How Robot Technology is Caring for the Elderly

Communication
Japan faces a rapidly aging population. As more and more of the population greys, fewer and fewer young people are available to care for the elderly. There is a particular shortage of health care workers who work with the elderly therefore the demand for elderly health care is not being met. Among health care workers, there is a high turnover rate which was close to 17% in 2013. Japan’s answer to this shortage is research in robot technology to assist in elderly health care.

A prototype robot, Robear, has been developed. Designed by Riken, a Japanese research institute, this robot is a polar bear cub look-alike that aids health care workers. The Robear is the successor of two previous heavier robots, RIBA and RIBA-II. Robear helps in lifting patients from beds and supporting them in walking. Apart from research in the robot’s abilities, research into understanding the needs of the elderly has also been done, especially in the appearance of the robot. Researcher Mukai says, “The polar cub-like look is aimed at radiating an atmosphere of strength, geniality and cleanliness at the same time.”

Another robot being developed in the country is the ChihiraAico, a 32-year-old Japanese woman look-alike that is supposed to ease communication between humans and non-humans. The creators at Toshiba are aiming to use ChihiraAico with patients with dementia to help them connect with counselors and medical staff with ease. On the other side of the Pacific, the USA is developing PARO, a robotic pet. There is evidence to show that pets can effectively combat loneliness among the elderly and PARO currently shows promising results. A pilot test in a home suggested that elderly residents feel calmer and less anxious after interacting with these robotic pets.

Robotic technology in Japan is not limited to health care, and has expanded to a range of end-of-life services. As more and more elderly people take charge of their funerals, Japan’s end-of-life industry has come up with ‘skyscraper graveyards’. Traditionally, the Japanese cremate the dead and store the ashes in the family crypts in cemeteries. Due to the space constraints, ‘skyscraper graveyards’ have become increasingly popular. Relatives are given identity cards and robotic arms assist them in retrieving the urns stored in vaults deep underground.

Using robots for elderly health care has advantages and disadvantages. On the one hand, robots can effectively aid in the under-staffed health care system in Japan by assisting in hospitals and elder care units. It can also be placed in individual homes and provide remote monitoring of the individual. Moreover, it can help combat loneliness. On the other hand, the use of such expensive technology raises questions on the lack of human relationships and its impact on family dynamics.

Is robot technology the future of elderly health care? What is the scope for robots outside of high income countries like Japan and USA? What, if any, impact will the high dependability on robots have on human-to-human interaction? Only time can answer these questions. Japan’s experiments with robots are promising, and if this technology proves to decrease the burden of aging on Japan’s health care, there will only be more demand and a greater space for robotic technology.

Namratha Rao is currently pursuing her MSPH in International Health in Social and Behavioral Interventions at the Johns Hopkins University Bloomberg School of Public Health. 

Promoting Advance Directives, Reducing Medicare Spending

More and more people are living to the age of 100. As people grow older, the importance of having an advance directive is crucial in making health care decisions, which may reduce overall cost of end-of-life care. While Medicare guarantees access to health insurance for certain Americans and lawful residents aged 65 and older, the program faces significant fiscal challenges over the long-term. Advance directives may reduce Medicare spending since older adults can opt out of aggressive medical intervention by dictating their wishes in the event of a life threatening illness. As Congress continues to debate over the best way to fix Medicare, costs will likely increase if older adults continue to ignore advance directives.

Living Will document with pen, closeupAbout 27.4 percent of Medicare expenses for the elderly are spent in the last year of a person’s life. Advance directives can reduce that percentage because older adults may not prefer lifesaving machines that impact costs. If a person wants to avoid lifesaving machines without having an advance directive, doctors will keep such people alive at the expense of other patients. The latter will be deprived of necessary medical treatment and hospitals may become overcrowded. Also, these machines and other medical resources will contribute to the cost of care because they are expensive and scarce. Unless people write binding living wills, families are reluctant to “pull the plug”, and medical professionals are afraid of being sued if they do. Increasing the use of advance directives is necessary in preventing such problems.

Studies have shown that adults are more likely to complete advance directives that are written in everyday language and less focused on technical treatments. However, many people are currently unaware of advance directives and even fewer complete them. Since advance directives are very lengthy and tedious to complete, most seniors prefer family surrogates. The present state of health care systems also compounds the problem. For instance, there are only two states that offer living will “registries”. Residents can file their living will and allow doctors and other health care providers to have access to their documents. However, the Washington State living will registry has been closed by the state government because lack of funds, among other problems.

If insurance pools take into account the costs spent on people that will never get well, premiums for younger and healthy people are going to be very expensive. It is difficult when people are without an advance directive and do not want lifesaving machines. At the same time, if such people want invasive and aggressive medical treatment in poor prognosis states, then health systems should accommodate and respect their wishes.

Advanced directives are not only for the elderly. Our society is getting older and people have to deal with it. Health professionals need to determine effective ways of promoting advance directives among elderly patients. For example, a study showed that a replicable intervention mainly targeting doctors achieved a moderate increase in advance directives among elderly ambulatory patients. Future interventions may need to address doctors’ attitudes and comfort discussing these documents since patients cite their physician most often as the one who influenced them most to make a health behavior change. Increasing the use of advance directives among elderly persons is important since it reduces Medicare spending and the national budget concurrently.

Living wills and health care proxies need restructuring hence these documents have to be well prepared to reduce confusion, jargon and ambiguity. It is also important for health care institutions to advocate and support the use of advance directives. More states should invest in living will registries and promote advance directives to increase enrollment. If a patient has an advance directive and requests lifesaving machines, families and health professionals should respect their wishes. In the long run, advance directives are necessary because they can reduce overall cost of end-of-life care for individuals and families.

Sophie Okolo is the Founder of Global Health Aging.