Transcription:
Using Voice-Controlled Personal Assistants to Reduce Social Isolation

Melanie:  Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole and joining me today is Dr. Katherine O'Brien. She's an assistant professor of geriatric medicine at Northwestern Medicine. Dr. O'Brien recently presented her research on the use of voice-controlled intelligent personal assistance with homebound older adults at the 2021 American Geriatric Society Annual Scientific Meeting. She joins me today to discuss her research and her work at Northwestern Medicine.

Dr. O'Brien, it's a pleasure to have you with us. I absolutely love this topic, how technology is helping us to advance and get our seniors, especially in this COVID time. And you just unveiled a new research study about voice-controlled intelligent personal assistance for managing social isolation and depression in homebound older adults. Can you give us a little background on this study?

Dr Katherine O'Brien: Thank you very much for having me today. So I agree. I think that this is a really important topic and one that there's a lot of work still to be done on. But we know that loneliness and social isolation especially are really rampant in our seniors. The data suggests that around 43% of older adults are lonely. Anywhere between 20% to 30% of those are socially isolated and those numbers all happened pre COVID. So, as I'm sure you can imagine, those numbers, if we asked people today, would probably be a lot higher.

We also know that social isolation is a powerful predictor of adverse health outcomes. Social isolation is an even more powerful predictor than things like obesity, sedentary lifestyles, air pollution. It's something important that I think a lot of us don't often think about as a risk factor when we're talking to seniors.

The other important component of this is thinking about homebound seniors. There is a couple of physicians that often describe this population as the invisible homebound, meaning that these are people that, as physicians and other healthcare professionals, sometimes we don't think about until we have an interaction in the healthcare system. Most of my clinical work is focused on this group as I run our house call practice at Northwestern. This is a group of patients that is near and dear to my heart and thinking about ways that we can help improve their home lives is something that I've been very interested in. And that's how this whole idea of thinking about leveraging technology that already exists to help some of these problems in our patient population came about.

Melanie: What a great study, Dr. O'Brien. I'm very interested in this as well. So tell us about some of these benefits of the smart home technology for older adults. And can it play a role as you said in reducing that social isolation? Tell us a little bit about what you found out and how technology like Google Home is helping your patients with quality of life issues.

Dr Katherine O'Brien: We don't really know the answers to those questions yet. This is an area that I think is ripe for studying. The main knowledge base that we have is a paper we published in the Journal of the American Geriatric Society last year, where we went on Amazon.com and read through the reviews of the Amazon Alexa that were either written by seniors or caregivers. And there was a lot of really interesting information about how people were using these devices in their homes.

And so that became the basis or the idea for this project moving forward. But we don't have a lot of information. People haven't looked at this area yet, about how can we use this technology, specifically for reducing social isolation and depression and other conditions in seniors. So that's the goal of our study, is to start to gather some of that type of information and turn this into a bigger project one day. But the long story short is that we think that this is definitely an area and a technology that seniors could use to help some of these symptoms going forward.

Melanie: Well, I completely agree. It's absolutely fascinating. So in your research, did you ever uncover common themes about how devices are used in caring for older adults? I told you this off the air, but as somebody whose father almost 97, was able to maneuver some of these devices and not others, this would have come in so handy for so many reasons. How are they being used for older adults and whether it's for social isolation or also some even emergent conditions.?

Dr Katherine O'Brien: Maybe it would be helpful if I give a little bit of background about what we're doing, because this is an ongoing project. What I presented at the American Geriatric Society was the first half of this project where we gathered a panel of experts and that included healthcare providers and, right now, we are adding in some seniors themselves. But physicians, social workers, nurses, people who have basically spent their careers working with older adults and had them put this device into their home and asked them to use it, thinking about how you think this device could be beneficial for a patient that you've cared for.

That's the background of what we did. And then we're going to use that information to create a booklet. Because if any of you have ever used one of these devices, the device comes in a box and that's it. You have to figure it out from there. Knowing a lot of our seniors aren't as familiar or as comfortable with technology, we thought that we wanted to make this device even more user-friendly. So we are creating a booklet based on that feedback to go along with the device and then we're going to roll it out into seniors' homes. That's the second part of the study, which is just getting ready to start, and then see if any of these measures do change using this device.

We found different themes about how people are using these devices and how we as healthcare workers think that they might use these devices. The most obvious would be entertainment. That would involve listening to music, audio books, those sorts of brain games. In our initial paper that we published looking at the Amazon reviews and in talking with our geriatric experts, companionship comes up interestingly. Having the devices, someone to talk with and interact back and forth with you, for some of those seniors that are isolated.

It has administrative functions, so creating shopping lists that your family can view later on. If you have a son or a daughter or a friend that goes grocery shopping for you, it's a great way to make a list. Reminders for our seniors that sometimes have trouble keeping track of their medications, reminding them to take their pills during the day. There are health and wellbeing functions, so exercise, meditation, all kinds of things like that, that the device can do.

Of course, the device can control the home. So for those of our seniors that are a little bit more technologically savvy that may have some smart devices, you can pair them with the device and control your environment that way. I think that could be a great option for someone who's truly bedbound to have a little bit of more control of their environment, to be able to turn on the lights or turn up and down the temperature, turn on their television.

And then emergency communication, which I think is crucial, so some of the devices can actually call 911, some of them you can program in family member's numbers, and all you have to do is tell the device to call so-and-so and you can get them on the line in the event of a fall, for example,

Melanie:  So did you identify any challenges with using voice-controlled intelligent personal assistance? Are there limitations to this technology?

Dr Katherine O'Brien: Yes, there are. And probably the biggest limitation is the fact that it is wireless, so a WiFi-controlled device. A lot of our seniors don't have a WiFi in their homes. Without that, the device of course can't work. So I think that's one big limitation, what our seniors have access to is going to determine whether they can even use this device.

Other things that people pointed out are the voice control feature sometimes can be a little bit spotty and people who maybe have, for example, Parkinson's disease, where their voice is not as strong as someone who doesn't have the disease, there's a worry that the device won't actually recognize the person who's speaking.

I think a lot of our geriatric experts pointed out that even with a technologically savvy senior, they worry about needing assistance of another person to set up the device. I don't think that these are the most user-friendly devices the more and more that I am working with them myself. So I definitely think that there are some limitations. That's hopefully some of the information that we'll be able to get in the second part of our study that will help us down the line and thinking about how we can better deploy these devices.

Melanie: Well, as you're telling us about some conclusions that you have drawn and, as we wrap this up and summarize, how are the older adults perceiving the benefits of these types of devices? And how will you incorporate what you're learning into your work at Northwestern Medicine?

Dr Katherine O'Brien: The thing that I love about this study is that I feel like the results of this are applicable to what I do on a day-to-day basis as a physician. This is something that is relatively cost-effective. We're so often thinking about with family members, what can we do? How can we make their lives better? What else can we bring in just to improve quality of life? And I think that this is something that, if we get some robust information, is something that as a physician I might be able to recommend to my patients. So that's one thing that I love because I feel like this research is something that I can take and I can apply to the person that I go see tomorrow on a home visit.

A lot of older adults we're finding are hesitant. Many of them just don't feel comfortable with technology. And so sometimes it takes a little bit of convincing them just to try this out. But I think that we have found, in that initial paper we published in JAGS, that once they do get the device in their home and once they've used it and gotten a little more familiar with it, it's actually not as hard as they think it would be to use. Many of them are seeing the benefits of technology like this. That is going to be one barrier that we have to overcome, is convincing people that this is something they actually can do. And I think that's the great part of doing this in a research environment, is that we've got a team of people that can help walk our seniors through how to use this device and how to familiarize them with it and this companion booklet that we've created will hopefully be a tool that will make this a little bit easier to use.

Melanie: Well, I certainly think so. So can you leave us with a parting piece of information for other providers who are listening, who are interested in setting this kind of thing up and bringing it up with their patients and how you would advise them to bring up this type of technology with their patients and their families?

Dr Katherine O'Brien: Probably the biggest parting piece of information that I have is that think about social isolation and your seniors, especially your homebound seniors, because I think that it's a huge missing screening piece in our health care work that we do on a day-to-day basis.

And there's no downside really in my mind to recommending an intervention like this, except for maybe if it doesn't work. But there really aren't a lot of risks to this type of technology. I really only see the potential for benefit. I definitely think that it's something that people could think about bringing up with our patients, who do maybe bring up feelings of social isolation and those that maybe have access to some help, that they can use to get the device set up. I definitely think that it's something that all of us should probably be thinking about, leveraging what we have available to us to help our homebound seniors.

Melanie: One-hundred percent. Great information and a fascinating study. And I hope that as you learn more, Dr. O'Brien, you will come on and share with us the results. So interesting. Thank you again for joining us. And that concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians.

To refer your patient or for more information, please visit our website at nm.org to get connected with one of our providers. Please also remember to subscribe, rate and review this podcast and all the other Northwestern Medicine podcasts. I'm Melanie Cole.