Sundowning – and everyday magic

Sundowning

Not to be confused with a stiff drink after a long day at work, sundowning is one of the most challenging aspects of dementia care, a major cause of partner stress and one of the most common causes of institutionalisation.

This cluster of distress and agitation affects an estimated 80% of people living in residential care. Sundowning is linked to wandering and associated mortality, making this one of the most dangerous manifestations of dementia – Wandering & Sundowning in Dementia, Persons with dementia missing in the community: Is it wandering or something unique?

A recent literature review suggests a threefold link with light.

1. Low light levels may contribute to the visual hallucinations that contribute to confusion and agitation – Light, sleep-wake rhythm, and behavioural and psychological symptoms of dementia in care home patients: Revisiting the sundowning syndrome.
2. ‘Non-image-forming’ effects of light, linking light exposure with sleep, mood and agitation with one study reporting a three-fold increase in incidents during the winter months – Weekly, Seasonal, and Geographic Patterns in Health Contemplations About Sundown Syndrome: An Ecological Correlational Study, Effect of Personalized Blue-Enriched White Light Intervention on Rest-Activity and Light Exposure Rhythms in Mild and Moderate Alzheimer’s Disease, Abnormalities of Rest-Activity and Light Exposure Rhythms Associated with Cognitive Function in Patients with Mild Cognitive Impairment (MCI).
3. ‘Invisible’ light, including infra-red (linked to improved mitochondrial function) and ultra-violet light (linked to Vitamin D synthesis) – The Effect of Ultraviolet B Irradiation Compared with Oral Vitamin D Supplementation on the Well-being of Nursing Home Residents with Dementia: A Randomized Controlled Trial, wavelengths largely absent from artificial lighting but present in abundance in natural light.

Research from the lab is great – but does it translate to real life?

Ed Russell, Chief Executive of WCS Care, is confident that it does. As he explained in a recent Innovators in Healthcare event, describing the dread that carers feel at the end of the day and the transformation following a retrofit installation in collaboration with Commercial Lighting Systems and John Bullock: 

“So before the lighting during the winter, we saw clear evidence of sundowning behaviour,  negative mood scores increased late afternoon just as daylight was decreasing outside. After lighting was installed…100% reduction of negative mood in that same period where it all would kick off before.. and that impacted other residents too. Before the lighting, one of our residents, Indigo, would lash out in frustration.  And that would trigger residents nearby.”

One carer said, ‘We used to dread it because it wasn’t just resident Indigo, it set off a chain reaction across the care home lounge or across the whole floor. And that doesn’t happen  anymore.’

As a lighting professional, that’s something you can raise a glass to.

Splitting hairs and chronotypes

If you’re an early bird with a night-owl partner, you’ll know that ‘standard’ recommendations about bed and wake times make very little sense in the real world.  These differences in body clock preferences or ‘chronotype’ are not a big deal in everyday life.

But they are critical when it comes to the emerging science of chronopharmacology, where optimising the timing of drug delivery can reduce the dose you need by 50% or more for the same effect – The clinical impact of chronopharmacology on current medicine. Your natural ‘morning or evening’ chronotype also affects your scores on tests, including working memory, one of the measures of cognitive decline associated with dementia – Chronotype and synchrony effects in human cognitive performance: A systematic review.

Until recently, working out your chronotype was a complex affair – either a subjective assessment using free online questionnaires, like this one – Chronoquiz or an analysis of your DNA.

A team from Berlin has developed a novel technique based on analysis of your hair, opening the door to a more reliable and affordable way to work out the best time to put you through your paces – Hair test reveals plasticity of human chronotype, and how light can help you and your loved ones to stay on top of your game – Beyond sleep: A multidimensional model of chronotype.

Dates for the diary

Logging in after a break?

Here are four dates in my diary – please add yours in the comments below!

• September 17-18 – Research Roundtable & Symposium: Diversity in the circadian, neuroendocrine and neurobehavioural effects of light in humans.
• October 8 – 9  – Care Show England.
• October 15-16 – Smart Buildings Show
• November 19-20 – Light25.

International day of clean air for blue skies 

International Day of Clean Air for Blue Skies.

I invite you to find a window – or better yet, step outside to take a moment to tip your head up and look up at the marvel that is the sky above you right now- whether it’s cloudy or clear, the Kármán

line, around 10,000 km above you, defines the boundary between Earth and the universe, where the blue sky ends and the darkness of space begins – The Kármán Line: Where space begins.

The photon or particle of sunlight that delights your eye set off to find you a million years ago, rising from the molten core of the sun before spinning out to travel the last 150 million kilometers in just 460 seconds. They will never be ‘seen’ again – How long does it take for light from the Sun to reach Earth? 

It’s tempting to complain about the shorter, darker days. I find that simply looking out for this moment of everyday magic really helps.