adults desire a robot that goes beyond simply performing the tasks, but is also caring, kind, and sociable. When designing robots for older adult care, robots should also be social to support successful interactions.

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A randomised controlled trial exploring the impact of a dedicated Health and Social Care Professionals team in the Emergency Department on the quality, safety, clinical and cost-effectiveness of care for older adults: Study Protocol

10.21203/rs.2.12207/v1 ◽

2019 ◽

Author(s):

Marica Cassarino ◽

Katie Robinson ◽

Íde O’Shaughnessy ◽

Eimear Smalle ◽

Stephan White ◽

...

Keyword(s):

Older Adults ◽

Cost Effectiveness ◽

Randomised Controlled Trial ◽

Controlled Trial ◽

Model Of Care ◽

Health And Social Care ◽

Effectiveness Of Care ◽

Randomised Controlled ◽

The Impact

Abstract Background Older people are frequent Emergency Department (ED) users who present with complex issues that are linked to poorer health outcomes post-index visit, often have increased ED length of stay and tend to have raised healthcare costs. Encouraging evidence suggests that ED teams involving health and social care professionals (HSCPs) can contribute to enhanced patient flow and improved patient experience by improving care decision-making and thus promoting timely and effective care. However, the evidence supporting the impact of HSCPs teams assessing and intervening with older adults in the ED is limited and identifies important methodological limitations, highlighting the need for more robust and comprehensive investigations of this model of care. This study aims to evaluate the impact of a dedicated ED-based HSCP team on the quality, safety, clinical and cost-effectiveness of care of older adults when compared to usual care. Methods The study is a single-site randomised controlled trial whereby patients aged ≥65 years who present to the ED of a large Irish hospital will be randomised to the experimental group (ED-based HSCP assessment and intervention) or the control group (usual ED care). The recruitment target is 320 participants. The HSCP team will provide a comprehensive functional assessment as well as interventions to promote a safe discharge for the patient. The primary outcomes include ED length of stay (from arrival to discharge) and incidence of inpatient admissions from the ED. Secondary outcomes include: ED re-visits, unplanned hospital admissions and healthcare utilisation at 30-days and six-month follow-up; patient functional status and quality of life (at baseline and follow-up); patient satisfaction; costs-effectiveness in terms of costs associated with ED-based HSCP compared to usual care; and perceptions on implementation by ED staff members. Discussion This is the first randomised controlled trial testing the impact of HSCPs working in teams in the ED on the quality, safety, clinical and cost-effectiveness of care for older patients. The findings of the study will provide important information on the effectiveness of this model of care for future implementation.

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The Impact of Frailty Screening of Older Adults With Multidisciplinary Assessment of Those at Risk During Emergency Hospital Attendance on the Quality, Safety and Cost-Effectiveness of Care (SOLAR): A Randomised Controlled Trial.

10.21203/rs.3.rs-447184/v1 ◽

2021 ◽

Author(s):

Aoife Leahy ◽

Rachel McNamara ◽

Catriona Reddin ◽

Gillian Corey ◽

Ida Carroll ◽

...

Keyword(s):

Older Adults ◽

At Risk ◽

Cost Effectiveness ◽

Older People ◽

Geriatric Medicine ◽

Research Centre ◽

Medical Assessment ◽

Assessment Unit ◽

Effectiveness Of Care ◽

The Impact

Abstract BackgroundOlder people account for 25% of all Emergency Department (ED) admissions. This is expected to rise with an ageing demographic. Older people often present to the ED with complex medical needs in the setting of multiple comorbidities. Comprehensive Geriatric Assessment (CGA) has been shown to improve outcomes in an inpatient setting but clear evidence of benefit in the ED setting has not been established. It is not feasible to offer this resource intensive assessment to all older adults in a timely fashion. Screening tools for frailty have been used to identify those at most risk for adverse outcomes following ED visit. The overall aim of this study is to examine the impact of CGA on the quality, safety and cost-effectiveness of care in an undifferentiated population of frail older people with medical complaints who present to the ED and Acute Medical Assessment Unit. MethodsThis will be a parallel 1:1 allocation randomised control trial. All patients who are ≥75 years will be screened for frailty using the Identification of Seniors At Risk (ISAR) tool. Those with a score of ≥2 on the ISAR will be randomised. The treatment arm will undergo geriatric medicine team-led CGA in the ED or Acute Medical Assessment Unit whereas the non-treatment arm will undergo usual patient care. A dedicated multidisciplinary team of a specialist geriatric medicine doctor, senior physiotherapist, specialist nurse, pharmacist, senior occupational therapist and senior medical social worker will carry out the assessment, as well as interventions that arise from that assessment. Primary outcomes will be length of stay in the ED or Acute Medical Assessment Unit. Secondary outcomes will include ED re-attendance, re-hospitalisation, functional decline, quality of life and mortality at 30 days and 180 days. These will be determined by telephone consultation and electronic records by a research nurse blinded to group allocation.Ethics and DisseminationEthical approval was obtained from the Health Service Executive (HSE) Mid-Western Regional Hospital Research Ethics Committee (088/2020). Our lay dissemination strategy will be developed in collaboration with our Patient and Public Involvement stakeholder panel of older people at the Ageing Research Centre and we will present our findings in peer reviewed journals and national and international conferences. Trial Registration: Clinical Trials.gov NCT04629690

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A randomised controlled trial exploring the impact of a dedicated health and social care professionals team in the emergency department on the quality, safety, clinical and cost-effectiveness of care for older adults: a study protocol

Trials ◽

10.1186/s13063-019-3697-5 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Marica Cassarino ◽

Katie Robinson ◽

Íde O’Shaughnessy ◽

Eimear Smalle ◽

Stephen White ◽

...

Keyword(s):

Older Adults ◽

Cost Effectiveness ◽

Randomised Controlled Trial ◽

Hospital Admissions ◽

Controlled Trial ◽

Health And Social Care ◽

Effectiveness Of Care ◽

Randomised Controlled ◽

The Impact

Abstract Background Older people are frequent emergency department (ED) users who present with complex issues that are linked to poorer health outcomes following the index visit, often have increased ED length of stay, and tend to have raised healthcare costs. Encouraging evidence suggests that ED teams involving health and social care professionals (HSCPs) can contribute to enhanced patient flow and an improved patient experience by improving care decision-making and thus promoting timely and effective care. However, the evidence supporting the impact of HSCP teams assessing and intervening with older adults in the ED is limited and identifies important methodological limitations, highlighting the need for more robust and comprehensive investigations of this model of care. This study aims to evaluate the impact of a dedicated ED-based HSCP team on the quality, safety, and clinical- and cost-effectiveness of care of older adults when compared with usual care. Methods The study is a single-site randomised controlled trial whereby patients aged ≥65 years who present to the ED of a large Irish hospital will be randomised to the experimental group (ED-based HSCP assessment and intervention) or the control group (usual ED care). The recruitment target is 320 participants. The HSCP team will provide a comprehensive functional assessment as well as interventions to promote a safe discharge for the patient. The primary outcome is ED length of stay (from arrival to discharge). Secondary outcomes include: rates of hospital admissions from the ED, ED re-visits, unplanned hospital admissions and healthcare utilisation at 30 days, and 4 and 6 months of follow-up; patient functional status and quality of life (at baseline and follow-up); patient satisfaction; cost-effectiveness in terms of costs associated with ED-based HSCP compared with usual care; and perceptions on implementation by ED staff members. Discussion This is the first randomised controlled trial testing the impact of HSCPs working in teams in the ED on the quality, safety, and clinical- and cost-effectiveness of care for older patients. The findings of this study will provide important information on the effectiveness of this model of care for future implementation. Trial registration ClinicalTrials.gov, NCT03739515. Registered on 12 November 2018.

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The essential needs for home-care robots in Japan

Journal of Enabling Technologies ◽

10.1108/jet-03-2020-0008 ◽

2020 ◽

Vol 14 (4) ◽

pp. 201-220

Author(s):

Mayuko Tsujimura ◽

Hiroo Ide ◽

Wenwei Yu ◽

Naonori Kodate ◽

Mina Ishimaru ◽

...

Keyword(s):

Older Adults ◽

Factor Analysis ◽

Home Care ◽

Family Caregivers ◽

Care Staff ◽

Cross Sectional ◽

Content Type ◽

Daily Monitoring ◽

Care Robots ◽

Level Of Agreement

Purpose This study aims to compare the level of needs for home-care robots amongst older adults, family caregivers and home-care staff and clarify the factors constituting these needs. Design/methodology/approach A cross-sectional, anonymous questionnaire survey was administered. It included 52 items related to needs for home-care robots rated on a four-point Likert scale. Means and standard deviations were calculated, and the Kruskal-Wallis test was performed for each item. Factor analysis was conducted on the needs of home-care staff. Findings Responses from 79 older adults, 54 family caregivers and 427 home-care staff were analysed. For all three groups, the level of agreement was high for the following needs: to inform family and support personnel immediately when older adults fall, about their location in case of natural disasters and about mismanagement of fire by older adults with dementia. For family caregivers and home-care staff, the level of need concerning monitoring was higher than for older adults. Extracted using factor analysis, the six factors representing the essential needs for home-care robots were risk minimisation, daily monitoring of the physical condition, supporting activities of daily living (ADL) and instrumental ADL, pre-empting problems, communication and miscellaneous support. Originality/value The results showed that the education of caregivers and the co-design process of robot development should involve home-care staff, older adults and family caregivers, which are important for making decisions about the use of home-care robots for older adults.

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