Dementia prevention, intervention, and care

United Nations Population Division

A comparison of the contribution of systolic versus diastolic blood pressure to risk of coronary heart disease and the role of mean arterial pulse pressure and systolic lability have been examined prospectively in 5,127 men and women during 14 years of biennial follow-up studies. Similar gradients of risk of subsequent coronary heart disease were observed whether persons were classified by their systolic or diastolic pressure, and no “safe” or critical level could be identified. Assessment of the net effect of each, employing discriminant analysis, indicated a stronger association of systolic than diastolic pressure with risk of coronary heart disease. Neither the systolic and diastolic pressure measurements in combination nor the pulse pressure and the mean arterial pressure measurements alone discriminated better than the systolic measurement alone. Systolic lability did not predict incidence of coronary heart disease independently of the associated level of blood pressure. There was a trend of declining relative importance of diastolic and a corresponding increase in the importance of systolic pressure with advancing age. Only in those under 45 was diastolic pressure predominant. The level of casually obtained blood pressure was a good predictor of coronary heart disease. The current practice of assessing the importance of blood pressure at all ages largely on the basis of diastolic pressure and the commonly held view concerning the innocuous nature of an elevated level of systolic pressure in the elderly requires reevaluation.

Systolic Versus Diastolic Blood Pressure and Risk of Coronary Heart Disease???The Framingham Study

Objective With an elderly population that is set to more than double by 2050 worldwide, there will be an increased demand for elderly care. This poses several impediments in the delivery of high-quality health and social care. Socially assistive robot (SAR) technology could assume new roles in health and social care to meet this higher demand. This review qualitatively examines the literature on the use of SAR in elderly care and aims to establish the roles this technology may play in the future. Design Scoping review. Data sources Search of CINAHL, Cochrane Library, Embase, MEDLINE, PsychINFO and Scopus databases was conducted, complemented with a free search using Google Scholar and reference harvesting. All publications went through a selection process, which involved sequentially reviewing the title, abstract and full text of the publication. No limitations regarding date of publication were imposed, and only English publications were taken into account. The main search was conducted in March 2016, and the latest search was conducted in September 2017. Eligibility criteria The inclusion criteria consist of elderly participants, any elderly healthcare facility, humanoid and pet robots and all social interaction types with the robot. Exclusions were acceptability studies, technical reports of robots and publications surrounding physically or surgically assistive robots. Results In total, 61 final publications were included in the review, describing 33 studies and including 1574 participants and 11 robots. 28 of the 33 papers report positive findings. Five roles of SAR were identified: affective therapy, cognitive training, social facilitator, companionship and physiological therapy. Conclusions Although many positive outcomes were reported, a large proportion of the studies have methodological issues, which limit the utility of the results. Nonetheless, the reported value of SAR in elderly care does warrant further investigation. Future studies should endeavour to validate the roles demonstrated in this review. Systematic review registration NIHR 58672.

https://bmjopen.bmj.com/content/bmjopen/8/2/e018815.full.pdf

Scoping review on the use of socially assistive robot technology in elderly care

This review aimed to identify the areas of need that older people have, and the available solutions. In particular, the robotic solutions are explored and critiqued and areas for future development identified. The literature was reviewed for factors that influence admission to nursing home care, and for technological solutions to these factors. The main issues facing older people are physical decline, cognitive decline, health management, and psychosocial issues. Robots exist that may meet some of the identified issues but gaps where robots could be developed include delivering interventions to prevent physical decline occurring and robots with multiple functions, including a range of cognitive stimuli and health education. To reduce barriers to acceptance, robots designed to provide physical and healthcare assistance should have a serious appearance. On the other hand animal-like robots can address psychosocial issues and function like pets. While smart phones and computers can offer some solutions, robots may promote adherence due to a social presence. Robots are being developed to address areas of need in older people, including physical, cognitive, medical and psychosocial issues. However more focus could be placed on developing preventative interventions, multifunctional robots, greater educational content and motivational aspects of appearance and interaction style.

The Role of Healthcare Robots for Older People at Home: A Review

http://www.phoque-paro.fr/wp-content/uploads/2013/11/2013-Paro-loneliness-RCT.pdf

The psychosocial effects of a companion robot: a randomized controlled trial.

A Pilot Randomized Trial of a Companion Robot for People With Dementia Living in the Community.

Aim

To investigate the effects of interacting with the companion robot, Paro, on blood pressure and heart rate of older people in a residential care facility.



Methods

This study used a repeated measures design. Twenty-one residents in rest home and hospital level care had their blood pressure taken three times; before, during and after interacting with the seal robot.



Results

Four residents who did not interact with the robot were excluded from the final analysis (final n = 17). The final analysis found that systolic and diastolic blood pressure changed significantly over time as did heart rate. Planned comparisons revealed that systolic and diastolic blood pressure decreased significantly from baseline to when residents had Paro (systolic, P = 0.048; diastolic, P = 0.05). Diastolic blood pressure increased significantly after Paro was withdrawn (P = 0.03).



Conclusion

Interacting with Paro has a physiological effect on cardiovascular measures, which is similar to findings with live animals.

Hayley Robinson

Papers

The psychosocial effects of a companion robot: a randomized controlled trial.

The Role of Healthcare Robots for Older People at Home: A Review

A Pilot Randomized Trial of a Companion Robot for People With Dementia Living in the Community.

Physiological effects of a companion robot on blood pressure of older people in residential care facility: A pilot study

Suitability of Healthcare Robots for a Dementia Unit and Suggested Improvements