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Archives of Gerontology and Geriatrics 54 (2012) 121126

Contents lists available at ScienceDirect

Archives of Gerontology and Geriatrics

journal homepage: www.elsevier.com/locate/archger

Designing robots for the elderly: Appearance issue and beyond

Ya-Huei Wu *, Christine Fassert, Anne-Sophie Rigaud
Assistance Publique-Hopitaux de Paris (APHP), Hopital Broca & Research Team 4468, Paris Descartes University, 54-56, rue Pascal, 75013 Paris, France

A R T I C L E I N F O A B S T R A C T

This paper provides the results of three focus groups organized in the framework of the ROBADOM
Article history: project, aiming at designing a service type assistive robot for the elderly with mild cognitive impairment
Received 3 September 2010 living at home. The main objective of these focus groups was to give some recommendations to
Received in revised form 24 January 2011 engineers in charge of the design of the robots appearance. Results showed that although many
Accepted 25 January 2011
humanoid robots were criticized by most participants, some small creative humanoid robots were
Available online 23 February 2011
appreciated. However, beyond the issue of the robot appearance, many ethical and social issues were
raised. These focus groups offered an opportunity for participants to discuss the very idea of an assistive
Keywords:
robot and to challenge some implicit preconceptions of the roboticists. Finally, we discuss how assistive
Assistive robots
Focus group
robots could be designed considering the social context of the elderly and how to implicate the elderly as
Needs of the elderly future end-users in the design process.
Robot design 2011 Elsevier Ireland Ltd. All rights reserved.

1. Introduction impairment to dementia) which might lead to difculties in

In the last years, many projects have addressed the use of robots
for supporting elderly people aging in place. Research in the
technical community has begun to identify specic needs and
values future robotic technologies might support for the aged
population. Some of these include support in managing the home;
maintaining personal and household supply; monitoring and
providing ambulatory support; and providing communication and
social interaction (Kawamura et al., 1996; Schraft et al., 1998;
Forlizzi et al., 2004). According to Broekens et al. (2009), robot
research in eldercare concerning assistive robots comprises both
rehabilitation robots and social robots. The rst ones emphasize
physical assistive technology. The second ones concern systems
that can be perceived as social entities with communication
capacities. Furthermore, studies on assistive social robots in
eldercare feature either pet-like companionship robot whose main
function is to enhance health and psychological well-being or
service type robots whose main function is to support daily
activities related to independent living.
Recent research, such as Nursebot project (Pollack et al., 2002),
Robocare project (Bahadori et al., 2003) and Care-o-bot (Graf et al.,
2004), has been increasingly focusing on service type assistive
social robots to support the elderly to live independently at home.
The rationale for the development of this kind of robots is that the
aged population experience different degree of cognitive decline
(ranging from aged-related cognitive decline, mild cognitive
* Corresponding author. Tel.: +33 1 4408 3503; fax: +33 1 4408 3510.
E-mail address: yahuei.wu@brc.aphp.fr (Y.-H. Wu).
performing complex daily activities and in some case to a loss of
autonomy. In this context, this kind of robots are conceived to
assist the elderly with cognitive impairment in the following ways:
(1) by providing assurance that the elder is safe and is performing
necessary daily activities, and, if not, alerting a caregiver; (2) by
helping the elder compensate for their impairment, assisting in the
performance of daily activities; and (3) by assessing the elders
cognitive status (Pollack, 2005).
According to Cesta et al. (2007), a key aspect of this kind of
robots consists in social interaction between human users and
robotic agents. The design of robots appearance is one of the
factors that might play an important role in humanrobot
interaction. However, most of the research efforts in human
robot interaction have not been focused on design (DiSalvo et al.,
2002; Fong et al., 2003). Moreover, the appearance of a robot is
considered as one of the factors involved in robot acceptance. First,
careful consideration of robot design is needed to minimize the
stigma of disability. Second, the robots appearance inuences how
people appraise the abilities of the robot and it can also have
profound effects on its accessibility, desirability and expressive-
ness (Fong et al., 2003; Broadbent et al., 2009).
In the context of Robadom project whose aim is to conceive a
service type of assistive social robot to support the elderly with
cognitive impairment, the issue of robots appearance was raised.
Though a few studies have dealt with this issue (Khan, 1998; Dario
et al., 1999; Scopelliti et al., 2005; Woods et al., 2005) in some way,
there is still a lack of knowledge in what the elderly would prefer
regarding the robots appearance. First, most of these studies used
questionnaires with closed questions to investigate this issue,
which might have introduced some bias from experimenters.

0167-4943/$ see front matter 2011 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.archger.2011.02.003
 Author's personal copy
122 Y.-H. Wu et al. / Archives of Gerontology and Geriatrics 54 (2012) 121126
Second, the populations investigated were not targeted specically
to the elderly.
Considering these problems, we decided not to tackle this issue
in a direct manner, through specic questions (e.g., which color
would you like the robot to be). Rather, we tried to explore some
criteria of esthetics of robots according to the elderly by collecting
their reactions toward different types of robots (in pictures and in
video clips) presented to them.
Therefore, in this study, we aimed at exploring how the elderly
perceived robots with regard to robot appearance based on
qualitative judgments and appreciations expressed spontaneously
by them. Our approach was more to open a dialog with roboticists,
than to provide detailed specications concerning the robot
appearance.
2. Methods
Three focus group sessions were conducted in order to
investigate how the elderly perceive a robots appearance. Focus
groups are used to discover more about topics that involve social
norms and are useful in revealing the diversity and concensus of
opinions regarding a given issue (Morgan and Krueger, 1998). The
sessions were facilitated by two members of the research team
(one as moderator and the other as observer/notekeeper). The
duration of all of the three sessions was approximately ninety
minutes with a break in the middle of each session. The sessions
were videotaped for further analysis.
2.1. Participants
A total of 15 older adults over the age of 65 (range from 66 to 89
years old) participated in three focus group sessions (4 in the rst,
5 in the second and 6 in the third). Three participants were male
and 12 were female. Thirteen of them were recruited from the
Memory Clinic of the Broca Hospital and two were recruited from
an association for the elderly. Seven participants suffered from
mild cognitive impairment, according to denition criteria of
Petersen et al. (2001) while eight participants were healthy elderly
without cognitive impairment.
2.2. Procedure
The focus group sessions were conducted at Collegiale hospital
in Paris, France. At the beginning of each focus group session, the
moderator described the research objectives and explained the
purpose of focus group discussion. Each session was composed of
four steps.
During the introduction step, participants were invited to talk
about their representations and perceptions about robots. The
precise question asked by the moderator was: What do robots
evoke in your mind?
The second step consisted in a presentation of 26 different robot
pictures (R2D2, robuLAB 10, Aibo, Amiet, Anybot Monty, Asimo,
Nexi-MDS, Care-o-bot13, Care-o-bot1II, Eve from WALL-E of Pixar,
HRP4C, iRobiQ, Robot Housekeeper, Kobian, Mamoru, Mechadroid
type c3, uBOT-5, Motoman SDA10, Nao, Paro, Pomi, My Spoon, Ri-
Man, SmartPal, Toyota i-foot, Twendy-One) displayed on a screen.
Again, the participants were invited to express their perceptions
and opinions for each of the robots.
The third step consisted in showing a set of video clips
comprising robots in action. Some robots were the same as those of
the preceding step, but most of them were not.
The last step consisted in a card sorting exercise. Twenty-one
pictures of robots were handed out to the group, and participants
were invited to choose their 3 favorite ones. They were told that if
you had an assistive robot at home, which appearance would you
like it to have? This last step was initially planned to be a
collective exercise, but it turned out that this was not possible, as
participants wanted to give their own personal preferences.
2.3. Analysis
The video recordings were transcribed. Then, the analyses of the
transcripts and eld notes were performed according to thematic
analysis and an inductive approach (Braun and Clarke, 2006). A
number of themes were identied from the ideas expressed by
participants during the different sessions and from the analysis of
the verbatim of participants. Some of them were related only to
one focus group, but most of them were common to the three
groups. Although some nuances might be identied between the
three groups, the main themes were common to the three of them.
This method allowed grasping the older peoples ideas, judgments
and perceptions about robots.
3. Results
The aim of the focus groups was in the rst place to provide
some insight to engineers concerning the esthetics of the robot, its
physical appearance. The approach chosen was mainly empirical.
We observed what were the preferences expressed by the
participants from a set of existing robots. Careful consideration
was given to the reasons expressed by participants for their
preference toward robots.
The discussion during the rst step (representations of robots)
was quite short for all the three groups. Robots are, for most of
them, used in workplaces to help human by performing difcult
and repetitive tasks. Some mentioned that robots may be used for
helping people with handicap or the elderly. Others associated
robots with domestic electrical appliances.
During the second step, the display of robot pictures allowed
eliciting more discussions. From the verbatim, a number of themes
have been identied. The rst one, explicitly addressed in the focus
groups, concerns the issue of appearance of robots. Some robots
were appreciated by most of the participants. This was the case for
Mamoru (Fig. 1), Eve (Fig. 2) and Paro (Fig. 3). For Mamoru
and Eve, participants used the term funny and cute to
describe them. For Paro, they found it charming. We could see
that these robots were attractive for them as their reactions toward
these three robots were very different from the reactions toward
others: seeing these robots, they laughed and gave positive
comments immediately and spontaneously. Concerning Aibo
Fig. 1. Mamoru.
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Y.-H. Wu et al. / Archives of Gerontology and Geriatrics 54 (2012) 121126
Fig. 2. Eve.
Fig. 3. Paro.
(Fig. 4) and Nao (Fig. 5), most of the elderly found them funny
but they said they are toys for children. A great majority of
participants insisted rst on the size of a robot: they did not want
cumbersome, human-size robots but rather something discrete,
rather small.
They also showed a negative attitude toward some humanoid
robots. This was particularly the case in the second group, where a
participant declared: If it is possible, I would prefer no robot at all.
Anyway, I would prefer a small machine rather than simulacra.
Fig. 4. Aibo.
123
Fig. 5. Nao.
Another one said: The less humanoid it is, the more I like it. These
robots (the humanoid robots) are caricature of humans. He
mentioned also this unpleasant aspect of false human. Other
participants in the group did agree: concerning the appearance,
the most important is not to look like a human. I prefer a mobile
trolley with many arms and wire cutters, able to fulll tasks, which
doesnt look like a human-being.
The matching between appearance and functions of robots was
also a topic of discussion. For some robots, participants did not
understand the gap between the simplicity of functions provided,
and the sophistication of the appearance. They needed to know
what a robot can do before judging its appearance and design.
During the discussion about humanoid robots, other themes
emerged. One of the themes concerns non-genuineness of
expressions of humanoid robots and of humanrobot interaction.
When looking at Kobian (Fig. 6), a participant sayed: It has an
expressive face. Another participant answers: An expressive face
is not an expression. In the same line, most of participants express
at rst glance positive attitude toward Paro, a seal which is able
to interact with people, and to react to touch, voice, etc. Most of
them found it charming and attractive. However, when the
moderator told them about its interaction capacities, a participant
said: But this is not a genuine interaction. She concluded later on:
To communicate with Paro is to communicate with nothing.
Fig. 6. Kobian.
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124 Y.-H. Wu et al. / Archives of Gerontology and Geriatrics 54 (2012) 121126
Fig. 7. Pomi.
Most of the participants expressed a strong reluctance (they
often use the term fear) toward a robot conceived as a substitute
of a human presence. They often evoked some social and political
issues, such as dehumanisation of our society. I cannot imagine a
world . . . with no contact, no one to speak to you, said a
participant. There are numerous critical remarks about the cost of
robots and nancing robotic projects instead of human resources
to the care of the elderly. Do we want a world where robots, and
not human-beings, are supposed to take care of the elderly? Some
participants even considered that it is cruel to provide robots to the
frail elderly who are isolated and do not have much human contact.
When a participant (of a high social status) suggests that robots
might be useful for those who, unfortunately, cannot afford to
have any human aid, he is strongly challenged by the other
members of the group: robots should not be an only option for a
shortage of caregivers.
In the card sorting exercise, Mamoru ranked rst when
considering the robots quoted as the three favorite ones. The
second and third favorite robots are: Nao, and Pomi (Fig. 7).
The comments for Mamoru were very positive, even from
participants who did not vote for it. Many participants assimilated
this small robot to a familiar object, such as tea pot, coffee pot or
porcelain. She is discrete, familiar, lovely. . . a typical nanny. A
participant explained that he prefers this kind of discreet robot to
assist him in daily life, for it may not be noticeable by his
grandchildren when they visit him. Another robot which is
appreciated by many of the participants is Nao: It is cute.
It is human-like, but it does not copy completely human. . . it is
rather creative in some way. This is not that I really like him, but he
is really funny. The comments on Pomi were almost as same as
those on Nao. Many participants chose Pomi because it is cute.
A number of participants insisted on the importance of creativity
for the design of robots. Again, humanoid robots generated
impassioned discussions.
Throughout all sessions of focus groups, the participants had
discussions far beyond the mere appreciation of the morphological
appearance of robots. Our results showed that ethical judgments
often underlie the esthetics ones. Very often, whether a robot is
good-looking or not is not the point for our participants. One of
them had this blunt statement when the moderator asked for a
comment on one of the robots: it is not beautiful, it is not ugly. . . it
is . . . a robot. Showing robots triggered among the three groups a
number of discussions, which were more in relation to the idea of
use and role of robots for elderly. These discussions, though out of
the scope of the initial purpose of our study, allowed us to consider
other issues as to the design of the robot for the elderly. These
debates and discussions also allowed us to gather some informa-
tion that could help us to reconsider the notion of users needs, and
to open a dialog with roboticists on this issue.
4. Discussion
From these results, we will detail further four topics. The rst
one concerns robot appearance which was addressed initially by
this study. Second, we will discuss the reactions of the elderly
toward humanoid robots. The third topic concerns the question of
social robots and how they could be designed in interaction with
the elderly. For the last part of the discussion, we will address how
to implicate the elderly as future end-users in the design process.
4.1. What kind of robot appearance is attractive for the elderly?
From the comments and reactions of the elderly, we nd that
Mamoru, Eve, Pomi, Paro and Nao were attractive to
them. Considering the usage of robots as an assistant, the
appearance of Mamoru, Nao and Pomi were preferred. The
criteria of attractive robot appearance that we can get from these
ndings are as follows. First, these robots share some features:
they are small (in comparison to human-size) and have some traits
between human/animal and machine. According to Duffy (2003),
anthropomorphic or life-like features should be carefully designed
with the aim to make the interaction with the robot more intuitive,
pleasant, and easy. Second, from the case of Mamoru, the elderly
seem to prefer a robot which looks like a familiar object in a home
setting. This point corresponds to the design guidelines of robotic
products proposed by Forlizzi et al. (2004). They suggest familiar
product forms with augmented product functionalities will t the
system and maximize early product adoption. Further, elders seem
to emphasize on the creativity in the design of robot appearance.
4.2. Why is the elderly reluctant toward some humanoid robots?
Our ndings indicated that although participants were reluc-
tant toward some humanoid robots, they did show very positive
attitude toward some creative small robot with human traits.
Whether a robot has a high degree of human likeness did not
matter for them, instead, they seemed to be attracted by the kind of
humanoid robots which somehow look like different from human-
being and which are creative.
Our ndings concerning the humanoid appearance is in line
with those from a number of studies. Dario et al. (1999) have
carried out a survey when designing the MOVAID prototype with
the elderly and people with disability. It turned out that
anthropomorphic robots were less socially acceptable, compared
to machine-like robots. The nal prototype was anthropomor-
phisized but also still looked like a machine. In a 2000-persons
survey, Arras and Cerqui (2005) have explored a number of
questions about the way people consider robots and their possible
use in their daily life. They found that people were not particularly
attracted by a humanoid appearance for robots: 47% of the
respondents preferred a robot with a humanoid appearance; 19%
rejected it; 35% didnt show their opinions. Besides, there is a
difference between young and old respondents: the older people
are, the less they like the humanoid appearance. Ray et al. (2008)
investigated what people expect from robots. They gathered
responses for a questionnaire from 240 people (aged from 10 to
more than 65 years). When asking what a domestic robot should
look like, half of the sample would like a household robot to look
like a small machine rather than a big one. Creature, human, and
animal appearances were undesirable. The preferred appearance is
a small machine-like robot.
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Y.-H. Wu et al. / Archives of Gerontology and Geriatrics 54 (2012) 121126
Fig. 8. HRP4C.
Furthermore, our ndings from focus group discussions lead to
some reections. The rst aspect concerns the category of
humanoid robots: what is exactly a humanoid robot? Do we
consider, for example, that HRP4C (Fig. 8), Nao and Mamoru
belong to the same humanoid category? There is indeed a great
difference in terms of human likeness between these three robots,
although they all have human traits. More theoretically, these
ndings invite us to question the category of humanoid robots, and
its uniqueness. The category of humanoid robots is denitely not a
natural one. It seems to be difcult to nd precise and common
criteria to judge which robots could be considered as humanoid.
Beyond esthetics, participants questioned in fact the values
underlying the design of each type of robot, or in other terms:
what do roboticists have in mind when designing this type of
robots? Some anthropomorphic robots were challenged with this
question: is it ok to copy human beings? For those who do not
like the idea, some robots are appreciated simply because they do
not pretend to look like human-beings. It is widely recognised that
we are all at least disconcerted by robots which are very human-
like, such as HRP4C. This may be particularly true for old people,
especially those at an advanced stage of dementia, who may not be
able to distinguish such a robot from a real human-being. This
raises of course some ethical issues: the elderly with dementia who
has impairment of judgment may be even more disoriented by this
new type of contact with a machine which is also supposed to be a
social companion, acting like a real human in many ways, and
amenable to be granted with some kind of subjectivity. Thus, what
is at stake here is far beyond a simple issue of appearance of the
robot. The implicit idea of a robot supposed to become a
companion rather than a simple aid might underlie the negative
opinions toward some humanoid robots. In this case, robots are
often criticized as being non-authentic in their expressions and in
their interaction with human. These ndings lead us to consider an
ethical issue which is also addressed by Sparrow and Sparrow
(2006): it is not only misguided, but actually unethical, to attempt
to substitute robot simulacra for genuine social interaction.
Robots could be accepted mainly as tools devoted to ll some
precise and limited tasks, such as a reminder system, a device to
search lost objects at home, or a system providing cognitive
stimulation. These are part of the functionalities planned for the
ROBADOM project. Our participants showed resistance toward
robots supposed to have more social interactions with them,
especially when they are suspected to decrease human presence
and contact. It is noteworthy that these opinions from the elderly
are shared by those from the younger. In the study of Carpenter et
al. (2009), when asking about what they would like the robots to do
125
for them in their home, most university students who participated
in the study identied menial tasks, such as chores, as their
expectation of robot duties. Participants would not like to see
robots in their home with a social purpose. They expressed some
concerns on this issue, such as potential confusion about whether a
robot was a machine or organic, the robot touching the human in a
social way and the false pretense of machine expressing humanlike
emotions.
4.3. Robots in social settings
It may be useful to clarify here another important point when
dealing with robots and the elderly. In a majority of projects aiming
at designing robots, though the explicit object is not to replace
human aid by robotics aid, or human presence by robot
companion, there is little specic consideration of the social
setting in which the robot takes place. Implicitly, the functions
provided and the interaction features are conceived for a dyad
elderly-robot. However, even though they live alone, most of the
elderly are not totally deprived of human presence. Family
members, friends, neighbors, professional caregivers or cleaning
women might be present in their daily life. Besides, all participants
have expressed in some way their strong opposition toward robots
conceived as substitute of the human care provided.
According to our results, we recommend that there is a need to
consider the context of the usage of an assistive robot which takes
into account the presence of other human beings. This may be
much more challenging: functionalities of robots should be
designed by taking into account various social contexts, which
include, for example, the possibility of a robot to assist the
caregiver and not directly the elderly, or the possibility of robots to
mediate the interaction with a medical or an emergency
assistance. Therefore, rather than a product that is used by one
person, a robot might offer opportunities for interaction among all
members of the elder ecology. These kinds of robots should allow
the elder to experience the same power, control, and agency as
others in the elder ecology (Forlizzi et al., 2004).
4.4. Considering the needs of the elderly in the design process
Our results advocate a better consideration of users needs: this
is particularly difcult that the elderly do not explicitly express the
needs in relation to the use of robots, while roboticists or
gerontologists are eager to provide this type of assistance
considered useful for this population. From this initial work, we
have found that it is necessary to take into account of users needs
by investigating them at a more micro level. For example, it might
be useful to consider the coping strategies developed by the elderly
for compensating their memory deciencies when designing new
devices. This would give a guidance to develop aids that enhance
and support, rather than replace the strategies actively developed
by the elderly.
5. Conclusion
In the context of the design of an assistive robot, focus groups
were organized with the initial objective to address the appearance
of the future robot. The discussions provide a number of results on
this point: many humanoid robots were not appreciated by the
majority of participants; however some robots with human traits
(such as Mamoru and Nao) are appreciated. Furthermore, many
social and ethical issues were also raised during these focus group
sessions.
Participants expressed reluctance toward some humanoid
robots which have inauthentic expressions and offer ersatz
interactions and companionships. This invites us to open a dialog
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126 Y.-H. Wu et al. / Archives of Gerontology and Geriatrics 54 (2012) 121126
with engineers in order to foster solutions which take into account
the variety of social contexts in which the elderly lives. This invites
us also to bring into question the way elderly users are implicitly
considered and imagined by designers of assistive devices. Finally,
we should consider elderly people not only as recipients of care,
but also users whose needs have to be carefully identied, with
their active participation.
Conict of interest statement
None.
Acknowledgements
This work has been supported by the French National Research
Agency (ANR) through TECSAN programme (project TECSAN
n8ANR-09-TECS-012).
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