INNOVATORS IN light at the end of the tunnel RESIDENTIAL HEALTHCARE:

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Pioneering healthcare professionals are battling the odds to invest in dynamic lighting solutions that actively support the sleep-wake cycle of their residents and staff. They are seeing first hand what a powerful difference that can make. These innovative care home managers point to a 32% reduction in falls, 8% reduction in anti-anxiety use and improved staff health and engagement.

The science backs up the heart-warming stories from the real world, with a growing number of studies pointing to the short and longer-term effects of circadian approaches to lighting. At the same time, leading academics are keen to highlight the complexities involved and warn against drawing simplistic conclusions: it is almost impossible to separate changes to the lights from other dimensions of the environment including staff attitudes, multiple underlying medical conditions and wide variations in visual and biological response in this ageing population.

Sleep and disruption to the circadian rhythm are critical symptoms of dementia, contributing to the night time wandering and confusion that are associated with increased risk of falls, depression and memory loss.

While drugs can deal with the most obvious symptoms of insomnia and agitation, they do not tackle the underlying cause: most residential care homes simply do not offer the contrast between bright, active days and dark, quiet nights that the ageing body clock needs to stay on track.

A growing body of scientific evidence suggests that changes to the lighting has the potential to improve the health and well-being of people living with dementia as well as the dedicated teams who care for them. In this context, it makes sense to invest in an environment that actively supports the sleep and wider mental health of resident and staff alike.

And yet, this is surprisingly rare as these small businesses operating from buildings that are often in desperate need of basic repairs struggle to raise the capital budgets needed to upgrade the lighting.

However, there are shining examples of best practice. Jo Cheshire, the Marketing Director at WCS Care explained why they reject many of the ‘high tech’ gadgets because they often end up in a drawer. In contrast, the lighting is embedded in the structure of the building and runs along in the background. She highlights the problem of retrofitting new lighting while maintaining the daily routine in a busy residential home.

Jo is working with the lighting designer John Bullock and the academic team at Oxford University to refine a model and specification that makes it possible and feasible for the UK care sector to adopt this approach. She points to the potential ripple effects if the approach was adopted across the industry, linking into reduced hospital admissions and reduced costs. But for Jo, resident health and wellbeing is always central to everything they do.

Jo points to her experience of innovating with acoustic monitoring: a system that allows night teams to be aware of unusual movement or sounds in a residents’ room without needing to physically go in and switch the lights on. ‘We were the first in the UK to introduce acoustics. We were able to evidence that this had a very big impact on reduction of falls at night and during the day for residents.’

That technology is now being funded through the NHS Transformation Directorate. Jo and the team at WCS Care would like to see a similar direction of travel for circadian lighting. If that funding is made available, the approach will become a more mainstream component, not only for new builds but for retrofit to older buildings too. Potential customers will ask for it and demand will continue to grow. Jo is clear that that potential customers choose WCS because of the technology.

Michelle Borreson who runs two rural residential facilities for Gundersen Health in the USA also took a retrofit approach. With a limited budget, all the products were ‘off the shelf’ with no special controls. Michelle is clear about the impact: After installing in 2017, we saw a 32% reduction in falls: from 9.12 falls per resident day to 6.17. We also saw a reduction in anti-anxiety medication use from 1.99 to 1.84 per 1,000 resident days. We saw some reduction in our antipsychotic use also on our dementia unit, from 1 to 0.92 per 1,000 resident days. These results are mirrored in a second property.

Anti-depressant use also fell: from 5.47 per 1,000 resident days to just 5.3. Anti-psychotic medication followed a similar trend - from 1.66 to 1.18 per 1,000 resident days. These results are all the more impressive as the fall took place during the pandemic, when residents couldn't see their families for long periods of time,

Michelle points to a reduction in electricity costs too. In the first year, one facility reported $3,000 savings per year, while the second noted a $4,000 reduction. She concludes: ‘We’re seeing less hypnotic use. And our residents are getting better sleep for sure.'

A third example, a state-run care home in Denmark, demonstrates how these benefits extend to staff too. Manager Kirsten Sorensen-Gosvig noted that after the lighting upgrade, her teams who work the evening shift were able to fall asleep more quickly after coming home from work: while they used to need around two hours to wind down, after the lighting installation, they were able to switch off after just one hour.

Her staff reported fewer conflicts between the residents during the evening and felt healthier and happier themselves. Staff working nights recorded quieter nights and found it easier to fall asleep when they got home after work. The care teams were surprised to note that within days of the new lighting installation, when the residents came out in the corridors, they turned around and went back to the bed in the apartment instead of getting dressed and looking for breakfast. They contrast this with the situation before the lighting, when patients who stepped out in the corridors seeing bright lights, thought it was morning, wanted to get dressed and asked for breakfast.

The dynamic lighting was so successful that the nurses all wanted to work nights in the buildings with the upgrade. So they set up a rotation system to settle the argument. Kirsten described how her teams were clear about the difference in their well-being on the mornings after night shifts spent under the standard and upgraded lighting.

Professor Shadab Rahman of Brigham Women’s Hospital at Harvard has carried out pioneering work on the impact of dynamic lighting on falls. Shadab and his team installed a dynamic lighting schedule in a recent large-scale study across a number of different sites. They tracked a 43 per cent reduction in the risk of falls following the lighting intervention. A full report will be in the next edition of designing lighting global

Scientists and care providers alike are keen to stress the need to keep an open mind and to focus on solutions that are simple, affordable and sustainable. But they all agree that the right light at the right time has the potential to offer a ray of hope for those living with dementia as well as those who love and care for them.

Professor Shadab Rahman quotes a Persian saying: "When you shut out the sun from coming through the window, the doctor comes in the door." ■

- Sponsored Bios, Glamox Luxonic and KNX/Theben in partnership with the SLL and IALD.

− Professor Shadab Rahman