Victor Wang

One area where AI can potentially enhance care is allogeneic hematopoietic stem cell transplantation (HCT). HCT is a complex procedure associated with significant physical and psychological distress, particularly in the first 30 days post-transplant, including delirium, post-traumatic stress, anxiety, depression, and loneliness. While medical teams strive to provide psychosocial support and education, access is limited by human resources. This single-arm pilot study adapted a ‘human-in-the-loop’… Show more

One area where AI can potentially enhance care is allogeneic hematopoietic stem cell transplantation (HCT). HCT is a complex procedure associated with significant physical and psychological distress, particularly in the first 30 days post-transplant, including delirium, post-traumatic stress, anxiety, depression, and loneliness. While medical teams strive to provide psychosocial support and education, access is limited by human resources. This single-arm pilot study adapted a ‘human-in-the-loop’ (HITL) AI avatar chatbot for patients undergoing HCT at the Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC) in Boston, MA (Clinical-Trials.gov Identifier: NCT05600101).

In this study, we adapted the care.coach (Millbrae, CA, USA) Avatar™ chatbot, as previous clinical trials had shown the avatar chatbot to reduce symptoms of loneliness, depression, anxiety, and hospital delirium, and prevent falls in older patients. This tablet-based HITL avatar chatbot utilized generative AI and deterministic software-driven protocols, with human oversight, to provide psychosocial support and health coaching to patients. The avatar chatbot used an LLM trained on conversational, empathetic speech to generate text-to-speech responses that were supervised and revised, as necessary, by trained health advocates (the HITL) employed by care.coach.

Of the 18 enrolled patients, 61% were female, and 72% were White. The median age was 63 years. The retention rate was 78%. Among the 15 patients actively engaging with the avatar chatbot, the median daily interaction time was 22 min (IQR 20–38), with a mean of 28 min. Overall, 52% of avatar chatbot usage time was dedicated to social engagement activities. Compliance with health-related activities, such as hydration and ambulation, prompted by the avatar chatbot, varied across cohorts. Show less

Hospitalized older adults often experience isolation and disorientation while receiving care, placing them at risk for many inpatient complications, including loneliness, depression, delirium, and falls. Embodied conversational agents (ECAs) are technological entities that can interact with people through spoken conversation. Some ECAs are also relational agents, which build and maintain socioemotional relationships with people across multiple interactions. This study utilized a novel form of… Show more

Hospitalized older adults often experience isolation and disorientation while receiving care, placing them at risk for many inpatient complications, including loneliness, depression, delirium, and falls. Embodied conversational agents (ECAs) are technological entities that can interact with people through spoken conversation. Some ECAs are also relational agents, which build and maintain socioemotional relationships with people across multiple interactions. This study utilized a novel form of relational ECA, provided by care.coach corporation: an animated animal avatar on a tablet device, monitored and controlled by live health advocates. The ECA implemented algorithm-based clinical protocols for hospitalized older adults, such as reorienting patients to mitigate delirium risk, eliciting toileting needs to prevent falls, and engaging patients in social interaction to facilitate social engagement. Previous pilot studies of the care.coach avatar have demonstrated the ECA’s usability and efficacy in home-dwelling older adults. Further study among hospitalized older adults in a larger experimental trial is needed to demonstrate its effectiveness.

Methods
This was a clinical trial of 95 adults over the age of 65 years, hospitalized at an inner-city community hospital. Intervention participants received an avatar for the duration of their hospital stay; participants on a control unit received a daily 15-min visit from a nursing student. Measures of loneliness (3-item University of California, Los Angeles Loneliness Scale), depression (15-item Geriatric Depression Scale), and delirium (confusion assessment method) were administered pre/post.

Results
Participants who received the avatar during hospitalization had lower frequency of delirium at discharge (P<.001), reported fewer symptoms of loneliness (P=.01), and experienced fewer falls than control participants. There were no significant differences in self-reported depressive symptoms. Show less

Grounded in a unique team-based geriatrics perspective, this book delivers a broad range of current, evidence-based knowledge about innovative technology that has the potential to advance the care and well-being of older adults. It provides key information about the development, selection, and implementation of technology products, and describes research evidence, education-based initiatives, and systems thinking. The book also examines challenges and barriers to implementation, adoption, and… Show more

Grounded in a unique team-based geriatrics perspective, this book delivers a broad range of current, evidence-based knowledge about innovative technology that has the potential to advance the care and well-being of older adults. It provides key information about the development, selection, and implementation of technology products, and describes research evidence, education-based initiatives, and systems thinking. The book also examines challenges and barriers to implementation, adoption, and innovation.

From telehealth and assistive technology in the home to simulation and augmented reality in educational settings, the text provides a hands-on, field-tested articulation of how products can aid in the transitional care process, chronic care delivery, and geriatrics/gerontology education. It discusses technology developments in rural areas, home telehealth, wearable technology, personalized medicine, social robots, technology to assist seniors with cognitive impairments, and the potential of artificial intelligence to enhance health care of older adults. The text is written to help health care professionals select the appropriate technology for their needs. Show less