Michael Chotiner

Many older people have trouble falling asleep and/or getting back to sleep at night, especially when stimulated by bright lights that they turn on in order to navigate to the bathroom or that attendants use during routine nighttime checks. In many cases, however, residents have difficulty locating light switches when they wake up, and so they try to get to the bathroom in the dark. Too often they fall.

Recently, a team at the Lighting Research Center at New York’s Rensselaer Polytechnic Institute published a study that put forth a novel approach to night lighting. Their ideas are designed to address special issues familiar to anyone who works in elder care facilities.

LRC’s Experimental Night Lighting System 
As an alternative to conventional lighting schemes, the Lighting Research Center developed a plan that includes arrays of amber LED night lights installed at floor level, around doorways and at bathroom fixtures to provide sufficient visual cues and ambient light for navigation in otherwise dark rooms.

Amber LEDs were specified because they are more efficient and less expensive than white LEDs, and because their light is less harsh than bright white lights. The night lights are controlled by photosensors, so they don’t go on during the daytime or when light from other sources is sufficient, and also by motion sensors, which turn the lights on slowly when a patient sets his or her feet on the floor or when an attendant enters the room.

These images show where the amber lights were mounted near the bedroom floor, around the bathroom doorway and in the bath itself. For photographic purposes, some of the overhead and general lighting were turned on, but under normal nighttime conditions, the general lighting would be switched off, and the amber lights would go on only when activated by the motion sensors. In developing the scheme, the LRC researchers theorized that the low light levels from the amber arrays would provide enough illumination for residents to make their way around their rooms safely and for staff to carry out nighttime checks. Without the disturbance of bright lights, researchers suspected, residents would have an easier time getting back to sleep after waking in the dark.

To test the theory, LRC mounted linear arrays of amber lights in bedrooms and baths in four suites at a Clifton Park long-term care facility. Details of the experimental setup include:

  • An LED array mounted under the bed frame providing 10 to 15 lux at the floor near the bed.
  • An LED array framing the bathroom door providing 2 to 10 lux at the floor and vertical and horizontal cues about the door’s location.
  • LED arrays in the bathroom—one just beneath the mirror above the lavatory sink and another at the grab bar near the toilet, providing 5 to 10 lux at the center of the bathroom floor.

Defining the Issues and Encouraging Feedback on the Night Lighting Experiment 
Before installing the night lighting arrays and controls, the LRC researchers surveyed both staff and residents to define some key issues around common lighting practices:

Staff Responses—Before

  • 100% reported turning on lights to perform nighttime checks.
  • 94% reported it was likely that a resident would wake up during nighttime checks.
  • 82% reported that they believed residents found overhead lights uncomfortably bright at night.

Resident Responses—Before

  • 91% reported that they found overhead lights glaring at night.
  • 83% reported that they woke up during nighttime checks.

Two weeks after installing the experimental system, the researchers polled staff and residents again in an effort to measure its effectiveness and acceptance.

Staff Responses—After

  • 100% said it was convenient to have lighting on a motion sensor.
  • 93% said the colored light was useful.
  • 81% said they had enough light to perform night checks.
  • 62% said there was enough light in the bathroom without turning on the overhead light.

Resident Responses—After

  • 100% said that the colored lights did not wake them up.
  • 100% said that the colored light was not uncomfortable when they woke up to go to the bathroom.
  • 100% said that they liked the colored light.

In subsequent tests in a laboratory setting, the researchers were able to establish that the amber arrays had a distinct impact on postural stability and control in older adults. The “horizontal and vertical perceptual cues,” they found, “significantly reduce sway velocity in the critical early phase of the sit-to-stand test,” which suggests that the scheme has the potential to reduce nighttime falls.

Michael Chotiner is a home improvement author and former contractor. He offers advice for eldercare and assisted living facilities for The Home Depot on a range of topics including using new LED technology to help improve design for residents. To find out more info about LED light bulbs and lighting, visit homedepot.com.

Photos courtesy of the Lighting Research Institute.