Impact of Upgraded Lighting on Falls in Care Home Residents |
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| Institution: | 1. Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women''s Hospital, Boston, MA, USA;2. Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA;3. Midwest Lighting Institute Inc., Cottage Grove, WI, USA;1. Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland;2. Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland;1. Cecil G. Sheps Center for Health Services Research and Departments of Family Medicine and Internal Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA;2. George E. Wahlen Department of Veterans Affairs Medical Center, University of Utah School of Medicine, and Geriatrics Research, Education and Clinical Center, Salt Lake City, UT, USA;3. Geriatric Specialty Care of Nevada and Pine Park Health, Reno, NV, USA;4. National Aging Research Institute, Melbourne, Australia;1. Hubbard Center for Nursing Research on Aging, University of Rochester, School of Nursing, Rochester, NY, USA;2. University of Rochester Medical Center, Department of Medicine, Rochester, NY, USA;3. Arizona State University, Edson College of Nursing and Health Innovation, Phoenix, AZ, USA;4. University of Rochester Medical Center, Department of Psychiatry, Rochester, NY, USA;5. Division of Geriatrics & Aging, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA;6. St. John Fisher College, Wegmans School of Pharmacy, Rochester, NY, USA;7. Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA;8. Department of Medicine, Vanderbilt University Medical Center, Center for Quality Aging, Nashville, TN, USA;9. Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, TN, USA;10. Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA;11. Department of Medicine, Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY, USA;12. University of Rochester Medical Home Care, University of Rochester Medical Center, Rochester, NY, USA;13. Finger Lakes Geriatric Education Center, University of Rochester Medical Center, Rochester, NY, USA;1. Department of Geriatrics, Getafe University Hospital, Getafe, Madrid, Spain;2. Department of Medicine and Public Health, Rey Juan Carlos University, Alcorcon, Spain;3. CIBERFES: CIBER''s thematic area for Frailty and Healthy Aging, Instituto de Salud Carlos III, Madrid, Spain;4. Biomedical Research Foundation of the Getafe University Hospital, Getafe, Madrid, Spain;5. Department of Geriatrics, Virgen del Valle Hospital, Toledo, Spain;1. Division of Geriatrics & Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA;2. Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA;3. School of Industrial and Labor Relations, Cornell University, Ithaca, NY, USA;1. Icahn School of Medicine at Mount Sinai, New York, NY, USA;2. Johns Hopkins University School of Medicine, Baltimore, MD, USA;3. Boston University School of Public Health, Boston, MA, USA;4. Boston VA Healthcare System, Boston, MA, USA |
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| Abstract: | ObjectivesFalls in care home residents have major health and economic implications. Given the impact of lighting on visual acuity, alertness, and sleep and their potential influence on falls, we aimed to assess the impact of upgraded lighting on the rate of falls in long-term care home residents.DesignAn observational study of 2 pairs of care homes (4 sites total). One site from each pair was selected for solid-state lighting upgrade, and the other site served as a control.Setting and ParticipantsTwo pairs of care homes with 758 residents (126,479 resident-days; mean age (±SD) 81.0 ± 11.7 years; 57% female; 31% with dementia).MethodsOne “experimental” site from each pair had solid-state lighting installed throughout the facility that changed in intensity and spectrum to increase short-wavelength (blue light) exposure during the day (6 am–6 pm) and decrease it overnight (6 pm–6 am). The control sites retained standard lighting with no change in intensity or spectrum throughout the day. The number of falls aggregated from medical records were assessed over an approximately 24-month interval. The primary comparison between the sites was the rate of falls per 1000 resident-days.ResultsBefore the lighting upgrade, the rate of falls was similar between experimental and control sites 6.94 vs 6.62 falls per 1000 resident-days, respectively; rate ratio (RR) 1.05; 95% CI 0.70–1.58; P = .82]. Following the upgrade, falls were reduced by 43% at experimental sites compared with control sites (4.82 vs 8.44 falls per 1000 resident-days, respectively; RR 0.57; 95% CI 0.39–0.84; P = .004).Conclusions and ImplicationsUpgrading ambient lighting to incorporate higher intensity blue-enriched white light during the daytime and lower intensity overnight represents an effective, passive, low-cost, low-burden addition to current preventive strategies to reduce fall risk in long-term care settings. |
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| Keywords: | Lighting melanopic care homes falls falls prevention aging |
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