ABSTRACT
The current randomized controlled trial investigated the effect of a robotic pet on social and physical frailty in community-dwelling older adults. The intervention group (n = 107) received a robotic pet and the control group (n = 113) received usual care following hospital discharge. Social and physical frailty were measured using the Questionnaire to Define Social Frailty Status and the FRAIL questionnaire. Cognitive function and depression were assessed using the Short Portable Mental Status Questionnaire and Geriatric Depression Scale, respectively. Continuous outcomes were compared between groups using t tests or Wilcoxon rank sum tests, as appropriate. Categorical outcomes were compared between groups using chi-square tests or Fisher's exact tests, as appropriate. Main findings showed the robotic pet positively impacted cognitive status in participants who reported they enjoyed engaging with their pet. This finding supported the theoretical premise of the current study that greater engagement with the robotic pet would yield greater improvement in study outcomes. [Research in Gerontological Nursing, 15(5), 229-237.].
Subject(s)
Frailty , Robotic Surgical Procedures , Aged , Frail Elderly/psychology , Frailty/psychology , Geriatric Assessment , Humans , Independent Living/psychologyABSTRACT
BACKGROUND: Hospitalized older adults often experience isolation and disorientation while receiving care, placing them at risk for many inpatient complications, including loneliness, depression, delirium, and falls. Embodied conversational agents (ECAs) are technological entities that can interact with people through spoken conversation. Some ECAs are also relational agents, which build and maintain socioemotional relationships with people across multiple interactions. This study utilized a novel form of relational ECA, provided by Care Coach (care.coach, inc): an animated animal avatar on a tablet device, monitored and controlled by live health advocates. The ECA implemented algorithm-based clinical protocols for hospitalized older adults, such as reorienting patients to mitigate delirium risk, eliciting toileting needs to prevent falls, and engaging patients in social interaction to facilitate social engagement. Previous pilot studies of the Care Coach avatar have demonstrated the ECA's usability and efficacy in home-dwelling older adults. Further study among hospitalized older adults in a larger experimental trial is needed to demonstrate its effectiveness. OBJECTIVE: The aim of the study was to examine the effect of a human-in-the-loop, protocol-driven relational ECA on loneliness, depression, delirium, and falls among diverse hospitalized older adults. METHODS: This was a clinical trial of 95 adults over the age of 65 years, hospitalized at an inner-city community hospital. Intervention participants received an avatar for the duration of their hospital stay; participants on a control unit received a daily 15-min visit from a nursing student. Measures of loneliness (3-item University of California, Los Angeles Loneliness Scale), depression (15-item Geriatric Depression Scale), and delirium (confusion assessment method) were administered upon study enrollment and before discharge. RESULTS: Participants who received the avatar during hospitalization had lower frequency of delirium at discharge (P<.001), reported fewer symptoms of loneliness (P=.01), and experienced fewer falls than control participants. There were no significant differences in self-reported depressive symptoms. CONCLUSIONS: The study findings validate the use of human-in-the-loop, relational ECAs among diverse hospitalized older adults.
Subject(s)
Hospitalization/trends , Telemedicine/methods , Aged , Aged, 80 and over , Case-Control Studies , Communication , Female , Humans , Interpersonal Relations , Male , Nurses , Pilot ProjectsABSTRACT
Hospital-based nurses who have not practiced in home health care may find it difficult to anticipate patients' needs during the transition from hospital to home. This column focuses on increasing competency in preparing patients for home health services.
Subject(s)
Continuity of Patient Care , Home Care Services , Patient Care Planning , Patient Discharge , Patient Education as Topic , Aged , Audiovisual Aids , Humans , Manuals as Topic , United StatesABSTRACT
This ethnographic study was conducted to determine what homeless people experience during the transition from street life into community housing. Data were gathered through participant observation at a program designed to secure housing and support services for homeless people upon discharge from a psychiatric hospital. Sixty homeless, mentally ill adults were followed from hospital discharge through their first 2 years in community housing. Homeless people interact with health care providers across a cultural divide produced by vast differences in their lived experiences. This cultural distance limits access to the services that these individuals require to achieve residential stability.
Subject(s)
Health Services Needs and Demand/organization & administration , Ill-Housed Persons/psychology , Mentally Ill Persons/psychology , Patient Discharge , Public Housing , Adaptation, Psychological , Adult , Aftercare , Anthropology, Cultural , Attitude to Health/ethnology , Case Management , Community Health Nursing , Community Mental Health Services , Cultural Diversity , Empathy , Female , Health Transition , Ill-Housed Persons/education , Humans , Longitudinal Studies , Male , Nurse's Role , Nursing Methodology Research , Social SupportABSTRACT
Nurses play a critical role in helping homeless patients make the transition from revolving door hospitalizations or emergency department visits to ongoing care through an outpatient clinic. This column focuses on increasing competency in the care of homeless patients. The next column will focus on a different type of transition-preparing hospitalized patients for discharge and referral to home health care.
Subject(s)
Clinical Competence , Ill-Housed Persons/psychology , Nurse's Role/psychology , Cooperative Behavior , Empathy , Health Services Needs and Demand , Humans , Nurse-Patient Relations , Patient Advocacy , Patient Discharge , Patient Participation , Practice Guidelines as Topic , Referral and Consultation , Total Quality Management/organization & administration , TrustABSTRACT
This qualitative longitudinal study documents the experiences of 60 people who are homeless and mentally ill from their state mental hospital discharge through their first two years in community housing. The study explores the personal, cultural, and environmental contexts of life for adults who are homeless and mentally ill and examines the interaction between an individual's needs and community resources. The research identifies forces that perpetuate homelessness and traces the struggles that people who are homeless and mentally ill encounter during the transition from the streets to stable housing. The findings describe a culturally based pattern of mutual avoidance between homeless mentally ill clients and caregivers, which limits delivery of services to the population. Recommendations include development of alternative systems of care delivery, expansion of educational experiences with underserved populations, and increased funding for service or research with people who are homeless and mentally ill.
