Exploration of a Robotic Cat to Address Dementia-Related Behaviors in a Long-Term-Care Setting

PURPOSE: Pet visitation programming in long-term care facilities has been a common activity offered to the elderly population to combat isolation. However, recent pandemic-related visitation restrictions have limited many activity offerings. Combined with relocations to more supportive environments during this time of a pandemic, feelings of confusion and agitation are exacerbated especially for those with dementia. A possible solution is the integration of technology-aided approaches to promote meaningful and person-centered activities to engage clients in occupation-based programming, and simulations offer useful alternative methods. [2] Various trials have investigated the benefits of robotic pets, [1] but offer unclear procedural guidelines regarding the specifics of the recommended setup and tasks for caregivers to implement during sessions. To apply a structured process of interacting with a robotic animal, researchers utilized the Occupational Adaptation (OA) model to incorporate pet care components that are meaningful and purposeful. [3] OA provides a framework to adapt to cognitive restrictions that interfere with everyday tasks in order to best support the participant. The research question is: What are the behavioral outcomes of the robotic JoyForAll cat after participation in the simulated pet care tasks of groom, feed, and play, for participants with dementia? Additional aims examined the feasibility and acceptance of the program.

DESIGN: Comparison-condition (i.e. quasi-experimental) design. Recruitment flyers were distributed to the Powers of Attorney of the residents of one dementia unit. Inclusion criteria were: Diagnosis of dementia, no known aversion to cats, and aged 65 years or older.

METHOD: Pretest included the Cohen-Mansfield Agitation Inventory (CMAI). For each session, the participant watched 10 minutes of cat videos (control session) followed by 10 minutes with the robotic cat (experimental session), totaling eight 20-minute sessions. Following previous recommendations, [4] sessions were administered in a consistent environment and were one-on-one with the researchers. Behaviors and affect within each control and experimental session were recorded via an observation tracking sheet modified from a previous study [1] and were analyzed using the independent t-test and chi-square analysis, respectively. After eight sessions, the posttest included the CMAI and a caregiver perception questionnaire. Agitation changes on the CMAI were analyzed with the Wilcoxon signed-rank test.

RESULTS: Of the 20 residents on the unit invited to participate in the study, 8 initially enrolled, with 5 residents completing the full eight sessions (62.5% adherence). Positive behavioral observations during robotic cat exposures, as compared to cat videos, were significant in comparison (p < 0.001). There were no differences in positive affect (p = 0.152) and negative affect (p = 1.000) between the robotic cat and the cat videos. No changes in CMAI were reported from pretest to posttest after eight sessions (p = 0.715). 100% of caregiving staff (n = 8) agreed that the robotic cat was beneficial.

CONCLUSION: Behavioral observations indicated more positive engagement during robotic cat sessions as compared to cat video sessions. Consistent with previous reports, agitation did not change over time and may be beneficial for families and caregivers to manage progressive dementia symptoms. Development of best practice programming to support this population is essential to promote psychosocial wellness and alleviate caregiver burden. These guidelines may offer set-up and the session task recommendations of the successfully adapted and simulated pet care activities of feed, groom, and play, for generalization to other care settings.

References

1. Moyle, W., Jones, C. J., Murfield, J. E., Thalib, L., Beattie, E. R. A., Shum, D. K. H., O’Dwyer, S. T., Mervin, M. C., & Draper, B. M. (2017). Use of a Robotic Seal as a Therapeutic Tool to Improve Dementia Symptoms: A Cluster-Randomized Controlled Trial. Journal of the American Medical Directors Association, 18(9), 766–773. https://doi.org/10.1016/j.jamda.2017.03.018

2. Neal, I., du Toit, S. H. J., & Lovarini, M. (2019). The use of technology to promote meaningful engagement for adults with dementia in residential aged care: A scoping review. International Psychogeriatrics, 32(8), 913–935. https://doi.org/10.1017/s1041610219001388

3. Schultz, S., & Schkade, J. K. (1992). Occupational adaptation: Toward a holistic approach for contemporary practice, part 2. American Journal of Occupational Therapy, 46(10), 917–925. https://doi.org/10.5014/ajot.46.10.917

4. Smits, C., Anisuzzaman, S., Loerts, M., Valenti-Soler, M., & Heerink, M. (2015). Towards practical guidelines and recommendations for using robotics pets with dementia patients. Canadian International Journal of Social Science and Education, 3, 656-670.