Understanding the Lighting Needsof the Elderly and Low Vision People

Sponsored by theIES District of Columbia Section

Robert Dupuy, IALD, LCRobert Dupuy Consulting, LLC

Portland, Oregon

Copyright 2014, Robert J. Dupuy

AIA APPROVED COURSE

AIA APPROVED COURSE

• 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.

COURSE DESCRIPTION

This presentation will help lighting professionals design better lighting for elderly and for low vision persons.

LEARNING OBJECTIVES

At the end of this course, participants will be able to:

1.Understand the lighting needs of over 20% of the US population.

2. Explore the combined effort of the Facilities Guidelines Institute Guidelines committee, the IES Lighting for Aged and Partially Sighted committee, the ASHRAE 90.1 committee and the Low Vision Design committee of the National Institute of Building Sciences to establish appropriate lighting power densities and lighting requirements for Senior Care Facilities.

3. Learn about the latest trends in lighting for elderly and low vision people.

4. Understand that aging is a world-wide phenomenon and its impact reaches far beyond senior housing.

An Important Global Trend

The world is aging:

2006: 11% of global population aged 60+

2050: 22% (more older people than children aged 0-14 for the first time in human history)

Why is the World Aging?

High fertility after World War II

The result of:– Reduced death rates at all ages

–Major reductions in the prevalence of infectious and parasitic disease

– Declines in infant and maternal mortality

– Improved nutrition during the 1900’s

Why needs of older people must be understood:

• Growth of the aging population:– 23% USA and 25% Canadian population will be

65+ in 2036.

• Increase of Visual Impairment with age– 19% of those 70+ have visual impairment

• Visual impairment impact people of all ages– 15 million blind/visually impaired people in the

US

– Only 1/3 of employment age are in the workforce.

Our Eyes Change as We Age

Overview of Normal Age-Related Changes to Vision

• Smaller pupil – less responsive

• Loss of focusing flexibility

• More light scatter within the eye

• Slower adaptation to lighting changes

• Less sensitive to blue light

• Reduce visual acuity

• Reduced contrast sensitivity

Changes to the Lens

Lens of a 10 year old Lens of a 65 year old

Less Light Reaches the Retina

Compared to 20-year olds, people Compared to 20-year olds, people over 60 receive only 1/3 of light on over 60 receive only 1/3 of light on the retina:the retina:– Smaller Pupil SizeSmaller Pupil Size – Thicker LensThicker Lens– Light Absorption within the EyeLight Absorption within the Eye

Eye Diseases More Prevalent in Older Adults

• Cataracts: 50% at age 65 – 75, 70% 75+Cataracts: 50% at age 65 – 75, 70% 75+

• Glaucoma: 3% of Caucasians age 65 Glaucoma: 3% of Caucasians age 65 10% of African-Americans age 65 10% of African-Americans age 65

• Increases with AgeIncreases with Age

• Macular Degeneration, 33% age 75Macular Degeneration, 33% age 75

• Foremost cause of blindness for 60+Foremost cause of blindness for 60+

• Diabetic Retinopathy: 45% of those with DiabetesDiabetic Retinopathy: 45% of those with Diabetes

• Type I & Type II Diabetes Type I & Type II Diabetes

Center of Design for an Aging SocietyCenter of Design for an Aging Society

Age-Related Eye Diseases Compared to Normal Vision

Courtesy: National Eye Institute, NIHCourtesy: National Eye Institute, NIH

Age-Related CataractsCourtesy: National Eye Institute, NIHCourtesy: National Eye Institute, NIH

Problems

• Reduced Contrast

• Glare Disability

• Haze in the lens

• Impacts everyone, sooner or later

Treatment

• Surgical removal of lens

GlaucomaCourtesy: National Eye Institute, NIHCourtesy: National Eye Institute, NIH

Problems:

• Needs strong light

• Reduced contrast

• Loss of side vision

• May lose vision for detail

Treatment:

• Medication

• Surgery

Age-Related Macular Degeneration

Courtesy: National Eye Institute, NIHCourtesy: National Eye Institute, NIH

Problems:

• Needs good strong light

• Seeing faces, reading, details and driving

Affects Central Vision

Generally untreatable

Very common

Severity varies

Diabetic RetinopathyCourtesy: National Eye Institute, NIHCourtesy: National Eye Institute, NIH

Problems:

• Needs good strong light

• Sensitive to Glare

Damage to blood vessels in the retina

45% of diabetics have some stage of retinopathy

Type I & Type II Diabetes

Implication of Age-Related Vision Loss

• Falls/Fractures Increase 200%

• Limited Mobility in Unfamiliar Areas

• Loss of Contrast Sensitivity – Limits Independence

• Reduced Ability to See Fine Detail

Light for Health

Vitamin D Synthesis for Healthy Bones by light on the skin

Maintains Circadian Rhythm by light through the eye

– Promotes Better Sleep Quality

– Prevents Depression– Reduces Agitation

Evolutionary Past ComparedTo Modern Day Light Exposure

• Past Times– Bright, full-spectrum days– Dark nights

• Modern Times– Dim, spectrum-restricted days

Inside buildings– Lighted nights

Daylight Exposure Varies Community vs. Care Facilities

Minutes of light received daily

• Middle-Aged Adults: 58

• Assisted Living Residents: 35

• Nursing Home Residents: 2

Hip Fractures Reduced by 84%Research Study

Elderly stroke patients who receive 15 minutes of sunlight exposure per day had 84% fewer hip fractures than those who were not regularly exposed to sunlight.

Sato Y, Metoki N, Iwamoto J and Satoh K. Amelioration of osteoporosis and hypovitaminosis D by sunlight exposure in stroke patients. Neurology 2003; 61:338-342.

2003 Discovery of Cell in Retina

Three independent research teams discovered a Photoreceptive & Transmitting Retinal Ganglion Cell with Connections to the Circadian Pacemaker

International Commission on Illumination

CIE x031:2006 "Proceedings of the 2nd CIE Expert

Symposium Lighting and Health"

Interior Lighting: Repeat Nature’s Color Rhythm

Cool During the Day Warm at Night

Causes of Age-Related Circadian Disruption

• Changes to the body clockNeural changes require stronger light input

• Less light reaches the retinaChanges to the eye

• Less light exposureDue to decreased mobilityNursing home placement

Care Facilities: Daylight limited to bedrooms

not where residents spend their time

Windows with Views of Gardens

• Increase daylighting

• Visual interest

• Entice residents to go outdoors

• Vitamin D

• Circadian rhythm

Use of Outdoor Space by NH Residents(QOL study)

How often able residents went outdoors (N-1058)

Daily 22%

Less than daily 16%

About weekly 17%

Less than once a week 13%

Less than once a month 32%

Skylights Compensate for Lack of Windows

Memory Care Facilities

Before Renovation During Renovation

Measurement for Color and Intensity of Light

Before Renovation After Skylight Renovation

Daylighting• More daylight

• Large skylights

• Larger windows

• Need BOTH

skylights and windows not just windows

Not all Daylighting is Good!Clear Glazing = Glare & Shadows

Recent Research:Utilizing Bright Light & Melatonin

Study in The Netherlands• 12 Assisted Care Homes• 189 Subjects studied over 3.5 years• Average age 85.5 with Dementia

Riemersmas-van der Lek RT, Swaab DF, Twisk J, Hol EM, Hoogendijk WJG, Van Someren

EJW, 2008, Effect of Bright Light and Melatonin on Cognitive and Noncognitive Function in

Elderly Residents of Group Care Facilities, Journal of the American Medical Association, Vol.

299. No.22, pp 2642-2655.

The sleep problem

•Poor sleep-wake rhythms in aging•Nocturnal agitation in Alzheimer’s disease•Consequences for cognitive performance

The biological problem: hypothesisMaintenance and repair of sleep regulating systems at high age

requires activation.

Lack of light exposure, the primary input to the SCN

Picture: Courtesy of Prof. S. Ancoli-Israel

The Netherlands’ Study

Interventions• Light: Delivered between 9AM – 6PM (Measured in

the direction of gaze)

Active: 1000 lux, 93 footcandles

Color Temperature: 4000K & 5000K

Placebo: 300 lux, 27 footcandles

• Melatonin: Taken one hour before bed

Active: 2.5 mg

Placebo:

Published Results from the Study in The Netherlands

• Nightly Restlessness Reduced – 9% per year

• Cognitive Impairment Reduced – 5%

• Depressive Symptoms Reduced – 19%

• Deterioration of ADL Reduced – 53% • Sleep Duration Increased (37 min.) – 8%

Riemersmas-van der Lek RT, Swaab DF, Twisk J,Riemersmas-van der Lek RT, Swaab DF, Twisk J, Hol EM, Hoogendijk WJG, Van Someren EJW, 2008, Hol EM, Hoogendijk WJG, Van Someren EJW, 2008,

EffectEffect of Bright Light and Melatonin on Cognitive and Noncognitive Function in Elderly Residents of of Bright Light and Melatonin on Cognitive and Noncognitive Function in Elderly Residents of

Group Care Facilities, Journal of the American Medical Association, Vol. 299. No.22, pp 2642-2655.Group Care Facilities, Journal of the American Medical Association, Vol. 299. No.22, pp 2642-2655.

Residents need high levels of light during the day

But, darkness when they sleep or low levels of amber light at night if they get up to use the bathroom.

Bathroom Lighting at Night

Bathrooms need different lighting for Day & Night

• Low-light levels at night

• Light should be warm in color

• Light the path from bedroom to bathroom– Amber night lights

Examples of State Regulations on Night Lights

• Plug in night-lights approved in CO• Resident bedroom must have night light (can be

overhead center fixture) MN• Light emitting surfaces of the night light may not be

in direct view of a resident in a normal in-bed position in PA

• IA requires recessed night light installed no higher than 18” above floor w switch at entrance

• Night lights switched at nurse station in CT• No mention of color!

Improve Lighting to Enhance Vision

• Provide appropriate light for day & night• Higher light levels during the day• Consistent even illumination• Eliminate glare • Combine direct/indirect lighting• Balance brightness of daylight• Provide gradual changes in light levels• Provide task lighting for daily living

ANSI/IESNA RP-28-2007 Lighting and the Visual Environment for Senior Living

Modify the Visual Environment

• Light Reflectance Values (LRV):– Ceilings: 75-90 LRV–Walls: 60-80 LRV– Floors: 40-20 LRV

• Provide Strong Contrast Between:– Floors & Walls– Handrails, Door Frames & Walls

Home-Like?

• Residential lighting is generally BAD!

• Why repeat what does not work for older people in care facilities?

ANSI/IES RP-28-2007The New Standard

Minimum Light LevelsANSI/IES RP-28-07

AREA AMBIENT TASK

Resident Room 30 FC 75 FCDining/Activity 50 FC DayBedrooms 30 FC 75 FCHallways (Day) 30 FC Hallways (Night) 10 FC Night

Comparison of Ambient lighting: RP-28-07 and Lighting

achieved with current LPD

AREA RP-28 Office Resident Room 30 FC 20 – 30 FC (Offices)Dining/Cafeteria 50 FC 20 FCBathrooms 30 FC 10 FCCorridors 30 FC 10 FCLobbies 50 FC 5-10 FC

Direct/Indirect Corridor Lighting

Fluorescent: Primary Source

Increase light levels at doorways:

• Reading apartment numbers & name of resident

• Allow resident to see the keyhole

• Emphasize the apartments

Layers of Light

ENHANCE LIGHTING

Standards are Changing

• ASHRAE 90.1: Increased LPD for Senior Care Facilities

• Guidelines for Design and Construction of Long-Term Residential Health, Care and Support Facilities

Changes to the FGI Guidelines

• Lighting

Recognizes light for Circadian Rhythm

Includes daylight & electric light

Light reflective values of ceiling & walls

Light Levels: ANSI/IES RP-28 Table 2

• Surface Characteristics

Contrast: Define elements in the built environment

Avoid reflective surfaces on floors & walls

• Lighting Controls

Light on when needed – off when not needed

New Things to Come

•Color Tuning

•Circadian Rhythm lighting moving into the workplace

•Individual controlability of luminaires

REMEMBER

• We need to add Human Factors to design

• Buildings should be viewed as a landscape made of living people

• Buildings are for people

• Lighting should adapt to people, not people adapting to the lighting

Questions?

This concludes the American Institute of Architects Continuing Education Systems Course

Robert Dupuy, IALD, LCLighting Consultant

Robert Dupuy Consulting LLC503-707-4508

Robert@robertdupuy.net