Social and Digital Innovations Towards Happy Healthy Longevity: Community University for Older People Initiative in Chiang Mai, Thailand, and Japan’s PARO Cuddly Robot Companion

Thet Htoo Pan, Myat Yadana Kyaw, Saiyud Moolphate, Kiattisak Mala, Takanori Shibata, Myo Nyein Aung and Masaru Hiraiwa

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Digitally Inclusive Healthy Ageing Communities (DIHAC) is a cross-cultural study primarily based on Japan, Republic of Korea, Singapore and Thailand, further expanding to India. DIHAC team has organized bi-monthly research meetings to provide a digital platform where innovative research and programs in digital and healthy ageing fields are presented and ideas, insights and networks are exchanged cross-culturally. The 26th DIHAC meeting witnessed how Thailand is establishing happy healthy longevity in the community and how a Japanese baby seal cuddly robot brings emotional and social support especially in persons with dementia.

Associate Professor Dr. Myo Nyein Aung, the Principal Investigator of DIHAC study, initiated the meeting by socializing old and new participants. The meeting was attended by more than 60 participants including researchers in global health and public health, faculties from universities, UN agency (ITU, ESCAP), clinicians, government officials, community stakeholders, and graduate students from Asia, Europe, USA and Africa.

The 26th DIHAC meeting was chaired by Mr. Masaru Hiraiwa, Director General, Planning and Strategy Bureau, National Center for Geriatrics and Gerontology (NCGG), Japan. Mr. Hiraiwa has been serving continuously at the Ministry of Health, Labor and Welfare, Japan for strategic planning and policy development. In his opening remarks, Mr. Hiraiwa explained that digital technology and internet connectivity have become a super-social determinant of health, citing an NCGG study as an example. Research shows that older adults who participated in online exercise programmes were more likely to have better cognitive and physical function. The Chair highlighted that there is still a digital gap among older adults, making digital inclusion critical for healthy ageing.

Figure: Chairperson Mr. Masaru Hiraiwa, speakers, international audience and DIHAC study team at the 26th DIHAC meeting

Presentation 1: Community University for Older Persons: An Initiative for Healthy Ageing in Keelek city, Chiang Mai, Thailand

In the first presentation, Mr. Kiattisak Mala, mayor of Keelek city, Chiang Mai, Thailand outlined the goals of establishing Community University for Older Persons. The primary objectives are (1) to enhance the quality of life through physical activity and nutrition, thereby creating ‘happiness’, (2) provide free internet access to bridge the digital divide in all villages of Keelek subdistrict, and (3) offer digital literacy training to ensure safe internet use. Following the mayor’s speech, Dr. Saiyud Moolphate, MPH, PhD, Lecturer and Head of Department of Public Health, Chiang Mai Rajabhat University (CMRU), Co-PI of the DIHAC study, Thailand detailed the programs in Community University for Older Persons. In Thailand, where over 20% of the population is aged 60 or older, Keelek subdistrict in Chiang Mai province has 30%, surpassing the national average [1]. As an initiative to promote healthy ageing, Community University was established in collaboration with the University (CMRU), Subdistrict Municipality, Primary Health Center, local stakeholders, non-governmental organizations and international institutions last year. The first batch of the University recruited 80 older adults from 8 villages within the Keelek sub-districts. Healthy ageing activities include tailored exercise, Thai traditional medicine, and CPR training for emergencies, as well as screening for age related health problems. Based on the evidence from cluster randomized controlled trial of Community Integrated Intermediary Care (CIIC) model conducted in Chiang Mai province, physical exercise programs such as resistance band training and functional training, caregiving techniques were introduced to older adults [2]. In addition, digital inclusion fosters social inclusion through SNS LINE. Older adults share photos and videos of their activities among the group to motivate and encourage each other in maintaining an active lifestyle.

Moreover, Intergenerational programs involve students teaching health promotion activities to older adults, who then share their knowledge with school children. Participants from Community University also interacted with international students from Japan and Singapore through language and cultural exchange. Examples include scaling up the evidence from RESIP-CVD study, a salt reduction program for healthier eating and using local wisdom such as traditional medicine for healthcare and promoting environmental health awareness. Other initiatives cover sustainable agriculture, air quality improvement, and cultural activities. The Social Engineer project empowers students to enhance the safety of older adults and quality of life by modifying their home to be more age friendly. Additionally, the Community University has planned to address digital access and usage gaps in Keelek city, increase the participation of older adults by digital technologies and ultimately the quality of life of older adults. Finally, Dr. Saiyud concluded that this social innovation will be evaluated and disseminate the results nationally and internationally. Future plans involve community innovation, expanded digital literacy, a Time Bank, and a living lab.

• Community University for older adults is a community-academic collaboration program in which evidence-based healthy ageing interventions from randomized control trials are implemented at the community level

• Intergenerational communication benefits older adults and younger generation through social and cultural exchange

• Digital technologies can promote healthy ageing by sharing activities among peer older adults through SNS, although there is persistent grey digital gap

Regarding the presentation from Chaing Mai Thailand, PhD students from Juntendo University discussed challenges faced in training university students for intergenerational communication activities and the evaluation plan of the Community University program. Dr. Saiyud mentioned that the major challenge was developing soft skills of university students through continuous practicing and usage of plain language instead of medical terms in communication with older adults. For the evaluation, the program will be accessed for physical, mental and social health of participants after one year of implementation.

Figure 2 : Mr. Kiattisak Mala, the mayor of Keelek city, Chiang Mai, Thailand introducing happy ageing policy and digital investment plan in his city 

Presentation 2: PARO: A Social Robot as an Older Person’s Companion

In the second part of 26th DIHAC meeting, Professor Takanori Shibata, PhD, Chief Senior Research Scientist, National Institute of Advanced Industrial Science and Technology (AIST), Japan discussed social and therapeutic seal robot: PARO. The cuddly robot in the shape of babe Harp Seal is widely used for various purposes, including as a companion for older adults, a biofeedback medical device, and support for Ukrainian refugees and space missions. Controlled by artificial intelligence (AI), PARO recognizes voices, learns new behaviors, and responds to touch, temperature, posture, light, and sound. PARO factory in Nanto City, Toyama Prefecture, Japan, has produced over 8,000 units used in 30 countries, carefully designed with detailed craftsmanship. In Japan, over 3,500 PAROs are in use. In the UK, PARO is included in the NICE guidelines as non-pharmacological treatment of dementia. Since 2018, it has been reimbursed by Medicare, Medicaid, and private insurers in the US. Research on PARO includes about 900 papers and 12 randomized controlled trials of PARO use for meta-analysis [3, 4]. Animal assisted therapy with PARO shows improvements in quality of life, loneliness, communication, sociability, caregiver burden, fall risk, and medication use for older adults. The baby seal robot PARO overcomes the drawbacks of animals and reduces negative emotions such as anxiety, anger and agitation in dementia patients. PARO has been used not only in dementia care, but also in acute care to reduce pain and agitation. The cuddly robot is also used in family support centers for Ukrainian refugees by International Organization for Migration (UN-IOM) and by United Nations Children’s Fund (UNICEF) in Poland. In addition, PARO serve as a companion to active older adults, improving loneliness and social isolation, especially in Japan where numbers of older adults living alone is increasing.

• More than 8,000 Personal Assistive Robot (PARO) are currently used across 30 countries

• PARO has proven effective in dealing with physical, mental and social well-being, and improving quality of life, especially in persons with dementia

• Digital technology and Artificial Intelligence (AI) can enhance healthy ageing, and social inclusion among older adults

Professor Shibata invited questions and addressed the main issues highlighted during the meeting. The baby harp seal model is used because it has lower expectations as a pet compared to a dog or cat, leading to better acceptance from users. Additionally, its seal shape and soft texture make it more cuddly and easy to hug. He also explained that cultural differences affect the acceptance of PARO. In Japan, acceptance is around 70% due to less experience with pets, while in the US and EU, acceptance is 80-90% because of greater familiarity with pets. A randomized controlled trial in a care facility for people with Alzheimer’s showed 95% acceptance of PARO, improving quality of life and dementia symptoms. Regarding challenges, the speaker addressed infection control in hospitals. He explained that PARO is made with silver ion, which helps disinfect bacteria, and that protocols and guidelines for maintaining PARO are provided in these settings. He also described PARO’s vibration sensors and heartbeat-like sensation, as well as its temperature control around 37°C, making it comfortable to cuddle. When asked about ethical considerations and the potential for installing cameras to monitor older adults’ cognitive states, Professor Shibata explained that cameras are not installed in PARO to protect users’ privacy. Another question focused on the importance of successful collaboration with stakeholders. With a higher proportion of older adults, Nanto City was one of the earliest adopters of the community-based integrated care system. In 2014, the Ministry of Health, Labor, and Welfare held a conference on long-term care insurance in Nanto City. PARO was introduced, allowing the city to lend PARO to older adults from long-term care facilities to their homes, reducing caregiving costs and burden, and promoting aging in place. Good relationships between local municipalities, healthcare centers, businesses, and researchers have created a win-win situation for using PARO.

Figure 3 Paro Robot

In the closing section, the chair, Mr. Hiraiwa, emphasized the significant role of digital literacy in the wellbeing of older adults. He highlighted the importance of digital technologies like PARO, noting that they help older adults lead healthier lives. In this context, he underscored the importance of the DIHAC project for digital inclusion and healthy ageing. PI Dr. Myo Nyein Aung concluded the meeting by announcing the next 27th DIHAC meeting in February 2025 and wishing all participants happy holidays and a new year.

References

1. Chiang Mai Provincial Statistical Office. Key Indicators of the Province. 2024 [cited 2024 Dec 12]; Available from: https://chiangmai.nso.go.th/statistical-information-service/key-indicators-of-the-province.html.
2. Aung, M.N., et al., Effectiveness of a community-integrated intermediary care (CIIC) service model to enhance family-based long-term care for Thai older adults in Chiang Mai, Thailand: a cluster-randomized controlled trial TCTR20190412004. Health Research Policy and Systems, 2022. 20(1): p. 110.
3. Rashid, N.L.A., et al., The effectiveness of a therapeutic robot, ‘Paro’, on behavioural and psychological symptoms, medication use, total sleep time and sociability in older adults with dementia: A systematic review and meta-analysis. Int J Nurs Stud, 2023. 145: p. 104530.
4. Chen, S.C., et al., Effect of a Group-Based Personal Assistive RObot (PARO) Robot Intervention on Cognitive Function, Autonomic Nervous System Function, and Mental Well-being in Older Adults with Mild Dementia: A Randomized Controlled Trial. J Am Med Dir Assoc, 2024. 25(11): p. 105228.

Authors

Thet Htoo Pan, M.D., is Ph.D. student at the Department of Global Health Research, Graduate School of Medicine, Juntendo University, Tokyo, Japan

Myat Yanada Kyaw, M.D., is Ph.D. student at the Department of Global Health Research, Graduate School of Medicine, Juntendo University, Tokyo, Japan

Saiyud Moolphate, M.P.H., Ph.D., is Lecturer and Head of Department of Public Health, Chiang Mai Rajabhat University, Co-PI of the DIHAC study, Thailand

Kiattisak Mala, Mayor of Keelek City, Chiang Mai

Takanori Shibata, Ph.D., is Chief Senior Research Scientist, at the National Institute of Advanced Industrial Science and Technology (AIST), Japan

Myo Nyein Aung, M.D., M.Sc., Ph.D., is Associate Professor at the Department of Global Health Research, Graduate School of Medicine, Juntendo University, Tokyo, Japan

Masaru Hiraiwa, is Director General, Planning and Strategy, National Center for Geriatrics and Gerontology, Japan