Lorraine C. Mion - US grants

PROJECT SUMMARY / ABSTRACT The aging population with its concomitant medical conditions, physical and cognitive impairments, at a time of strained health care resources, establishes the urgent need to design and implement technologies that enhance or maintain physical and cognitive function and improve quality of life among older adults. Robotic technologies in the form of socially assistive robots (SAR), with capabilities for autonomously detecting and meaningfully responding to older adults' engagement and behavior, have the potential for addressing physical, cognitive, and/or social conditions. The field of SAR is still in early development. We propose to introduce SAR for not only one person - one robot interaction, but also to utilize the robot to foster interactions between two people. The specific aims of this two-year pilot study are: 1) design and validation of an autonomous robotic architecture for older adults with and without cognitive impairment or apathy and 2) assess the feasibility, acceptability and tolerance of the robot-mediated intervention. To accomplish Aim 1, we will refine our current robotic architecture ARIA (Adaptive Robot-Mediated Intervention Architecture) to create several new engaging cognitive, physical and social tasks suitable for older adults and extend the ARIA's capability to include more than one person in the robot-mediated activities to foster human-to-human interaction. We will conduct laboratory experiments involving 30 older adults (10 without cognitive impairment, 10 with mild cognitive impairment, and 10 with mild to moderate dementia) in which we will test the individual capabilities as well as integrated functioning of the robotic system. In Aim 2, we will conduct two pilot feasibility studies at an independent living, assisted living and dementia care senior center. In Pilot Study 1, we will enroll 12 adults, 4 with no cognitive impairment, 4 with mild cognitive impairment, and 4 with mild to moderate dementia, to participate three times weekly for 4 weeks in a series of physical, cognitive and social activities. Pilot Study 2 will include 6 pairs of older adults (2 with no cognitive impairment, 2 pairs with MCI, and 2 pairs with dementia) to attend three sessions a week for 4 weeks. This will allow us to expand the robotic capabilities to monitor more than one person and to encourage social engagement between the older adults. All study procedures will remain the same as in Pilot Study 1. Aims 1 and 2 experiments will be videotaped. Older adults' reactions to the robotic interactions will be gathered by survey, and observation using observer-rated tools. In addition to informing future clinical trials of SAR effectiveness, the information from the proposed study will contribute to the long-term goals supporting the development of robotic strategies to enhance physical function, cognition and socialization of older adults in the community setting.

Project Summary/Abstract 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.

This project seeks to reduce loneliness in older adults who reside in long term care (LTC) communities through new augmented reality (AR) technology. Loneliness is a serious condition that is related to increases in heart disease, depression, suicide, mental and physical decline, and reduced quality of life and death. Two out of five older adults in the U.S. report being lonely. Even more alarming, three out of four LTC older adults experience loneliness. The COVID-19 pandemic, with its accompanying safety protocols, has intensified loneliness across the LTCs. The project will discover how augmented reality can reduce loneliness in LTC older adults by linking them with family members who reside elsewhere. This project will allow older adults and family members to see each other’s 3-dimensional realistic images, eat meals together, and interact with one another in various activities, such as playing cards. Investigators of this project are experts in engineering, computer science, gerontology, nursing, medicine and social health science. Working with older adults and family members in the design and testing of the AR technology, the team will compare AR to 2D interactive communication technologies, such as Zoom or Facetime. Initial understanding of the feasibility and acceptability of this enhanced AR technology among older adults, families and LTC staff will guide future studies targeting loneliness, ultimately improving quality of life for older adults. The community focus for this project will be older adults residing in LTC communities in Middle Tennessee with the potential to scaling the solution across the nation.<br/><br/>The project will fundamentally advance the scientific and the technological methodologies of collaborative Augmented Reality to enhance social presence and thus social connectedness, to create realistic and socially appropriate interactions. It will make several fundamental contributions in both technology and social science during the course of this research: 1) create a novel multi-objective optimization based framework that minimizes positional errors of the hand of the avatar while preserving its nonverbal behavior with respect to the human it represents; such an ability will allow shared activities (e.g., drinking tea together) with appropriate social nonverbal behavior (e.g., gaze and postures), a critical component of communication; 2) create a new methodology of a user’s motions onto its avatar to generate naturalistic, socially appropriate motion that respects dissimilarities between the user’s and its avatar’s environments (e.g., differences in room geometries) through novel motion mapping and optimization that ensures natural walking patterns; 3) develop a greater understanding of the feasibility, acceptability and social presence in the use of varying collaborative AR activities and environments for older adults with different levels of cognitive impairment and their family members; 4) develop a greater understanding of the impact of collaborative AR on loneliness based on level of cognitive impairment; 5) gain a greater understanding of the logistics and deployment of this technology in LTCs and family homes to inform scalability; and 6) create activity design guidelines for reduction of loneliness in older adults. The research will be conducted through participatory design using key stakeholders (e.g., older adults, activity directors, LTC management) and evaluated using a two-arm experimental design comparing collaborative AR to current state-of-the-art 2D interactive communication technologies.<br/><br/>This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.