Advanced lighting technologies enhance resident care: 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.

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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.

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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.

* Residents would report having less disturbed sleep.

* Residents would report that the lighting is not glaring or uncomfortable at night.

Although not directly tested, the placement of LED lights around the bathroom door (which was in view from the bed in most rooms) was designed to provide vertical and horizontal perceptual cues that could help orient residents as they got out of bed at night, potentially decreasing the chance of falls.

Measuring the Results

Before the lighting installation, 12 residents and 17 staff members were surveyed about the existing lighting in the bedrooms (table 1). Three weeks after the new lighting installation, the 17 staff members and 4 residents participating in the study were asked about the new LED lighting scheme (table 2).

Survey Findings

"The change from bright overhead lights at night to soft colored lights produced a dramatic improvement in residents' comfort and sleep," Dr. Figueiro observes. Before the installation, more than 80% of the residents said they were awakened at night by nurses turning on lights, and they found the glare and brightness uncomfortable. Afterward, all the residents reported no sleep disturbance and no discomfort from the colored lights. Dr. Figueiro notes that during her follow-up visits to Schuyler Ridge, residents and staff commented about how much they appreciated the new lighting. One nurse even reported, "Every assisted living facility should have these lights."

Dr. Figueiro says, "I was quite pleased by the positive response we received from the staff and residents about the new lighting. These subjective results demonstrate the need and opportunity for innovative lighting options in long-term care facilities." She notes that lighting brightness and placement in resident bedrooms and bathrooms can be adjusted easily to fit the needs of the residents and staff and to fit with the layout of the room.

Future Work

Dr. Figueiro says the purpose of pilot studies such as this is to demonstrate the possibilities for using new technologies and techniques in real-world applications. The next step, however, will be for manufacturers to develop off-the-shelf products that facilities can purchase and install themselves. "Right now, manufacturers are not mass-producing lighting systems such as the one we developed for this study," she says. Lighting designer Freyssinier notes that it is possible to have a similar system custom-designed by a lighting or electrical contractor familiar with LED technology and advanced lighting controls. Another issue is the high first-purchase cost of LEDs, although Dr. Figueiro and Freyssinier note that costs are coming down every year.

Regardless of facility type or size, lighting technologies combined with thoughtful design can successfully assist staff and provide comfort to residents at night. "With so many new options available," Dr. Figueiro says, "uncomfortable, disruptive lighting at night can be a thing of the past."

Jennifer Taylor is a Senior Communications Specialist with the Lighting Research Center, part of Rensselaer Polytechnic Institute, Troy, New York, which is the leading university-based research center devoted to lighting. Since 1988, the LRC has built an international reputation as a reliable source for objective information about lighting technologies, applications, and products. It also provides training programs for government agencies, utilities, contractors, lighting designers, and other lighting professionals. For more information, visit www.lrc.rpi.edu. To send your comments to the author and editors, e-mail [e-mail]. To order reprints in quantities of 100 or more, call [phone].

Acknowledgment

The study described in this article was conducted in 2004 by the Lighting Research Center at Rensselaer Polytechnic Institute with funding from the Alliance for Solid-State Illumination Systems and Technologies (ASSIST). OSRAM SYLVANIA donated the materials for the study, which were then donated to the participating facility.

Table 1. Before the installation

Nursing staff survey                                Yes   No  No Opinion

Do you turn on the room lights for performing       100%  0%   0%
checks on the residents at night?
When checking on the residents at night, are they    94%  6%   0%
likely to wake up?
Do the residents find the room lights                82%  0%  18%
uncomfortably bright at night?

Resident survey                                     Yes   No  No Opinion

Does a staff member turning on the lights at night   83%  0%  17%
wake you up?
Do you find the overhead lighting bright or          91%  0%   9%
glaring at night?
Is it difficult to find or reach the lighting        83%  8%   9%
controls at night?

Table 2. After the new LED lighting installation

Nursing staff survey                              Yes   No    No Opinion

Is there enough light for performing checks on     81%   19%  0%
residents during the night?
Is the (colored) lighting useful?                  93%    0%  7%
Is there enough lighting in the bathroom without   62%   38%  0%
having to turn on overhead lighting?
Is it convenient to have the lighting on a        100%    0%  0%
motion sensor?

Resident survey                                   Yes   No    No Opinion

Does the colored light wake you up at night when    0%  100%  0%
the nurses come in?
Is the colored light uncomfortable at night if      0%  100%  0%
you get up to go to the bathroom?
Do you like the colored light?                    100%    0%  0%