Hippocratic Oath – and dynamic lighting helps to heal at home

First, do no harm

One in five older adults suffer from insomnia, contributing to cognitive decline, depression and falls. Sedative medication is over-prescribed in long-term residential care despite little evidence that it improves sleep, while many of the most commonly-used drugs increase mood swings and risk of falls – Optimizing Sleep for Residents in Long-term Care Without Sedatives. These issues are compounded by errors when carers give out the drugs, with one study finding an average of six administration errors per resident per week. This chaotic situation isn’t just bad for patients. Potentially Inappropriate Medication accounts for up to 17.5% of the medication bill in a residential care home – AU$410 to $470 per year – Costs of potentially inappropriate medication use in residential aged care facilities.

So, finding a way to help patients get to sleep naturally makes good business sense – Dementia Enlightened?! A Systematic Literature Review of the Influence of Indoor Environmental Light on the Health of Older Persons with Dementia in Long-Term Care Facilities.

Lighting is the obvious solution, with a growing number of studies demonstrating the potential of a regular cycle of bright days and dark nights to support a healthy body clock in older adults. This trial found nighttime wandering, the number of daytime naps cut by over half. Time asleep went up by 90 minutes and time out of bed went down by over an hour – Biodynamic lighting effects on the sleep pattern of people with dementia.

So what’s in the gap? Current lighting guidelines for Healthcare (LG2) and Communal Residential Buildings (LG9) do not consider these non-visual effects, a situation compounded by current energy codes for connected loads that, when taken literally, preclude delivering the light levels needed for circadian entrainment. Lighting professionals have no input at all to window coverings and darkness at night, arguably as important as daytime conditions

But, as this impassioned review by Professors Sean Cain and Andrew Philips point out, if doctors have information about a situation that may be harming their patient but fail to act, they risk breaking their Hippocratic Oath that states “first, do no harm” – Do no harm: the beginning of the age of healthy hospital lighting.

Perhaps the same should apply to other building professionals too?

The right to sleep 

You have a right to enjoy privacy and a peaceful nights’ sleep, thanks to the European Court of Human Rights Article 8 – Article 8 protects your right to respect for your private and family life, CASE OF HATTON AND OTHERS v. THE UNITED KINGDOM.

But safeguarding those rights for patients who need regular night-time checks, is more complex.

Two nurses were frustrated by the need to wake their patients during their rounds, switching on the lights and fumbling with clumsy controls. They felt manufacturers were out of touch with life on the front line. So they came up with their own simple solution: a wearable rechargeable LED light – NURSE-LED STARTUP MANUFACTURES WEARABLE LED LIGHT TO ILLUMINATE WORKSPACES WITHOUT DISTURBING PATIENT SLEEP.

Another team designed a similar approach, a rechargeable dim blue-depleted portable light ‘pod’. Patients in this small pilot study reported a small but significant 2-point average improvement on the Hospital Anxiety and Depression Scale. 8 out of 10 of the care providers who used it in this trial responded that ‘the lighting pods provided adequate lighting for overnight care tasks’… Occam’s razor in action? – Effect on nurse and patient experience: overnight use of blue-depleted illumination.

Lighting up Mealtimes in Residential Care 

Many older adults lose weight following admission to residential care, which in turn increases their need for assistance with everyday tasks – and the cost of care, including average Medicare claims goes up – The relationship between weight status and the need for health care assistance in nursing home residents, Prevalence Rates and Characteristics of Malnutrition, Frailty, and Other Nutrition and Muscle Mass-Related Conditions Document Potential Quality of Care Gap for Medicare Patients in US Skilled Nursing Facilities.

Interestingly, there is a growing problem of obesity among Nursing Home residents- one large-scale French study identified an an average of 18.5% of the Nursing Home population in this category – The Journal of Nursing Home Research Sciences.

Whether the problem is weight loss or weight gain, lighting can help to modulate appetite and create a comfortable, convivial atmosphere.

1. Set their body clock. Bright days, soft evenings and dark nights support healthy molecular circadian function, leading to improved metabolism and blood sugar regulation – Circadian Rhythm Changes in Healthy Aging and Mild Cognitive Impairment.

2. Set the tone. Ambient lighting alters how hungry we feel, how much we eat, and even how fast we eat it. A bright, calm and welcoming atmosphere in the dining room will help them to relax and enjoy their meal – eating up to 300 more calories per meal in one study – Does eating environment have an effect on food intake in the elderly?

3. Improve staff satisfaction – There is a direct link between staff satisfaction and resident outcomes, including weight loss –Nursing Home Employee and Resident Satisfaction and Resident Care Outcomes. Lighting is directly linked to care team satisfaction  –  Technological Imagination in the Green and Digital Transition,  and office worker satisfaction too – Linking Lighting Appraisals to Work Behaviors.

No place like home 

Perhaps not surprisingly, we get better faster at home, surrounded by familiar sights and sounds.

But could a lightbulb help that process? 

A fascinating study suggests that, for people recovering from a traumatic brain injury, dynamic lighting in their home could help to reduce sleep disturbance and increase their willingness to engage in normal daily activities. 

Compared to the controls, there was less sleep disturbance and insomnia, faster reaction times and greater engagement with productive tasks – Home-based light therapy for fatigue following acquired brain injury: a pilot randomized controlled trial.