understanding the lighting needs of the elderly and low vision people sponsored by the ies district...
TRANSCRIPT
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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
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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.
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COURSE DESCRIPTION
This presentation will help lighting professionals design better lighting for elderly and for low vision persons.
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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.
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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)
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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
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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.
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Our Eyes Change as We Age
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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
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Changes to the Lens
Lens of a 10 year old Lens of a 65 year old
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Daylight Exposure Varies Community vs. Care Facilities
Minutes of light received daily
• Middle-Aged Adults: 58
• Assisted Living Residents: 35
• Nursing Home Residents: 2
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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.
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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"
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Interior Lighting: Repeat Nature’s Color Rhythm
Cool During the Day Warm at Night
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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
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Care Facilities: Daylight limited to bedrooms
not where residents spend their time
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Windows with Views of Gardens
• Increase daylighting
• Visual interest
• Entice residents to go outdoors
• Vitamin D
• Circadian rhythm
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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%
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Skylights Compensate for Lack of Windows
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Memory Care Facilities
Before Renovation During Renovation
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Measurement for Color and Intensity of Light
Before Renovation After Skylight Renovation
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Daylighting• More daylight
• Large skylights
• Larger windows
• Need BOTH
skylights and windows not just windows
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Not all Daylighting is Good!Clear Glazing = Glare & Shadows
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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.
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The sleep problem
•Poor sleep-wake rhythms in aging•Nocturnal agitation in Alzheimer’s disease•Consequences for cognitive performance
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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
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The Netherlands’ Study
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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:
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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.
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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.
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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
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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!
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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
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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
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Home-Like?
• Residential lighting is generally BAD!
• Why repeat what does not work for older people in care facilities?
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ANSI/IES RP-28-2007The New Standard
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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
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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
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Direct/Indirect Corridor Lighting
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Fluorescent: Primary Source
Increase light levels at doorways:
• Reading apartment numbers & name of resident
• Allow resident to see the keyhole
• Emphasize the apartments
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Layers of Light
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ENHANCE LIGHTING
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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
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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
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New Things to Come
•Color Tuning
•Circadian Rhythm lighting moving into the workplace
•Individual controlability of luminaires
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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
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Questions?
This concludes the American Institute of Architects Continuing Education Systems Course
Robert Dupuy, IALD, LCLighting Consultant
Robert Dupuy Consulting LLC503-707-4508