Research by a preeminent technical institute points the way toward more acceptable alternatives Light, or the lack thereof, plays a role in the quality of care and safety experienced by residents in nursing homes and assisted living facilities, especially during nighttime hours. For example, an overhead light turned on at night during a check on a resident can be glaring and disruptive to sleeping residents. Conversely, a nightly trip to the bathroom can be difficult for residents making their way in the dark, increasing the risk of falls and injuries.
New options and advancements in lighting technology, however, are showing promise in applications designed for increased safety and enhanced care in long-term care facilities. A recent study conducted by the Lighting Research Center (LRC) at Rensselaer Polytechnic Institute in Troy, New York, showed just how well innovative lighting solutions can work for residents and staff. Mariana Figueiro, PhD, an LRC light and health specialist who has researched lighting designs and treatments for the elderly and those with Alzheimer's disease, says, "For seniors, we know that as vision deteriorates, it becomes harder for the eyes to adapt to both dark environments and rapid changes in brightness." These common vision difficulties led Dr. Figueiro and an LRC research team to conduct a pilot lighting demonstration study at Schuyler Ridge Residential Health Care, a 120-resident skilled nursing facility in Clifton Park, New York. (The facility is part of Seton Health, a comprehensive, integrated healthcare system anchored by St. Mary's Hospital in nearby Troy.) The intent was to identify useful, energy-efficient lighting solutions that could improve the comfort and care of seniors and assist the nursing staff in their nightly rounds.
Among the new technologies available, light-emitting diodes, or LEDs, show the most promise for use in unique and custom lighting designs. Unlike traditional incandescent lightbulbs, LEDs are tiny semiconductor chips that emit light in a range of vivid colors. LEDs have been used for decades as indicator lights in electronics and, more recently, in traffic signals, exit signs, and automobile taillights. According to Nadarajah Narendran, PhD, LRC director of research and organizer of the Alliance for Solid-State Illumination Systems and Technologies (ASSIST), the sponsor of the Schuyler Ridge pilot study, recent advancements have improved LEDs' brightness and efficiency, allowing them to be used for still more lighting purposes. They also operate 40 to 50 times longer than traditional incandescent lamps, increasing their cost-effectiveness over time.
In the long-term care facility, Dr. Narendran says, LEDs can offer many advantages for residents and staff, such as more acceptable night-lighting and emergency signaling. LEDs also can be configured to work during a power outage. The Pilot Study
Through discussions with the Schuyler Ridge staff, Dr. Figueiro and LRC researchers learned of several long-term care'specific challenges that could be resolved with new lighting. The facility's nursing staff indicated that most falls occur when unattended residents are in their own rooms, performing tasks such as getting in and out of bed. Hard-to-reach lighting controls and bright, glaring room lights add to the difficulty seniors have getting up in the middle of the night. Additionally, nurses need to check residents several times at night and often disrupt their sleep and comfort by repeatedly turning on the room lights.
"Based on these issues," says Dr. Figueiro, "we determined that a minimal, nondisturbing lighting scheme that turned on automatically could potentially help residents getting up at night, as well as be used by nurses for their rounds without the need to turn on the bright overhead lighting."
For the study, the LRC team designed custom LED-based lighting systems to install in four bedrooms and bathrooms in the facility. In the bedrooms, the team mounted strings of amber-colored LEDs to the underside of the bed frame, around the bathroom door frame (figure 1), and under the mirror and handrail in the bathroom (figure 2). Jean Paul Freyssinier, an LRC lighting design specialist, says the bed-frame lighting was selected specifically to illuminate the floor. "By putting the light close to the floor where it is needed rather than lighting up the whole room, we can use less light and power than with overhead lighting," he says. The door-frame lighting system created enough indirect light to illuminate the room adequately without causing glare (figure 1). Each system was controlled by a photosensor, which ensured that the LED lighting did not come on during the day or when the overhead lights were on, and by a motion sensor that slowly turned the lights on when the resident put his/her feet on the floor or when a nurse walked into the room.
Dr. Figueiro notes that the lower light levels and lighting placements in the bedrooms were designed to allow the staff to perform their tasks adequately while minimizing the chance of their waking the resident. "However, if the resident did wake up, he or she would not experience the same discomfort normally felt when viewing bright overhead lights at night," says Dr. Figueiro.
The LRC team hypothesized that residents and staff would prefer the new lighting compared with the existing lighting because:
- Staff would still be able to perform their tasks at night.
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