Lighting & the Ageing Population

Proposal for a national conference, organised by the Institution of Lighting Professionals

The Background

• The UK, in common with other industrialised countries has a rapidly ageing population – every year our average age rises by 5 weeks!

• In 2010, 16% of the population was over 65 – by 2035 that figure will be almost a quarter of the population

• Currently there are 800,000 sufferers from Alzheimer’s and other forms of dementia

• Huge knock-on effects in terms of health, housing and work• On the basis of current research and technological

developments, we believe that lighting could have significant positive effects on these areas of life

• Currently the elderly are very poorly served by lighting in the UK – massive lack of awareness of the issues

Impacts of Lighting on Older People

The impacts of lighting on older people fall into two main groups, as shown above

1. Lighting for Visual Function and Visual Comfort in Older

People

1a. Workplace Lighting

• Due to the crisis in pensions, many more people forced to remain in work beyond 65• Widening age range within the work- force in offices and other workplaces• 65-year olds require 3 times the amount of light to achieve the same visual task efficiency as 20 year olds• Of the 9 million people over 64, some 2 million (22%) have some

degree of sight loss that affects their lives – many of these may be forced to remain in work too

• Not just the amount of light that can have an effect on workplace efficiency – also the lighting quality, in terms of its spectrum, colour rendering capability and spatial distribution

Design Challenges

• This presents a considerable lighting design challenge – most workplace lighting not catering for the older worker

• At the same time, current lighting design practice is moving away from ergonomics towards energy savings – may actually worsen the situation

• Older people in the workplace and the home will need increased light levels – which might involve more energy, not less

• IESNA in the USA has recognised this – lobbying for visual needs for older people to over-ride existing energy codes.

• No such moves in the UK.

1b. Lighting in Homes for Older People• The situation in institutions for older people is even

worse, with residents more vulnerable and less aware of the issues -- in common with many care home owners/managers.

Percentage of different age groups in care homes for older people

Visual Afflictions of Older People

• Loss of visual acuity – growing inability to focus• Loss of contrast sensitivity – inability to identify

objects’ edges• Greater sensitivity to glare• Slower light-dark adaptation• Poorer depth perception

Visual Afflictions of Older People• As well as being the normal inconveniences of ageing, these

visual deficiencies can contribute to falls -- the most common cause of accidental death or serious injury among older people

• Falls cost the NHS £4.6 million per day – projections for 2021 show the number of admissions through falls will increase by 33% for men and 16% for women

• In particular, as the most frail members of the population, 60% of care home residents fall every year

• Better lighting in old people’s own homes and care homes – in particular the creation of higher luminance contrast -- could help reduce these problems

Innovative Design Solutions

Originated at the Lighting Research Centre in the USA, this innovative LED door frame lighting system, for night-time use, is just one example of how lighting design can help.

A pressure pad under the rug by the bed turns on the LEDs to give horizontal and vertical cues to the location of the bathroom door

UK lagging behind in terms of innovation?

1c. Design Guidelines

There are useful guidelines for lighting living spaces for There are useful guidelines for lighting living spaces for people with sight loss – e.g. Thomas Pocklington Trust’speople with sight loss – e.g. Thomas Pocklington Trust’s

Design Guidelines

Main TPT recommendations:

•Increased light levels for task and ambient lighting + greater use of daylight•Minimisation of glare – low specularity of finishes•Balanced light levels within the space to avoid excessive adaptation•Increase of contrast between different surfaces and objects (e.g. light switches and walls)•Good colour light spectrum and CRI of light sources

High contrast step edges for older people

Design Guidelines• However, the guidelines are not being followed – a recent

TPT survey showed that only one out of 11 new buildings for older people complied with specialist design guidance

• Nine lounges lit to only half the recommended minimum• 30% of lounges, 50% of dining rooms and all the activity

rooms fell short of the minimum daylight level for buildings recommended in the BS Code

• One important issue here – is there a conflict between greater energy savings and the need for higher lighting levels for older people?

2. Therapeutic Benefits of Lighting for Older People

Background: the Biological and Psychological Effects of Light

• We have learnt in the last 15 years or so that the effects of light go well beyond visual function and comfort

• There are non-visual pathways from the eyes to the brain which via the suprachiasmatic nucleus (SCN) in the hypothalamus, trigger the production of hormones at different times of the day

Location of the ‘third eye’ or the Suprachiasmatic Nucleus (SCN) in the brain which responds to light levels and controls the body’s hormone system – and ultimately the circadian system

Biological and Psychological Effects of Light• This ‘body clock’ controls our circadian systems• A robust 24-hour pattern of light-dark (preferably

provided by exposure to strong natural light) is vital to maintaining our bodily health and well-being – and in particular our patterns of sleep and alertness

• Circadian systems can be disrupted by too little light during the day – or light at wrong time at night

• This can cause the disruption of sleep patterns – and is often associated with other health problems.

Details of the Circadian System

A 48-hour cycle of the body’s circadian system, showing the relationship between light-dark and the production of melatonin (sleep hormone), cortisol (which maintains alertness during the day) and growth hormones, vital for cell production and replacement. The latter occurs almost entirely during the hours of sleep.

Circadian Patterns in Older People

• Disruption and impairment of the circadian system is increasingly common in older people

• Their eyes are less efficient, so less light is available to trigger the circadian system

• Also older people at home or in care institutions often lack high levels of light, particularly natural daylight

• Most facilities have constant, relatively low levels of artificial lighting – and constant lighting impairs sleep ability

• 40-70% of people over 65 suffer from chronic sleep disturbance – and Alzheimer’s sufferers are particularly affected

Depression

• In addition to sleep disorders, depression can be exacerbated by disrupted circadian rhythms (as it can be with younger people who suffer from SAD syndrome)

• Studies show that when older people are exposed to high circadian light levels during the day, and dim levels at night, sleep duration and

efficiency are improved – and the incidence of depression reduced• These simple, relatively in- expensive therapies still rarely used in care homes

The Importance of Blue Light

• Light with a high blue spectral content is most effective in therapeutic terms

• Studies at Univ. of Surrey have shown that the use of blue-saturated light with care home residents in the afternoon increases sleep at night – and day-time alertness

• These types of therapy have even greater effect on Alzheimer’s patients.

• Dutch trials with blue light improved night-time sleep patterns, slowed cognitive deterioration and reduced depression, agitation and aggressiveness

Vitamin D Deficiency

• Vitamin D deficiency is widespread problem in northern European countries

• Vitamin D only naturally available through exposure to sunlight and the consumption of oily fish

• Vitamin D deficiency is linked to a whole range of health risks, including low bone mineral levels + weak, brittle bones, cognitive impairment, type 2 diabetes and breast, colon and prostate cancer in the elderly

• More exposure of older people to regular low levels of direct sunlight would help, but Vitamin D supplements may also be required.

3. Lighting Design Implications

Lighting Design ImplicationsNatural Lighting•The design of old people’s living facilities should incorporate access to natural daylight – on both therapeutic and energy-saving grounds•Sun rooms, patios, courtyards and heated conservatories should be made easily available for all residents•Skylights, glass brick walls and light-transmissive glass doors should also be used•Rooms should be designed with interesting exterior views onto natural environments, where possible

Design Implications

Artificial Lighting Systems•Therapeutic daylight compensation lighting systems should be incorporated into facilities•These should offer higher, blue-enhanced light during certain times of the day, using intelligent controls•Incorporating such sophisticated lighting in a non-intrusive way into a domestic environment is the biggest design challenge•Small, local light fittings + ‘fake’ skylights may be two possible solutions

Artificial Daylight Systems

Real-life Trial: a Double Benefit

In this trial carried out by researchers at a residential/ nursing home in Switzerland, higher light levels supplied by daylight + ceiling-mounted light

panels, both made the residents sleep better – and facilitated increased social interaction and activity, as residents could see their co-residents more easily.

Custom-Designed System for Care Homes

Helios custom-designed lighting concept for the rooms of older people ( from the Lighting Research Centre in the USA) is an automatic system

incorporating bright light therapy, blue LED therapy, dawn-to-dusk simulation lighting and movement sensor to switch on the night-time light

4. The Proposition:National Conference on Lighting

for Older People

Conference• There are clearly a large number of cost-effective lighting design

improvements that could enhance the lives of our ageing population in the workplace, in their own homes and in residential care facilities

• How can this potential be conveyed to the health sector, charitable bodies, government departments, age-related quangos and owners and managers of care homes?

• The ILP proposes a major national conference on the issue – and follow-up campaign -- with the support of one or more lighting sponsors.

• The conference could be an important way the health and care sector to learn about lighting’s considerable potential – and for the lighting community to make links with these important health and social care services.

Conference

• Provisional title:

‘Lighting for Life’Lighting and the Health and Wellbeing of Older People in the UK

Supporting Organisations

Support, marketing and conference branding to be sought from all leading health organisations, research bodies and charities for the

elderly and those with impaired vision – Alzheimer’s Society, Age UK, RNIB, Thomas Pocklington Trust, Dementia Research Trust, National Care Association, Registered Nursing Home Association, the King’s

Fund, Care Home UK, BUPA Care etc.

Provisional Topics/ Speakers

• Intro from senior Health Minister?

• Lighting for an ageing workforce (Peter Boyce or speaker from Arup)• Lighting to optimise old people’s vision and visibility in the home (Thomas

Pocklington Trust)• Lighting for people with dementia (Univ. of Stirling)• Older people, SAD syndrome and affordable lighting solutions (??)• Circadian lighting systems for old people’s homes (Univ. of Surrey)• Sunlight, its importance to Vitamin D production and the immune system (??)• Designer of the US Helios and LED doorframe system (Mariana Figueiro,

Lighting Research Centre, Renssellaer Polytechnic, USA)• The role of daylight in clinical and surgical recovery• US Draft Standards for Residential Care Homes (IESNA speaker)

…………………………………………………………………………• DESIGN WORKSHOP: collaboration between an architect and lighting

designer, to present a concept for a state-of-the-art residential home, with ideal lighting conditions.

Target Audience/ Delegate Rates/Timescale

• Healthcare professionals, researchers and academics in gerontology, Alzheimer’s etc, architects for the health sector, lighting designers, social care specialists, voluntary sector (special delegate rates), owners and managers of care homes etc.

• Such a conference could easily attract 300-400 delegates – a percentage of profits to be invested in some ongoing research work in this area.

• Delegate day rate £200-250 (lower rate for charity representatives?) One/two free places for supporting organisations

• Conference to be held in London in spring 2014.