Assessment of personal care and medical robots from older adults’ perspective
Goher et al. Robot. Biomim.
Assessment of personal care and medical robots from older adults' perspective
K. M. Goher 0
N. Mansouri 2
S. O. Fadlallah 1
0 School of Life & Health Sciences, Aston University , Aston Triangle, Birmingham B4 7ET , UK
1 Department of Mechanical Engineering, Auckland University of Technology , 55 Wellesley St, Auckland 1010 , New Zealand
2 Department of Land Management and Systems, Faculty of Agribusiness and Commerce, Lincoln University , PO Box 85084, Lincoln 7647, Christchurch , New Zealand
Demographic reports indicate that population of older adults is growing significantly over the world and in particular in developed nations. Consequently, there are a noticeable number of demands for certain services such as healthcare systems and assistive medical robots and devices. In today's world, different types of robots play substantial roles specifically in medical sector to facilitate human life, especially older adults. Assistive medical robots and devices are created in various designs to fulfill specific needs of older adults. Though medical robots are utilized widely by senior citizens, it is dramatic to find out into what extent assistive robots satisfy their needs and expectations. This paper reviews various assessments of assistive medical robots from older adults' perspectives with the purpose of identifying senior citizen's needs, expectations, and preferences. On the other hand, these kinds of assessments inform robot designers, developers, and programmers to come up with robots fulfilling elderly's needs while improving their life quality.
Assistive medical robots and devices; Robot assessment; Older adults' perspective; Assistive walking devices; Information and communication technology; Older adults' needs assessment
Recent decades have witnessed a noticeable development
in information and communication technology (ICT).
This development has led to advent of various types of
robots in vast majority of industries, namely
manufacturing, military, medical and health care, entertainment, and
]. In the medical sector, assistive medical
robots and devices play substantial role in senior citizens
lives. The population of senior citizens is growing
substantially over the world [
]; therefore, the demand for
specific needs rises [
13, 52, 53
]. Growth in aging
population results in noticeable number of issues such as dearth
of health-care centers, professionals, and services 
as well as huge burdens of health-care costs [
]. In order
to diminish costs related to readmission and
transportation, and also to ameliorate quality of health-care services
and older adult’s independency, health-care services are
shifted to older adults’ home from medical centers [
Therefore, different types of assistive medical robots,
namely remote presence robot, paro-robot, telerobot,
skillegent robot, RIBA [
], and devices such as wheeled
], are created to fulfill various needs and
compensate disabilities. Assistive medical robots and
devices not only have facilitated older adult’s tasks,
but also have promoted their life quality and kept their
autonomy . For instance, mobile manipulated robot
offers to bring object(s) to older adults or by their request
], telerobot monitors health condition and medication
of elderly [
], pet robot companies older adults [
rolling walker assists elderly to have better mobility,
stability, and balance [
Overview and contribution
There are a noticeable number of assistive robots and
devices to empower older adults to carry out their daily
routine tasks independently. Yet in accordance with
conducted research studies, older adults do not incline
toward the use of technology. In other words, there is a
gap for improving assistive technology to increase robot
acceptance and fulfill elderly’s needs. The authors of this
paper provide a review of assessment of assistive
medical robots and devices from older adults’ perspective to
identify the factors associated with assistive
technology acceptance. The authors of this paper believe that
adequate and accurate understanding of senior citizens’
needs and expectations will inform robot designers,
programmers, and developers to create user-friendly and
user-centered robots and devices meeting required
features and functions. We aim at identifying the reasons
causing decline of robot acceptance and also to assess
older adults’ needs and expectations. We believe that in
order to boost acceptance of older adults to use robots, it
is important to assess not only their needs and
expectations, but also their attitudes toward technology.
This paper is organized as follows: “Assistive technologies
overview” section presents a detailed overview of
assistive technologies and their associated features.
“Assessment of assistive medical robots” section introduces an
overview of assessment of medical robots from older
adults’ perspectives. In “Assessment of walking devices
and related technologies” section, we investigate the
assessment of assistive walking aids and in particular
“Older adults satisfaction of other assistive devices”
section focuses on presenting older adults’ satisfaction of
other assistive devices. The paper is concluded in
“Conclusion” section where we emphasize on specific attitudes
of older adults toward the use of assistive technologies in
Assistive technologies overview
Different types of robots have been developed to provide
various aids for older adults. The information in Table 1
reveals that enhancements in technology have
compensated elderly’s disabilities, which improved their life
quality and health conditions through remote controlling
]. Moreover, assistive robots and devices are
developed to provide physical aid to elderly to
accomplish their routine activities such as feeding, management
of medication, and emergency control [
it is obvious that older adults benefit from assistive
robots and devices to retain their autonomy, diminish
health-care needs, accomplish daily tasks, and increase
social communication . Albeit a great number of
useful assistive robots and devices are developed, yet some
older adults decline to accept technology in their routine
Assessment of assistive medical robots
Though a great number of assistive medical robots and
devices are developed for older adults, yet there is lack
of research studies related to acceptance of assistive
technology from older adults and their caretakers’ perspective
]. We believe that it is important to conduct
further research work surrounding this field. The declined
acceptance of older adults of assistive technologies is
mainly related to the limited knowledge and the
embarrassed emotions [
]. Moreover, [
] it is found out that
there are two primary factors affecting use of assistive
technology: abilities and attitudes. In accordance with
conducted ethnographic studies, older adults incline to
utilize assistive technology when the dignity and
autonomy of them are maintained [
]. Ethnographic studies
provided a series of recommendations to robot
designers and developers. The recommendations are in terms
of robot dimensions which should be fit within elderly’s
place, robot interface which should be easy to use, and
interaction feature which should meet elderly’s abilities.
Older adults’ attitude toward health‑care robots
There are two primary factors influence adoption of
technology by older adults: ease of use and usefulness
22, 33, 62
]. Ease of use factor refers to level of older
people’s knowledge about assistive technology. Older
adults, who are intermediate and familiar with assistive
technology, show positive perspectives [
usefulness refers to provision of physical assistance and
task monitoring such as carrying and picking up a heavy
item . The behavior of older adults has proved that
elderly decline to utilize assistive robots if their tasks are
not found useful [
]. Findings of the aforementioned
research studies have shown that robot functionalities,
related to nonsocial tasks and robot interaction, are the
most influential factors in technology acceptance by the
older people [
It is stated that older adults commonly refuse to use
assistive technology because of being novice at
accomplishing tasks with technology [
]. In addition, it is said
that older adults, unlike young people, are concerned
about learning technology skills. This tends to make
them refusing to use technology [
]. From a large-scale
research study, it is found that older adults show
positive attitudes toward assistive technology adoption when
they are assisted with significant task [
]. A number of
research studies revealed that cost is one of the primary
factors which make older people concerned. They incline
to adopt assistive technology if the advantages outweigh
the cost [
15, 45, 59
]. In accordance with previous
studies, the use of technology appeals older adults if it only
offers them greater autonomy [
]. Moreover, unlike
Assistive walking devices are primarily created to
compensate older adults’ disabilities, while
maintaining better balance, stability, and walking support.
They also help in facilitating mobility, maneuvering,
walking, standing, sitting, and independency. These
devices are enhanced with information and
communication technology to detect fall incidents, fall
prevention, and also ameliorate alarming system. The
enhancement in walking devices reduces waiting
time to receive assistance [
]. Furthermore, ICT assists
medical professionals and caretakers to monitor fall
incidents closely [
Albeit a great number of medical professionals believe
that animals have deleterious health consequences
such as injuries and infection, a noticeable number
of them subscribe to the belief that interaction with
animal leads to emotive effects to patients. For this
reason, animal robots with the purpose of
communicating with and entertaining older adults, ameliorating
health condition, and relieving distressing imitate
animal behaviors [
Pearl and Wakamuru robot [
], robo robot [
], and RIBA [
Mobile manipulator robot [
Rolling walker [
], knee walker [
], crutch [
], and cane
], NeCoRo [
], AIBO [
], bandit [
accompany robots [
Tele-operated robot [
This type of robot primarily identifies older adults’ needs iCub robot and nao robot [
and also provides services for both elderlies and their
caregivers. The main features of this robot are to
provide medication reminder, to detect issues and take
action to inform caregiver, manage plans, and assist
elderly to take off [
youngsters, older adults show different attitude toward
Moreover, negative attitudes toward robots and
negatechnology acceptance. Older adults decline to trust on
tive image of robots were noticed. The same attitude has
technology, and also they think it is complex to utilize
been reported after carrying the same study for one more
]. Moreover, the behaviors of older adults have proved
month of interaction. Older people responded that
assisthat when they face difficulties, they tend to give up
tive robots are not useful, whereas they found robots
rather than asking for help [
safe, interesting, and easy to use. This finding reveals a
In other conducted research work by Wu et al. [
total contrast with previous studies, indicating that older
they investigated adoption of assistive robots by elderly
adults’ behavior toward assistive robots ameliorates after
and also analyzed elderly’s perspective after 1 month
direct interaction [
]. It has been noticed in this
of direct interaction with assistive robots. Two groups
study that older people found themselves not in needs of
of cognitively intact healthy (CIH) and mild cognitive
impairment (MCI) participated in this study. Both groups
In the work done by Morris et al.  and Heart and
declined to show willingness to utilize assistive robots.
], elderly showed fear of dehumanization
toward adoption of assistive robots. Ethical and
societal issues were considered as a barrier of adoption of
assistive technologies. Participants responded that use
of assistive robots gives them the impression of being
watched and monitored. This gives rise to exceeding the
importance of elderly’s privacy.
Beer and Takayama [
] assessed mobile remote
presence (MRP) systems from older adults’ point of view.
They reported that benefits of MRP systems were
obvious to elderly; therefore, older adults showed willing
to utilize such a system in social and medical contexts.
Older adults had positive attitudes to number of benefits
from assistive robots, namely decreased traveling cost,
improved visualization, and reduction in social
isolation. On the other hand, they were concerned about call
management, lack of face-to-face communication, and
Older adults’ preferences from health‑care robot’s functions
Older people prefer to have far more communication
with health-care robots. For instance, they prefer to
converse with robots about the topic related to robot itself,
rather than talking about health-care and activities [
Moreover, older people consider robots as a
performance-directed machine, rather than a social device [
Broadbent et al. [
] conducted an important research
work to investigate not only older adults’ perspectives
toward health-care robots, but also their caretakers as
well. In their study, it was found that caregivers were
concerned about their jobs that may be replaced by
healthcare robots. On the other side, this research highlighted
that older adults have positive perspective about
healthcare robot apart from concerns related to reliability,
privacy, and safety. In terms of robot’s functionality, fall
detection feature appealed vast majority of elderly.
Moreover, functions such as big buttons, clear voice, and
visible screens are significantly favorable. Older adults prefer
robots to automatically detect and monitor fall incidents
without wearing any device or being nearby a call button.
Past research work revealed that in terms of robot
appearance, unlike youngsters, older adults prefer less
human-like and more serious robots [
4, 16, 58
]. It is
stated that the robot’s tasks should be commensurate
with appearance and shape. Moreover, the robot is not
necessarily required to be human-like if its functions do
not require. In terms of size, adjustable robots with
minimum of five feet are highly accepted.
Further research work has been conducted by Smarr
et al. [
] with the purpose of identifying the tasks that
need robot assistance. In this study, tasks were
categorized into three categories: self-maintenance activities of
daily living (ADLs), instrumental activities for daily living
(IADLs), and enhanced activities of daily living (EADLs).
Assistance for IADL tasks consists of housekeeping such
as laundry and medication reminder. On the other hand,
tasks such as new learning and pastime refer to EADL.
Older people prefer to have robot assistance rather than
human assistance for IADLs and then EADLs. In
contrast, it was found that older people favor to have
assistance for ADLs and also some specific tasks of IADLs
and EADLs, namely decision on medication, meal
preparation, and social interaction. The results of this study
are similar to Broadbent et al. [
] findings. This makes
us able to conclude that older adults prefer to have robot
assistance for monitoring and physical aid, while they
prefer human aid for decision-making tasks.
Considering medication management as a prime
example, older adults prefer health-care robots to either bring
them medicine or remind them of the regular doses.
However, they favor human assistance to make decision
what and/or when medicine to take. This concept assists
designers and developers of health-care robots to
furnish robot with high level of intelligent to enable them to
make the right decision.
Assessment of walking devices and related technologies
Wheeled walkers provide walking support for a big
number of older people to compensate their moving and
walking disabilities. Wheeled walkers are used
primarily for maintaining mobility and balance [
] as well
as alleviating fall incidents . Though they are used
by a noticeable number of users, yet there is a need for
improvement to fulfill older adults’ needs and
]. This section gives a review of previous
conducted research studies on the assessment of assistive
walking devices from older adults’ perspective.
Wheeled walkers limitations
Van Riel et al. [
] reported that the use of wheeled
walkers usually results in severe fall injuries. Based on
previous research by Lindemann et al. [
], there are various
limitations associated with the use of wheeled walkers
which causes serious fall incidents to older adults
including walking backward, downhill and uphill, holding an
item when fronting obstacle(s), encountering obstacles
such as stairs in public transportation, and walking on
uneven surfaces. Older adults encounter difficulties to
retain their balance and control to open a door which is
in reverse direction of their assistive wheeled walker. This
situation becomes more challenging when a user holds
an item while passing through a door. For this reason,
older adults stated that it is easier to walk through a door
or to open the door without wheeled walker. Despite
there have been numerous approaches and developments
to overcome the mentioned limitations of wheeled
walkers, the proposed solutions were not satisfactory.
For instance, walking backward through a door using a
walker is still a challenge for most users. This is due to the
fact that front wheels of the walker provide 360° rotation,
whereas the rotation of back wheels is restricted.
Rentschler et al. [
] recommended a walker with a rotation
feature and intelligent obstacle prevention to overcome
Older adults’ satisfaction of other assistive devices
A noticeable number of research works have been
accomplished to evaluate older adults’ experience feedback and
satisfaction level from assistive technologies. Privacy is
considered to have a significant concern to older people.
For instance, they prefer to have faint pictures at their
private places of the house (bedrooms) while they do
not hesitate to have transparent images in other general
areas (dining room and lounge) [
]. Cameras and
visual surveillance systems are unfavorable to the older
adults . Moreover, disabilities in having control over
the assistive device are one of the main reasons that older
people decline to adopt ICT [
18, 38, 43, 66
]. They also
prefer having complete control over the assistive device
12, 34, 43
]. For instance, older people incline to switch
off false alarm by themselves. In addition, cost of
assistive device and maintenance charges are of a great
concern to older adults. This makes them decline acceptance
of expensive assistive devices [
23, 24, 47, 64
]. One more
observation is older people favor attractive and dainty
devices created in different colors [
findings of this research show that it is difficult for them to
press the button of device and read the gray color text
and background [
]. Older adults encountered less
hardship to wear wrist devices; therefore, this type of
device design impressed them substantially [
Brownsell and Hawley [
] indicate that ICT devices empower
elderly to feel independent and safe to take risk.
All in all, various assistive medical robots and devices
are designed and developed for growing population of
older adults. Although there are common needs and
preferences among different segment of older adults, it
should be considered that each segment has its specific
needs and preferences. Consequently, it is substantial
to develop the right assistive robot or device for them.
Apart from needs and preferences of older adults, cost
of robot or device is a primary factor in acceptance and
adoption. Proper management of production cost and
design of a sound sale strategy are of great importance in
this regard. Research, discovering needs and preferences
of elderly from assistive medical robots and devices has
paved the ground for researchers and scholars to design
robots and devices fulfilling their needs and expectations.
Findings around acceptance of assistive devices from
older adults’ perspectives should be on top of the data
necessary to inform the design and development process.
Furthermore, understanding their attitudes while dealing
with, approaching by, or having interaction with assistive
robots is of great importance to inform the designers,
developers, and programmers.
KMG initiated the project topic. This project will investigate the assessment
of assistive medical robots from older adults’ perspectives with the purpose
of identifying older adults’ needs, expectations, and preferences. The findings
of this particular research project will inform robot designers, developers, and
programmers to come up with robots fulfilling elderly’s needs while
improving their life quality. He revised the draft written by NM. KMG added significant
sections around the paper contribution and conclusion. NM reviewed relevant
contribution to this research and compiled the paper. All authors read and
approved the final manuscript.
The authors of this paper would like to thank Lincoln University in New
Zealand for offering the funding support for this publication.
The authors declare that they have no competing interests.
This research is originally funded by research grant from Lincoln University,
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.
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