Abstract
Healthcare for older adults with dementia is an important healthcare problem in Japan and in other developed countries. Importantly, healthcare workers in Japan are also getting older. In order to address solutions to this problem, using robots is being realized and is starting to assist healthcare and welfare practice needs. The aim of this study was to identify the characteristics of a transactive phenomenon in relationships among older adults with dementia, with nurses as intermediaries and with a cognitive skill-aid robot. Subjects were two institutionalized older adults who were diagnosed with dementia using Hasegawa’s Dementia Scale-Revised; a Kabochan (Nodding Kabochan) fixed with a remote-controlled speaker, Pechat (Kabochan with Pechat). Measurements of autonomic nervous activity were done using wearable electrocardiography attached to the subjects for four hours. Heart Rate Variability data were assessed at various frequency bands using a HRV software tool. In a continuously recorded data, interbeat (R-R) intervals were obtained for a 1-min segment using the maximum entropy method. In this study, the two major spectral components of HRV, the variances of the low-frequency (LF: 0.04 - 0.15 Hz) band and high-frequency (HF: 0.15 - 0.4 Hz) band, were calculated. Activities and behaviors of subjects transacting with Kabochan were observed by the expert nurses and video-recorded. Throughout the transaction period, observations were recorded of patients’ behavior, words uttered and over-all contents of the transactive conversation with the Kabochan or Kabochan with Pechat. Identified characteristics were transactive relationship phenomenon; changes in autonomic nervous system activity of persons with dementia are expressed as per one minute, linguistic response of elderly people, transactive relations among Kabochan, Kabochan with Pechat, and nurses as intermediaries. These were exhibited as Figures: Situation 1, A Sense of Fear, Situation 2, A Pleasant Sensation, and Situation 3, Misunderstanding and Confusion. It also showed that autonomic nervous system activity of persons with communication skills is actively changing in older adults with dementia. Conversation of adding Pechat to the Kabochan illustrated that nurses as intermediaries showed emotional conversations as established by effectively manipulating the Pechat. Also, it was revealed that if Kabochan with Pechat uttered words about patient’s personal information in a conversation, the patient felt a sense of fear. The researchers suggest that when developing future communication robot for elderly with dementia, it is necessary to consider, for an effective conversation, transactive relationships including nurses as intermediaries. The role functions of these intermediaries have been shown of high versatility, indicating that situations such as these can also be controlled by other healthcare providers such as by occupational therapists.
Highlights
Challenges of a society with a decreasing population and increasing population of older adults with dementia are healthcare problems in Japan, and of other developing countries [1] [2]
The transactive relationship is presented as a conversational dialogue with older persons, the Kabochan or the Kabochan with Pechat, and two nurses
In explaining the characteristic transactive relationships, the evidence using physiological instrumentations and video-recorded images supports the recognition of opportunities for distinguishing transactive relations which are valuable to the effective application of communication robots in human health care situations, especially for older adults with dementia
Summary
Challenges of a society with a decreasing population and increasing population of older adults with dementia are healthcare problems in Japan, and of other developing countries [1] [2]. In addition to matching services, NEDO provides various services including information sharing with government agencies, building networks between companies and researchers, and collecting feedback on future policies to promote the application of robotic nursing care devices [4]. With these initiatives, non-industrial robots were mass produced, examples of which were for those for walking support robots [5] [6] or communication robots [7] [8]. These robots are being introduced in hospitals, nursing homes and in Japanese households
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