Abstract
BackgroundAs the world’s population rapidly ages, the number of older adults with cognitive impairment will also increase. Several studies have identified numerous complex needs of people with dementia, which assistive technologies still fail to support. Recent trends have led to an increasing focus on the use of embodied conversational agents (ECAs) as virtual entities able to interact with a person through natural and familiar verbal and nonverbal communication. The use of ECAs could improve the accessibility and acceptance of assistive technologies matching those high-level needs that are not well covered to date.ObjectiveThe aim of this thematic literature analysis was to map current studies in the field of designing ECAs for patients with dementia in order to identify the existing research trend and possible gaps that need to be covered in the near future. The review questions in this study were as follows: (1) what research frameworks are used to study the interaction between patients with dementia and ECAs? (2) what are the findings? and (3) what are the barriers reported in these studies?MethodsSeparate literature searches were conducted in PubMed, Web of Science, Scopus, and Embase databases by using specific umbrella phrases to target the population (patients with dementia) and the technology-based intervention (embodied conversational agent). Studies that met the inclusion criteria were appraised through the Mixed Methods Appraisal Tool and then discussed in a thematic analysis.ResultsThe search process identified 115 records from the databases and study references. After duplicates (n=45) were removed, 70 papers remained for the initial screening. A total of 7 studies were finally included in the qualitative synthesis. A thematic analysis of the reviewed studies identified major themes and subthemes: the research frameworks used to gather users’ perspectives on ECAs (theme 1), the insights shared by the 7 studies as well as the value of user involvement in the development phases and the challenge of matching the system functionalities with the users’ needs (theme 2), and the main methodological and technical problems faced by each study team (theme 3).ConclusionsOur thematic literature analysis shows that the field of ECAs is novel and poorly discussed in the scientific community and that more sophisticated study designs and proofs of efficacy of the approach are required. Therefore, by analyzing the main topic of the narrative review, this study underscores the challenge of synchronizing and harmonizing knowledge, efforts, and challenges in the dementia care field and its person-centered paradigm through the user-centered design approach. Enabling strict collaboration between interdisciplinary research networks, medical scientists, technology developers, patients, and their formal and informal caregivers is still a great challenge in the field of technologies for older adults.
Highlights
BackgroundThe world’s population is rapidly aging and approximately 47 million people are experiencing dementia worldwide
Inclusion criteria were published papers written in English with the aim of studying the use of embodied conversational agent (ECA) (1) among older adults (≥65 years) with dementia living at home, in long-term care, or nursing homes and their formal and informal caregivers, (2) for coping in patients with dementia without any restriction in terms of service applications, (3) for presenting empirical findings about interactions between users and ECAs, and (4) in randomized controlled trials
12 papers were excluded because (1) studies recruited both patients with dementia and older adults in good health status (n=3), (2) no empirical feedback from users was reported (n=3), (3) the intervention was performed using both ECAs and other technologies (n=2), and (4) the intervention was not specific for patients with dementia (n=4)
Summary
BackgroundThe world’s population is rapidly aging and approximately 47 million people are experiencing dementia worldwide. Several studies [23,24,25,26,27] proposed the use of screen-based entities designed to stimulate human face-to-face conversation skills called as embodied conversational agents (ECAs) or personal virtual assistants [28,29]. Such virtual entities are able to interact with a person through verbal and nonverbal communication. Enabling strict collaboration between interdisciplinary research networks, medical scientists, technology developers, patients, and their formal and informal caregivers is still a great challenge in the field of technologies for older adults
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