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Understanding the Lighting Needs of the Elderly and Low Vision People Sponsored by the IES District of Columbia Section Robert Dupuy, IALD, LC Robert Dupuy.

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Presentation on theme: "Understanding the Lighting Needs of the Elderly and Low Vision People Sponsored by the IES District of Columbia Section Robert Dupuy, IALD, LC Robert Dupuy."— Presentation transcript:

1 Understanding the Lighting Needs of the Elderly and Low Vision People Sponsored by the IES District of Columbia Section Robert Dupuy, IALD, LC Robert Dupuy Consulting, LLC Portland, Oregon Copyright 2014, Robert J. Dupuy AIA APPROVED COURSE

2 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 of handling, 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.

3 COURSE DESCRIPTION This presentation will help lighting professionals design better lighting for elderly and for low vision persons.

4 LEARNING OBJECTIVES At the end of this course, participants will be able to: 1.Understand the lighting needs of over 20% of the US population. 2. Explore the combined effort of the Facilities Guidelines Institute Guidelines committee, the IES Lighting for Aged and Partially Sighted committee, the ASHRAE 90.1 committee and the Low Vision Design committee of the National Institute of Building Sciences to establish appropriate lighting power densities and lighting requirements for Senior Care Facilities. 3. Learn about the latest trends in lighting for elderly and low vision people. 4. Understand that aging is a world-wide phenomenon and its impact reaches far beyond senior housing.

5 An Important Global Trend The world is aging: 2006: 11% of global population aged : 22% (more older people than children aged 0-14 for the first time in human history)

6 Why is the World Aging? High fertility after World War II The result of: – Reduced death rates at all ages – Major reductions in the prevalence of infectious and parasitic disease – Declines in infant and maternal mortality – Improved nutrition during the 1900s

7 Why needs of older people must be understood: Growth of the aging population: – 23% USA and 25% Canadian population will be 65+ in Increase of Visual Impairment with age – 19% of those 70+ have visual impairment Visual impairment impact people of all ages – 15 million blind/visually impaired people in the US – Only 1/3 of employment age are in the workforce.

8 Our Eyes Change as We Age

9 Overview of Normal Age-Related Changes to Vision Smaller pupil – less responsive Loss of focusing flexibility More light scatter within the eye Slower adaptation to lighting changes Less sensitive to blue light Reduce visual acuity Reduced contrast sensitivity

10 Changes to the Lens Lens of a 10 year oldLens of a 65 year old

11 Less Light Reaches the Retina Compared to 20-year olds, people over 60 receive only 1/3 of light on the retina: – Smaller Pupil Size – Thicker Lens – Light Absorption within the Eye

12 Eye Diseases More Prevalent in Older Adults Cataracts: 50% at age 65 – 75, 70% 75+ Cataracts: 50% at age 65 – 75, 70% 75+ Glaucoma: 3% of Caucasians age 65 10% of African-Americans age 65 Glaucoma: 3% of Caucasians age 65 10% of African-Americans age 65 Increases with Age Increases with Age Macular Degeneration, 33% age 75 Macular Degeneration, 33% age 75 Foremost cause of blindness for 60+ Foremost cause of blindness for 60+ Diabetic Retinopathy: 45% of those with Diabetes Diabetic Retinopathy: 45% of those with Diabetes Type I & Type II Diabetes Type I & Type II Diabetes

13 Center of Design for an Aging Society Center of Design for an Aging Society Courtesy: National Eye Institute, NIH Age-Related Eye Diseases Compared to Normal Vision Courtesy: National Eye Institute, NIH

14 Courtesy: National Eye Institute, NIH Age-Related Cataracts Courtesy: National Eye Institute, NIH Problems Reduced Contrast Glare Disability Haze in the lens Impacts everyone, sooner or later Treatment Surgical removal of lens

15 Courtesy: National Eye Institute, NIH Glaucoma Courtesy: National Eye Institute, NIH Problems: Needs strong light Reduced contrast Loss of side vision May lose vision for detail Treatment: Medication Surgery

16 Courtesy: National Eye Institute, NIH Age-Related Macular Degeneration Courtesy: National Eye Institute, NIH Problems: Needs good strong light Seeing faces, reading, details and driving Affects Central Vision Generally untreatable Very common Severity varies

17 Courtesy: National Eye Institute, NIH Diabetic Retinopathy Courtesy: National Eye Institute, NIH Problems: Needs good strong light Sensitive to Glare Damage to blood vessels in the retina 45% of diabetics have some stage of retinopathy Type I & Type II Diabetes

18 Implication of Age-Related Vision Loss Falls/Fractures Increase 200% Limited Mobility in Unfamiliar Areas Loss of Contrast Sensitivity – Limits Independence Reduced Ability to See Fine Detail

19 Light for Health Vitamin D Synthesis for Healthy Bones by light on the skin Maintains Circadian Rhythm by light through the eye – Promotes Better Sleep Quality – Prevents Depression – Reduces Agitation

20 Evolutionary Past Compared To Modern Day Light Exposure Past Times – Bright, full-spectrum days – Dark nights Modern Times – Dim, spectrum-restricted days Inside buildings – Lighted nights

21 Daylight Exposure Varies Community vs. Care Facilities Minutes of light received daily Middle-Aged Adults: 58 Assisted Living Residents: 35 Nursing Home Residents: 2

22 Hip Fractures Reduced by 84% Research Study Elderly stroke patients who receive 15 minutes of sunlight exposure per day had 84% fewer hip fractures than those who were not regularly exposed to sunlight. Sato Y, Metoki N, Iwamoto J and Satoh K. Amelioration of osteoporosis and hypovitaminosis D by sunlight exposure in stroke patients. Neurology 2003; 61:

23 2003 Discovery of Cell in Retina Three independent research teams discovered a Photoreceptive & Transmitting Retinal Ganglion Cell with Connections to the Circadian Pacemaker International Commission on Illumination CIE x031:2006 "Proceedings of the 2nd CIE Expert Symposium Lighting and Health"

24 Interior Lighting: Repeat Natures Color Rhythm Cool During the Day Warm at Night

25 Causes of Age-Related Circadian Disruption Changes to the body clock Neural changes require stronger light input Less light reaches the retina Changes to the eye Less light exposure Due to decreased mobility Nursing home placement

26 Care Facilities: Daylight limited to bedrooms not where residents spend their time

27 Windows with Views of Gardens Increase daylighting Visual interest Entice residents to go outdoors Vitamin D Circadian rhythm

28 Use of Outdoor Space by NH Residents (QOL study) How often able residents went outdoors (N-1058) Daily22% Less than daily16% About weekly17% Less than once a week13% Less than once a month32%

29 Skylights Compensate for Lack of Windows

30 Memory Care Facilities Before Renovation During Renovation

31 Measurement for Color and Intensity of Light Before Renovation After Skylight Renovation

32 Daylighting More daylight Large skylights Larger windows Need BOTH skylights and windows not just windows

33 Not all Daylighting is Good! Clear Glazing = Glare & Shadows

34 Recent Research: Utilizing Bright Light & Melatonin Study in The Netherlands 12 Assisted Care Homes 189 Subjects studied over 3.5 years Average age 85.5 with Dementia Riemersmas-van der Lek RT, Swaab DF, Twisk J, Hol EM, Hoogendijk WJG, Van Someren EJW, 2008, Effect of Bright Light and Melatonin on Cognitive and Noncognitive Function in Elderly Residents of Group Care Facilities, Journal of the American Medical Association, Vol No.22, pp

35 The sleep problem Poor sleep-wake rhythms in aging Nocturnal agitation in Alzheimers disease Consequences for cognitive performance

36 The biological problem: hypothesis Maintenance and repair of sleep regulating systems at high age requires activation. Lack of light exposure, the primary input to the SCN Picture: Courtesy of Prof. S. Ancoli-Israel

37 The Netherlands Study

38 Interventions Light: Delivered between 9AM – 6PM (Measured in the direction of gaze) Active: 1000 lux, 93 footcandles Color Temperature: 4000K & 5000K Placebo: 300 lux, 27 footcandles Melatonin: Taken one hour before bed Active: 2.5 mg Placebo:

39 Published Results from the Study in The Netherlands Nightly Restlessness Reduced – 9% per year Cognitive Impairment Reduced – 5% Depressive Symptoms Reduced – 19% Deterioration of ADL Reduced – 53% Sleep Duration Increased (37 min.) – 8% Riemersmas-van der Lek RT, Swaab DF, Twisk J, Hol EM, Hoogendijk WJG, Van Someren EJW, 2008, Effect of Bright Light and Melatonin on Cognitive and Noncognitive Function in Elderly Residents of Group Care Facilities, Journal of the American Medical Association, Vol No.22, pp

40 Residents need high levels of light during the day But, darkness when they sleep or low levels of amber light at night if they get up to use the bathroom.

41 Bathroom Lighting at Night Bathrooms need different lighting for Day & Night Low-light levels at night Light should be warm in color Light the path from bedroom to bathroom – Amber night lights

42 Examples of State Regulations on Night Lights Plug in night-lights approved in CO Resident bedroom must have night light (can be overhead center fixture) MN Light emitting surfaces of the night light may not be in direct view of a resident in a normal in-bed position in PA IA requires recessed night light installed no higher than 18 above floor w switch at entrance Night lights switched at nurse station in CT No mention of color!

43 Improve Lighting to Enhance Vision Provide appropriate light for day & night Higher light levels during the day Consistent even illumination Eliminate glare Combine direct/indirect lighting Balance brightness of daylight Provide gradual changes in light levels Provide task lighting for daily living ANSI/IESNA RP Lighting and the Visual Environment for Senior Living

44 Modify the Visual Environment Light Reflectance Values (LRV): – Ceilings:75-90 LRV – Walls:60-80 LRV – Floors:40-20 LRV Provide Strong Contrast Between: – Floors & Walls – Handrails, Door Frames & Walls

45 Home-Like? Residential lighting is generally BAD! Why repeat what does not work for older people in care facilities?

46 ANSI/IES RP The New Standard

47 Minimum Light Levels ANSI/IES RP AREAAMBIENT TASK Resident Room30 FC 75 FC Dining/Activity50 FC Day Bedrooms30 FC 75 FC Hallways (Day)30 FC Hallways (Night)10 FC Night

48 Comparison of Ambient lighting: RP and Lighting achieved with current LPD AREARP-28 Office Resident Room30 FC20 – 30 FC(Offices) Dining/Cafeteria50 FC20 FC Bathrooms30 FC10 FC Corridors 30 FC 10 FC Lobbies50 FC5-10 FC

49 Direct/Indirect Corridor Lighting

50 Fluorescent: Primary Source Increase light levels at doorways: Reading apartment numbers & name of resident Allow resident to see the keyhole Emphasize the apartments

51 Layers of Light

52 ENHANCE LIGHTING

53

54 Standards are Changing ASHRAE 90.1: Increased LPD for Senior Care Facilities Guidelines for Design and Construction of Long-Term Residential Health, Care and Support Facilities

55 Changes to the FGI Guidelines Lighting Recognizes light for Circadian Rhythm Includes daylight & electric light Light reflective values of ceiling & walls Light Levels: ANSI/IES RP-28 Table 2 Surface Characteristics Contrast: Define elements in the built environment Avoid reflective surfaces on floors & walls Lighting Controls Light on when needed – off when not needed

56 New Things to Come Color Tuning Circadian Rhythm lighting moving into the workplace Individual controlability of luminaires

57 REMEMBER We need to add Human Factors to design Buildings should be viewed as a landscape made of living people Buildings are for people Lighting should adapt to people, not people adapting to the lighting

58 Questions? This concludes the American Institute of Architects Continuing Education Systems Course Robert Dupuy, IALD, LC Lighting Consultant Robert Dupuy Consulting LLC


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