PaperlayerView exact revision on arXiv

Source-linked AI summary

Stakeholder Insights for Designing In-Home Social Robots for Dementia Disorientation Detection and Caregiver-Aware Intervention

Emmanuel Akinrintoyo, Nicole Salomons

arXiv:2608.22008v2cs.RO

TL;DR

Disorientation in dementia remains insufficiently examined as an everyday socio-technical challenge for socially assistive robots. The paper analyses 14 semi-structured interviews with dementia caregivers and practitioners, finding recurrent, fluctuating disorientation and support needs centered on behavioural cues, emotional sensitivity, routine integration, and caregiver-aware escalation.

  • Problem

    Existing technologies and SAR research provide limited support for recognising and responding to disorientation as it unfolds in everyday life.

  • Method

    The study conducted 14 semi-structured interviews with dementia caregivers and practitioners and analysed responses through qualitative content analysis.

  • Results

    Disorientation was described as recurrent and fluctuating, emerging through behavioural patterns, while direct correction could provoke distress and supportive robotic assistance was considered acceptable.

  • Takeaways & Limitations

    SARs should provide simple, context-aware orientation support that integrates into daily routines and supports caregivers through selective, timely intervention.

  • Takeaways & Limitations

    The study acknowledges that caregiver and dementia-professional perspectives may differ from PwDs’ lived experiences.

Abstract

from arXiv · show

Dementia disorientation detection and intervention remain under-examined as socio-technical challenges for socially assistive robots (SARs). We conducted 14 semi-structured interviews with dementia caregivers and practitioners (DCPs) to investigate how disorientation is experienced, recognised, and managed in everyday life. The findings reveal that disorientation is recurrent and fluctuating. It often emerges through behavioural cues such as repeated questioning, inappropriate activity timing and disrupted daily routines. Caregivers described orientation as emotionally charged, and direct correction may increase distress. The DCPs were generally receptive to robotic assistance when framed as supportive rather than corrective. Based on the insights, we identify essential design implications for SARs that provide context-aware orientation support, integrate into daily routines and support caregivers through timely escalation.

I. INTRODUCTION

Dementia-related disorientation is distressing, fluctuating, and interactionally expressed in everyday routines, while existing assistive technologies leave real-time recognition largely to caregivers. This study investigates how SARs could provide supportive, context-aware assistance without replacing caregivers.

  • Motivation: Disorientation disrupts daily activities, increases anxiety and agitation, and raises caregiver burden and institutionalisation risk.People may forget medication, feeding, and hygiene schedules, reducing independence and quality of life.
  • The problem: In daily life, disorientation emerges through behavioural changes such as repeated clarification, inappropriate activity timing, and context-misaligned actions.Caregivers must recognise these interactional patterns rather than rely only on isolated cognitive errors.
  • Technology gap: Existing reminder, wayfinding, and fall-detection technologies mainly provide passive prompts or alerts rather than recognising disorientation as it emerges.Consequently, caregivers remain primarily responsible for real-time recognition and response.
  • Opportunity: SARs could detect behavioural cues, provide contextual orientation support, and reduce confrontational correction through routine prompts and less emotionally charged interaction.The proposed role is supportive assistance, not caregiver replacement.
  • Study contribution: Through 14 semi-structured DCP interviews, the study identifies SAR requirements to integrate with routines, provide simple orientation support, and respect lived experience.The work frames detection and intervention in PwDs’ homes as an interactional and socio-technical challenge.

II. BACKGROUND

Disorientation affects awareness of time, place, and person, and it fluctuates with context rather than forming a stable binary condition. Effective support therefore requires continuous, context-aware detection and intervention.

  • A. Disorientation: Disorientation concerns awareness of time, place, and person, with temporal, spatial, and person-recognition difficulties appearing in different forms.Examples include confusion about event sequences, difficulty navigating familiar spaces, and trouble recognising caregivers or family members.
  • A. Disorientation: Disorientation is not binary: a PwD may appear oriented in familiar settings but become disoriented under stress, cognitive load, or environmental change.Its daily fluctuation complicates both clinical assessment and technological support.

B. Technology-Based Disorientation Detection in the Home

Home-based technologies increasingly monitor behavioural or movement deviations associated with disorientation, but existing approaches primarily detect changes and provide limited real-time support.

  • Sensor-based monitoring: Smart-home motion, door, and environmental sensors can monitor deviations in daily living activities and assess activity performance.One machine-learning system evaluated automated activity-quality scores against clinical assessments using 179 participants, including PwDs.
  • Spatial detection: GPS-based systems detect possible spatial disorientation by identifying abnormal movement trajectories against historical patterns.The cited system reported approximately 95% detection with a false positive rate below 3%.
  • Digital biomarkers: Smartphones and wearables can capture gait and speech signals for digital-biomarker detection of disorientation.A wearable accelerometer approach detected spatial disorientation with an AUC of 0.75, but these methods mainly focus on detection.

C. Social Robots and Responsible Intervention in Dementia

Prior dementia SAR research has emphasized therapeutic and symptom-focused interventions in structured settings, leaving everyday disorientation detection and response comparatively underexplored. This study addresses that gap through stakeholder consultations focused on timely, context-sensitive support in daily routines.

  • C. Social Robots and Responsible Intervention in Dementia: Earlier SAR studies primarily targeted therapeutic, emotional, and cognitive outcomes such as mood, engagement, agitation, depression, memory, and executive function.Many interventions used PARO or humanoid robots in residential, clinical, or structured activity settings.
  • C. Social Robots and Responsible Intervention in Dementia: These interventions were generally short-term, structured, and activity-based rather than designed for continuous everyday disorientation support.They rarely addressed behavioural indicators such as repeated questioning or activities occurring at unusual times.
  • C. Social Robots and Responsible Intervention in Dementia: The study uses consultations with DCPs to examine how SARs can recognise confusion during ordinary activities and routines while delivering timely, context-sensitive intervention.The aim is to identify both opportunities and challenges for robot-based support.
  • C. Social Robots and Responsible Intervention in Dementia: The research conducted 14 one-hour Microsoft Teams interviews with professional and family caregivers, therapists, practitioners, and service-design leads.Participants contributed complementary caregiving, therapeutic, and service-design perspectives.

A. Results

Participants described disorientation as common, fluctuating, and embedded in everyday routines rather than occurring as a single observable event. It was recognised through recurring behavioural and temporal cues, especially at night, suggesting a need for context-aware robotic support.

  • 1) Theme 1: Disorientation is a Recurrent and Fluctuating Experience:: Disorientation was described as common and fluctuating, recurring throughout the day and sometimes returning shortly after orientation.Caregivers often inferred it from repeated behaviours or failed orientation attempts.
  • 1) Theme 1: Disorientation is a Recurrent and Fluctuating Experience:: Eleven participants reported temporal disorientation as the most common form, while others emphasised place disorientation.
  • 1) Theme 1: Disorientation is a Recurrent and Fluctuating Experience:: Eight participants identified nighttime disorientation as particularly problematic because staff numbers were low and family members were absent.Participants linked this context to risks such as a person moving from bed toward the front door unnoticed.
  • 1) Theme 1: Disorientation is a Recurrent and Fluctuating Experience:: Disorientation emerged through routine disruptions including nighttime wakefulness, mistimed meals, repetitive calls, missed activities, agitation, and conversational temporal slips.
  • 1) Theme 1: Disorientation is a Recurrent and Fluctuating Experience:: Participants proposed that robots could interpret behavioural cues over time using routine activities, temporal context, and deviations from expected patterns.Suggested interventions included interrupting nighttime autopilot thinking and explaining that it was not yet time to get up.

2) Theme 2: Aiding Orientation Is Challenging and Requires Careful Communication:

Aiding orientation was described as emotionally demanding and often fragile. Reorientation could initially help but frequently produced short-lived benefits, requiring adaptive prompts that prioritise wellbeing and reduce caregiver burden.

  • 2) Theme 2: Aiding Orientation Is Challenging and Requires Careful Communication:: Six participants described technology as motivated by the overwhelming nature of disorientation, particularly the emotional strain and exhaustion experienced by family caregivers.
  • 2) Theme 2: Aiding Orientation Is Challenging and Requires Careful Communication:: Three family caregivers highlighted the emotional burden of repeated reorientation, while five professionals emphasised the risks of correction itself.Repeated or poorly timed correction could overwhelm PwDs and contribute to challenging behaviour.
  • 2) Theme 2: Aiding Orientation Is Challenging and Requires Careful Communication:: Reorientation was often initially effective but frequently short-lived, requiring repeated effort with limited lasting benefit.
  • 2) Theme 2: Aiding Orientation Is Challenging and Requires Careful Communication:: Orientation support should prioritise emotional wellbeing alongside informational accuracy by using adaptive, supportive prompts rather than corrective interactions.The intended design outcome is reduced distress or agitation together with lower caregiver burden.

3) Theme 3: Robotic Intervention Is Acceptable When It is Supportive and Context-Aware:

Robotic intervention was generally acceptable when framed as supportive, simple, personalised, and context-aware. Acceptance depended on perceived usefulness, familiarity, individual preferences, trust, and control over sensing and privacy.

  • 3) Theme 3: Robotic Intervention Is Acceptable When It is Supportive and Context-Aware:: Twelve of fourteen participants, including all family carers, were generally open to robotic intervention when it was framed as supportive rather than corrective.Caregivers considered robots potentially helpful in low-risk, routine situations where reminders or presence supplemented care.
  • 3) Theme 3: Robotic Intervention Is Acceptable When It is Supportive and Context-Aware:: Nine participants identified appropriate contexts involving simple, non-intrusive reminders in familiar domestic spaces, adapted to PwDs’ personal preferences.
  • 3) Theme 3: Robotic Intervention Is Acceptable When It is Supportive and Context-Aware:: People in the early stages of dementia were described as engaging well with simple, familiar technologies that supported autonomy, independence, and self-orientation.Examples included tablets, memory clocks, large calendars, and whiteboards.
  • 3) Theme 3: Robotic Intervention Is Acceptable When It is Supportive and Context-Aware:: Acceptance of robotic support was shaped by perceived usefulness, personalisation, trust, prior technological familiarity, and individual preferences.Participants recommended user and caregiver control over sensing and privacy settings, with assistance aligned to routines.

4) Theme 4: Non-Intervention and Emotional Deescalation as Deliberate Care Strategies:

Caregivers sometimes deliberately withheld correction because direct reorientation could provoke distress, anger, or frustration. The findings support selective robotic intervention that adapts to emotional context and may reassure, distract, or refrain from intervening.

  • 4) Theme 4: Non-Intervention and Emotional Deescalation as Deliberate Care Strategies:: Caregivers often avoided active correction when prior experience suggested that mistimed intervention could quickly return a PwD to confusion.
  • 4) Theme 4: Non-Intervention and Emotional Deescalation as Deliberate Care Strategies:: Restraint was used to reduce frustration or stress, including selectively telling the truth when caregivers judged that full correction could be harmful.
  • 4) Theme 4: Non-Intervention and Emotional Deescalation as Deliberate Care Strategies:: Direct corrections could provoke negative reactions because PwDs experienced them as confrontational or invalidating.Participants reported that computer-delivered support might feel less emotionally charged than repeated human correction.
  • 4) Theme 4: Non-Intervention and Emotional Deescalation as Deliberate Care Strategies:: SARs should use selective intervention, adapting to emotional context and potential consequences through reassurance, distraction, or non-intervention.

5) Theme 5: Caregiver Notification and Escalation Are Essential:

Caregiver involvement is essential when disorientation creates safety risks, uncertainty, or situations requiring human judgment. SARs should support—not replace—caregivers through timely escalation while reducing supervision demands and care burden.

  • Ten participants emphasised caregiver involvement when disorientation involved safety risks or uncertainty.
  • Six caregivers preferred timely, direct notification when intervention was urgent or robotic support was insufficient.
  • SARs should recognise when disorientation exceeds automated support and notify caregivers as part of a broader care network.
  • Robots should reduce caregiver work rather than add complexity, especially during high-risk periods or constant-supervision demands.

6) Theme 6: Integration into daily routines:

Daily routines can anchor orientation, while their disruption can signal emerging disorientation. SARs should interpret behavioural patterns over time and provide emotionally sensitive orientation support within familiar activities.

  • Integration into daily routines: Eight participants described long-established routines as supporting orientation, with confusion intensifying when those routines broke down.
  • Integration into daily routines: SARs should embed orientation within familiar routine activities and detect routine disruptions as opportunities for early intervention.
  • Integration into daily routines: Disorientation is better recognised as a behavioural pattern unfolding over time than through isolated cognitive errors.
  • Integration into daily routines: SARs should offer orientation as suggestions, prompts, or conversational cues because direct correction can increase frustration or agitation.

C. Long-Term Integration into Routine

Long-term SAR integration should be gradual and aligned with established routines rather than framed as correction. However, caregiver and professional perspectives may differ from PwDs’ lived experiences, requiring future engagement before deployment.

  • Long-Term Integration into Routine: Established routines anchor orientation, and their breakdown often intensifies disorientation.
  • Long-Term Integration into Routine: Assistive technologies were described as most effective when introduced early and aligned with familiar practices.
  • Long-Term Integration into Routine: SARs should be embedded gradually within PwDs’ daily routines rather than used as corrective tools.
  • Long-Term Integration into Routine: Caregiver and dementia-professional perspectives may differ from PwDs’ lived experiences.
Loading 2608.22008v2…