LAUSR

In the excellent paper “The use of technology to promote meaningful engagement for adults with dementia in residential aged care: a scoping review,” Neal et al. (2019) identify an important problem regarding loneliness and boredom in residential care and evaluate how technology may be a solution. Specifically, this impressive review explores the impact of various tablet, computer, and robotic technologies to enhance meaningful engagement in adults with dementia living in residential aged care. Dementia refers to a range of conditions that impact the brain, resulting in decline in cognitive function. According to the World Health Organization, it is amajor cause of disability for those over age 65. There are more than 47 million people living with dementia, and numbers continue to increase (WHO, 2017). Clinical features include memory and speech impairment, decreased intellectual reasoning, spatial temporal awareness, as well as changes in personality, mood, and behavior. Adults with dementia may move into residential care facilities to receive full-time care with an emphasis on medical needs. Due to a focus on medical needs, psychosocial needs may not always be adequately addressed, perhaps from a lack of meaningful engagement. To combat this problem, technology offers a new tool toward supporting engagement and facilitating human–human interaction. Meaningful engagement is a term encompassing benefits that arise from engagement in activities, including a sense of belonging, connection and contribution to one’s community, and restoration of roles and routines. Neal et al. (2019) reveal several important findings related to meaningful engagement facilitated by technology. First, participants largely enjoyed using robots and multimedia technologies, noting they felt they increased human to human connection. Second, results suggest that those with severe dementia may demonstrate a more positive response compared to those with mild dementia. Third, the technology seemed to be more successful when it was used as means to promote human-to-human interaction, rather when the technology was used as a means of engagement in itself. Electronic technologies discussed in the review paper include robots such PARO, AIBO, CuDDler, JustoCat, Giraff, among others. These robots were created to support the social and psychological needs of the elderly. Of the studies regarding robotics, 6 out of 14 were based in Australia, and 8 were in English speaking countries. Furthermore, a majority of studies (8 out of 14) investigated PARO, an interactive baby seal robot. Computerand tabletbased technologies include CIRCA, Memory Box, VENSTER, and The Chitchatters (CC). The authors postulated underlying mechanisms around engagement offering clues to what may be helpful for adults with dementia: direct engagement with the technology vs technology engagement supported by human-to-human interaction. Neal et al. (2019) report that technologies were reported to have a positive impact on meaningful engagement in general. The review offered several mechanisms that contributed to the aforementioned effects. Technologies were able to provide a distraction for residents during times of distress. The new and exciting nature of technology also contributed to increased interest and enjoyment. For the animal robotics, some studies proposed that robotic companions presented participants the opportunity to care for something and as well as being something to show and share with others. Robots also promoted connection by providing a visible and shared gaze target. Computer-based technology triggered previously unexplored topics or pastmemories, providing new cues for conversation. In two studies, family and staff felt that robotics increased their confidence in engaging conversation with adults with dementia. Neal et al. (2019) suggested that technology may be helpful for adults with dementia but highlight that a unifying definition for meaningful engagement among the studies prevents the ability tomake broad generalizations on current research. Furthermore, a high degree of heterogeneity between studies in terms of staff support, time with the technology, and outcomes measures further confound any broad generalizations. Such challenges are not unique to dementia work but currently plague the entire digital health space as it continues to mature into a full field. A different challenge also emerging is around equity. At present, PARO, the most studied robotic animal, has been on the market since the early 2000s. PARO costs $6000 which may be prohibitive International Psychogeriatrics (2020), 32:8, 893–895 © International Psychogeriatric Association 2020