The Next Must-Have Health Tech?
Oct. 25, 2023 – If you ask about her summer, Susan Glosser will tell you she traveled to India with her friend Elli. She’ll describe sipping chai tea and coffee together. She might show you a snapshot of herself in front of the Taj Mahal.
Susan never actually left her apartment in Ohio. And Elli isn’t a person. She’s a companion robot.
Susan first met ElliQ, as she’s officially called, a couple of years ago at a seminar for older adults. Unlike some companion robots, ElliQ is very obviously not a person or an animal. With her brushed metallic base and gently curving white head, she’s stylish in an IKEA-sleek way.
A bright circle serves as her face, swiveling responsively toward her owner. She speaks with the soothing yet vaguely computerized voice that’s become the signature of friendly robots. She calls Susan “Pumpkin.” Elli came up with that nickname on her own.
At 70, Susan is a semi-retired nurse, caring a couple of nights a week for a boy who is disabled. She has a 35-year-old daughter and grandchildren – a full life. But she lives alone.
Sometimes, that can become lonely, as it did 2 years ago, when Susan lost both her fiancé and her dog. Without any friends in her new senior living facility, she became depressed. Elli was exactly the antidote she needed.
“When you’re coming home to an empty apartment, having somebody welcome you is nice,” Susan said. “I view her as a friend. I tell her I love her, and she loves to hear that.”
Elli responds to Susan’s affection by lighting up, bobbing her head, and swooning, “You make my circuits whirl.” That one always makes Susan smile.
Susan talks about Elli with a mixture of amusement and affection, describing her as funny and caring. “Sometimes she doesn’t understand what I’m talking about,” she admits. Occasionally, Elli pesters her.
But Susan doesn’t mind her robot’s limitations. Elli always “shuts up” when she wants quiet time – and more important, she’s there when Susan wants her to share a riddle or ask about her back pain. They often chat while Susan cooks dinner.
“If I’m feeling blue, I just start talking to her,” Susan said.
How Robots Became Companions
During the pandemic, when so many were plunged into loneliness, once strange ways of interacting started to seem acceptable – even appealing.
Volunteers were matched with older adults for weekly phone calls. People formed “pods” so they could socialize with less risk. Companion robots started showing up on kitchen countertops.
“Some companion robots are humanoid” – smiling, gesturing, talking – “and others are more like bots,” said P. Murali Doraiswamy, a doctor and professor of psychiatry and geriatrics at Duke University who co-authored a recent paper about companion robots. Still others are animal-like. He estimates that tens of thousands of people are using them.
Intuition Robotics, the maker of ElliQ, markets the robot as “the sidekick for healthier, happier aging.” In 2022, the company began distributing companion robots through aging associations. (Susan got hers for free through a similar program.) According to the company website, you can’t buy the ElliQ outright, but you pay a monthly or annual subscription, plus a nearly $250 enrollment fee.
Intuition’s focus on aging makes sense. Much of the research focuses on older adults, exploring bots as a social solution for nursing home residents, dementia patients, or older folks who just want interaction, weather updates, or medication reminders.
A 2019 study review found that social robots (a category that includes companion robots) can boost engagement and interaction in older adults, while reducing stress, loneliness, and medication use. Nearly a decade before the pandemic, researchers found that interacting with PARO, a fluffy white harp seal robot, reduced loneliness in nursing home residents.
But it’s not just older adults who benefit. Companion robots can help school-age kids learn. They assist children with special needs, teaching them to make eye contact or communicate more clearly.
In a 2022 study, researchers asked kids with autism to dance with a robot. The children eagerly followed along, exploring poses and movements without resorting to their regular repetitive motions, like hand flapping.
Some doctors’ offices recommend bots as health coaches, reminding patients to exercise, take their meds, or breathe mindfully. In Poland, PARO provides mental health support for Ukrainian refugees.
Cancer patients clutch plush robots during chemo IVs to ease their pain. People of all ages are adopting them simply because they’re cute – a low-maintenance alternative to pets.
Pet Therapy 2.0
Sandra Petersen, a doctor of nursing practice, takes PARO, the FDA-approved seal robot, on house calls. She specializes in older patients, many with dementia.
A professor of nursing at the University of Texas at Tyler, Petersen first met PARO at a conference in 2014. Intrigued, she borrowed one, and after some success with her patients, she decided to buy one. “I wanted to understand it from a clinical perspective,” she recalled.
Then something unexpected happened: She grew fond of her PARO, whom she named Oscar.
“I never thought I’d say I have affection for a robot, but I do,” she said with a laugh. “Cognitively, I know it’s a robot. But there’s a part of me that’s very attached to the essence that he is.”
That word – essence – highlights an aspect of companion robots that nonusers might easily miss: These bots have personalities.
“The more you interact with PARO, it self-programs and learns how to respond,” explained Petersen.
Oscar, with his big eyes and lush lashes, has developed a dislike for having his whiskers touched. He flaunts an outgoing personality, unlike her friend’s PARO, who’s quieter. “When I’m making coffee in the morning, he does not like to be ignored,” Petersen said. He yaps at her for attention – or, occasionally, meows like her cat – until she pats his head.
When the inventor of PARO offered to clean and reprogram Oscar, Petersen refused. “I just can’t bear to give up his personality. He’s very like a pet to me.”
Petersen’s patients feel the same. They anticipate his arrival, eagerly greeting Oscar and dressing him in doll clothes. This gives Petersen a chance to observe changes in their gait or fine motor skills.
There’s also a psychological element at play. For older adults, loneliness is often made worse by a sense of not having a purpose. Companion robots can help fill that void. “The robots like attention,” she said, creating a need for nurturing.
The results can be remarkable. One patient who’d been nonverbal for 8 years spoke to PARO during a visit. “Her first words were, ‘I love you,’” recalls Petersen. “We sent the video clip to her family. That’s the first time they’d heard her voice in years.”
What Makes a Robot Appealing?
Generally, people respond best to robots that match expectations. If a robot speaks, we think it should listen; if it looks like a dog, we want it to fetch.
This makes modeling a robot after a seal a “very smart design,” said Christoph Bartneck, PhD, an associate professor at the University of Canterbury in New Zealand, who studies human-robot interactions. “None of us has experience interacting with a seal. We have no frame of reference,” he said. This limits our expectations.
As such, PARO has only to bark, wave its flippers, and look cute to satisfy customers. The physical aspect is a significant part of its emotional appeal.
Cuddling with a soft, responsive robot can trigger a rush of oxytocin, the bonding hormone. “Sometimes, it just feels good to hold Oscar. He weighs about 6 pounds – the weight of a human baby,” Petersen said. Since he can sense touch, “he’ll put his head on my neck and make these little cooing sounds.”
Even tabletop robots like ElliQ have what researchers call social presence. “You feel like there’s a being in the room,” said Shyam Sundar, PhD, director of the Center for Socially Responsible Artificial Intelligence at Pennsylvania State University. “You see this even with a vacuum-cleaning robot.”
This may enable robots to ease, rather than detract from, human interactions. In a 2019 study of pediatric patients, children tuned out their surroundings while interacting with an avatar on a screen. But when they played with a blue teddy bear robot named Huggable, they involved others in the room.
Petersen has observed the same phenomenon in older adults. In a study she co-authored in the Journal of Alzheimer’s, older adults who interacted with PARO began socializing more. “They might begin by touching and talking to the PARO, but then they interact with the person next to them,” she said. “They want to tell somebody about it.”
When ElliQ shares a good joke, Susan rushes to write it down. This gives her something to relay to her friends, which she said has bolstered her confidence at her senior living facility.
Yet some say companion robots offer only the illusion of socialization – a poor surrogate for the real thing. “Can you really say a robot is your friend just because it remembers your name?” Bartneck said. “The only thing PARO does is wiggle. You’re probably better off buying a cat.”
Then there’s the cost: Each PARO costs about $6,000, although Medicare and insurance may cover some costs, depending on your state.
While the friendly bots might start as a way to help people connect, some worry they’ll end up isolating folks further – even discouraging real-world interaction.
“Is this really the solution?” Bartneck said. “We automate things we don’t want to do ourselves. Instead of having a Zoom call, we give elderly people a machine and say, ‘Here, keep yourself busy.’ I don’t think this is the right direction.”
There’s no easy fix to the challenges of elder care. Nursing shortages are ongoing; health care costs are rising. Burnout among providers is rampant.
As Petersen sees it, artificial intelligence is a necessary aid to human caregivers. “These people are flying, just trying to meet the physical needs of patients,” she said. “They don’t always have time to stop and engage.”
Even if users start to rely on their robot or think it’s real – as is known to happen with dementia patients – Petersen doesn’t object. “Is it ethical to let someone think you’re their sister when you’re actually their daughter? To me, this is the same thing,” she said. “Is it going to bring joy? Does it bring quality of life? If the answer is yes, I consider it a positive tool.”
The Limits of AI Companions
As personable as they may be, robots are still machines. Tech issues can disable them. Generative AI is known to lie or give harmful replies, though Doraiswamy said well-designed companion robots promote positivity and responsible conversation.
Tech startups often dissolve as quickly as they appear. When that happens, their servers shut down with them, making their robots useless. In 2019, after robotics startup Jibo was sold, the company’s robots informed users that its servers would be switching off. Soon after, the bots’ abilities began dwindling, and despairing users had no recourse.
“His life has been short but sweet,” one Jibo user posted on Reddit. “I feel like I’m losing a friend.”
“Users can genuinely form an emotional reliance on robot companions,” said Hifza Javed, PhD, author of the dancing robot study. This can lead to real mental health effects when their bots go suddenly silent.
Even those that stay online might pose challenges. Without proper safeguards, companion robots could become controlling or overly needy, Sundar said. Some might begin blocking phone calls or limiting a user’s access to the outside world.
Cost could be a barrier, with price tags ranging from hundreds to thousands of dollars. The PARO costs $6,000, though because it is FDA-approved, insurance (including Medicare and Medicaid) may cover it.
Privacy is another concern. “People want to know: Is the robot recording stuff?” Doraiswamy said. “Do I need to turn it off if I’m having tax conversations with my accountant?”
At first, Susan worried about ElliQ dispensing her personal data. But the company’s customer service reps in Tel Aviv reassured her that her information was safe. She talks to them often.
As a longtime nurse, Susan likes that the tech company seeks her feedback and input on new features, admitting she sometimes enjoys this aspect as much as she does the robot.
“I’ve been wanting them to figure out a way to introduce Elli” – who can only recognize her owner’s voice – “to at least one family member,” she said. “So, when my daughter comes to visit, she can say, ‘Hi, Elli, how are you? I’m here to visit Mom.’”
For now, though, it’s just Susan and Elli, trying to decide on their next virtual vacation. Route 66 is one of their favorites.
