lighting for elders and the aging eye

LIGHTING FOR ELDERSAnd the Aging Eye

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© Visa Lighting 2015

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 ofhandling, 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.

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 ofhandling, 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 DescriptionAs our population continues to age so do our eyes. The visual requirements of older persons are much different than the younger population. Increased light levels, attention to contrast, detail and the healing attributes of lighting are all important factors in designing lighting for the elderly. This presentation will identify ways in which the eye ages, common diseases and what we can do with lighting as a tool in designing for the aging eye.

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

1. Understand the terminology and physical factors of the eye.2. Describe the phases of the aging eye and common diseases.3. Look at lighting solutions where lighting can be used as a tool

when designing for the elderly.4. Describe evidence based research on ighting that can improve

human health.

Trends

An Aging Population Baby boomers account for the largest

percentage of acute care patients

In 2012, 22% of patients 65 and older made a trip to the emergency room

The healthcare industry is bracing for what’s been dubbed the “silver tsunami”

http://www.healthcaredesignmagazine.com/article/generational-shift

Trend - Community

Trend – Home Settings Apartments or units vs. large nursing

homes Smaller units add marketability to the

community Adds connectivity to the larger

community by having seniors use neighborhood amenities and facilities

80 is the new 65!

Communal Spaces

Acute Care Settings

Trend – Aging in Place Baby boomers will live longer,

happier in their own homes

Aging Eyes Need More Light Now that we know the trends, how do we light the spaces?

Vision and the Aging Eye

Parts of the Eye

LENS

Reduced Acuity

Cone of Light Causes less

ability to focus

Lens Becomes Yellow

The lens is responsible for allowing your eyes to focus The lens is in a constant state of adjustment With age, the lens looses a lot of its elasticity At roughly age 50, the lens can no longer change shape

Pupils Become Smaller

70 Years

20 Years

Age Related Eye Diseases

Normal Diabetic Eye Disease Dry Eyes

Cataracts Age Related Macular Degeneration

Glaucoma

Eye Disease Increases with Age

Parts of the Eye- PHOTORECEPTORS

Photopic Vision – ConesHigh Light Levels – Daytime

Cones Peak Sensitivity – 555nm

Scotopic Vision – RodsLow Light Levels - Nighttime

Rods Peak Sensitivity – 498 nm

Brown University - 2002 IPRGC- third photo-receptor discovered Intrinsically photosensitive retinal ganglion cells Turns light energy into brain signals that control

the circadian clock Intrinsically photo-sensitive retinal ganglion cells Peak Sensitivity at 484 nm

http://brown.edu/Administration/News_Bureau/2001-02/01-080.html

Action Spectra – Photo Pigment Response Photopic Vision/Cones –

Photopsin R 564 nm G 533 nm B 437 nm

Scotopic Vision/Rods – Rhodopsin G 533 nm

Circadian/Retinal Ganglion Cells (ipRGC’s) – Melanopsin B 459-484. Peak sensitivity at 484 nm

Color Temperature

Daylight

Incandescent

Fluorescent

LED – Coated vs. Blue

The Internal Clock

Circadian Rhythm Circadian Rhythm: A roughly 24 hour cycle in the physiological

processes of living beings, including plants and animals.

Photoreceptors in the eye allow light and environmental cues to help regulate core body temperature and melatonin production.

Suprachiasmatic Nucleus (SCN)Controls:

Temperature Hunger Thirst Fatigue Hormone levels Circadian Cycles

Circadian Rhythm

Organs with Peripheral Clock Cells Brain Liver Lungs Kidney Heart Pancreas Gastro-Intestinal

Tract

Research shows…Light that mimics nature can improve: Circadian system functions Sleep Mood Performance Health

Health, Light & Design

Daylight Considerations In elders less light reaches the back of the eye

because the pupil size decreases with age

They lose retinal neurons that are needed to see light & dark patterns that keep our biological rhythms in line

Due to physical limitations they may be deprived of natural sunlight

Elders are less sensitive to blue light

Daylight So what can we do to help design for the aging eye?

Vitamin D – 20 mins. A day

GET OUTSIDE – Sunlight allows the body to maximally utilize calcium and optimize muscle function

Balance Daylighting w/ electric light

Skylight Awareness & Shadow

Circadian (Blue) LightExposure Increases:

Seratonin (impulse control) Cortisol (stress) Gaba (calm) Dopamine (alertness) Follicle Stimulating Hormone (reproduction) Gastrin Releasing Peptide (GRP) Neuropeptide Y (hunger) TSH (metabolism) Suppresses melatonin

Northern Hemisphere

In the Northern Hemisphere there is insufficient UVB sunlight radiation/Vitamin D available in the months between November and March

• 2% in FloridaVs.• 10% in New

Hampshire

Seasonal Affective Disorder (SAD) Decreased Serotonin

(Neurotransmitter)

Increased Melatonin (Hormone) Levels

Seasonal Affective Disorder (SAD) Light Treatments

Timing Duration Wavelength Age dependent and

individualistic Sources must be UV

filtered

Circadian (Amber) LightAbsence of Blue Increases:

Melatonin (sleep)

Vasointestinal peptide (lowers blood pressure)

Growth Hormone (metabolism and repair)

Regulate Circadian Rhythm Keep sleep disturbances to a minimum Maintain sleep schedule, decrease naps as needed Exposure to bright white light in the morning (2 hours when possible) Amber/Red light at night only (650nm) Blue light exposure in early evening (470nm)

Alzheimer’s Alzheimer’s disease is the most common

form of dementia – Damages the SCN part of the Brain Memory loss Sleep disorders Impaired logic & cognition Inappropriate social behavior Agitation Mood swings

Applying ConceptsElderly and Alzheimer FacilitiesSisters of St. Francis Study, 2010 – Stella Niagara Health Center, NY

Exposure to enhanced interior and outdoor daylight

Removed all white light from hallways at night Utilized red, warmer wavelengths

Applying ConceptsSisters of St. Francis StudyResults of removal of white light in corridor

Slept through the night Awake during the day Reduced Insomnia Lower incidence of flu & colds Reduction and stabilization of blood pressure Lower incidence of night wandering Hallucinations ceased Improved lucidity Increased social participation

Design Recommendations

Light Levels (FC)The IESNA Lighting Handbook10th Edition Handbook (2011)

Lighting and the Visual Environment for Senior Living RP-28-07

Location and Task Age 25 - 65 Age 65+ Senior LivingExterior Entry (Night)  10  20 10Stairways (High Activity)  10  20 30Elevator Interiors  5  10 30Reading/Waiting Areas  30 60  30 waitingGroup Dining 30 60 50Bedroom   15  30 30Bathroom (Fixtures)  15 30  30Kitchen Area  30  60 30Hallways (Active)  10  20 30Hallways (Sleeping)   5  10 10Nurse Stations   50 100  30 (10 at night)Physical Therapy   30 60 30 (50 task)Examination Rooms   100 200  30 (100 task)Laundry   30 60  30 (50 task)

RP-28-07 (FC)Area Ambient Light Task LightDining 50

Living 30 75 (Reading)Bedroom 30 75 (Reading)Bathroom 30 60 (Grooming)Kitchen 30 50 Halls (& path to bathroom**) 30 day/10 at night

Entrance 30Closet 30Laundry 30

Color Rendering IndexFor healthcare you typically need 80 CRI +

Fall Prevention Falls account for 25% of all hospital admissions,

and 40% of all nursing home admissions. 40% of those admitted do not return to independent living; 25% die within a year

Others have their quality of life greatly reduced

Provide Good LRVLight Reflectance Values

YesNoNo

Provide Chromatic ContrastChromatic Contrast : When the color can produce contrast and enhance visibility

Use complimentary hues (those which lie directly opposite each other on the color wheel)

Avoid Strong Floor Patterns Elders will perceive strips as steps or changes in

elevations

Avoid Contrast and Shadows

Reflective vs. Disability Glare

Disability GlareReflective Glare

Avoid Reflective Surfaces

Use lensed fixtures over reflective surfaces

Avoid ReflectionsReflections may be confusing for those with vision or mental health problems.

Provide Shielded Light Sources

Uniform and Glare-Free Lighting

Uniform, Adjacent Spaces

Night Lighting Light path from bed to

the bathroom Provide amber lights at

floor level all night Provide amber ambient

light from above that can be turned on when needed

Provide pre-set dimmers with fade

Allow for AdaptationAdaptation: The ability of the eye to adjust to various light levels

As the eye ages there is a delay in this adjustment(30 min.) - Full light to dark adaptation in a 20 yr old(45 min.) - Full light to dark adaptation in a 50 +

Important at points of Egress to the outdoors Lobbies and corridors should be dimmed according to

time of day to allow for adaptation

Provide Pre-Set Dimmers with FadeProvide a pre-set dimmer with fade to allow eyes time to adjust between brightness levels.

Avoid FlickerFlicker: Noticeable periodic or irregular changes in source luminance

Can cause discomfort glare, migraines, Epilepsy triggers Check age of lamp and Lamp/Ballast/Driver compatibility

Layer Light for Interest

Stairs 30 f.c. Even light from above

Reading 75 f.c. Shade Blue light Even

Living 30 f.c.

general 75 f.c. task Dimming

Bedroom 30 f.c.

general 75 f.c. task Amber night

light

Task Lighting 75 f.c. Close to task Shielded

source

Bathroom 30 f.c. Amber night light

Grooming 60 f.c. Best 3

sides 2 sides Top

Dining

50 f.c.

Kitchens 30 f.c. 50 f.c.

task

Entries 30 f.c. Key hole Wayfinding

Halls 30 f.c. day 10 f.c. night Amber night

light

Lighting Codes and Standards

The Lighting Handbook – IES 10th Edition Has recommended lighting levels by age

ANSI/IESNA RP 28-07 Lighting and the Visual Environment for Senior

LivingASHRAE Energy and lighting power density code requirements

Check local code

Conclusion Increase light levels when designing for the elderly

Pay attention to source and color

Decrease white light and bright light sources at night

Maintain regular sleep patterns

Increase exposure to daylight

Resources Center of Design for an Aging Society Institute for Patient Centered Design The Center for Health Design Research Department American Health

Care Association Lighting Research Center Center for Human Centric Lighting

This concludes The American Institute of ArchitectsContinuing Education Systems Course

Thank YouLauren Roberts, LC, EDAC, IESHealthcare Market Development Managerlroberts@visalighting.com