lighting for elders and the aging eye
TRANSCRIPT
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 [email protected]