In America and other ageing societies around the world, it has become common for the elderly to be cared for by their greying children or older workers. That's largely because the younger labour force is shrinking, and few want to do such low-paying, back-aching work.
Japan sees an answer in robots.
At Minami Tsukuba nursing home near Tokyo, caregiver Asami Konishi wears a robotic device on her hips that cuts the stress on her back when she bends and lifts someone.
"It really helps when I have to pick up a heavier male patient," said the 34-year-old.
The lumbar device and other cyborg suits made by Cyberdyne Inc. can help the wearer build strength and restore mobility, like standing up and walking. Cyberdyne's gear works by reading bioelectric signals from the brain to the muscles, thus mimicking and supporting the movement intended.
"It fuses the human and robots and information systems," said Yoshiyuki Sankai, an engineer who founded Cyberdyne in 2004.
Other bigger, more familiar Japanese firms also are developing robots to target the enfeebled and elderly. Panasonic makes a robotic bed that transforms into a wheelchair. Sony's robot puppy and other "carerobo" animals are seen as therapy for loneliness and dementia.
"Just looking at it makes people smile, exercising their facial muscles," said Kenshin Noguchi, Minami Tsukuba's business promotion manager, referring to Paro, the name of a furry baby seal robot designed by Japan's Intelligent Systems Research.
Paro, which costs about US$3,700 (RM15,512), reacts to touch, sound and light. A hand grazes its whiskers and Paro's head and legs move. Paro also blinks and lets out a harp seal's cry. At Minami Tsukuba, the robot usually sits on the office counter by the front door, where residents pass by and stroke or hug it.
Rec time at the Shintomi nursing home in Tokyo includes a sing-along led by Pepper, a four-foot-tall, big-eyed humanoid robot. SoftBank, the telecommunications and finance giant, has sold some 16,000 of them, mostly to retailers and banks in Japan. Pepper interacts with customers, answering common questions (Where's the bathroom?) and making product pitches. (There are a few hundred Peppers at work in the United States.)
"In Japan, they can't create people fast enough to fill more remedial jobs," said Collin Sebastian, head of engineering at SoftBank Robotics America, a 100-employee division based in San Francisco that opened about three years ago.
Indeed, Japan's lead in advanced robotics for healthcare is driven by its demographic conundrum. More than most, the nation's population is shrinking and ageing rapidly. Already more than a quarter of its population is 65 or older (compared with 16% in the United States), and by 2050, that's expected to rise to around 40% in Japan. Even now elderly are taking care of elderly.
Culture also plays a role in Japan's embrace of robots. Many Japanese grew up with Astro Boy, the robotic child with X-ray vision and an ability to fly that was created in the 1950s and serialised in manga comics and television.
"Robotics is part of their lives. There's appreciation for that type of technology and novelty," said Sebastian.
The United States has been slower to adopt robots. Experts think that's partly due to unrealistic expectations and partly to fear. American consumers want robots to perform like humans, and yet there's apprehension that may have come from Hollywood's depiction of cyborgs and artificial intelligence in popular movies such as The Terminator and The Matrix.
At another level, people fear robots as job killers. When Sebastian and his SoftBank colleague made the rounds this month on Capitol Hill, many of the questions centred on how advances in robotics would affect existing American jobs. Industrial robots have long been deployed by US manufacturers, such as robotic arms that weld car parts at assembly plants.
To be sure, automation has eliminated a lot of routine work. But Robert Atkinson, president of the Information Technology and Innovation Foundation, a Washington think tank, says productivity statistics over the last decade suggest it's not been nearly so bad in manufacturing.
Even then, he said, substituting human labour with robots may not be a bad thing when there aren't enough workers to do certain tasks, whether its picking strawberries, stocking shelves or caring for the elderly.
Although the United States isn't ageing as fast as Japan, America's 65-and-over population already numbers more than 52 million, and that is projected to nearly double by 2060, when the elderly will make up about one out of four Americans.
At the same time, the United States – like Germany, South Korea and other advanced nations – faces a shrinking share of prime-aged workers over the next decade, including younger ones who might be best suited for the physical demands of elderly care.
Jobs at assisted-living facilities in the United States are projected to grow around 40% over the next decade, several times faster than the average. But labour shortages are also likely to abound, aggravated by low wages.
The median annual pay for home and personal care aides was US$24,200 (RM101,455) last year. Nursing assistants and orderlies working at residential care homes didn't do much better, earning US$28,530 (RM119,603).
Pay and turnover are problems in Japan's elder care industry, too.
At Minami Tsukuba, Noguchi wants to boost the quality of care by lowering the number of residents per each caregiver, from three to 2.5. But even workers such as Konishi, who has seven years of experience in elder care, makes around US$20,000 (RM 83,846) a year for four full days of work a week.
Others burn out because care-giving is hard on the body, especially as workers get older. Noguchi reckons that's where robots could help stem turnover. Equipment such as Cyberdyne's lumbar device could keep workers in their jobs longer, and he thinks it could also make it easier to recruit younger people if the workplace is teeming with robots and has a more high-tech feel to it.
Cyberdyne's chief executive, Sankai, sees wider workforce applications for his products. His lumbar device, for example, could lower the risk of back injury for airport workers handling bags, he says, and those labouring in agricultural fields. The average age of a Japanese farmer is 69.
But it's healthcare that drives Cyberdyne and Sankai's personal ambitions. As a nine-year-old, Sankai was captivated by Isaac Asimov's science fiction novel I, Robot. Soon after, he began tinkering and conducting experiments in rocket combustion and testing the movement of the legs of frogs with electrical stimulus.
Sankai, 61, has a doctorate in engineering from the University of Tsukuba, and Cyberdyne's public offering in 2014 catapulted him into Forbes' list of Japanese billionaires.
Cyberdyne has yet to make a profit, but some of the company's robotic, or exoskeleton, suits have received regulatory approval in Japan, the European Union and the United States for use in treating certain medical conditions, such as strokes and spinal cord injuries.
Yoshiaki Kawasaki, 70, credits the company's robotic limb suit for enabling his 68-year-old wife to walk again after a brain haemorrhage left her bedridden, her left leg paralysed. He says she went for 90-minute treatments once or twice a week – and two months later was able to walk normally.
"She can also jog," Kawasaki said, speaking from Cyberdyne's testing studio at a shopping mall in Tsukuba, where he volunteers as a way of showing gratitude to the company.
Many others who have tried Cyberdyne products haven't seen such breakthrough results, but Sankai believes his robotic suits could be effective in restoring motor functions in patients with such crippling diseases as muscular dystrophy and polio.
Hospitals and rehab centres in Italy, Malaysia and the Philippines, among other countries, are using Cyberdyne products. Others, including Saudi Arabia, are undertaking clinical trials with Cyberdyne robotics.
In the United States, Cyberdyne last year formed a joint venture with Brooks Rehabilitation Medical Group based in Jacksonville, Florida.
Amy Morace, the partnership's development and sales manager, says Brooks' outpatient facilities are using eight Cyberdyne lower-body suits to work with patients with spinal cord injuries, for which Cyberdyne was cleared by the Food and Drug Administration.
Out of 22 completed cases so far, two persons, including a California man in his 40s who injured his spine in a car accident, came in a wheelchair and walked out on foot, unaided by any device, after three months of intensive rehab wearing the Cyberdyne suit.
Of the others, Morace says, all were better off at the end, with some having greater bladder control and improved sensation and mobility.
Private insurers don't cover the programme, which runs up to US$24,000 (RM100,603), depending on the protocol. But Sankai sees the day when that will change as more research and clinical data are collected and demands from a growing senior population increase.
"For the elderly person, sometimes they don't have opportunities to talk with somebody and sometimes physical function is reduced," said Sankai. "We have to prepare the technologies." – Los Angeles Times/dpa
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