Research Papers

If you are interested in learning more about the latest research associated with frailty and the way in which it is defined, experienced and managed then please explore our repository of academic research papers found below. If you are looking for a less in-depth perspective then you might also like to review our collection of public-facing reports on frailty.


Dr Ebrahim Mulla Academic Clinical Fellow, Leicester GP Training Programme
Dr Ursula Montgomery GP Partner and Chair, East Leicestershire Clinical Commissioning Group

Ageing well is ‘everyone’s concern’. However, everyone who ages does not necessarily live with frailty, and frailty is no respecter of age. This article is part of a series unravelling frailty. We draw upon the latest thinking, evidence and policy to explore the nature of frailty, why frailty matters and how GP services are developing to meet the challenge to better support people living with frailty.

Frailty: Past, present and future?

Dongmin Kwak and LaDora V Thompson

The prevalence of frailty across the world in older adults is increasing dramatically and having frailty places a person at increased risk for many adverse health outcomes, including impaired mobility, falls, hospitalizations, and mortality. Globally, the concept of frailty is gaining attention and the scientific field has made great strides in identifying and conceptually defining frailty through consensus conferences, in advancing the overall science of frailty by drawing on basic science discoveries including concepts surrounding the hallmarks of aging, resilience, and intrinsic capacities, and in identifying the many challenges faced by professionals within diverse clinical settings. Currently, it is thought that frailty is preventable, thus the identification of a person's degree of frailty is vital. Identification of frailty is achievable through widely used frailty screening tools, which are valid, reliable, and easy to use. Following the identification of a person's degree of frailty, targeted intervention strategies, such as physical activity programs must be implemented. In this perspective, we provide a historical perspective of the frailty field since the last quarter of the 20th century to present. We identify the proposed underlying pathophysiology of multiple physiological systems, including compromised homeostasis and resilience. Next, we outline the available screening tools for frailty with a physical performance assessment and highlight specific benefits of physical activity. Lastly, we discuss current scientific evidence supporting the physical activity recommendations for the aging population and for older adults with frailty. The goal is to emphasize early detection of frailty and stress the value of physical activity.

Talking about frailty: The role of stigma and precarity in older peoples’ constructions of frailty

Victoria Cluley University of London, Business School, 106 Bunhill Row, London EC1Y 8TZ, UK
Graham Martin
THIS Institute, University of Cambridge, UK
Zoe Radnor
University of London, UK
Jay Banerjee
Consultant in Emergency Medicine, University Hospitals of Leicester, UK

The clinical identification of frailty is increasingly thought to be important in countries with ageing populations. Understanding how older people labelled as frail make sense of this categorisation is therefore important. A number of recent studies have reported negative perceptions of the term among older people themselves. Building on this, we focus on how and why those assessed to be frail make sense of frailty as they do. We draw on 26a discourse analysis of situated interviews with 30 older people accessing emergency care in an English NHS hospital. Three interpretive repertoire pairs (Frailty is 26a bodily issue/frailty is about mind-set; Frailty is 26a negative experience/frailty is an inevitable experience; I’m not frail/I feel frail), identified across the participants’ talk, are outlined and discussed in relation to discourses of the fourth age and precarity. We conclude that frailty is often seen in terms what others have referred to as ‘real’ old age and is linked to discourses of dependence and precarity.

Managing frailty as a long-term condition

Jennifer K. Harrison, Andrew Clegg, Simon P Conway and John Young

Frailty is a distinctive late-life health state in which apparently minor stressor events are associated with adverse health outcomes. This article considers how the conceptualisation of frailty as a long-term condition offers new management approaches based on systematically applied preventative and proactive interventions. Frailty shares the key features of the common long-term conditions: it can be ameliorated but not cured; it is costly at an individual and societal level; it is progressive; it impacts adversely on life experience and it has episodic crises. The recognition of frailty as a long-term condition is not merely a semantic issue—a wide range of benefits can be anticipated. Primary care-based registers for frailty could be established and chronic disease models applied systematically for co-ordinated and person-centred preventative and proactive care. A team approach is a key component of long-term condition management, incorporating support, follow-up and behaviour change interventions that go beyond the scope of a traditional medical approach. This approach would ideally require changes in secondary care to embrace greater community-based working and closer relationships with the primary health and care team. Although our understanding of interventions to modify or treat frailty has improved, there is considerable scope for further development. Identifying frailty as a long-term condition would be an important step in distinguishing people with frailty as a discrete population for new research.

Mary Ni Lochlainn, Natalie J. Cox, Thomas Wilson, Richard P. G. Hayhoe, Sheena E. Ramsay, Antoneta Granic, Masoud Isanejad, Helen C. Roberts, Daisy Wilson, Carly Welch, Christopher Hurst, Janice L. Atkins, Nuno Mendonça, Katy Horner, Esme R. Tuttiett, Yvie Morgan, Phil Heslop, Elizabeth A. Williams, Claire J. Steves, Carolyn Greig, John Draper, Clare A. Corish, Ailsa Welch, Miles D. Witham, Avan A. Sayer and Sian Robinson.

Frailty is a syndrome of growing importance given the global ageing population. While frailty is a multifactorial process, poor nutritional status is considered a key contributor to its pathophysiology. As nutrition is a modifiable risk factor for frailty, strategies to prevent and treat frailty should consider dietary change. Observational evidence linking nutrition with frailty appears most robust for dietary quality: for example, dietary patterns such as the Mediterranean diet appear to be protective. In addition, research on specific foods, such as a higher consumption of fruit and vegetables and lower consumption of ultra-processed foods are consistent, with healthier profiles linked to lower frailty risk. Few dietary intervention studies have been conducted to date, although a growing number of trials that combine supplementation with exercise training suggest a multidomain approach may be more effective. This review is based on an interdisciplinary workshop, held in November 2020, and synthesises current understanding of dietary influences on frailty, focusing on opportunities for prevention and treatment. Longer term prospective studies and well-designed trials are needed to determine the causal effects of nutrition on frailty risk and progression and how dietary change can be used to prevent and/or treat frailty in the future.

Sex-specific interventions to prevent and manage frailty

Natasha Reid, Adrienne Young, Leila Shafiee Hanjani, Ruth E. Hubbard and Emily H. Gordon

There is growing interest in interventions that delay, slow, and even reverse frailty. In this narrative review, we explore the evidence on exercise, nutrition, medication optimisation and social support interventions for frailty and consider how these relate to underlying frailty pathophysiology. We also consider pathophysiological mechanisms underpinning sex differences in frailty before evaluating the limited evidence for sex-specific frailty interventions that is currently available. Through this review of the literature, we generate a list of potential sex-specific interventions for frailty. While individual-level recommendations are certainly important, future work should turn the focus towards population-level interventions that take into account sex differences in frailty, including changes to healthcare and socioeconomic systems, as well as changes to the built environment to promote healthy behaviours.

Frailty in Healthcare Settings

Kevin F. Boreskie, Jacqueline L. Hay, Patrick E. Boreskie, Rakesh C. Arora and Todd A. Duhamel

Healthcare systems need to adapt to better serve an aging population with complex presentations. Frailty assessments are a potential means to address this heterogeneity in aging to identify individuals at increased risk for adverse health outcomes. Furthermore, frailty assessments offer an opportunity to optimize patient care in various healthcare settings. While the vast number of frailty assessment tools available can be a source of confusion for clinicians, each tool has features adaptable to the constraints and goals of different healthcare settings. This review discusses and compares barriers, facilitators, and the application of frailty assessments in primary care, the emergency department/ intensive care unit and surgical care to cover a breadth of settings with different frailty assessment considerations. The implementation of frailty-aware care across healthcare settings potentiates better healthcare outcomes for older adults

Frailty syndrome: Implications and challenges for health care policy

Gotaro Kojima, Ann E M Lijas and Steve Iliffe

Older adults are a highly heterogeneous group with variable health and functional life courses. Frailty has received increasing scientific attention as a potential explanation of the health diversity of older adults. The frailty phenotype and the Frailty Index are the most frequently used frailty definitions, but recently new frailty definitions that are more practical have been advocated. Prevalence of frailty among the community-dwelling population aged 65 years and older is ~10% but varies depending on which frailty definitions are used. The mean prevalence of frailty gradually increases with age, but the individual’s frailty level can be improved. Older adults, especially frail older adults, form the main users of medical and social care services. However, current health care systems are not well prepared to deal with the chronic and complex medical needs of frail older patients. In this context, frailty is potentially a perfect fit as a risk stratification paradigm. The evidence from frailty studies has not yet been fully translated into clinical practice and health care policy making. Successful implementation would improve quality of care and promote healthy aging as well as diminish the impact of aging on health care systems and strengthen their sustainability. At present, however, there is no effective treatment for frailty and the most effective intervention is not yet known. Based on currently available evidence, multi-domain intervention trials, including exercise component, especially multicomponent exercise, which includes resistance training, seem to be promising. The current challenges in frailty research include the lack of an international standard definition of frailty, further understanding of interventions to reverse frailty, the best timing for intervention, and education/training of health care professionals. The hazards of stigmatization should also be considered. If these concerns are properly addressed, widespread application of public health approaches will be possible, including screening, identification, and treatment of frailty, resulting in better care and healthier aging for older people.

Frailty at the Front Door

Zoe Wyrko

Significant numbers of older people attending hospital can be considered to be frail or living with frailty. This is a multicomponent syndrome with many manifestations that leads to poorer outcomes in terms of mortality, morbidity and institutionalisation. Recognition and management of frailty can be challenging, and requires a true multidisciplinary approach, but appropriate assessment and subsequent intervention have been proven to be beneficial. This article discusses the background to frailty, and a number of validated frailty scores which can be applied by non-specialists in the acute environment. It highlights other resources which are available to help with the management of this complex group of patients, and discusses potential local and national service developments in this area.

Frailty in Residential Settings

Gotaro Kojima Department of Research, Dr. AGA Clinic, Tokyo, Japan
Yu Taniguchi
Center for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan
Reijiro Aoyama
Department of Japanese Studies, The Chinese University of Hong Kong, Shatin, Hong Kong
Marianne Tanabe
Veterans Affairs Pacific Islands Health Care System, Honolulu, HI, USA

Older adults may be at increased risk of loneliness. Frailty is also common in older adults, however, associations between loneliness and frailty have been understudied. This systematic review and meta-analysis aimed to explore evidence on how loneliness and frailty are correlated. Methods: A systematic search of the literature was conducted using 4 electronic databases in February 2022 for any studies published in 2000 or later that provided cross-sectional or longitudinal associations between loneliness and physical frailty in community-dwelling older adults. A meta-analysis was attempted to combine data when possible.

Frailty and Assistive Robotics

A critical analysis of the representations of older adults in the field of human-robot interaction
Dafna Burema
This paper argues that there is a need to critically assess bias in the representations of older adults in the field of Human–Robot Interaction. This need stems from the recognition that technology development is a socially constructed process that has the potential to reinforce problematic understandings of older adults. Based on a qualitative content analysis of 96 academic publications, this paper indicates that older adults are represented as; frail by default, independent by effort; silent and technologically illiterate; burdensome; and problematic for society. Within these documents, few counternarratives are present that do not take such essentialist representations. In these texts, the goal of social robots in elder care is to “enable” older adults to “better” themselves. The older body is seen as “fixable” with social robots, reinforcing an ageist and neoliberal narrative: older adults are reduced to potential care receivers in ways that shift care responsibilities away from the welfare state onto the individual.

The Effectiveness of Assistive Technologies for Older Adults and the Influence of Frailty: Systematic Literature Review of Randomised Controlled Trials
Mariana Liselotte Fotteler, Viktoria Muhlbauer, Simone Brefka, Sarah Mayer, Brigette Kohn, Felix Holl, Walter Swoboda, Petra Gaugisch, Beate Risch, Michael Denkinger and Dhayana Dallmeier
The use of assistive technologies (ATs) to support older people has been fueled by the demographic change and technological progress in many countries. These devices are designed to assist seniors, enable independent living at home or in residential facilities, and improve quality of life by addressing age-related difficulties. This paper aimed to evaluate the effectiveness of ATs on relevant outcomes with a focus on frail older adults.

An analysis of design recommendations for socially assistive robot helpers for effective human-robot interactions in senior care

Fraser Robinson and Goldie Nejat

As the global population ages, there is an increase in demand for assistive technologies that can alleviate the stresses on healthcare systems. The growing field of socially assistive robotics (SARs) offers unique solutions that are interactive, engaging, and adaptable to different users’ needs. Crucial to having positive human-robot interaction (HRI) experiences in senior care settings is the overall design of the robot, considering the unique challenges and opportunities that come with novice users. This paper presents a novel study that explores the effect of SAR design on HRI in senior care through a results-oriented analysis of the literature. We provide key design recommendations to ensure inclusion for a diverse set of users. Open challenges of considering user preferences during design, creating adaptive behaviors, and developing intelligent autonomy are discussed in detail. SAR features of appearance and interaction mode along with SAR frameworks for perception and intelligence are explored to evaluate individual developments using metrics such as trust, acceptance, and intent to use. Drawing from a diverse set of features, SAR frameworks, and HRI studies, the discussion highlights robot characteristics of greatest influence in promoting wellbeing and aging-in-place of older adults and generates design recommendations that are important for future development.

Socially assistive robots on the market: Experiences from inpatient care and potentials for care at home

Christph Strunck, Verena Reuter, Vera Gerling, Pia-Saskia Berg and Anja Ehlers

The article addresses commercial socially assistive robots (SAR). There is evidence of the impact of SAR on older persons in institutional settings. Family care at home has not yet been the subject of systematic research; however, especially at home SAR could help to prevent loneliness, provide emotional support, and foster communication.

Living with a Telepresence Robot: Results From a Field-Trial

Laura Fiorini, Alessandra Sorrentino, Mattia Pistolesi, Claudia Becchimanzi, Francesca Tosi and Filippo Cavallo

Population around Europe is getting older; many older adults would like to live independently in their homes as long as possible. Personalized integrated care plan strategies envisage the possibility of home care services for those people at risk of frailty. In this context, the robot could empower people to live independently. In the presented work, 20 frail older adults were asked to live with a telepresence robot (i.e., Double Robot), through which the formal caregiver could remotely visit them. A total of 284 days of field-test trial was evaluated with a proposed framework that explores several domains, including system reliability, maintainability, system acceptance, user attitude, and user experiences. At the end of the experimentation, the system was used for 4241 mins accomplishing 151 telepresence services, and the results underline optimal system reliability and high user experience. Based on the collected feedback, the proposed telepresence robot can be exploited into integrated care services. The evaluation of a system should envisage a complex, multidisciplinary, and holistic approach that may influence the success or failure of the robot's purpose if not properly analyzed during the evaluation and design phase.

How wearable sensors have been utilised to evaluate frailty in older adults

Grainne Vavasour , Oonagh M. Giggins , Julie Doyle and Daniel Kelly

Globally the population of older adults is increasing. It is estimated that by 2050 the number of adults over the age of 60 will represent over 21% of the world’s population. Frailty is a clinical condition associated with ageing resulting in an increase in adverse outcomes. It is considered the greatest challenge facing an ageing population affecting an estimated 16% of community-dwelling populations worldwide. The aim of this systematic review is to explore how wearable sensors have been used to assess frailty in older adults.

Hojjat Abdollahi; Mohammad Mahoor; Rohola Zandie; Jarid Sewierski; Sara Qualls

This paper presents our recent research on integrating artificial emotional intelligence in a social robot (Ryan) and studies the robot's effectiveness in engaging older adults. Ryan is a socially assistive robot designed to provide companionship for older adults with depression and dementia through conversation. We used two versions of Ryan for our study, empathic and non-empathic. The empathic Ryan utilizes a multimodal emotion recognition algorithm and a multimodal emotion expression system. Using different input modalities for emotion, i.e. facial expression and speech sentiment, the empathic Ryan detects users emotional state and utilizes an affective dialogue manager to generate a response. On the other hand, the non-empathic Ryan lacks facial expression and uses scripted dialogues that do not factor in the users emotional state. We studied these two versions of Ryan with 10 older adults living in a senior care facility. The statistically significant improvement in the users' reported face-scale mood measurement indicates an overall positive effect from the interaction with both the empathic and non-empathic versions of Ryan. However, the number of spoken words measurement and the exit survey analysis suggest that the users perceive the empathic Ryan as more engaging and likable.

Effect of a Robotic Pet on Social and Physical Frailty in Community-Dwelling Older Adults: A randomised controlled trial

Chava Pollak, Sharon Stahl Wexler and Lin Drury

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.

Seeking at-home long-term autonomy of assistive mobile robots through the integration with an IoT-based monitoring system

Matteo Luperto, Javier Monroy, Francisco-Angel Moreno, Francesca Lunardini, Jennifer Renous, Andrej Krpic, Cipriano Galindo, Simona Ferrante, Nicola Basilico, Javier Gonzalez-Jinemez and N. Alberto Borghese

In this paper, we propose a system that stems from the integration of an autonomous mobile robot with an IoT-based monitoring system to provide monitoring, assistance, and stimulation to older adults living alone in their own houses. The creation of an Internet of Robotics Things (IoRT) based on the interplay between pervasive smart objects and autonomous robotic systems is claimed to enable the creation of innovative services conceived for assisting the final user, especially in elderly care. The synergy between IoT and a Socially Assistive Robot (SAR) was conceived to offer robustness, reconfiguration, heterogeneity, and scalability, by bringing a strong added value to both the current SAR and IoT technologies. First, we propose a method to achieve the synergy and integration between the IoT system and the robot; then, we show how our method increases the performance and effectiveness of both to provide long-term support to the older adults. To do so, we present a case-study, where we focus on the detection of signs of the frailty syndrome, a set of vulnerabilities typically conveyed by a cognitive and physical decline in older people that concur in amplifying the risks of major diseases hindering the capabilities of independent living. Experimental evaluation is performed in both controlled settings and in a long-term real-world pilot study with 9 older adults in their own apartments, where the system was deployed autonomously for, on average, 12 weeks.

Co-Production Methodology with Older Adults

What do Older Adults Want from Social Robots? A Qualitative Research Approach to Human-Robot Interaction (HRI) Studies

Roger Andre Soraa, Gunhild Tondel, Mark W. Kharas and J Artur Serrano

This study investigates what older adults want from social robots. Older adults are often presented with social robots designed based on developers’ assumptions that only vaguely address their actual needs. By lacking an understanding of older adults’ opinions of what technology should or could do for them–and what it should not do–we risk users of robots not finding them useful. Social and humanistic research on the robotization of care argues that it is important to prioritize user needs in technology design and implementation. Following this urgent call, we investigate older adults’ experiences of and approach to social robots in their everyday lives. This is done empirically through a qualitative analysis of data collected from six group interviews on care robots with health care service users, informal caregivers (relatives), and professional caregivers (healthcare workers). Through this “Need-Driven-Innovation” study we argue that, to secure a functional and valuable technology-fit for the user, it is crucial to take older adults’ wishes, fears, and desires about technology into account when implementing robots. It is also crucial to consider their wider networks of care, as the people in these networks also often interact with the assistive technology service users receive. Our study shows that more qualitative knowledge on the social aspect of human-robot interaction is needed to support future robot development and use in the health and care field and advocates for the crucial importance of strengthening the position of user-centered qualitative research in the field of social robotics.

Co-research with older people: a systematic literature review

Hayley James and Tine Buffel

Interest in co-research with older adults has grown in the past 20 years, yet few published studies have addressed why and how older people have been involved as partners in research. This article presents a systematic review of the literature, examining the aims and challenges of co-research and the ways in which older adults can be involved in research. Systematic searches covering several databases were conducted, yielding a total of 3,293 articles, with 27 papers reviewed which involved older people as co-researchers across more than one stage of the research cycle. We find that co-research with older people offers improved understandings of the issues facing older people; more inclusive and responsive policy, practice and service design; and opportunities for co-researchers to develop new skills whilst giving voice to marginalised groups of older people. The analysis highlights the different ways in which older adults can be involved across phases of research, and identifies ethical, methodological and practical challenges encountered in the process. Involving older adults as co-researchers, while labour intensive and practically challenging, holds promise as an underdeveloped resource for social gerontology, as well as older people themselves. The paper identifies four pathways for improving and extending co-research: developing diversified structures of involvement, supporting co-researchers, embedding research rigour and ensuring co-ownership of change.

Involving Socially Excluded Groups in Age-Friendly Programs: The Role of a SPatial Lens and Co-Production Approaches

Sophie Yarker and Tine Buffel

Despite the identification of social inclusion as a key objective of age-friendly policies and programs, there is limited research evidence as to either the extent to which this has been achieved or how it might be realized. Gaps remain in our understanding of how age-friendly programs might involve different groups of older people and the possible barriers that might be encountered. This paper seeks to address this gap by drawing on evidence from the Ambition for Aging program in Greater Manchester, UK, which implemented a range of projects designed to tackle social isolation in later life. The paper argues that due to its co-production approach and spatial lens, Ambition for Aging was able to involve sections of the older population that otherwise might have remained excluded. In providing further insights relevant to age-friendly programs, the paper also considers some of the barriers experienced by the Ambition for Aging program and builds a case that taking a spatial justice perspective to age-friendly work may help identify and overcome obstacles to achieving social inclusion.

Wendy A. Rogers Travis Kadylak, and Megan A. Bayles

We reviewed human–robot interaction (HRI) participatory design (PD) research with older adults. The goal was to identify methods used, determine their value for design of robots with older adults, and provide guidance for best practice.

Assistive robots may promote aging-in-place and quality of life for older adults. However, the robots must be designed to meet older adults’ specific needs and preferences. PD and other user-centered methods may be used to engage older adults in the robot development process to accommodate their needs and preferences and to assure usability of emergent assistive robots.

Bottom-Up Research on Assistive Robots for the Aging Population

Isabel Schwaninger, Astrid Weiss and Geradline Fitzpatrick

Robots are developed in the hope to solve various problems that our societies currently face. One of the most pressing problems is the aging population, placing increasing pressure on the care system as people live longer, and often with chronic diseases. Robots are also considered as a possible solution to this problem. However, imaginations of the role of robots are frequently driven by technology-utopian top-down agendas without regard to practical realities of everyday life of the older adults and other stakeholders they seek to support. This chapter presents an overview of assistive technology for the aging population, along with building blocks for Human-Robot Interaction (HRI) research in these contexts, and the challenges that arise. On this basis, we characterize ways of conducting bottom-up research to explore trustworthy HRI for older adults in home environments.

Facilitated Online Video Interviewing with Older People with Advancing Frailty: A Novel Approach to Co-Production

Nicholson, C, Green R and King H

The voices of older people with advancing frailty (OPWF) are less often heard in research, made worse by the COVID-19 pandemic. In-person video interviews with this population about their care needs were adapted to a facilitated online video design. This paper assesses whether this design can support older people's participation in and co-production of research.

Deployment of Assistive Robotic Solutions

Maaike Van Assche, Mirko Petrovic, Dirk Cambier, Patrick Calders, Patrick Van Gelder and Dominique Van de Velde

Due to increasing age and an increasing prevalence rate of neurocognitive disorders such as Mild Cognitive Impairment (MCI) and dementia, independent living may become challenging. The use of socially assistive robots (SARs) is one solution that can enable older adults with cognitive impairment to remain independent. However, at present, there is a lack of knowledge about the attitudes of older adults with MCI and their caregivers towards SARs.

Implementation of Assistive Technologies and Robotics in Long-Term Care Facilities: A Three-Stage Assessment Based on Acceptance, Ethics and Emotions

Annette Franke, Elmar Nass, Anna-Kathleen Piereth, Annabel Zeti and Christian Heidl

Assistive technologies including assistive robots appear to be a promising response to the increasing prevalence of older adults in need of care. An increasing number of long-term care facilities try to implement AT/AR in order to create a stimulating environment for aging well and to reduce workload for professional care staff. The implementation of new technologies in an organization may lead to noticeable cultural changes in terms of social interactions and care practices associated with positive or negative emotions for the employees. This applies especially for LTCFs with high rates of vulnerable residents affected by increasing care needs and specific ethics in nursing and cultural rules within the setting, This, Systematic consideration in leadership management of emotions and ethical aspects is essential for stakeholders involved in the implementation process.

Irena Papadopoulos, Sheila Ali, Chris Papadopoulos, Nina Castro, Nicholas Faulkes, Christina Koulouglioti

The study aimed to explore the views and attitudes of care home workers about the socially assistive robot that was trialled in their workplace, in order to identify training needs in relation to the hypothetical future use of these robots in their workplace.

Care home workers face challenging workload conditions which may require the exploration of new solutions such as the use of socially assistive robots (SARs)

Integrating Social Assistive Robots, IoT, Virtual Communities and Smart Objects to assist as-home independently living elders: the MoveCare Project

Matteo Luperto, Javier Monroy, Jennifer Renoux, Francesca Lunardini, Nicola Basilico, Maria Bulgheroni, ANgelo Cangelosi, Matteo Cesari, Manuel Cid, Aladar Ianes, Javier Gonzalez-Jimenez, Anastasis Kounoudes, David Mari, Victor Priscariu, Arso Savanovic, Simona Ferrante and N. Alberto Borghese

The integration of Ambient Assisted Living (AAL) frameworks with Socially Assistive Robots (SARs) has proven useful for monitoring and assisting older adults in their own home. However, the difficulties associated with long-term deployments in real-world complex environments are still highly under-explored. In this work, we first present the MoveCare system, an unobtrusive platform that, through the integration of a SAR into an AAL framework, aimed to monitor, assist and provide social, cognitive, and physical stimulation in the own houses of elders living alone and at risk of falling into frailty. We then focus on the evaluation and analysis of a long-term pilot campaign of more than 300 weeks of usages. We evaluated the system’s acceptability and feasibility through various questionnaires and empirically assessed the impact of the presence of an assistive robot by deploying the system with and without it. Our results provide strong empirical evidence that Socially Assistive Robots integrated with monitoring and stimulation platforms can be successfully used for long-term support to older adults. We describe how the robot’s presence significantly incentivised the use of the system, but slightly lowered the system’s overall acceptability. Finally, we emphasise that real-world long-term deployment of SARs introduces a significant technical, organisational, and logistical overhead that should not be neglected nor underestimated in the pursuit of long-term robust systems. We hope that the findings and lessons learned from our work can bring value towards future long-term real-world and widespread use of SARs.

Technological risks and ethical implications of using robots in long-term care
Lillian Hung, Jim Mann, Jennifer Perry, Annette Berndt and Joey Wong

The pandemic provides a unique opportunity to examine new directions in innovative technological approaches in long-term care (LTC) homes. While robotics could enhance staff capacity to provide care, there are potential technology risks and ethical concerns involved in technology use among older people residing in communal aged care homes. This qualitative descriptive study explores the technological risks and ethical issues associated with the adoption of robots in the specific context of LTC homes.

Don't Stand so Close to Me: Acceptance of Delegating Intimate Health Care Tasks to Assistive Robots

Vivian Lotz, Andre Calero Valdez and Martina Ziefle

As the share of older adults worldwide increases, the supply of affordable and accessible health care may not match the pace with the growing demand. Thus, assistive care robots receive growing attention. However, while their potential is great in terms of preserving the patients’ sense of autonomy and meeting staff shortages, scepsis remains from a social science perspective. Care tasks often require close physical contact between caretaker and -receiver. This can be difficult, whether it is a human caregiver, or a robot. Notwithstanding that, everyone in need of care tends to hold different expectations, requirements, and prerequisites. Thus, acceptance issues might vary on the acceptance of assistive care robots and preference regarding who should handle which tasks.

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