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Lighting and the Elderly


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  • 1. Lighting and the Elderly Prof. Andrew Price Shariful Shikder Health and Care Infrastructure Research and Innovation Centre (HaCIRIC) Department of Civil and Building Engineering Loughborough University
  • 2. Health and Care Infrastructure Research andHealth and Care Infrastructure Research and Innovation CentreInnovation Centre • Research centre focusing on healthcare infrastructure systems – built environment and large scale integrated technical infrastructure – • Primary funding from EPSRC – £7.2m plus £3m from the 4 existing IMRCs (at Loughborough, Imperial, Salford and Reading). • Research themes 1. Managing innovation in a context of technological change 2. Procurement for innovation 3. Innovation in facility design and construction processesInnovation in facility design and construction processes 4. The built environment and improving care delivery practices 5. Delivering increased performance of health and care infrastructures through operations management 6. Knowledge management in complex systems 7. Design and evaluation of integrated systems
  • 3. HaCIRIC Loughborough University ProjectsHaCIRIC Loughborough University Projects
  • 4. Strategic Healthcare Planning
  • 5. Design and Evidence Based Decision Making
  • 6. Elderly Lighting
  • 7. • Aged population is increasing • 45% increase over five decades for aged over 50 (1951-2003) • The number is projected to increase by a further 36% by 2031 Fig: Mortality rates, by age, England and Wales Fig: Number of people aged 50 and over. (Source: Office for National Statistics; Government Actuary's Department) Thousands 0 5,000 10,000 15,000 20,000 25,000 30,000 1901 1911 1931 1951 1961 1971 1981 1991 2003 2011 2021 2031 Projections Elderly Population
  • 8. • More of them are living in houses. • A good number also living in care homes. • Almost 20% of men and 35% of women elderly (aged over 90). Fig: Percentage of people who live in communal establishments: by age and sex, April 2001, GB • Watchdog urges holistic approach to elderly care in UK (Guardian 5 December 2007) • Different study suggests many older people continue their daily work in unexpected low illuminance. • Older adults living in nursing homes receive far less bright light exposure for circadian rhythm and Vitamin D synthesis. Elderly Dwelling place (Noell-Waggoner, 2006)
  • 9. • Study suggest visual ability get worse after the age of 50 due to physical and pathological changes. • General visual ability declinations occurred in (Boyce, 2003; CIBSE , 1997; Sturnieks 2008). • Visual acuity – ability to focus • Contrast sensitivity – ability to identify object’s edge. • Glare sensitivity • Light-dark adaptation • Depth perception • These predicaments causes difficulties in • Object identification • Visual search and • Change detection Elderly Visual Ability
  • 10. Importance of Lighting Lighting is necessary because, • Adequate illumination level and luminance contrast offset different visual difficulties by elderly. • Provides safe navigation. • Helps in vitamin D synthesis. • Reduce depression and control circadian rhythm.
  • 11. • Death rate for elderly is the highest for injury or poisoning among all age groups. • Falls are one of the most common cause of severe injury or accidental death among elderly. Fig: Trends in mortality rates for all injury and poisoning by sex and broad age group, 1979-2004 Falls or Balance Disorder for Elderly
  • 12. • Evidence suggests (Abdelhafiz and Austin, 2003; Lord, 2006), • Poor lighting or inadequate floor finishes are two main causes of falls. • Visual impairment is believed to be associated with accidental falls causing hip fracture. • Misinterpretation of spatial information and misjudgement of distances - lead to reduced balance control and obstacle avoidance ability. • Higher luminance contrast can play significant role in reducing falls. • Falls can have longer effects causing, • Personal or Institutional expenses • Extreme discomfort • £1 (£981 million) billion cost of elderly falls per year (BBC News, August 2003) Falls or Balance disorder for Elderly
  • 13. Depression and Lighting • Depression in nursing homes is widespread. • Winter depression or Seasonal Affective Disorder (SAD) is very common suffering for elderly residing in nursing homes (Abrams et al,1992). • Light therapies showed considerable success in reducing depressions. • The American Association Committee on Research in Psychiatric treatments concluded that bright light and dawn simulation treatments (for non-seasonal depression and SAD) are effective as most antidepressant pharmacotherapy trials (Golden et al., 2005). • Expose to Blue LEDs in early evening improves circadian activity (Figueiro, 2005).
  • 14. Examples of Innovation • Progressive architects and designers can use newer theories of light therapies in their design (Figueiro, 2005) • Proposed 24 hour lighting system for elderly by Figueiro, (Lighting Research Centre, RPU, USA): • An array of blue light LEDs (max wavelength = 470 nm) delivering at least 30 lux at the cornea and placed on dining tables, television screens or wheelchairs. • Night light that reduce falls risk and help maintain sleep. • Provide perceptual information that enables the residents to orient themselves with respect to the vertical and horizontal planes. Nightlights that provide horizontal and vertical cues
  • 15. Examples of Innovation Helios Lighting System Concept for Elderly • An automatic lighting system incorporates, • Bright light therapy • Blue LED therapy • Dawn-dusk simulation. • Automatic sensor based night time light etc.
  • 16. Conclusions • Revision of lighting regulations is required, • Photo-biological impacts are not considered (Noell-Wagonner, 2006). • Horizontal illuminance level is well described, but extended recommendation is expected for vertical illuminance and luminance distribution. • Along with Safety and easy navigation, Therapeutic performance and Energy efficiency are key modifiers for future elderly lighting design decision. • Careful consideration is required in implementing vertical light sources to avoid disability and discomfort glare. Energy efficiency Therapeutic performance Safety and navigation Elderly Lighting Elderly Lighting
  • 17. Related Project • Improving the Aesthetics and Lighting Characteristics of Healthcare Environments: Innovation through Modelling and Simulation Aim: To develop and demonstrate how innovative design solutions relating to aesthetics and lighting, particularly the visual appearance of healthcare space (e.g. the availability of natural light/ day light and use of the arts) impact on the clinical outcomes of patients, facility performance and staff productivity. Artificial lighting illuminance in a nursing home
  • 18. Methodologies • Review of literature to build theory around the concepts of healing/supportive/health promoting environments and the relationships between aesthetics, lighting and the patient experience. • Case studies and site trials will be used to capture/evaluate evidence of the application. This will include exploration and evaluation of existing facilities by on-site measurements of environmental properties and patient recovery rates. • Development of Modelling, Simulation and Visualisation configurations and decision making support systems to integrate the Evidence Base to support more innovative solutions. • Conduct Modelling and Simulation to evaluate/optimise design alternatives, assess performance and validate design solutions.
  • 19. Thank You!
  • 20. References • Sturnieks, D. L., George R,. St, Lord, S. R. (2008) Balance disorders in the elderly, Clinical Neurophysiology, 38, pp.467—47 • Boyce, P. R. (2003) Human Factors in Lighting, 2nd ed., New York: Taylor and Francis Inc. • Biderman A, Cwikel J, Fried A V and Galinsky D (2002) Depression and falls among community dwelling elderly people: a search for common risk factors, Journal of Epidemiol Community Health, 56, pp.631-636 • Lord C. J., Colvin D. P. (1991) Falls in the Elderly: Detection and Assessment, Annual International Conference of the IEEE Engineering in Medicine and Biology Society, 13(4) • Scuffham, P., Chaplin, S., Legood, R. (2003) Incidence and costs of unintentional falls in older people in the United Kingdom, J Epidemiol Community Health, 57, pp.740–744 • Lord, S. R. (2006) Visual risk factors for falls in older people, Age and Ageing, 35(S2), pp.ii42–ii45 • Noell-Waggoner (2006) Lighting In Nursing Homes – The Unmet Need, Proceedings of the 2nd CIE Expert Symposium Lighting and Health, International Commission on Illumination Publication, CIE 031. • CIBSE (1997) Low Vision – Lighting Needs for the Partially Sighted, CIE Central Bureau, Vienna • Dalkea, H., Little, J., Niemann, E., Camgoz, N., Steadman, G., Hill, S., Stott, L. (2006) Colour and Lighting in hospital deisgn, Optics and Laser Technology, 38, pp. 343–365 • National Statistics UK (2008)a Population: Ageing (Updated 21st August 2008) Available at: [Accessed 27 November 2008]. • Guardian UK (2008) Watchdog urges holistic approach to elderly care (5th December 2007) Available at: [Accessed 25 November 2008]. • National Statistics UK (2008)b Income, wealth & expenditure (22 November 2005) Available at: [Accessed 27 November 2008]. • BBC (2008) £1 billion cost of elderly falls (20 August 2003) Available at: [Accessed 27 November 2008] • Abrams R. C., Teresi J. A., Butin D. N. (1992) ‘Depression in nursing home residents’, Clinic in geriatric medicine, 8, 309-322. • Golden, R. N., Gaynes, N. B., Ekstrom, R. D., Hamer, R. M., Jacobsen, F. M., Suppes, T., Wisner, K. L., Nemeroff, C. B. (2005) ‘The Efficacy of Light Therapy in the Treatment of Mood Disorders: A Review and Meta-Analysis of the Evidence’, American Journal of Psychiatry, 162, 656-662. • Figueiro, M. G. (2008) ‘A proposed 24 h lighting scheme for older adults’, Lighting Research and Technology, 40, 153-160. • [Accessed February 2009] • Abdelhafiz AH, Austin CA. Visual factors should be assessed • in older people presenting with falls or hip fracture. Age Ageing • 2003; 32: 26–30.