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 Intl. Journal of Human–Computer Interaction, 30: 369–393, 2014
Copyright © Taylor & Francis Group, LLC
ISSN: 1044-7318 print / 1532-7590 online
DOI: 10.1080/10447318.2013.873278
Socially Assistive Robots in Elderly Care: A Mixed-Method
Systematic Literature Review
Reza Kachouie, Sima Sedighadeli, Rajiv Khosla, and Mei-Tai Chu
La Trobe University, Melbourne, Australia
The world’s population is aging, and developed countries are
engaged in developing a new aged-care paradigm to reduce spiral-
ing healthcare costs. Assistive technologies like Socially Assistive
Downloaded by [Monash University Library] at 01:18 21 May 2015
Robots (SAR) are being considered as enablers to support the pro-
cess of care giving or keep elderly at home longer. This article
reports a mixed-method systematic review of SAR in elderly care
and recognizes its impact on elderly well-being, integrating evi-
dence from qualitative and quantitative studies. It follows the prin-
ciples explained in Cochrane Handbook for Systematic Reviews of
Interventions and classifies interventions, measures, and outcomes
of field trials of SAR in elderly care. Eighty-six studies in 37 study
groups have been included. The findings imply positive effects of
SAR on elderly well-being. Ten significant recommendations are
made to help avoid the current limitations of existing research
and to improve future research and its applicability. This review
revealed that SAR can potentially enhance elderly well-being and
decrease the workload on caregivers. There is a need for rigorous
research methodology, person-centered care, caregiver expectation
model, multimodal interaction, multimodal data collection, and
modeling of culturally diverse groups to facilitate acceptability of
SAR.
1. INTRODUCTION
The world’s population is aging, and aged care is con-
cerned with supplying proper care for the elderly as the process
of ageing weakens their capability to look after themselves.
Predominantly, healthcare provided by human professionals is
the preferred type of care, but additional assistance is strongly
desired. To address this looming problem, researchers are work-
ing on technologies such as social robotics to support the
process of caregiving.
Personal robots are created to act in residential premises,
such as homes and nursing homes, and expected to become part
of our daily life. Consequently, these robots are designed to have
the ability to interact like humans or at least like pets. Any robot
Reza Kachouie is now with the Department of Marketing, Monash
University, Melbourne, Australia.
Address correspondence to Reza Kachouie, Department of
Marketing, Monash University, P.O. Box 197, Caulfield East,
Melbourne, Victoria 3145, Australia. E-mail: reza.kachouie@monash.
edu
369
developed in this manner as a social entity, and possibly able to
communicate with users, will fall into the category of social
robots (Broekens, Heerink, & Rosendal, 2009). Dautenhahn
and Billard (1999) stated that social robots are able to par-
ticipate in social interactions. Moreover, Fong, Nourbakhsh,
and Dautenhahn (2003) emphasized the critical role of social
interaction and used the term “socially interactive robots.”
Furthermore, to have a flexible interaction with humans, intel-
ligent robots should have knowledge sharing ability (Hiraki &
Anzai, 1996). Researchers have been working for more than two
decades to improve human–computer interactions; for exam-
ple, on tele-operations (Shneiderman, 1990), neural network-
based eye-tracking device (Wolfe & Eichmann, 1997), and
speech-driven embodied interactive actor (Watanabe, Okubo,
Nakashige, & Danbara, 2004).
Assistive robots for elderly people can be broadly catego-
rized into two groups (Broekens et al., 2009). First, rehabil-
itation robots; these robots focus on physical assistive tech-
nology features and are principally not communicative, like
smart wheelchairs (Gomi & Griffith, 1998), artificial limbs, and
exoskeletons (Kazerooni, 2005). The second group are assistive
social robots and are divided into two subgroups: service robots
and companion robots. Service robots are used to support basic
tasks of independent living, such as eating and bathing; mobility
and navigation; or monitoring, for example, Care-o-bot (Graf,
Hans, & Schraft, 2004). Companion robots aim to enhance
the health and psychological well-being of elderly people, for
instance, Paro (Wada, Shibata, Saito, & Tanie, 2003a) and
Artificial Intelligence Robot (AIBO; Kanamori et al., 2003).
In another study, Broadbent, Stafford, and MacDonald (2009)
categorized healthcare robots into robots that provide physical
assistance, companionship, and monitor health and safety. They
emphasized that the essential intention of healthcare robots is to
enhance the health and standard of living for human beings.
There is not a formal definition or survey of assistive robotics
(Bemelmans, Gelderblom, Jonker, & de Witte, 2012; Feil-Seifer
& Mataric, 2005), but Feil-Seifer and Mataric (2005) described
socially assistive robotics as the meeting point of assistive
robotics and socially interactive robotics and stated that this
kind of robot has the purpose of aiding humans by emphasizing
the importance of social interaction in the process of providing
 370 R. KACHOUIE ET AL.
specific assistance. It is obvious that it is neither possible nor
helpful to insist on drawing a solid line between different types
of robots, as most new robots involve more than one activity
group. In this article, our focus is Socially Assistive Robots
(SAR).
Researchers widely acknowledge that there is a need for
comprehensive reviews in the field of human–computer inter-
action, so researchers engage more and more in reviewing
literature in this context (e.g., Zhou, Rau, & Salvendy, 2012).
One of the most recent ones is the systematic review done by
Bemelmans et al. (2012) with the aim of outlining an inte-
grated report on the published effects and effectiveness of
SAR for the elderly. Another recent review has been published
with the focus on applying social commitment robots in the
care of elderly people with dementia (Mordoch, Osterreicher,
Guse, Roger, & Thompson, 2013). Broekens et al. (2009) also
reviewed related effects of assistive social robots on well-being
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and health of the elderly. There are also some other existing
reviews (e.g., Nejat, Sun, & Nies, 2009; Shibata & Wada, 2011).
In another paper, Shibata (2012) reported the results of Seal
robot therapy in dementia care and mentioned the qualitative
and quantitative evaluations. Although these reviews have been
published recently, most do not include research from 2009 and
beyond. Moreover, they do not take into account all different
types of robots or the diverse databases in different areas such
as healthcare, engineering, and robotics. Research in the inter-
disciplinary area of SAR is of growing interest, and each year
a large number of new studies are published. Hence, there is a
need for a systematic review attempting to synthesize existing
studies with a holistic viewpoint about SAR in the context of
aged care.
2. THE REVIEW
2.1. Aim
The aim of this systematic review is to present an integrated
report on published studies about SAR in the context of elderly
care, to enable scholars to realize what is already known (Levy
& Ellis, 2006) and connect ongoing studies to superior dialogue
in the literature (Cooper, 1984; Creswell, 2009; C. Marshall &
Rossman, 2006).
2.2. Design
This systematic review follows the principles explained in
Cochrane Handbook for Systematic Reviews of Interventions
(Higgins & Green, 2011).
Traditionally, systematic reviews rely on facts from quan-
titative studies, but the benefits of including the results of
qualitative research are increasingly recognized (Tacconelli,
2010) and may enhance the quality of the review (Thomas
et al., 2004). As the nature of elderly care is multifaceted and
complicated, so it should be explored using mixed methods.
Thus, this review integrates evidence from qualitative as well
as quantitative studies.
2.3. Search Methods
The search was carried out in September 2012. In the first
step, a wide range of databases including the MEDLINE and
PubMed, CINAHL, the Cochrane library, BioMed, IEEE digital
library (Xplore), SCIRUS, ACM digital library, ProQuest, and
JSTOR were searched systematically for various types of pub-
lications such as journal articles, conference proceedings and
extended abstracts about socially assistive robots in elderly care.
Moreover, a free search was done in La Trobe University library
and Google Scholar. No limitation was applied to publication
date.
To reduce the likelihood of excluding relevant publications,
the search in before mentioned databases was based on the
subject (i.e., social robots) and the context (i.e., elderly care).
Therefore, the search term included two parts.
The terms “robot∗ ”, “assis∗ device∗ ”, “assis∗ technolo∗ ”,
and “self-help device” as the subject in conjunction with
“aged”, “elder∗ ”, “senior∗ ”, “old person∗ ”, “old people”, and
“dementia” as context, including their database-specific the-
saurus equivalent, their associated Medical Subject Headings
terms, and subheadings, were used in the search process.
In addition, to prevent from excluding related studies, the
names of specific robots (i.e., “AIBO,” “Care-o-bot,” “CERO,”
“Feelix,” “Hug,” “iCat,” “Ifbot,” “Matilda,” “NeCoRo,”
“PaPeRo,” “Paro,” “Pearl,” “Robocare,” and “Sparky”) were
used as the subject. The asterisk (∗ ) character used to substitute
for any other potential character(s) in the search term; accord-
ingly, “elder∗ ” represents the terms “elder,” “elders,” “elderly,”
and “elderliness.”
Reviews done earlier are useful to locate potentially related
references (Littell, Corcoran, & Pillai, 2008), so existing
reviews’ references were scanned and new references har-
vested and added to the collection of possibly eligible studies.
Further inclusion and exclusion criteria for reviewing studies
are mentioned in the following subsection.
2.4. Inclusion/Exclusion Criteria
Only publications in English were considered for this
research, and technical reports of robots’ characteristics and
features were excluded. Other inclusion criteria are in harmony
with the aims of this review, namely, participants were elderly,
and interventions were any kind of interaction such as free
interaction and supervised interaction in groups or one-on-one.
There was no exclusion based on the location of interaction,
such as homes, nursing homes, or retirement villages.
Sometimes making judgments about the intelligence or
autonomy of a robot, or the level of its perception of the envi-
ronment, is misleading. Therefore, in this review, none of the
 SOCIALLY ASSISTIVE ROBOTS IN ELDERLY CARE
related studies were excluded because of low degree advance-
ment (e.g., in terms of intelligence or autonomousness) of the
robot(s) being used.
By involving at least two researchers in the review pro-
cess, the chance of excluding relevant studies will be discarded
(Edwards et al., 2002). Therefore, two reviewers of our research
team independently scored the list of potentially relevant publi-
cations based on the relevancy of the publication’s title to SAR
in the context of elderly care on a 3-point scale (0, 1, and 2) to
represent not relevant, relevant, and very relevant. Scores of two
researchers were added up, and those publications that received
a minimum 2 out of 4 were treated as relevant. The eligibility
decision was made through discussion on the publications with
the score of 1. Subsequently, abstracts of the remaining stud-
ies went through the same scoring process, and any potential
discrepancies were also resolved through discussion.
Afterward, full texts of possibly related articles were
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acquired. Two reviewers independently assessed studies to test
whether they fulfilled the inclusion criteria. Disagreements were
resolved through discussion and debate with other research
team members.
2.5. Quality Appraisal
The quality of qualitative and quantitative studies was
appraised by using frameworks developed by Spencer, Ritchie,
Lewis, and Dillon (2003) and Thomas et al. (2004) respec-
tively. Although some studies were based on low method-
ological quality, they include original information and creative
ideas. Therefore, none of the studies were excluded based on
methodological quality or a minimum quality threshold.
2.6. Data Extraction and Synthesis
Data extraction forms for this review were developed apply-
ing PICO approach (Participants, Interventions, Comparator,
and Outcomes; listed next). One reviewer carried out data
extraction. Afterward, the second reviewer double-checked
extracted data. The review team resolved disagreements by
discussion.
• Participants: Age, sex, type of disease, country
• Interventions: Robot, place (e.g., home, nursing home,
day service center), type, intensity, duration, free or
supervised sessions, one-to-one or group sessions
• Comparator: With placebo robot or not
• Outcomes: Effects on elderly, tools, and scales to
measure effects on them
2.7. Duplicate Publications
Duplicate publication may cause exaggerated intervention
effectiveness qualitatively (Gøtzsche, 1989; Huston & Moher,
1996) and cause greater emphasis than is warranted (Angell &
Relman, 1989; Huston & Moher, 1996). It can take different
forms such as same manuscripts, expressing different outcomes
371
or numbers of participants (von Elm, Poglia, Walder, & Tramèr,
2004) as well as accumulating additional data to duplicated
data (Tramèr, Reynolds, Moore, & McQuay, 1997) without any
type of cross-referencing. It requires some “detective work” to
uncover the duplicate publications (Higgins & Green, 2011) and
find out core ideas.
Therefore, after data extraction, studies were grouped to
avoid data duplicity. If we found any study that had been
published more than once (maybe with some changes), then
the study synthesis and report were done based on the most
complete study or one with the longest duration.
3. RESULTS
3.1. Search Outcome
In the first step, 816 potentially eligible publications are
found through database searching and 851 through free search-
ing and reference harvesting. There were 1,144 publications left
after removing the identical ones and overlaps. After title scor-
ing, 253 publications are put aside for further consideration, of
which 20 are given review scores of 0 + 2 = 2 (i.e., one reviewer
scored 0 and other reviewer scored 2). There were 105 publica-
tions selected based on the abstract scoring that 12 of them are
scored 0 + 2 = 2. For calculating the interrelated agreement
between two reviewers, the weighted Cohen’s kappa coefficient
is determined (J. Cohen, 1968). The values of weighted kappa
are calculated 0.68 in second steps and 0.82 in third steps, which
shows the agreement’s strengths between two raters are good
and very good respectively (Altman, 1991).
Eighty-two publications were found to meet inclusion crite-
ria after reviewing the full texts, which includes all duplicate
publications and 34 study groups. Each group includes studies
that have been published more than once. Figure 1 presents a
schematic flow diagram of the review process. It is based on the
PRISMA statement (Moher, Liberati, Tetzlaff, Altman, & The
Prisma Group, 2009) with some minor modifications.
3.2. Overview of Included Studies
Table 1 presents a comparison among various studies based
on interventions and measures chosen. Studies’ quality varies
vastly.
Participants and Settings
Number and age of participants varies vastly among included
studies; the majority of participants were women, most of the
study groups are done in Japan (n = 19), and the most com-
mon trial environment was nursing home. The participants
suffer from a wide range of diseases and most are experiencing
different stages of dementia.
Robots
In the following paragraphs, there is a brief description of
each of the robots in alphabetical order.
 372 R. KACHOUIE ET AL.

Records identified through Additional records identified through free
database searching search and reference harvesting
(n = 831)
Identical records removed
(n = 1,198)
Records screened based
on title
(n = 1,198)
Records screened based
on abstract
(n = 277)
Full-text articles assessed
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and bumper sensors, microphones, and a laser range finder
and is powered by battery. Healthbot software communicates
(n = 876)
with several web services to retrieve and update information
(Jayawardena et al., 2012). The speech synthesis system engen-
ders New Zealand accent (Watson, Teutenberg, Thompson,
Roehling, & Igic, 2009).
iCat. The iCat (interactive Cat) is a catlike robot made
of hard plastic. iCat is not mobile and has been developed
by Philips Electronics (de Ruyter, Saini, Markopoulos, & van
Records excluded
(n = 921) Breemen, 2005). It is equipped with 2 DC motors and 11 RC
servos that are used to control eyes, eyelids, eyebrows, mouth,
and head position, which enables the robot to engender facial
Records excluded expressions such as sad and happy (Philips Research, 2005).
(n = 163)
Moreover, a camera, microphones, speaker, and touch sensors
are installed inside the iCat. It is capable of connecting to a
home network to surf the internet or control devices such as
Full-text articles excluded
TV or VCR (Breemen, Yan, & Meerbeek, 2005). The iCat can

for eligibility
(n = 28)
(n = 114)
Publications included in
synthesis
(n = 86)
Study groups
(n= 37)
FIG. 1 Review process’ schematic flow diagram.
AIBO. AIBO is an entertainment autonomous doglike
mobile robot developed and manufactured by Sony. Its exte-
rior is solid plastic. It is programmable by users and weighs
about 1.6 kg. AIBO is embodied by 18 degrees of freedom,
which enables it to present complicated motions in addition to
smooth walking. It has a wide variety of sensors including range
finder, microphone, speaker, touch sensor, camera, and angular
velocity and acceleration sensor (Sony, 1999). AIBO potentially
enhances the quality of life of elderly and disabled by playing
with them.
Bandit. Bandit is a humanoid upper-torso mounted on a
wheeled platform and equipped with speaker, camera, and range
finder. The humanoid Bandit II torso consists of 22 degrees
of freedom in arms, hands, neck, waist, eyebrow, and mouth
(A. Tapus, 2009a), so the robot is able to perform individual
or combined motion of face, head, and arms, and this makes
it highly expressive (Clair, Mead, & Matarić, 2010). Bandit is
used in various contexts such as study human–robot interaction,
imitation learning, and therapy. Moreover, Bandit has been used
and evaluated in three different types of roles: social aid, cogni-
tive games, and encouraging physical activity (A. Tapus, Fasola,
& Matarić, 2008).
Healthbot. The Healthbot robot is a joint research project
between UniServices of the University of Auckland and the
Electronic and Telecommunications Research Institute in Korea
(University of Auckland, n.d.). Yujin Robot provided Robot
hardware. It is equipped with a rotatable touch screen, ultrasonic
be used as a research platform for doing analysis of interac-
tion between humans and SAR (Looije, Cnossen, & Neerinex,
2006).
Ifbot. Ifbot is a communication robot with the ability to
react to words and ask questions. The purpose of developing
Ifbot is to reduce the sense of loneliness in elderly through some
basic conversations (Kanoh, Iwata, Kato, & Itoh, 2005). It is
equipped with 101 LEDs as well as 10 motors to move eyes,
eyelids, and head. To express different emotions, the LEDs act
with motors (Matsui, Kanoh, Kato, Nakamura, & Itoh, 2009).
Ifbot helps the elderly as a result of engaging their minds by
responding to words and asking questions.
Nodding Kabochan. Nodding Kabochan is developed by
PIP Co. ltd. and Wiz Corporation and resembles features
of shape, voice, and motion of a 3-year-old boy (AARP
International, n.d.). Originally, it is produced to provide relax-
ation to elderly through communication and is capable of
singing, talking, and moving in response to touch and speak-
ing. Kabochan’s sensors are installed in its hands, feet, mouth,
and main body.
Nabaztag. Nabaztag (also known as Karotz) is a rabbit-
shaped robot, capable of connecting to the Internet to execute
specific tasks through a server. Nabaztag is able to react to
some predefined commands and does not have any features
for learning or memory (Klamer & Ben Allouch, 2010). It is
equipped with webcam, speaker, and microphone. In addition,
the ears can rotate 360 degrees. Some of the tasks that can
be performed by Nabaztag include making Internet calls and
accessing the TV guide, weather, and news. It can notify the
user about updates on Facebook and Twitter. It is possible
to control Nabaztag by smartphone or tablet (Karotz, n.d.).
NeCoRo. NeCoRo is a catlike robot capable of autonomous
action and movement, developed by Omron Corporation in
Japan to improve the user’s quality of life (Nakashima,
Fukutome, & Ishii, 2010). It is covered with acrylic fur and
weighs about 1.6 kg. NeCoRo is able to perceive user actions by
internal sensors, including sight, sound, touch, and orientation.
 Downloaded by [Monash University Library] at 01:18 21 May 2015

TABLE 1
Characteristic of Included Studies
Patients
Robot References (No, Age, Disease) Country - Place - Term Intervention Measures Outcomes
Paro Saito, Shibata, Wada, 26 female, 73–93, Japan Day service Free interaction Face scale, Summarized Improvement in feelings
and Tanie (2002a); 16 nondementia, center 5 wk, in groups of up to POMS, Comments of of elderly, Positive
Saito, Shibata, Wada, 3 slight degree, 3 a 20 min/d or 8 patients nursing staffs, Burnout social and
and Tanie (2002b); little high degree, 40 min/d, scale for nursing staff psychological effects,
Saito, Shibata, Wada, 4 high degree 3 d/wk Decrease in nursing
and Tanie (2004); dementia staff’s mental poverty;
Wada, Shibata, Saito,
and Tanie (2002a,
2002b, 2002c, 2002d,
2004a)

373
Saito, Shibata, Wada, 23 (12+11) Japan Health service Free group interaction, POMS, Face scale, Improvement in moods
and Tanie (2003); T. (4+2 male), facility (2 buildings) one group with Paro Urinary tests, and reduction in
Shibata, Wada, Saito, M age 84.6 4 wk, 1 hr/d, 4 d/wk and the other with comments of nursing depression and
and Tanie (2004, and 85.5, Not placebo Paro staffs dejection levels in
2008); K. Wada, dementia both groups without
Shibata, Saito, and much difference,
Tanie (2003a, 2003b, Increase in laughing,
2003c, 2003d, 2003e) Encourage
communicating with
each other and nursing
staff, Ability to adjust
to stress, Decrease in
nursing staffs’ stress;
(Continued)
 Downloaded by [Monash University Library] at 01:18 21 May 2015

TABLE 1
(Continued)
Patients
Robot References (No, Age, Disease) Country - Place - Term Intervention Measures Outcomes
Shibata and Wada 14 female, 77–98, Japan Health service Free group interaction GDS, Face scale, A tendency to improve
(2008); K. Wada, 1 nondementia, 4 low facility 1 yr (5yr), Comments of nursing depression after
Shibata, and degree, 5 moderate 1 hr/d, 2 d/wk (In staffs 8 weeks, Improvement
Kawaguchi (2009); degree, 4 a little high 2009 they mentioned in moods, Increase in
K. Wada, Shibata, degree dementia it is still an ongoing social activities,
Saito, Sakamoto, and experiment since Encourage
Tanie (2005a, 2005b, 2003) communication with
2005c); K. Wada, each other and
Shibata, Saito, and caregivers, Patients
Tanie (2004b, 2004c); did not lose their
K Wada, Shibata, interest in the
Saito, and Tanie long-term, Robot is

374
(2006); K. Wada, durable and safe;
Shibata, Sakamoto,
Saito, and Tanie
(2005); K. Wada,
Shibata, Sakamoto,
and Tanie (2005);
Wada, Shibata,
Sakamoto, and Tanie
(2006)

Wada, Shibata, Musha, 14 (4 male), M age 79.2, Japan Clinic 20 min Free interaction in EEG recording then Improvement in cortical
and Kimura (2005, Mild to moderately groups of 5 to analyze using neurons activity of
2008) severe dementia 10 patients DIMENSION, 7 patients, especially
Questionnaire on patients who liked
the robot;
 Downloaded by [Monash University Library] at 01:18 21 May 2015

Kidd, Taggart, and 23 (16+7), 60–104, USA 2 nursing homes Free interaction with Questionnaire including Increase in social
Turkle (2006); High functioning in 4 mo, 20 min/2 wk, either: turned on Paro, close- ended and interactions, even
Taggart, Turkle, and one nursing home and (8 plus 4 visits) Paro in the off verbal open-ended more in the presence
Kidd (2005) schizophrenia and/or condition or no object, questions, of caregivers or
senile dementia in the groups of 3 patients, Observations experimenters,
other 1 caregiver and including video Pleasing, Feel-good
1 experimenter observations and evocative
experiences, Paro is
more interesting when
turned on, Subjects
engaged easily and
freely in casual
conversation without
Paro, Paro is heavy
and do not match
expectations
(swimming);

Kawaguchi, Shibata, 12 (1 male), 67-89, Japan Nursing home Free interaction with Urinary tests, Video Increase in social

375
and Wada (2010); Different stages of 2 mo, 9:30 hr/d 2 robots in 2 different recording observation, interaction and density
Wada and Shibata dementia levels in public area Free-pile sort method, of social networks,
(2006a, 2006b, 2006c, interview Improvement of
2007a, 2007b, 2007c, subjects’ vital organs
2008a, 2008b) reaction to stress,
Patients encouraged to
communicate;

Giusti and Marti (2006) 5 (1 male), 56-85, 3 mild Italy Nursing home Mostly spontaneously Qualitative and Variables, such as
and 2 sever dementia 1 mo, 20 min/d, and only partially quantitative speech contextual factors, the
2 d/wk structured interaction and behavioral robot’s characteristics,
analysis stimulus, and personal
history play an
important role whilst
creating significance
and interpretation of
Human-Robot
interaction;
(Continued)
 Downloaded by [Monash University Library] at 01:18 21 May 2015

TABLE 1
(Continued)
Patients
Robot References (No, Age, Disease) Country - Place - Term Intervention Measures Outcomes
Marti, Bacigalupo, 1 male (results Italy Nursing home Field study, therapists Direct observation, Robot interaction
Giusti, Mennecozzi, confirmed by 8 more 6 mo autonomously chose Video observation, stimulates emotion
and Shibata (2006) cases), Moderate when and where to Physicians and nurses expression, social
dementia present Paro assessment intercourse, and
dialogue, Decrease
stress;

Wada, Shibata, Asada, 5, Senile dementia Japan Home 1 wk Free interaction at home Analyzing recorded Positive effects of art
and Musha (2007) (for 1 week between EEG using therapy, Interaction
2 other usual weeks of DIMENSION with the robot at home
3 weeks art therapy) (comparing results of seemed effective in
weeks with and two out of five
without robot), Family subjects maintaining
observation art therapy effects;

376
AIBO Kanamori et al. (2003) 6 (5 female at nursing Japan 5 in nursing home Free interaction Scores of emotional Significant reduce in
home, 1 male at and 1 in home 7 wk, words, amount of loneliness, Significant
home), 5 control 1 hr/d, 4 d/wk speech and increase in activity,
group, M age of Satisfaction, AOK Improvement in health
women: 68.2, man: 84, Loneliness Scale, related quality of life,
On wheelchair, good SF-36, Decrease in CgA;
cognition Endocrinological
estimation using
salivary CgA

Suga, Sato, Yonezawa, 15, 3 groups: Japan Day-care center Robot-assisted activity Change in concentration Robot Interaction
Naga, and Shimizu Alzheimer, senile 30 min MHPG, HVA, and CS stimulates emotional
(2003) dementia, in saliva (collected activation vs.
and group before and after emotional healing,
activity) Potential rehabilitative
effect on senior
citizens with
Alzheimer’s disease;
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Mival, Cringean, and 10–12 (in two groups), Scotland Retirement and Interaction in focus Observation Perceived autonomy and
Benyon (2004) 64-93 day-care center 2 s group proactive interaction
are important,
Companion needs
some utility to turn
interaction into
relationship;

Sakairi (2004) 8 (2 male), 68-89, Japan Group home Stimulated activity N-dementia scale, Improvement in
Senile dementia 30 min/wk, not clear MMSE scale, behavior activities and
how many weeks scale, video emotional state,
observation of speech, Smoothing
words, length, communication with
substance staff in a group home
and establishment of
friendly relations with
occupants;

Tamura et al. (2004) 13 (1 male), M age 84, Japan Geriatric health Group occupational Video recording Both toy dog and AIBO
Severe dementia care facility 7 d, therapy and observation by encouraged patients’

377
5 min/d (two comparison between occupational therapy activity while doing
experiments, 4d +3d) AIBO dressed, AIBO and total number of occupational therapy,
undressed and toy dog activity changes Increase in social
counted and activity and
compared. socialization, No
significant difference
between AIBO
dressed up or
undressed;

Greco, Anerdi, and 24 (12 male), M age Italy Room of medical Supervised activity Observation, Negative feelings
Rodriguez (2009); 76.6, in early stages of examination 1 s questionnaire towards technology do
Odetti et al. (2007) dementia of different not affect interaction,
types Awareness is needed
for positive cognitive
interaction,
Men/Women alike,
Higher education
negatively relates to
acceptance;
(Continued)
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TABLE 1
(Continued)
Patients
Robot References (No, Age, Disease) Country - Place - Term Intervention Measures Outcomes
Banks, Willoughby, 12 AIBO, 13 real dog, USA Long term care Free one-to-one Modified LAPS, UCLA Dog and robot therapy
and Banks (2008) 13 Control group, No facility 8 wk, interaction in residents loneliness scale reduced loneliness
known history of 30 min/wk room (more improvement in
psychiatric disease or most lonely
Alzheimer’s disease participants),
Residents became
attached to robots,
Attachment was not
the mechanism to
decrease loneliness by
animal-assisted
therapy;

Hamada et al. (2008) 5 (in card game), 6 (in Japan Nursing home 5 d One-to-one card game, Frequency of occurrence Coordinator special

378
ball game), (once card game, once group ball game (moving the body, skills not necessary in
Considerable dementia ball game) looking and talking) in recreation games,
video observation Improvement of
(during and after abilities of elderly;
recreation)

NeCoRo A. Libin and 9 female, 83–98, early to USA Nursing home 2 s Supervised free Observations, ABMI, Both cats held
Cohen-Mansfield severe dementia (one with robot and interaction Lawton’s Modified participants’ interest,
(2002, 2004) 1 with toy cat in two Behavior Stream, Significant pleasure
different days) scale of engagement increase and agitation
(attention, attitude, decrease whilst
intensity, duration of playing with the
engagement) robotic cat, Significant
decrease in physically
disruptive behaviors
and overall agitation
whilst playing with the
toy cat;
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A. V. Libin and Libin 16 and 16 (5 and Japan and USA 15 min Interactive session PRCIS Older people enjoyed
(2004) 8 male), 2 groups, accompanied by a more than younger
20 to 35 → 19, standardized people, No difference
65-79 → 13 introduction between the sexes on
the subscale of tactile
and manipulative
interactions, Males
from both cultures
liked the robot’s active
behavior more than
females, Americans
consider interactions
with robotic cat more
exciting and
interesting, Positive
effects of prior
experience and liking
pets on the interest in
robot;

379
Nakashima, Fukutome, 33 staff members Japan Elderly-care Free interaction of Interview staff members, Communication among
and Ishii (2010) (12 males), Teenager facility 1 yr residents and questionnaire (filled users was promoted,
to 50s outpatients by staff) Playing with the robot
made users calmer,
more comfortable,
easier, gentler, and
happier;

Bandit Tapus (2009a, 2009b); 3 female (in some USA Care facility 6 mo, Robot encouraged SMMSE, evaluation of Robot vs. screen agent
Tapus, Tapus, and reports 4 including 20min/wk (excluding music-based cognitive response time and encouragement
Mataric (2009a, 1 male), 70+, 1 mild, 2 months learning) game, (in some reports wrong answers, improved response
2009b, 2009c, 2009d) 1 moderate, 1 severe comparing with screen questionnaire (music time more, More
dementia agent) therapist feedback) efficient, natural, and
preferred interaction
with robot rather than
screen agent, Increase
in positive behavior,
Improvement in
SMMSE score;
(Continued)
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TABLE 1
(Continued)
Patients
Robot References (No, Age, Disease) Country - Place - Term Intervention Measures Outcomes
Fasola and Mataric 11 (1 male), 65+ USA Senior living Engaging in a seated Questionnaire Robot is viable and
(2010) facility 2 wk, 2s/wk arm exercise scenario useful in motivating
as exercise instructor users to do simple
physical exercises;

iCat Heerink, Krose, Evers, 36 (11 male) Netherland Eldercare Conversation to set Revised UTAUT Social abilities and
and Wielinga (2006, institutions 10 min reminder, get direction questionnaire, factors influencing
2007); Heerink, Krose, to supermarket and observation, video acceptance are
Wielinga, and Evers next day weather recording significantly
(2006a, 2006b, 2009) forecast (comparing correlated, More
more socially socially
communicative with communicative
less socially interface is more
communicative accepted as a
interface), (comparing conversational partner,

380
with screen agent) Rise in anxiety due to
fear of breaking or
doing something
wrong, More socially
communicative
condition increase
acceptance of a
conversational partner,
Embodiment plays a
role in acceptance;

Heerink, Krose, Evers, 30 (8 male), 65-94 Netherland 2 eldercare Free interaction Questionnaire, robot Social presence affects
and Wielinga (2008, institutions 10 d (comparing with recordings, robot log perceived enjoyment,
2009); Heerink, Krose, screen agent by other file which itself affects
Wielinga, and Evers users) intention to use robot,
(2008) Intention to use
predicts actual use
(with some differences
between the agents);
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Healthbot Stafford et al. (2010)
32 residents (9 male), New Zealand Supervised predefined Questionnaire, revised Pre-interaction
68–9221 staffs Retirement village 1 s activities PANAS, RAS emotions, attitudes
(1 male), 26-62 towards robots, and
experience with robot
affect acceptance of
healthcare robots,
Level of robot or
computer knowledge
was not associated
with overall robot
rating, Education level
was inversely
associated with overall
rating

Jayawardena et al. 67 (42, 25, 5), 65+ New Zealand Three studies: -free Questionnaire, Promising results for
(2012) Retirement center 2 w interaction in public observation elderly acceptance of
spaces -free the robot
interaction in private
spaces -remote

381
monitoring falls

Ifbot Kanoh et al. (2011) 10 (2 male), 75–88, Japan Health care Supervised classroom Video recording Positive impression of
2 moderate and 6 mild facility 15 min (each activity in groups of 5 observation, robot, Positive opinion
dementia, 7 depressive group) comments and about the robot
opinions collected in assisted activity
focus group program;

Matilda Khosla, Chu, Kachouie, 34 (6 male), 71–98, Australia 3 Nursing One-to-one activities, Questionnaire, Improvement in
Yamada, and Dementia, Depression, home 4 d group activities interview, observation, personalization of
Yamaguchi (2012); Parkinson disease, video recording care, Improvement in
Khosla et al. (2012) deafness, short term observation, robot wellbeing of elderly
memory loss and etc recordings of emotions (through these
constructs: Positive
engagement,
Acceptability,
Personalization of
care, Encouragement
of healthy living,
Usefulness);
(Continued)
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TABLE 1
(Continued)
Patients Country - Place -
Robot References (No, Age, Disease) Term Intervention Measures Outcomes
Nabaztag Klamer and Ben 3 female, 50, 60, 65 Netherland Home Free interaction Semi-structured Not effective in
Allouch (2010) 10 d interviews improvement of
users’ health, Users
did not find the
robot very useful,
only 1 user made
relationship with
the robot;

Nodding Tanaka et al. (2012) 34 (all female), 16 of Japan Home 8 w Free interaction Pre- and post-study Cognitive functions
Kabochan them in control questionnaire, blood may be improved by
group, 66-84, No and saliva samples, living with a
dementia APG, ADL, BMI human-type
communication

382
robot

PaPeRo Sasama, Yamaguchi, 10 (7 males) Japan Home and Interaction based on Questionnaire (after Increase in:
and Yamada (2011) common place Robot-Guided 1st stage) communications
157 d (1st stage Interaction with family
12 d) Framework, in members, number
second stage robot of friends, and
replaced with a outdoor activities;
computer graphics
version of robot

Pearl Montemerlo, Pineau, 6 USA Retirement 3 days open-ended Debriefings Robot could
Roy, Thrun, and home 5 d interactions, 2 days autonomously
Verma (2002); robot guide provide guidance
Pineau, (12 scenarios) for elderly
Montemerlo, residents, High level
Pollack, Roy, and of excitement;
Thrun (2003)
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Robovie Sabelli, Kanda, and 55, M age 83.9, Japan Elderly care Daily greetings, Observation, Comforting users
Hagita (2011) Stable mental center 3.5 mo, encouraging the semi-structured by listening to
health 1/wk or 2/wk elderly to interviews, them, their
perform difficult open-ended problems and
tasks, chatting questions, respond with
transcriptions of positive and kind
interaction words,
Enjoyment
through chatting,
supporting
emotional
response, and
positive
interactions;

Wonder Yamamoto, 7 (3 male), M age Japan Home Free interaction Questionnaire and System is effective
Miyazaki, of men 83, Several mo interviews with in sense of
Tsuzuki, and women 78 patient and security and joy
Kojima (2002) operation staff, of life;

383
system use log
and history

Different robots (Pleo, Hutson, Lim, 6 (2 male), 66–85 UK Home 3 s + 1 focus group, Pre- and post-study Most robots did not
Huggable, FurReal Bentley, Bianchi- 5 to 17 d (9 home followed by free questionnaire, meet
Cat, Keepon, Mood Berthouze, and studies) interaction at diary forms expectations,
Lamp, I-Cat, Bowling (2011) home, then two during study, Participants
Nabaztag, Teddy focus groups post-study unsatisfied with
Phone, Robosapien interview robots, Social
and Heart) Robots could
potentially
improve
wellbeing of
elderly, tested
robots focus
more on health
care and behavior
among elderly;
(Continued)
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TABLE 1
(Continued)
Patients Country - Place -
Robot References (No, Age, Disease) Term Intervention Measures Outcomes
Different pet-type Hamada, Hashimoto, 15 Several elderly, Japan Nursing home Activity with their Observation and Robot is effective,
robots Akazawa, More than 80% -care house for the own pet-type robot Evaluation of an Human intervention
Matsumoto, and female, 68-98 aged 1 hr and one volunteer intervention person between
Kagawa (2004) Activity of one and an institution elderly-robot
volunteer and member, Barthel interaction impacts
several elderly Index, FIM the elderly view
(Functional about the external
Independence world;
Measure)

384
Unknown Hamada et al. (2006) 18 (5 in one part), Japan Nursing home Robot therapy, Questionnaire filled Movement became
Considerable comparing different by staff, type and more active, More
dementia methods (with frequency of laughter, richer
active intervener, patients’ action to expression and
with passive robot, communication
intervener, without after therapy,
intervener) Intervener plays a
significant role in
robot therapy.
Note. s = session; min = minute; hr = hour; d = day; wk = week; mo = month; yr = year; POMS = Profile of Mood States; GDS = Global Deterioration Scale; EEG =
Electroencephalography; DIMENSION = Diagnosis Method of Neuronal Dysfunction; CgA = Chromogranin A; AOK LS = Ando = Osada & Kodama Loneliness Scale; MMSE =
Mini–Mental State Examination; SMMSE = Standardized MINI-MENTAL Mini–Mental State Examination; MLAPS = modified Lexington Attachment to Pets Scale; ABMI = Agitated
Behaviors Mapping Instrument; PRCIS = Person–Robot Complex Interactive Scale; UTAUT = Unified Theory of Acceptance and the Use of Technology; PANAS = The Positive and
Negative Affect Schedule; RAS = Robot Attitude Scale; APG = Accelerated plethysmography; ADL = Activities of Daily Living; BMI = Body Mass Index.
 SOCIALLY ASSISTIVE ROBOTS IN ELDERLY CARE
NeCoRo reacts with inbuilt 15 actuators (A. V. Libin & Libin,
2004). The responses could be verbal or nonverbal, such as
mewing, tail wagging, stretching the body and paws, and
cuddling when being touched (E. Libin & Libin, 2003).
PaPeRo. PaPeRo (Partner-Type Personal Robot)—which in
Australia has been named Matilda—is a baby-face humanlike
assistive communication robot, developed by NEC in Japan.
It weighs about 6.5 kg and is equipped with camera, micro-
phones (i.e., sound direction detection and speech recognition),
speakers, LEDs (in different parts), and sensors including touch,
elevation, ultrasonic, and bumper sensors. It is also capable
of connecting to wireless networks as well as sending off
information via AV or display output. PaPeRo is wheeled, is
movable, and turns its head left/right and up/down (NEC, n.d.).
Basic features of PaPeRo include speech recognition and speech
synthesis, face recognition (detection, identification, and track-
ing), and autonomous behavior, plus reaction to touch (NEC,
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n.d.). It is being used to engage elderly in one-to-one and
group activities and games for improving well-being as well
as personalization of care (Khosla, Chu, Kachouie, Yamada, &
Yamaguchi, 2012).
Paro. Paro is an animaloid interactive robot in the shape
of baby seal, developed by the National Institute of Advanced
Industrial Science and Technology in Japan. It is covered by
natural-feel fur and ubiquitous surface tactile sensors placed
between the hard internal skeleton. Paro lets researchers study
physical interaction between humans and robots (Shibata, 2004;
Wada & Shibata, 2007a). It is equipped with other sensors
including light sensor, balance, speech recognition, and sound
source determiner (Wada & Shibata, 2007a). In addition, it
has some actuators including eyelids, back limb, front paw,
and neck movement motors. It is not mobile and weighs about
2.8 kg. Paro is developed to benefit the elderly with its psy-
chological, physiological, and social effects by maintaining a
long-term interaction (Shibata & Wada, 2011).
Pearl. Pearl is an autonomous robot developed to aid the
elderly as part of the Nursebot project at Carnegie Melon
University (Pollack, 2005). It is able to follow patients around,
communicate via a touch screen graphical display, and serve as
a tele-presence device. Pearl is equipped with two PCs, SICK
laser range finders, sonar sensors, stereo camera systems, and
wireless Ethernet. It is able to recognize and synthesize speech
by using microphones and speakers (Pollack et al., 2002).
In addition, for online video streaming, Pearl includes fast
image capture and compression software. It also includes some
other features such as autonomous mobile robot navigation
systems.
Robovie. Robovie is a humanlike robot developed to com-
municate with humans. It is equipped with different sensors,
including skin sensors, tactile sensors, microphones, vision
sensors, and ultrasonic obstacle detecting sensors, which are
installed on a mobile platform (Kanda, Ishiguro, Ono, Imai,
& Nakatsu, 2002). The combination of sensors and various
actuators for moving eyes, head, and arms facilitate performing
385
interactive meaningful behavior (Kanda, Ishiguro, Imai, & Ono,
2004). Robovie weighs about 40 kg.
Wonder. Wonder is the name of a wombatlike robot ter-
minal, which is equipped with a microphone and speaker for
speech recognition and synthesis. Moreover, the head and hands
are sensitive. The head, ears, eyes, and hands are moveable, and
the robot weighs about 3.5 kg (Yamamoto, Miyazaki, Tsuzuki,
& Kojima, 2002).
4. DISCUSSION
The findings of this systematic review can possibly help
to demonstrate researchers’ knowledge about socially assistive
robots, their effectiveness, and various applicable approaches to
measure their effects.
4.1. The Effects of Socially Assistive Robots on the Elderly
Nearly all of the included studies report positive effects of
SAR in elderly care. However, it could be assumed that the ulti-
mate goal of SAR is to improve well-being of elderly people.
Because of the multifaceted nature of well-being (Diener, 2009;
Michaelson et al., 2009; Pollard & Lee, 2003; Stiglitz, Sen,
& Fitoussi, 2009), in order to acquire deeper and more orga-
nized knowledge about the effects of SAR on well-being of the
elderly, it is better to categorize them.
Seligman (2011) hypothesized that there are five constructs
out of which one or more should be nurtured to experience
well-being. These constructs (Positive emotion, Engagement,
Relationships, Meaning, and Accomplishment) are known by
the acronym PERMA and have been validated in various set-
tings. The interrelatedness of the five constructs sometimes
limits their mapping related to experiences of the elderly in
their interactions with SAR. In addition, there is no explicit
construct to map physical and physiological well-being of the
elderly. Keeping these perspectives in view, Table 2 shows the
mapping between PERMA constructs and well-being outcomes
of the elderly related to this study. Some reported effects are too
general or may affect more than one construct, so we have put
them in a new category “Other effects” in Table 2.
4.2. Threats to Generalizability
The effects of SAR on the elderly could not be easily gener-
alized due to the drawbacks of included studies. Although this
review has comprehensive strategy, precise inclusion/exclusion
criteria and systematic screening and extraction of data,
some limitations may have occurred and affected this review.
Throughout the quality appraisal of studies, several issues have
been uncovered, and if a minimum threshold had been implied,
many studies would be excluded including those with valuable
information. Some major limitations are discussed in the rest of
this section.
First, studies illustrate that the cultural background of par-
ticipants affects their attitudes toward robots significantly (e.g.,
 386 R. KACHOUIE ET AL.
TABLE 2
Summary of Outcomes
Construct Outcomes
Positive emotions Improvement in feeling and mood,
improvement in emotional state,
feeling good experience, decrease in
stress level, increase in laughter,
elderly become calmer, increase in
sense of security and joy of life,
richer expressions
Engagement Evocative experience, increase in
activities, ease to externalize elderly
internal emotions, increase activity
during occupational therapy,
motivating physical activity, more
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active movements
Relationships Increase in social interactions and
activities, increase in social networks
and ties, positive social effects,
decrease in loneliness, encourage and
smooth the communication,
attachment to robot, facilitate the
establishment of friendly relationship
Meaning Decrease in depression
Achievement Sense of achievement in winning
one-to-one or group games
Other effects Positive psychological effect,
improvement in cortical neurons,
positive reaction of vital organs to
stress, decrease in CgA, improvement
in abilities, decrease in physical
disruptive behavior and overall
agitation, improvement in
personalization of care
Bartneck, Suzuki, Kanda, & Nomura, 2007; Rau, Li, & Li,
2009), but most of the studies were done in Japan. Second, even
though researchers showed the robot’s appearance affects its
acceptance (e.g., Forlizzi, DiSalvo, & Gemperle, 2004; Hirsch
et al., 2000; Powers & Kiesler, 2006; Wu, Fassert, & Rigaud,
2012), the majority of included studies used animal-like robots.
Third, few studies tested robot assistance at home, possibly
because it needs more resources and time; in addition it is not
simple to supervise. On the other hand, evidence shows that
there is a tendency among the elderly to live independently
in their homes (Lawton, 1985; Scopelliti, Giuliani, & Fornara,
2005; Tinker & Lansley, 2005). Moreover, aging at home is
encouraged by governments to alleviate the cost of aged care
facilities (Broadbent et al., 2009) and is societies’ preferred
choice (Vega & González, 2012). Therefore, there is a need
to do some cross-cultural studies, engaging different types of
robots and home-based field trials. Moreover, regarding cul-
tural diversity and heterogeneity in many developed countries’
populations, designing a multilingual robot could be a great
advantage.
The fourth drawback is that the majority of participants in
studies were women; but many studies confirm that gender
affects people’s reactions to robots (e.g., Forlizzi, 2007; Mutlu,
Osman, Forlizzi, Hodgins, & Kiesler, 2006) or causes nega-
tive attitudes toward robots (Nomura, Kanda, & Suzuki, 2006).
On the other hand, statistics illustrate that in 2010, women were
almost half the total population in the group of people older
than 65 (0.56 in the world and 0.59 in more developed coun-
tries). It is predicted that this ratio will not change much in 2050
(0.55 in the world and 0.56 in more developed countries; United
Nations, 2010). Therefore, engaging equal numbers of male and
female participants may result in more reliable outcomes.
Fifth, it is important to know users’ expectations (Oestreicher
& Severinson Eklundh, 2006), as they affect human–robot inter-
action (Lohse, 2010). Based upon expectations and perceptions,
a user decides whether interaction with a robot is worthwhile
(Komatsu, Kurosowa, & Yamada, 2011). The gap between
expectations of a robot and its actual function can influence the
user’s behavior (Komatsu, Kurosawa, & Yamada, 2012). Thus,
determining user needs and providing proper technology might
increase the rate of acceptance (Kobb, Hilsen, & Ryan, 2003).
On the other hand, it is not possible to recognize the importance
of certain expectations based on video observation and evalu-
ation of the experience after interaction with a robot (Lohse,
2011). However, most of the included studies came up with
inadequate understanding on stated and perceived expectations.
Sixth, only a few studies included stakeholders other than
the elderly. Different stakeholders (e.g., nurses, family mem-
bers, managers of nursing homes) have different needs and
their expectations of robots vary widely, and it is important to
consider their perspectives (Broadbent et al., 2009), so one of
the starting points should be identification and examination of
various stakeholders’ expectations (Sitte & Winzer, 2004).
Seventh, one missing element in included studies is giving
inadequate attention to person-centered care. Person-centered
care requires gathering and making use of personal information
in care and seeing the elderly as a person (Edvardsson, Winblad,
& Sandman, 2008; Slater, 2006). Moreover, respecting elderly
choices and employing their past life experiences (Brooker,
2007; McCormack, 2004) and subjective perceptions (Downs,
Small, & Froggatt, 2006) are critical in person-centered care.
In developing SAR, researchers should look at the world from
the viewpoint of the elderly (Brooker, 2007).
Eighth, many of the included studies are weak in terms
of writing and reporting, which limits the reproducibility and
repeatability of trials. A number of included studies are obser-
vational and rarely follow any report standard or guideline
such as STROBE (von Elm et al., 2007). Transparent report-
ing is necessary to decide whether or how the results of studies
could be included in systematic reviews (Egger, Schneider, &
 SOCIALLY ASSISTIVE ROBOTS IN ELDERLY CARE
Smith, 1998). The quality of trial-report points to the degree
that any specific report presents information about designing
the trial, conducting it, and analyzing the results (Moher et al.,
1995). Important details of methodology are often omitted in
reports (Jüni, Altman, & Egger, 2001). Besides miscalculations
and mismatches in quantitative data, there is also insufficient
detailed information about the trial or intervention. Another
problem is careless information arranging, which can prevent
readers from understanding the findings clearly. Instead of
giving direct statistics about participants and results, unclear
adjectives such as “sometimes” and “often” were used in some
of the included studies.
Ninth, in some studies, there are minor contradictions among
the results; for example, in one study (i.e., Kidd, Taggart, &
Turkle, 2006) it is mentioned that during the trial, there was a
tendency to prefer the turned-on robot. But, in another study
(i.e., Saito, Shibata, Wada, & Tanie, 2003), it is mentioned that
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there is not much difference in improvement of moods and
reduction in depression between groups interacting with Paro
and placebo Paro.
Last limitation to generalizability is inadequacy from the
research methodology viewpoint. Jüni et al. (2001) mentioned
assessment of a trial’s methodological quality and reporting
quality are highly related, and normally imperfect reporting
indicates imperfect methods (Schultz, Chalmers, Hayes, &
Altman, 1995). Nearly all the included studies are uncontrolled
trials; in addition, using control groups is infrequent among
the studies. Moreover, double- or single-blind experimentation
was impossible, as the aim of studies has been clarified to par-
ticipants in advance to get their consent. These may result in
conscious or subconscious bias, which reduces the validity of
the results.
One challenge of observational studies is minimizing the
consequences of overt biases as well as assessing the effects
of potential hidden biases. However, none of the studies men-
tioned employed methodological attempts such as Propensity
Score Matching to reduce overt biases.
Moreover, most of the studies did not pay enough attention
to novelty effect and Hawthorne effect, which threaten external
validity (e.g., Bernstein, Bohrnstedt, & Borgatta, 1975; Bracht
& Glass, 1968). This may influence generalizability of results
(McCarney et al., 2007; Onwuegbuzie & Leech, 2007). Many
of the studies were not long enough to eliminate novelty effect
(e.g., interest or stress in facing new technology); also, super-
vised interaction—the case of many included studies—may
increase the Hawthorne effect.
In addition, low sample size (e.g., N = 3) limits effective
conclusions. Likewise, in qualitative studies, proper sample size
is linked to effective responses to research questions. Sample
size becomes obvious during the progression of research and
could be determined by data saturation (M. N. Marshall, 1996).
Using this approach for realizing adequate sample size is very
scarce in included studies.
387
Furthermore, D. J. Cohen and Crabtree (2008) sug-
gested that techniques such as triangulation—use of multiple
data sources—helps researchers conduct rigorous qualitative
research. However, whereas researchers in many included stud-
ies used different sources of data to improve understanding, they
did not pay enough attention to the validity and reliability of the
measures and gathered data.
5. CONCLUSION
The world’s population is aging, and aged care is concerned
with supplying proper care for the elderly. To address this loom-
ing problem, researchers are working on technologies such as
social robotics to support the process of caregiving as well as
to assist elderly people in remaining in their own homes longer.
Expressing the impact of socially assistive robots on the quality
of life for the elderly is important not only for the elderly them-
selves but also for health sector policymakers, nursing home
managers, nurses, and elderly family members.
This article provides a systematic review of socially assistive
robots in elderly care by integrating evidence from previous
qualitative and quantitative studies. It mostly follows the prin-
ciples explained in Cochrane Handbook for Systematic Reviews
of Interventions. Relevant publications were sourced from the
following databases: MEDLINE and PubMed, CINAHL, the
Cochrane library, BioMed, IEEE digital library, SCIRUS, ACM
digital library, ProQuest, JSTOR, and Google scholar.
In total, 86 studies in 37 study groups have been included in
this review. This review revealed that several robots have been
developed with different designs, attributes, and applications.
Moreover, researchers put them in practice in different settings
and applied diverse types of research methods. Ten significant
recommendations have been made based on limitations of pre-
vious studies to improve future research and its applicability.
The research in this field is still in an early developmental phase
and therefore has its limitations. Innovative research strategies
are needed to overcome these imperfections. In future research,
there is a serious need for addressing methodological issues and
conducting research more rigorously.
This review showed that SAR could potentially enhance
well-being of the elderly and decrease the workload for nurses.
We categorized the reported effects of SAR on the elderly based
on PERMA (Seligman, 2011) and added a sixth category for
more general or physiological effects (as shown in Table 2).
For future research, we suggest that person-centered care
needs to be embedded in the design of SAR. Moreover, for
improving personalization of care, different needs, expecta-
tions, and preferences of individuals should be considered.
The results show that the robots that are capable of enhancing
broader aspects of well-being of elderly people are more accept-
able than the ones with less coverage. Therefore, future studies
should address well-being from different viewpoints. It could be
seen that there are not many studies, comparing different robots.
 388 R. KACHOUIE ET AL.
Finally, the findings of research in this field would be important
for designers and companies developing robots. Developing an
expectation management model that can cover different needs
of various stakeholders could resolve some limitations in this
field. In addition, due to limited computing and storage capa-
bility of robots and complexity of SAR tasks, new approaches
such as cloud computing and web-based interfaces are greatly
needed.
ACKNOWLEDGEMENTS
Reza Kachouie expresses sincere gratitude to all La Trobe
Business school faculty members and staff for their valuable
support during the design and development of this review.
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ABOUT THE AUTHORS
Reza Kachouie is currently a Ph.D. student at Monash
University. With a multidisciplinary background, in applied
mathematics, engineering, and management, he has work expe-
rience in academia and industry. He has coauthored publications
in management and social robotics. His research interests are
dynamic capabilities, new product development, and social
innovation.
 SOCIALLY ASSISTIVE ROBOTS IN ELDERLY CARE
Sima Sedighadeli is working on her second master’s
in Business Information Management and Systems at La
Trobe Business School. She has completed her bachelor’s in
Industrial Management and master’s in industrial Engineering.
She has worked as human resource officer and research
assistant. Her research interests are high-performance work
systems, new service development, and socially assistive
robotics.
Rajiv Khosla has a multidisciplinary background in man-
agement, engineering, and computer science. He has received
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several research and teaching excellence awards. He has edited
five books and has more than 170 refereed publications. His
research has made significant impact with about 30 films and
documentaries and 230 reports in 14 countries.
Mei-Tai Chu is currently a senior lecturer and program
director of MBIMS program at La Trobe University. She has
worked as a consultant and engagement manager for more than
40 Communities of Practices driven Knowledge Management
implementation before joining academia. She is regularly pub-
lished in good-quality journals in diverse areas.