Excretion Care Robots for Disabled Older Adults: A Scoping Review

Excretion Care Robots for Disabled Older Adults: A Scoping Review 1. Research Background With the accelerating global aging process, the care needs of disabled older adults have become a prominent social issue. Demographic data shows that the total number of people over 60 years old in China has exceeded 300 million, among which disabled and semi-disabled older adults account for about 10%, reaching more than 45 million. Excretion care is one of the most urgent and private rigid needs of this group. More than 50% of nursing home residents suffer from urinary and fecal incontinence, and 60% to 90% of these incontinent residents have significant mobility problems, with severe cognitive impairment in many cases. For disabled older adults, the inability to complete independent excretion and subsequent care not only easily leads to complications such as urinary tract infections, incontinence dermatitis, and pressure ulcers (about 35% of disabled older adults have experienced skin infection problems due to delayed cleaning), but also seriously damages their personal dignity, causing strong shame and social avoidance behaviors. Traditional excretion care relies heavily on manual operations, which has many limitations. On the one hand, it imposes a heavy burden on nursing staff: excretion cleaning work accounts for 30%-40% of nursing staff's daily working hours, and it is one of the main reasons for occupational burnout and staff turnover. On the other hand, the traditional model has low efficiency in infection control, and the incidence of related infections in users of traditional nursing beds is more than 40% higher than that of intelligent bed systems with automatic cleaning functions. In this context, excretion care robots, as a key technical solution to address the shortage of nursing manpower and improve the quality of care, have attracted widespread attention. However, the current market for elderly care robots is structurally imbalanced: companion robots and mobile assistive robots account for more than 70% of shipments, while nursing robots with mature and reliable defecation and urination cleaning functions account for less than 5% of the market. Most products fail to effectively solve the core care problems of disabled older adults. Therefore, it is particularly necessary to systematically sort out the research status of excretion care robots for disabled older adults, identify research gaps and development directions, which is the core background of this scoping review. 2. Research Purpose As a type of literature review that focuses on comprehensively covering the research field and identifying research gaps, this scoping review aims to systematically sort out and synthesize the existing research on excretion care robots for disabled older adults. Specifically, the research purposes include the following four aspects: 1. Systematically collate the technical characteristics, functional modules and application scenarios of existing excretion care robots, including but not limited to sensing systems, cleaning and disinfection mechanisms, human-machine interaction methods and autonomous movement capabilities; 2. Analyze the current research progress in the field of excretion care robots, including the effectiveness of technological applications, the main research methods adopted, and the distribution of research regions and institutions; 3. Identify the key technical bottlenecks, research gaps and potential challenges in the research and application of excretion care robots, such as the limitations of precision operation, the lack of long-term effect evaluation, and ethical and privacy issues; 4. Provide targeted suggestions for future research directions, industrial development and policy formulation, so as to promote the practical application and healthy development of excretion care robots and better meet the excretion care needs of disabled older adults. 3. Research Methodology This scoping review will be conducted in strict accordance with the Arksey & O'Malley framework, which includes five key steps: formulating research questions, identifying relevant literature, selecting literature, collating and summarizing data, and consulting and reporting results. At the same time, the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) statement will be followed to ensure the standardization and transparency of the research process. 3.1 Literature Search Strategy The search will cover both Chinese and English databases to ensure the comprehensiveness of literature collection. English databases include PubMed, Web of Science, IEEE Xplore Digital Library; Chinese databases include CNKI, Wanfang Data Knowledge Service Platform. The search keywords will be combined around the core elements of "disabled older adults", "excretion care robots" and "assistive technology", such as English keywords: "disabled older adults", "excretion care robot", "auxiliary excretion robot", "nursing robot", "assisted living technology"; Chinese keywords: "disabled elderly", "excretion care robot", "auxiliary excretion robot", "nursing robot", "elderly assistive technology". The search time range will be from the establishment of the database to the present, and there will be no restrictions on the initial search language, but non-Chinese and non-English literatures will be excluded in the subsequent screening process. 3.2 Inclusion and Exclusion Criteria Inclusion criteria: (1) The research object is disabled older adults (including the elderly with mobility disorders, cognitive impairment, etc.); (2) The research content involves excretion care robots (including prototype design, technical research, application evaluation, etc.); (3) The literature type is peer-reviewed journal papers, conference papers, dissertations and research reports; (4) The literature contains available empirical data or theoretical analysis. Exclusion criteria: (1) The research object is not disabled older adults (such as children with disabilities, young and middle-aged disabled people); (2) The research content only involves traditional excretion care methods without mentioning robot technology; (3) Popular science articles, abstracts, book reviews and non-peer-reviewed literature; (4) Literature with incomplete content or unreadable full text. 3.3 Data Extraction and Analysis Two researchers will independently screen the retrieved literature according to the inclusion and exclusion criteria, and extract data from the included literature. The data extraction content includes: basic information of the literature (title, author, publication year, region), research object characteristics, robot technical parameters and functional modules, research methods and research design, key research results, existing limitations and suggestions. In case of disputes in the screening and data extraction process, a third researcher will be invited to negotiate and resolve. After completing the data extraction, descriptive statistical analysis and thematic analysis will be used to sort out and synthesize the data, summarize the research status and characteristics of the field, and identify research gaps. 3.4 Consultation Process To improve the practicality and pertinence of the research results, this study will conduct consultations with relevant stakeholders, including geriatric care workers, robot R&D personnel, disabled older adults and their family members. The consultation content will focus on the practical application effects of excretion care robots, existing problems and potential needs, and the consultation results will be integrated into the final review report to provide more comprehensive and in-depth references for subsequent research and practice. 4. Expected Outcomes This scoping review is expected to achieve the following outcomes: 1. A comprehensive and systematic literature map of excretion care robots for disabled older adults will be formed, which will clearly show the time distribution, regional distribution, research institution cooperation network and key research topics of relevant research, and help readers quickly grasp the overall layout of the field. 2. A detailed summary of the technical status of excretion care robots will be completed, including the types and characteristics of core technologies (such as multi-sensor fusion technology, posture recognition algorithm, flexible control technology), the composition of functional modules (such as sensing and prediction system, cleaning and disinfection system, human-machine interaction system) and the current application effect. At the same time, the advantages and limitations of existing technologies will be analyzed, such as the high recognition accuracy of the D-S evidence theory-based excretion recognition algorithm (up to 90%) and the problems of poor adaptability of some robots to individual differences. 3. Key research gaps and development challenges in the field will be identified, including: the lack of research on long-term clinical effect evaluation of excretion care robots; the insufficient attention to user experience and psychological acceptance of disabled older adults; the imperfect research on ethical and privacy protection issues (such as the risk of sensitive data leakage); the lack of interdisciplinary research cooperation between engineering technology, medical care and social sciences; and the lack of relevant industry standards and policy support. 4. Targeted research and practice suggestions will be put forward. For academic research, it is suggested to strengthen interdisciplinary cooperation and carry out in-depth research on key technical bottlenecks such as individual differences adaptation and long-term effect evaluation; for industrial development, it is recommended to focus on the research and development of modular and low-cost products to improve market accessibility; for poli