We Have Seen The Light!

Imagine spending your entire day indoors, wearing sunglasses, or having ink spots throughout your field of vision – or even worse – only looking through a pinhole in a black piece of paper.  These are just the tip of the proverbial iceberg when discussing elderly visual acuity. Some suffer from regular aging eyes, some have extreme conditions like Macular Degeneration, and others with Dementia may have a variety of visual issues, all magnified by their disease.  In general, elderly people need light that is at a higher level, that also controls for glare, where there is an increase in contrast and is uniform to best utilize their vision.  This is even more critical for people with most forms of Dementia, since they have an even greater reduction in their visual field.   Thus, Memory Care communities & all other levels of care who house residents with Dementia should have: high levels of light, window shades that shield but do not fully block sunlight, methods to contrast between objects and backgrounds, as well as general lighting should be even throughout the entire space.  Good lighting, and particularly natural light, is certainly important to consider when working to provide excellent quality of care to elders whom have Dementia.[i]

The exposure to light through natural means is preferred, versus human-made, electrical lighting.  Natural light is better than electrical light because of its intensity, its broad spectrum, its general availability and the Vitamin D it provides our bodies.  General availability makes natural light less likely to restrict the movement and social activity of a resident.  Natural light signals to a resident the time of day and provides information about weather conditions to our subconscious.  This information helps to promote a maintained spatial awareness and wayfinding for an elderly individual.[ii]

A significant number of older people report sleeping challenges.  Indeed, only 23% of older adults report not having issues with sleep.  Sleep issues are even more profound in individuals with Dementia.  Several factors lead to a disruption of the circadian rhythm such as over-medication, sleep apnea and environmental components such as too much noise and poor daily light exposure.  These sleep challenges for individuals with dementia can lead to wandering at night, erratic awake-sleep patterns and other issues.  The sleep challenges can also make it more difficult for caregivers to appropriately provide care.[iii]

An individual’s circadian rhythm is regulated from the light that retinal ganglion cells receive in the eye.  This light is then transmitted to the body clock.  To keep our sleep/wake cycle synchronized our body takes cues from Mother Nature to match the different color of light throughout a day.  Thus, we need to receive blue-white light during the day, warm light in the early morning and evening and no light at night.  This light is best received from natural sunlight, but properly tuned and colored artificial light can also be incorporated.[iv]

Clinically significant depression impacts 20%-30% of all individuals with Dementia.  Exposure to bright white light, specifically natural sunlight, as one rises in the morning has been demonstrated as an effective treatment option in accordance with the above-mentioned natural Vitamin D that sunlight provides.  The exposure to natural light can lead to a reduced reliance on drug treatments used to manage symptoms of depression.[v]

A positive dining experience and other group interactions are critical so that elders with Dementia maintain a high quality of life.  The dining activity is not only important in terms of the intake of nutrients and calories but is also beneficial in terms of the social experience.  Environmental barriers such as glare, dim lighting and low contrasts between the table, plates and food all contribute to a significantly poorer intake of nutrients and calories as well as a less enjoyable social experience.  Good lighting also has a positive impact for staff and visiting family members, which will only enhance the elderly resident’s dining experience.[vi]

Good lighting has been shown to reduce the risk of falls and fractures.  Falls are the leading cause of accidental death for older people. One study demonstrated that daily sunlight exposure for fifteen minutes reduced hip fractures by 84%.  Another significant factor to a greater risk of falls are issues directly corresponding to reduced vision.  Falls can cause fractures, which can speed up physical decline & narrow the already limited time-frame towards the death of an individual.  Roughly 20 percent of elderly people who suffer a hip fracture, die within a year of that often-avoidable fracture.  Moreover, the existence of quality lighting, carefully designed in a community, greatly reduces the chance of falls and life-threatening fractures.

[vii][i] Dupuy, R., Noell-Waggoner, E.  (March 18th, 2010).  Memory Care Communities-Why Good Lighting Matters
[ii] Konis, K.  (2018).  Field Evaluation of the Circadian Stimulus Potential of Daylit and Non-Daylit Spaces in Dementia Care Facilities.  Building and Environment.  135, 112-123.
[iii] Dupuy, R., Noell-Waggoner, E.  (March 18th, 2010).  Memory Care Communities-Why Good Lighting Matters
[iv] Dupuy, R., Noell-Waggoner, E. (March 18th, 2010).  Memory Care Communities-Why Good Lighting Matters
[v] Konis, K., Mack, M., Schneider, E. (2018).  Pilot Study to Examine the Effects of Indoor Daylight Exposure on Depression and Other Neuropsychiatric Symptoms in People Living with Dementia in Long-Term Care Communities.  Clinical Interventions in Aging.  13, 1071-1077.
[vi] Dupuy, R., Noell-Waggoner, E.  (March 18th, 2010).  Memory Care Communities-Why Good Lighting Matters
[vii] Dupuy, R., Noell-Waggoner, E. (March 18th, 2010).  Memory Care Communities-Why Good Lighting Matters

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