A large proportion of older adults residing in long term care (LTC) settings, such as nursing homes and assisted living facilities, suffer from Mild Cognitive Impairment (MCI), Alzheimer's disease (AD) and AD-related dementias (ADRD). Apathy is common in persons with AD and ADRD with prevalence rates up to 72%. It is associated with further cognitive decline, functional deficits, reduced quality of life, social isolation, and increased mortality. Apathy imposes significant burden on LTC staff and negatively impact quality of care, staff satisfaction and turnover. Since few pharmacologic options exist, a major strategy is to foster older adults' engagement in social, physical and cognitive activities, primarily those that are multimodal in nature. However, these interventions often require significant personnel time and resources, a major concern given the current nursing shortage and high turnover among LTC nursing personnel. The Centers of Medicare and Medicaid Services mandates LTC facilities to provide meaningful engaging activities for residents, which can be resource intensive and are difficult for many US LTC settings. In order to partially mitigate some of these issues, intervention based on an intelligent socially assistive robot (SAR) based architecture, called ARIA (Adaptive Robot-mediated Intervention Architecture), developed under a R21 grant, that can adaptively and dynamically interact with older adults with MCI, AD and ADRD who reside in LTC settings, is proposed in this grant application. This interdisciplinary proposal is directly aligned with the NIA goals of understanding and developing effective interventions using smart technology to reduce the burden of age-related diseases and address the special caregiver needs of those caring for persons with dementia (PWD). This multi-phase, multi-site, mixed methods clinical trial will systematically examine responsiveness and engagement among persons with MCI or dementia to two types of SARs (humanoid and animal), its effect on cognitive, physical and social function as well as the impact of SARs on informal and formal caregivers with a goal towards future scalability and sustainability.
The specific aims of the proposed research are:
Aim 1 : To improve our novel social robotic interaction architecture through additional software development to a) make it more versatile in combining multimodal quantitative data capturing engagement, b) more robust such that non-experts can operate it and create new tasks by concatenating task primitives, and c) expand tasks to address varying degrees of cognitive and physical impairments of older adults (Months 1-18).
Aim 2 : To compare the effect of usual care (UC) group to UC+ARIA group on reducing apathy among older adults with mild cognitive impairment (MCI), mild dementia, or moderate dementia (Months 19-48).
Aim 3 : To identify barriers and facilitators to SAR implementation across sites to address future scalability and sustainability (Months 18-42). This study will contribute to the development of improved intelligent technology as an effective approach to engage older PWD with the long term goal of enhancing function and quality of life.
As an increasing number of older adults are suffering from Mild Cognitive Impairment (MCI), Alzheimer's disease (AD) and AD-related dementias (ADRD); providing them with quality care in long term care (LTC) facilities is becoming problematic due to resource limitations, nursing shortage and high turnover among LTC nursing personnel. A novel approach to utilize socially assistive robotic systems that can meaningfully engage this group of older adults through physical, cognitive and social activities is proposed in the hope that such smart technology will be able to augment, and not replace, the current system of care. This study will contribute to the development of improved intelligent technology as an effective approach to engage older persons with dementia with the long- term goal of enhancing their function and quality of life as well as improving LTC staff satisfaction.
