Lighting and the Elderly
Prof. Andrew Price
Health and Care Infrastructure Research and Innovation Centre (HaCIRIC)
Department of Civil and Building Engineering
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
6. Knowledge management in complex systems
7. Design and evaluation of integrated systems
HaCIRIC Loughborough University ProjectsHaCIRIC Loughborough University Projects
• 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
Fig: Number of people aged 50 and
over. (Source: Office for National Statistics;
Government Actuary's Department)
1901 1911 1931 1951 1961 1971 1981 1991 2003 2011 2021 2031
• More of them are living in houses.
• A good number also living in care
• 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
• 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
• Glare sensitivity
• Light-dark adaptation
• Depth perception
• These predicaments causes difficulties in
• Object identification
• Visual search and
• Change detection
Elderly Visual Ability
Importance of Lighting
Lighting is necessary because,
• Adequate illumination level and luminance
contrast offset different visual difficulties by
• Provides safe navigation.
• Helps in vitamin D synthesis.
• Reduce depression and control circadian
• 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
• Evidence suggests (Abdelhafiz and Austin, 2003; Lord, 2006),
• Poor lighting or inadequate floor finishes are two main causes of
• 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
• 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
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
• 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
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
• Provide perceptual information that enables the
residents to orient themselves with respect to the
vertical and horizontal planes. Nightlights that provide
horizontal and vertical
Examples of Innovation
Helios Lighting System Concept for
• An automatic lighting system incorporates,
• Bright light therapy
• Blue LED therapy
• Dawn-dusk simulation.
• Automatic sensor based night time light etc.
• 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
• 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.
• Improving the Aesthetics and Lighting Characteristics of Healthcare
Environments: Innovation through Modelling and Simulation
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
• 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
• 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.
• 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: http://www.statistics.gov.uk/cci/nugget.asp?id=949 [Accessed 27 November 2008].
• Guardian UK (2008) Watchdog urges holistic approach to elderly care (5th December 2007) Available at:
http://www.guardian.co.uk/society/2007/dec/05/socialcare.longtermcare [Accessed 25 November 2008].
• National Statistics UK (2008)b Income, wealth & expenditure (22 November 2005) Available at: http://www.statistics.gov.uk/cci/nugget.asp?id=1269 [Accessed 27 November
• BBC (2008) £1 billion cost of elderly falls (20 August 2003) Available at: http://news.bbc.co.uk/1/hi/health/3167005.stm [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.
• http://www.tuvie.com/helios-lighting-system-concept-for-elderly-people [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.