Evidence-Based Lighting g for Long-Term Care Jefferey F. Knox, IES Senior Lighting Designer, Schuler Shook Provider Number: A090 Course Number: C21-17 28 September 2013 Credit(s) earned on completion of this course will be reported to AIA CES for AIA members. Certificates of Completion for both AIA members and non-aia members are available upon request. This course is registered with AIA CES for continuing professional education. As such, it does not include content that may be deemed or construed to be an approval or endorsement by the AIA of any material of construction or any method or manner of handling, using, distributing, or dealing in any material or product. Questions related to specific materials, methods, and services will be addressed at the conclusion of this presentation. 1
Copyright Materials This presentation is protected by US and International Copyright laws. Reproduction, distribution, display and use of the presentation without written permission of the speaker is prohibited. Schuler Shook 2011-2013 Course Description Architects focused on healthcare design will in coming years be asked to provide innovative environments for long-term care as the Baby Boomers retire and many develop dementia. Chronic sleep disorders in elderly residents in long-term care stemming from a lack of natural light have been identified as both a clinical challenge and as an opportunity for evidence-based interior lighting design. Designers can and should use evidence from the ongoing research to inform design strategies for senior living environments where residents have limited it access to outdoor activities that provide exposure to bright, natural light. 2
Learning Objectives In this session, attendees will Discover the relevance of light to human health Identify biological issues in lighting for senior environments Acquire perspective on the current circadian light knowledge set Explore the application of innovative lighting design principles 3
Current State 80,000 100,000 lux MELATONIN NADIR CORTISOL PEAK COGNITION PEAK MELATONIN LEVELS REMAIN LOW DURING THE DAY BODY TEMP RISES THROUGH THE DAY SCN BEGINS ACTIVE INHIBITION OF CORTISOL MELATONIN SUPRESSED SEROTONIN RISE AWAKENING CORTISOL SURGE BODY TEMP NADIR MELATONIN RISE MELATONIN PEAK CORTISOL NADIR BODY TEMP PEAK 4
Visual Pathway Microsoft Office Clip-Art Image; Creative Commons 3.0 license Non-Visual Pathway retinohypothalamic tract (RHT) iprgc - SCN Microsoft Office Clip-Art Image; Creative Commons 3.0 license 5
New Definition of Light Scientists have concluded that light does more than just affect the visual system. The definition of light should be expanded to include optical radiation entering the eye that affects the circadian, neurobehavioral and neuroendocrine systems. http://www.lrc.rpi.edu/ Accessed 19 March 2012 Relative Response of Non-Visual and Visual Receptors Circadian Response is Independent of Visual Response 480nm 550nm 6
Daylight Spectra Fluorescent Spectra SPX30 SPX41 7
Photoreception 100,000 10,000 In lux 1,000 Noon Sun Overcast Day Retail Window Sunset 100 Candle 10 Full Moon 1 Starlight 0.001 Photopic Circadian? Mesopic Scoptopic Controllable Properties of Light Quantity Spectra Dynamic Properties Duration Dose = Quantity x Spectra Duration 8
Thomas Henry Huxley, 1863 HOMO SAPIENS SAPIENS 9
Homo sapiens sapiens Aging Eye and Circadian Light Progressive Loss of Light Transmission Pupil Area Decreases, Reducing Retinal Illuminance Yellowing of Lens Filters Blue Light, Reducing Circadian Photoreception 10
Current State Rest Activity Rhythm Van Someren, E. J. W., & Riemersma-Van Der Lek, R. F. (2007). Live to the rhythm, slave to the rhythm. Sleep Medicine Reviews, 11(6), 465 484. doi:10.1016/j.smrv.2007.07.003 11
Rest Activity Rhythm Van Someren, E. J. W., & Riemersma-Van Der Lek, R. F. (2007). Live to the rhythm, slave to the rhythm. Sleep Medicine Reviews, 11(6), 465 484. doi:10.1016/j.smrv.2007.07.003 Van Someren et al. (1997) Biol Psychiatry 41:955-63 12
Van Someren et al. (1997) Biol Psychiatry 41:955-63 Other image 13
MOTION SENSOR MIRROR WITH MIRROR LIGHT STEPLIGHT STEPLIGHT MOTION SENSOR 14
Practical Intervention Sloane, P. D., Noell-Waggoner, Eunice, & Hickman, S. E. Implementing a lighting intervention in public areas of longterm care facilities. Alzheimer Care Quarterly, 6, 280 293. 15
A Lighting Environment for Long-Term Care Design the Light Design the Darkness Provide a Dynamic System to Permit a Balanced 24 Hour Lighted Environment (Typically) Increased Light Levels in All Day Use Areas During the Day Must include the Action Spectrum May Boost Light in AS Only (blue) Reduced Light Levels at Evening Dimming Required Provide Circadian Darkness at Night Visible Light for Caregivers Address Nighttime Caregivers Needs for Healthful Lighting Improved Outcomes Improve Health and Well-Being of Residents Improve Health and Well-Being of Staff Improve the Bottom Line for the Organization 16
Improve Health and Well-Being of Residents Improved Mood (relieved depression) Improved Sleep Allows Natural Healing Improved Day to Day Rhythm Regular Wake/Sleep & Feed/Fast Pattern Participation in Daytime Activities Balance of Neurohormones and Neurotransmitters Slow Progression of Cognitive Decline Reduced Aggression (when combined with Melatonin) ALL Benefits Non-Pharmacological Reduce Workload Staff Outcomes Patients Sleep at Night Awake During the Day Reduce Stress Improved Co-operation and Response Reduced Aggression Improve Job Satisfaction Improve Retention Workplace Lighting for Staff Improve Sleep Reduce Health Risk 17
Organizational Outcomes Reduced Cost of Care Reduced Workload for Staff Reduced Need for Medication Cost of Medicine Cost of Distribution Reduced Risk Fewer Aggressive Incidents Reduced d Falls Risk When Patients t Sleep Better Market Differentiation Healthy, Happy Patients that Lead More Normal Lives, Require Less Medication, and have Fewer Aggressive Episodes 18
Thank you Questions? This concludes The American Institute of Architects Continuing Education Systems Program 19