Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jan 18, 2019
Open Peer Review Period: Jan 21, 2019 - Mar 18, 2019
Date Accepted: Aug 19, 2019
(closed for review but you can still tweet)
A Protocol-Driven, Digital Conversational Agent at the Hospital Bedside to Support Nurse Teams and Mitigate Risks of Hospitalization in Older Adults
ABSTRACT
Background:
The isolation and disorientation often experienced by hospitalized older adults places these individuals at risk for many inpatient complications including loneliness, depression, delirium and falls. Embodied conversational agents (ECA) are technological entities that can interact with people through conversation. Some ECAs are also “relational agents,” which build and maintain socio-emotional relationships with people across multiple interactions. This study utilized a novel type of relational ECA provided by care.coach: 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 orienting patients to mitigate delirium risk, elicitation of toileting needs to prevent falls, and engaging patients in social interaction. 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:
We examined 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 hospitalized at an inner-city community hospital. Intervention participants received an avatar for the duration of their hospital stay; participants on the control unit received a daily 15-minute visit from a nursing student. Measures of loneliness (3-item UCLA loneliness scale), depression (15-item Geriatric Depression Scale) and delirium (Confusion Assessment Method) were administered upon study enrollment and prior to 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:
Study findings validate the use of human-in-the-loop, relational ECAs among diverse hospitalized older adults.
Citation
Per the author's request the PDF is not available.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.