Cuddly seals and robot PAS: the future of elderly care
Artificial intelligence and robotics are already being used to help care for people with dementia. The possibilities are endless – and alarming. Corinne Purtill reports
Among the symptoms of dementia is a phenomenon called “sundowners syndrome”: an increase in agitation, confusion and anxiety as late afternoon transitions to evening. Its cause isn’t well understood; anxiety over end-of-day activity and hormonal fluctuations have been floated as theories. Whatever the trigger, sundowners can make otherwise amiable people combative and even violent, a frightening and unsettling experience for patients and caregivers alike. Staff in hospitals and nursing homes typically treat the symptoms with sedative drugs. But in recent years, facilities from Japan to the US have turned instead to a specialist: a robot baby seal named Paro.
Paro spent a decade in development at Japan’s National Institute of Advanced Industrial Science and Technology. The robot seal came to market in 2004 and is now in use in many parts of Asia, Europe and North America to offer the psychological benefits of pet therapy in situations where a real animal isn’t practical. A new Paro costs about $6,000. People who work with seniors with dementia describe it as a furry little miracle. Sandra Petersen, a professor of nursing at the University of Texas at Tyler, had a patient with advanced Alzheimer’s who hadn’t spoken in eight years. The woman picked up a Paro, cradled it in her arms and whispered “I love you” into its fur.
Paro responds to touch and sound, and makes cooing noises modelled after those of real baby harp seals. If you stroke Paro and talk softly to it, it will gurgle and turn towards you. If you speak to it sharply, it will immediately stop whatever it’s doing and try something else in an effort to please you. The choice of animal is deliberate: a robot dog might evoke a frightening childhood memory of a snarl or a bite, but who’s ever had a bad run-in with a baby seal? Paro never needs to be fed or walked; it never jumps, scratches or growls; its companionship can be summoned at any time of the day or night. That might seem elementary, but one of the most valuable things a robot or artificial intelligence can do for the elderly is to simply be present: constantly, tirelessly, consistently present. A caregiving AI needs no sleep, never gets sick or distracted, has no obligation apart from its service. It accomplishes the essential task of caregiving: placing the care recipient at the centre of one’s attention.
Paro alleviates the intense anxiety and agitation that frequently accompany dementia. A patient holding a Paro is less likely to
wander, another common hazard of the condition. “I’ve been in this field for 25-plus years,” says Randy L. Griffin, a nurse who created the first Paro training programme in the US. “There isn’t any other thing we have in dementia care today that [is effective] at every stage of this illness.”
“The thing with pets is that they’re living and sentient and may have an off day,” says Kathy Martyn, a lecturer in health sciences at the University of Brighton. “They may not want to perform at three in the morning or on a hot afternoon.” Martyn and I meet on Brighton’s Falmer campus, in East Sussex. A Paro sits squawking on a table between us, craning its head quizzically toward the sound of our voices with a faint, motorised whirr. Throughout the conversation we each reach out from time to time to stroke Paro’s fur or give it a scratch behind the ears. At one point I involuntarily make a goofy face at it, the way one does to win over a puppy or a baby.
Paro is about the size and weight of a human infant. With Martyn’s permission, I pick Paro up and hold it against my chest, as patients often do. It immediately evokes the muscle memory of hours spent rocking small humans of similar size, to a degree that brings an unexpected lump to my throat. That, too, is part of Paro’s design. Caring for others is an essential part of being human. It’s also one of the first things to be taken away as a person’s physical and mental reflexes slow. “Often you’ll see someone petting Paro and he’ll cry, and they’ll say, ‘Don’t cry.’ They’re taking care of something. He gives the person the ability to give love, as well as receive love,” Griffin says.
One of the guiding principles of robotics and artificial intelligence in healthcare is that robots – or the people who design and deploy them – should not practise deception; it’s not ethical to let someone believe they’re having an interaction with a real human or animal when the thing they are engaging with is, in fact, a robot. Healthcare providers who use Paro say they introduce the device factually, with different degrees of clarity depending on the person they’re working with. Some will explain that it is a robot. Others will simply say, “This is Paro.”
“We never present him as anything other than what he is: a robotic seal,” Martyn says. But because of their cognitive disabilities, not all patients are able to distinguish between what’s real and what’s not. Some confirm that they recognise Paro is a
“Paro responds to touch and sound, and makes cooing noises modelled after those of real baby harp seals”
toy. Others interact with it as if it were a living animal. Sometimes patients call the robot by the name of a child, or a cat they used to have.
“I’ve been confronted by people about that,” Petersen says. But people concerned about the harm a relationship with Paro might do to a person with dementia do not understand the gravity of the condition, she argues. “You come to a point in dementia where you can’t trust yourself. It’s like being dropped in another country where you don’t speak the language, you don’t know what time of day it is. It’s terribly, terribly fear-producing. They know something’s wrong, but they can’t figure out what it is. And it never ends for them. I don’t think people realise how horrific it is.” The sedatives typically used to treat that agitation can themselves increase the risk of falls, infection and further confusion. “Most of my patients are on an average of 14 to 28 medicines a day,” Petersen says. “If I can use a robot to control symptomatology rather than four or five pills that person might take to control anxiety, why wouldn’t I use that?”
Given the comfort it brings, insisting that patients recognise its artificiality seems cold and beside the point. But you don’t have to peer very far into the future to see the possibility of interactions in which it will be difficult even for a person with full cognitive facilities to tell the difference between robots and reality. The New Zealand tech company Soul Machines, based in Auckland, creates AI interfaces that look uncannily like high-definition video chats with a real human being. It doesn’t quite pass the Turing Test, but it’s easy to imagine a situation in which someone with limited eyesight or cognitive disabilities believes they’re having a human conversation when talking to a robot like Soul Machines’ Ava. The firm licenses its user interface technology to businesses and institutions. Its technology has powered digital assistants for banks, airlines and software companies, as well as a prototype virtual assistant, voiced by the actress Cate Blanchett, that was designed to help people with disabilities navigate Australia’s public benefits system. Robot companions for the infirm, then, are not too far a leap.
Nor is the prospect of a future in which a family converses with the lively AI recreation of a person suffering from dementia, while a caregiver – robot or human – tends to their ailing body in another room. The potential for deception is already here. A few years ago, Brent Lawson, the president of 1am Doll USA, a manufacturer of life-sized rubber sex dolls, was on the phone with a client who wanted a specific doll. The man was particularly concerned that the doll’s hair was just so, and peppered Lawson with questions about the colour and style. Eventually he explained that he didn’t need a doll for sex. He needed a doll that resembled his late sister. The man was currently caring for his elderly mother in the late stages of dementia. The ailing woman asked for his sister every day, and he could no longer bear to keep breaking the news to her that her daughter was dead. “The mother had Alzheimer’s and dementia, and apparently her sight wasn’t so great, so rather than having to explain every day that the sister wasn’t there he could just point across the room and say, ‘She’s right there, and she’s taking a nap,’” Lawson says.
A dystopian future in which robot sex dolls babysit our nanas is appalling. It’s also extremely unlikely. Much of the research on AI’S potential to support ageing individuals is focused not on building virtual friends, but on helping elderly individuals with practical tasks, especially those that help an older person age in their own home. Elliq, a “social robot” designed for use by older people, is one such prototype. The desktop robot offers reminders for appointments and medication times, books car rides, plays music and audiobooks, and nudges users to accomplish goals like going out for exercise or calling a friend. The settings can be adjusted so Elliq alerts caregivers if it hasn’t detected any user activity in a specified time. In extreme cases, caregivers can access the robot’s camera and microphone, and check on the older adult directly. Used with discretion, this virtual key is helpful for both parties.
In fact, there are some applications that may give users a greater sense of privacy. In one survey of older people from 2016, respondents preferred getting help from a machine rather than a human in 28 out of 48 daily tasks, especially mundane manual ones like finding their keys or cleaning their home. (For personal care tasks like bathing or shaving, respondents tended to want people to help them, not machines.) In this school of design, the best use of AI is to take on the physical tasks of caregiving and free up human capital for the relational aspects. “We want to leverage what people do best: the compassion, the empathy, the human touch,” said Conor Mcginn, a professor at Trinity College Dublin involved in designing robots for use in care homes and hospitals.
But the temptation to outsource some of the emotional labour of caregiving to AI is going to be intense. By 2050 there will be as many adults aged 65 and older in the US as there are children under 18 – an unprecedented demographic threshold that many industrialised countries will reach even sooner than the US. Most people lucky enough to live long lives will, at some point, reach a stage in which they require regular assistance with the tasks of daily life – assistance usually provided by a family member. Ensuring that an elderly person is dressed, fed, bathed, exercised and properly medicated each day is a full-time job that can strain a caregiver’s health, job and relationships. An adult child may understandably become frustrated when a parent with advanced dementia lashes out or asks the same anxious question repeatedly. AI never will. The better robots get at keeping us company, the less incentive there will be to allocate human resources to that task.
It’s not entirely clear what we lose when we outsource love, care, and intimacy to something that can’t actually feel those things in return. As part of MIT professor Sherry Turkle’s field research, she and her team gave a robotic infant called My Real Baby to children and elderly people, and interviewed them about the experience. They visited Edna, an 82-year-old woman, and presented her with My Real Baby. Edna’s two-year-old greatgranddaughter, upon whom she typically doted, was also visiting. Over several hours, the researchers and Edna’s family watched in astonishment as the older woman ignored the human toddler’s pleas for food, while fussing over the electronic baby’s cries.
For a person frustrated by the increasing difficulty of daily life, Turkle wrote, “My Real Baby’s demands seem to suit her better than those of her great-granddaughter… [It] gives her confidence that she is in a landscape where she can get things right.” The appeal of robots as providers and recipients of care may lie in part in their comparative simplicity to us humans. They are free of the struggle that lies at the heart of our most intimate relationships, the one between our all-too-human limits – of time, insight, understanding, patience – and our desperation to get things right.
“The better robots get at keeping us company, the less incentive there will be to allocate humans to that task”