Smiles all round as robotic pets calm and delight people living with dementia

PARO The Therapeutic Companion Robot from ZEST Dementia & Aged Care

These “animals” may be little more than toys, but the soothing effect they have on many people living with dementia offers new insight into our need to give affection and receive it.

There are more than 100,000 people living with dementia in residential aged-care facilities in Australia, along with 280 robot seals. They are joined by unknown numbers of robot dogs and cats, a small company of robot parrots, and one or two robot horses. To the wonder of many, the robots and the residents get on together very well.

“I was a bit of a sceptic,” says Professor Wendy Moyle, program director at the Menzies Health Institute at Griffith University, Queensland. “In 2009, I looked at this pet robot and thought, ‘Oh, would it really have an effect?’ They seemed to me very expensive, and there hadn’t been a lot of research done on them. So we started doing pilot study work and the results had a lot more significance than I ever imagined. To my surprise, we found they reduced anxiety and improved people’s moods.”

The most popular “companion robot” in Australia is Paro the baby harp seal, which holds the curious Guinness World Records title of World’s Most Therapeutic Robot. Paro is made in Japan, costs about $8000 and is the size and weight of a six-month-old baby, with licorice button eyes shaded by ladybird lashes, and a coat of fluffy white fur. To look at Paro is to love him. He cries out to be cuddled. Sometimes literally.

At the Royal Freemasons Coppin Centre in Melbourne – a large and diverse residential facility where 17 people with dementia live in the memory support unit – a beaming woman named Norma strokes Paro in her lap. She tells Para he’s lovely, and Paro wags his flipper. I ask Norma if Paro looks at her.

“Yeah,” says Norma, “and closes his eyes and goes back to sleep. He’s thinking, ‘I’d better be good with her or she might belt me.’” Norma laughs. She laughs a lot. She used to be a farmer’s wife. She and her husband kept horses and dogs. “They all had to do what they were told, didn’t they?” she says.

I offer a colourless reply, and Paro opens his eyes and turns to face me – coquettishly curious and desperately cute – then falls asleep. Norma darts between confusion and clarity. I ask if she often holds the seal. “It’s the first time I’ve seen him,” she says.

“You’ve played with him lots of times!” says a carer, leisure and lifestyle assistant Julie Cleary.
And Norma remembers. “I did, too,” she says.Advertisement

Cleary and I, together with a manager, cluster around Norma. Paro mews. “He’s talking,” says Norma. “He’s telling me I’ve got to watch you three.” I laugh. She laughs. The staff laugh. Paro barks and wags his flipper again.

We’re all joking around. I introduce myself to Paro as the world’s greatest journalist. “He turned away when you told him that!” says Norma. He did, too. Nothing gets past Norma. I ask what she does with her days, other than play with Paro.

“I’ve got to keep the place going,” she replies, with a jaunty smile. Norma’s on a roll now. “I’ve got to feed my husband when he gets home.” And suddenly it’s not so funny anymore,  because Norma’s husband is dead.

Dementia is an exhausting, isolating and progressively debilitating condition. As the disease develops, people living with it find it incrementally more difficult to communicate or interact with other people in any meaningful way. They speak less frequently, move less purposefully, think less clearly and, eventually, drift away.

There is no cure for dementia, but there are strategies to manage personal decline. If people living with dementia can be engaged in activities they can lead happier, more fulfilling lives, and might even be able to reduce their medication.

In 2013, the year after Wendy Moyle published her surprising finding that robot pets really could improve the moods of people living with dementia, her Centre for Health Practice Innovation received a $1.5 million grant from the National Health and Medical Research Council to conduct the largest and most rigorous study of mechanised pet toys anywhere in the world. It involved 415 residents with dementia from 28 Queensland nursing homes in trials in which they were given either no toy; a Paro with its robotics disabled; or the full robotic Paro.Advertisement

“Sometimes it can be difficult to tell with a person with dementia whether they’re happy or sad,” says Moyle, “because their facial features can often look the same, particularly in the later stages of dementia.” But both the robot and the plush toy stimulated a change in the residents’ expressions and increased their “pleasure” response.

“People given the Paro enjoyed engaging with the robot,” says Moyle. “They talked to it and the robot responded to them. Whereas the people who were given the non-robotic toy didn’t have as much engagement. That suggested it was actually the robotics that was necessary to keep people with dementia engaged.”

While robot and non-robot toys alike could lower a person’s level of agitation, only the robot reduced motion agitation (in which “people with dementia become highly agitated and display it in terms of movement”). Moyle’s team’s findings were immensely encouraging.

“It doesn’t have an impact on everybody,” says Moyle, “and we would never expect that to be the case. Because this was such a large study, we included people with all types and stages of dementia. The robot is more useful for people in the early and mid stages of dementia. In the severe stages of dementia, it has no impact whatsoever.”

Disappointingly, Paro had no effect on residents’ sleep patterns. But then, he is only a robot seal.

One autumn morning at the memory support unit, I watch a residents’ activity session in their lounge area. One group has a Paro, a teddy bear and a plush dog; another a Rubik’s cube and some pieces of felt. Other people play with fiddle boxes or learning games.

Effort has been made to make the room feel homey. There’s an arched front door with elaborate leadlight, supposed to look like the entrance to a suburban home in the 1960s. A string of plastic leaves runs the length of a timber beam. A man wearing a dressing gown stops to point out to me a butterfly among the greenery.Advertisement

Playing on the wall-mounted television is André Rieu, who is always popular with the residents, less so with the staff. Two men have fallen asleep, one of them drifting off in front of Rieu.

We move to a quieter, less busy room, where we won’t disturb too many residents. A carer gives Paro to Canadian-born Jackie, who hugs the seal tightly. “I don’t want to lose him,” she says. Like Norma, Jackie is funny, friendly, happy to talk and keen to help. “Sometimes I put him on my shoulder,” she tells me, stroking Paro. “And that makes him happy.” Does it make her happy, too? “Oh, yes,” says Jackie.

Beside Jackie sits German-born Hanni, who sits with her eyes closed and appears more lost, repeatedly calling “hallo”, like an echo, and counting plaintively from one to 10. Jackie seems not hear her. She yawns because she got out of bed too early, and treats Paro to another stroke.

“He doesn’t move very much,” says Jackie. “He’s a bit lazy, and that’s my fault. Because I hate running after him. I can’t run after him all the time.” Jackie is in a wheelchair. And she would never need to chase Paro.

“He doesn’t run,” says Cleary. “Or swim.” But Jackie loves him. “She pats him and talks to him and comments on him when he moves,” says Cleary. “He calms her down.”

It is difficult to persuade Jackie to pass Paro to Hanni but, when she does, Hanni quickly softens and curls into a cuddle for the seal. Her insistent, beseeching “hallo” – as if nobody listens to her (they do) or bothers to reply – melts into “Hallo, darling, hallo.”

Hanni finds it difficult to hear and seems to have trouble making sentences, but suddenly she can speak – about Paro. She likes him because he doesn’t go looking for things, he just stays with her. As she hugs the seal, she returns to her unending tally. “One, two, three?…”Advertisement

Jackie’s escort, lifestyle assistant Robert Naumoff, says Paro is popular in the home. He can sit Paro on a table in the lounge room and the residents will take turns to brush him.

“A lot of the residents who have language barriers respond well,” says Naumoff. “They talk in their own language to him. I think people who find it hard to talk especially enjoy it.”

At the end of the day, a robot animal speaks every tongue and none.

The Royal Freemasons purchased one Paro for each of its 17 homes in Victoria, encouraged by Dementia Australia (DA, formerly Alzheimers Australia), the national advocacy body for the estimated 447,000 Australians living with dementia and the 1.5 million people who care for them.

They were influenced by DA’s business innovation manager, Dr Tanya Petrovich, who in 2009 had begun to notice “quite extraordinary” interactions between normally withdrawn residents and Paro in Western Australia, where she then worked, and had started to tour care homes with DA’s own demonstration seals.

The Freemasons asked Petrovich to make videos that might persuade donors to contribute to fundraising for the Paro. Inevitably, her clip found its way to YouTube, where it became a surprise viral hit. The manufacturer now uses Petrovich’s film to promote Paro all over the world.Advertisement

Petrovich remains wildly enthusiastic about Paro. She says not all of his virtues are visible in group activities, when he is shared around. If Paro is given to one person, he learns the voice of his owner and answers specifically to that voice. He hears, recognises and responds to the name he is given.

“They’re sensitive to light, so as the light starts to decrease, they’ll go to sleep and wake up when the lights are back on,” she says. They have antibacterial fur, sensors in their whiskers, “quite a few senses or capabilities that make them as lifelike as possible”.

DA’s robot therapy representation course deliverer – probably the only person with that job description in Australia – is Wendy Henderson, who regularly briefs residential carers about the benefits to residents of a variety of robot pets and animatronic animals. It is through Henderson that I meet Nelson the horse, Biscuit the dog, Lulu the cat and a quite exasperating preloved parrot.

Henderson has assembled all her animals for me in a room at the national head office of Dementia Australia in Melbourne. She says DA first developed animal representation therapy about seven years ago to try to help out facilities with residents who needed something that they could stroke, pet, touch or cuddle, when you couldn’t accommodate a real animal.

“A live animal gets the most spontaneous response,” says Henderson. “That is beautiful. But we can’t always have a live animal.”

When allotting an animated toy companion, it is important to find out whether a resident has a history as an animal lover – or animal abuser, for that matter – and to know which animals they treasure and which, if any, they fear. Paro has a huge advantage in these stakes, since only a tiny percentage of the population have had any experiences, either positive or negative, with a baby harp seal.

First up is Nelson the horse, who is about the size of a small pony or a very large dog. Up close, Nelson is obviously a manufactured product, although he has an unnervingly realistic mouth. From a distance, he might be mistaken for an actual miniature pony.

“He normally stands out here in the foyer,” says Henderson. “We had a fill-in receptionist one day, and somebody had left Nelson turned on. And our receptionist was talking away and, all of a sudden, the horse shakes his head. And then it whinnies. And she nearly jumped out of her skin. She sent an email, ‘Who’s put this animal down here?’”

When Henderson let her know it was an animated toy, the receptionist wrote, “I feel like it’s staring at me.” Henderson replied, “It probably is.”

Nelson belonged to an elderly woman from Nelson Bay, NSW, named Kaye, who lived with vascular dementia. Kaye had loved horses all her life but clearly couldn’t take a horse with her into residential care. “Nelson replaced that love of the horses enough for her to be proud of it, to pat it, to talk to it,” says Henderson. “When it was switched on, it would neigh back at her. It gave her a lot of pleasure at a time in her life when she couldn’t go out to live animals, couldn’t go out in the paddock. The horse lived in the bedroom with her. When it’s turned on, you can feed it a carrot. A plastic carrot.”

Did the horse come with the carrot? “Yes,” says Henderson. “And you’ve also got a brush. It was therapeutic for Kaye to brush the horse’s mane and take the halter off and on – something that she always did. So it was that repetitive action that she was able to do – the stroking and patting – that gave her comfort.”

Henderson turns on the horse for me. It moves its head to the side and whinnies when she scratches its neck. If I were a temporary receptionist, I would be looking for a new job.

Although Moyle stresses the toys are of no use to people with advanced dementia, Henderson says, “Nelson was with Kaye right through to the end, always by her bed. And she could just put her hand out and scratch his nose.”

Henderson moves on to Biscuit, the pretend dog. If you touch his ear, Biscuit turns his head towards you. While we’re talking about Biscuit, Nelson neighs. Henderson attempts to quieten him with his carrot, but Nelson seems reluctant to take it.

Nelson is one of toy company Hasbro’s range of FurReal Friends. Many of the cheaper “robots” are actually FurReal animatronic animals, which run on a loop and cost a couple of hundred dollars – as compared to the $8000-plus for a Paro.

Officially, Nelson is a “Butterscotch” pony – and he wags his tail to hear mention of his breed. Eventually, Henderson coaxes Nelson to gnaw his carrot six times, as advertised.

“Kaye would feed her horse carrots throughout the day,” says Henderson. “And it kept Kaye happy. She was doing something that represented what she’d always loved. And it was a way for her to express affection and be engaged when she couldn’t have the real thing.”

It is important for people living with dementia to be able to demonstrate affection. Often they receive love and care, but they can’t necessarily return it. Nelson gives them a chance to be useful or kind. Carers might ask a resident to brush the horse for them or look after him for half an hour. It’s important they give a set period for the task, or an elderly person might think they have been left all day with a horse.

Biscuit the dog is the favourite with residential care staff. He looks much more like a real dog than Paro does a seal or Nelson does a horse. When Henderson rubs his chest, he raises a paw to shake. He looks at me, moves his head from side to side, wags his tail and barks.

Living dogs are unsure what to make of Biscuit. “When we had a person working here who also trained guide dogs,” says Henderson. “The guide dogs would come down and sniff Biscuit and they’d bark at each other.”

Biscuit is a golden retriever, but he’s the last of his line. While various smaller dogs – such as cocker spaniels and poodles – are still available from Hasbro, “they don’t make the big one any more,” says Henderson, “because there are a lot of issues with the joints.” Apparently, Biscuit’s front knees give him problems. “I’ve had him fixed a couple of times,” says Henderson, “so we’re a bit mindful about how he’s used.”

Care workers in some homes might bring their own dogs to work once or twice a week. They can’t take them every day, because the residents want to pat them so frequently that the dog gets tired, and feed them so much food that the dog grows fat. But a dog or a cat can offer tremendous comfort.

“When a resident is unwell and maybe bed-bound,” says Henderson, “you’ll often find a cat will find its way to that room and then jump up on the bed and lay down beside the resident. And the resident is then able to stroke the cat while they’re convalescing. The cat instinctively knows that resident is not well. Animals are very perceptive, very instinctive. But when you can’t have the real thing?…”

Biscuit starts panting. “All right,” says Henderson, soothingly, “we’re not paying you any attention, are we?”

Next up is Lulu. She looks a bit dishevelled, like a dead cat that has bounced, or a cat-shaped mophead. “Lulu needs a jolly good clean,” admits Henderson. “She got taken to a facility and was left there for a few weeks. And Lulu was fed. Real food. Which they’re not supposed to do.” The meat got stuck in her fur. “We had the devil’s own job cleaning her,” says Henderson.

Lulu refuses to perform for me. “Oh, don’t tell me the battery’s flat,” says Henderson. “She’s been left on.”

Apparently, when Lulu is fully charged, she purrs and rolls over, meows, and bats with her paw. Lulu was mid-bat when her battery failed. “That’s why her paw’s up,” says Henderson, “because that’s where she’s stuck at the moment.” She looks like a frozen imitation of a Chinese lucky cat wealth figure.

Henderson used to work in care homes, and she remembers a resident named Joy who would not talk to people, but loved to sit out in the corridor, lean down and pat the pretend cat. “People would walk past and say, ‘Hello, Joy. How’re you today? How’s the cat?’?”

Joy was no longer isolated all day. “We educate other residents, too,” says Henderson, “the ones that are cognisant. You don’t want other residents to say, ‘Oh, that’s stupid! That’s just a toy!’ That flattens all your initiatives. So we say, ‘We need your help. We need you to tell us if it’s working or not. Can you help us keep an eye on that?’ And they usually agree then, because they’ve got a job too.”

Henderson introduces me to the parrot, Squawkers McCaw, another FurReal animatronic toy and the poor man of the menagerie. “One of our staff found him in an op shop and brought him back,” says Petrovich, “so then I had to find instructions on the internet.”

Squawkers has a light sensor. A hand waved over his head makes him blink. A pat on the back coaxes him to coo and move. “Some of them learn to swear, too,” says Henderson.

But I’m distracted from Squawkers by Lulu, who is resting in an unlikely huddle with Biscuit and Nelson. I’m certain I saw Lulu cock her ears. A moment later, she tilts her head. The cat keeps moving! It’s got batteries in it! It moved its head! It moved its paw! “That response you just gave is like the response of a person with dementia,” says Henderson, not unkindly.

But she told me the cat wasn’t working. “The battery’s flattening,” Petrovich reassures me. “Sure, she’s using just a little bit.” The next time Squawkers coos, Lulu meows in response. This is definitely one of the stranger situations in which I have found myself.

“What are you doing?” the parrot asks me. Half a dozen times. He came with a toy cracker, but we don’t have it. He is supposed to talk back or mimic me, but he just blinks coquettishly and asks what I’m doing, whatever I say. It turns out he’s not in repeat mode. Henderson fiddles with a switch beneath his wings and eventually he says, “Pretty bird?” and “What do you want?” in response to my question about who’s the world’s greatest journalist.

Then he falls asleep, ostentatiously snoring, and wakes up with a cheery “Hi there!”

I don’t like Squawkers much.

“I’m hungry,” he says.

You’re a pretend cockatoo, mate. Get over it.

The carers at the Coppin Centre offer to introduce Paro to a man named Bill. When he sees the seal, Bill smiles, but that may be because his face is fixed in a permanent grin. “I don’t think it’s going to impress me very much,” says Bill, and he walks away.

Petrovich says some people reject the machines: “There was a case of someone with younger-onset dementia – this person was in their late 40s – who picked up Paro and threw him across the room. Some people love pets, cats and dogs, other people hate them. It’s similar with robots.”

Henderson says she has seen one elderly man cry tears of joy when presented with Paro. “Animals provoke all kinds of emotive responses, and that’s what you’re looking for – but you don’t know what you’re going to get. Someone who might love dogs might hate the robotic dog because they have enough insight left to understand that it is a robotic dog.”

Eventually, Paro is joined by Coppin Centre resident and trustee Keith Thornton, who is not living with dementia but bought Paro for the centre because, he says, “I was told it was necessary for the demented people.” Does he enjoy being with Paro himself? “Well, yeah, of course I do,” says Thornton, smiling. “My great-grandchildren enjoy being with her.” It is at this point that I realise Paro may be gender-fluid.

The use of care robots and animatronic toys has its critics, who suggest it might be unethical to give them to people who perhaps can’t differentiate them from living animals. And it’s difficult to say what Norma, for example, thinks Paro might be, but I suspect her perception changes by the minute.

There is an argument that people should look after other people, and people living with dementia should be encouraged to feel affection and connection with members of the human race, rather than robots or toys. (FurReal’s early advertising slogan was “They love you for real, Fur Real friends” – and, clearly, they don’t.)

However, for Wendy Moyle, they were never supposed to replace people, but rather be “used as conduits through which social interaction with another human can take place” and give people living with dementia something to do in those inevitable periods when their carers were attending to something or someone else.

Moyle predicts robot companions will soon become more sophisticated and cheaper. Once a sceptic, she knows she sounds like a spruiker when she talks about Paro, and she stresses she has no commercial relationship with any manufacturer of robot or animatronic pets. “But,” she says, “when families say to me things like, ‘That’s a very expensive product?…’ what I tend to say it is a reusable product. In our study with 415 people, I still have all of the Paros I used and they still function. Their maintenance cost is not expensive, they can be used among many people in a nursing home – and, if you were using a real dog instead, you’d still pay $1000-$4000 for a dog, and you’ve got to have food, etc.”

There’s no need to walk robots or have them wormed. They are never going to bite your grandson or dig up your neighbour’s garden. They won’t die on you, as long as you change their batteries or keep them charged. And Paro – although not poor Lulu – has the secret of eternal youth: his skin can be removed from his body and washed, reused or replaced.

“They take a bit of electricity,” says Moyle, “and a bit of cleaning, and that’s it. People with dementia at home tend to get very attached to them. They don’t have to worry about forgetting to feed them or having to take them outside to toilet them. There are some big advantages about having a robot animal compared to a real animal.”

Source: Sydney Morning Herald – Mark Dapin SEPTEMBER 21, 2019