Presentation is loading. Please wait.

Presentation is loading. Please wait.

Rest-Activity and Light Exposure Patterns in Older Adults: Methodological Implications Thomas Hornick MD Patricia Higgins RN, PhD 1.

Similar presentations


Presentation on theme: "Rest-Activity and Light Exposure Patterns in Older Adults: Methodological Implications Thomas Hornick MD Patricia Higgins RN, PhD 1."— Presentation transcript:

1 Rest-Activity and Light Exposure Patterns in Older Adults: Methodological Implications Thomas Hornick MD Patricia Higgins RN, PhD 1

2 Objectives Understand the influence of circadian rhythm disruptions on overall health. Understand the influence of circadian rhythm disruptions on overall health. Identify clinical characteristics of circadian rhythm disturbances in older adults Identify clinical characteristics of circadian rhythm disturbances in older adults Recognize the importance of chronobiology in elders sleep-wake disturbances. Recognize the importance of chronobiology in elders sleep-wake disturbances. Describe results from preliminary studies assessing the use of circadian light therapy in a nursing home unit and measurement of circadian light exposure in a case study of home-dwelling older adults. Describe results from preliminary studies assessing the use of circadian light therapy in a nursing home unit and measurement of circadian light exposure in a case study of home-dwelling older adults. 2

3 Types of rhythms 1. Ultradian (heart beat, respirations, appetite) 2. Infradian (menstrual cycle) 3. Circannual (annual breeding cycles) 4. Circadian (sleep-wake cycle) Rhythms allow organisms to time events and anticipate change! Biological Rhythms 3

4 Arendt

5 With Zeitgeber 5

6 Disruption of circadian rhythm Poor performance/fatigue (Reinberg et al, 2007, Laposky et al 2008) Poor performance/fatigue (Reinberg et al, 2007, Laposky et al 2008) Weight gain(Knutson et al, 2007) Weight gain(Knutson et al, 2007) Breast cancer (Stevens et al 2001) Breast cancer (Stevens et al 2001) Other conditions Other conditions 6

7 Why older adults? Sleep disorders are common Sleep disorders are common Complaints among caregivers of persons with dementia frequently revolve around disordered day/night cycles Complaints among caregivers of persons with dementia frequently revolve around disordered day/night cycles Medications for sleep are less safe in this population Medications for sleep are less safe in this population 7

8 Aging and light Older adults spend much of their time in muted indoor lighting. Older adults spend much of their time in muted indoor lighting. 35 minutes/day of bright light exposure compared to approximately 58 minutes of bright light per day for middle-aged adults. (Sanchez 1993)35 minutes/day of bright light exposure compared to approximately 58 minutes of bright light per day for middle-aged adults. (Sanchez 1993) Reduced light exposure compounded due to physiologic changes Reduced light exposure compounded due to physiologic changes senile meiosis, cataract formation, and/or increased light absorption by the crystalline lens. (Charmin 2003)senile meiosis, cataract formation, and/or increased light absorption by the crystalline lens. (Charmin 2003) Attenuation of light exposure by more than 80% in normal older adults relative to young adults.Attenuation of light exposure by more than 80% in normal older adults relative to young adults. 8

9 Age related losses in retinal illumination Turner et al Br J Ophthalmol November; 92(11): 1439–1444 9

10 . Wikipedia, accessed 10/30/09 10

11 Role of Retinal Receptors Three known retinal receptors: process visual and circadian timing information Three known retinal receptors: process visual and circadian timing information Rods and cones: visual data Rods and cones: visual data Intrinsically photosensitive retinal ganglion cells (iPRGC): primarily light-dark data Intrinsically photosensitive retinal ganglion cells (iPRGC): primarily light-dark data 11

12 Turner et al Br J Ophthalmol November; 92(11): 1439–1444 Spectral sensitivity of photopic, scotopic and circadian (melatonin suppression) photoreception 12

13 iPRGCs: History 1998: Melanopsin in light-sensitive cells on frog skin (Provencio et al, Proc Natl Acad Sci ) 1998: Melanopsin in light-sensitive cells on frog skin (Provencio et al, Proc Natl Acad Sci ) 2000: Melanopsin-containing cells found in retinal ganglion cell layer (Provencio et al, J Neuroscience) 2000: Melanopsin-containing cells found in retinal ganglion cell layer (Provencio et al, J Neuroscience) Most likely comprise the retinohypothalamic tract Most likely comprise the retinohypothalamic tract Sensitive to wavelengths in the nm (blue light) Sensitive to wavelengths in the nm (blue light) 2002: Light responses from melanopsin- containing ganglion cells in humans (Berson et al, Science) 2002: Light responses from melanopsin- containing ganglion cells in humans (Berson et al, Science) 13

14 Intrinsically photosensitive retinal ganglion cells (iPRGCs) Timing Photoreceptors Located throughout retina (~3000) Express melanopsin Blue light sensitive(peak 460nm) Regulate photoperiodism (sensitivity to length of day and night) Higher excitatory threshold than rods/cones Transmits to SCN 24-hour light-dark pattern on the retina is the most efficient stimulus for entrainment of circadian rhythms in humans 14

15 Suprachiasmatic nucleus (SCN) is master pacemaker Suprachiasmatic nucleus (SCN) is master pacemaker 1.Activity in SCN correlates with circadian rhythms 2.Lesions of SCN abolish free-running rhythms 3.Isolated SCN continues to cycle 4.Transplanted SCN imparts rhythm of the donor on the host 5.SCN is known to be compromised in older adults with dementia. (Harper et al 2008) 15

16 Role of Melatonin Melatonin Melatonin Primary role in humans is to convey information about the daily light-dark cycle to physiological systems Primary role in humans is to convey information about the daily light-dark cycle to physiological systems Peaks during sleep, suppressed by light. Peaks during sleep, suppressed by light. 16

17 Melatonin Rhythms and Aging Zeitzer et al Sleep November 1; 30(11): 1437–1443. Average (±SEM) plasma melatonin in young (top, n=90) and older (bottom, n=29) subjects during a normally phased sleep episode (closed boxes) and a constant routine where they remained awake at the same clock hours (open circles). Data were aligned such that each subject's wake time was graphically adjusted to 08:00 and the data from the baseline day and night and from the CR(constant routine) expressed relative to wake time; sleep time is from 24:00 to 08:00. Melatonin data were averaged hourly within and then across subjects Age 65-81, mean 68 17

18 Plasma melatonin suppression by bright light in 65 year old man Duffy et al Neurobiol Aging May; 28(5): 799–807. Plasma melatonin data from subject 19G7, a 65 year old man who was exposed to a 3,527 lux light stimulus. Upper panel: plasma melatonin data from the initial circadian phase estimation procedure (CR1); middle panel: plasma melatonin data from the intervention day, with the 6.5-h experimental light exposure indicated by the open box; lower panel: plasma melatonin data from the final circadian phase estimation procedure (CR2) shown in the solid symbols, with data from CR1 replotted from above in the open symbols. During CR1, the fitted peak of the melatonin secretion (MELmax) occurred at 03:45, 3.5 h before habitual wake time. During CR2 MELmax occurred at 06:30, a 3.5 h phase delay. Melatonin was suppressed by 78% during the 6.5-h 3,527 lux light stimulus. 18

19 Melatonin suppression with bright light Duffy et al Neurobiol Aging May; 28(5): 799–807. Phase shift of fitted plasma melatonin peak (MELmax) vs. illuminance of experimental light stimulus. Data from each of the ten subjects are plotted individually and shown with square symbols. Solid line represents the 4- parameter logistic model fit to the data, with the 95% confidence interval of the model shown in the dotted lines. For comparison, the 4- parameter logistic model fit to the data from our previous study in younger adults [64] is shown in the dashed line.64 19

20 Circadian light transfer function Figueiro, et al

21 Clinical applications 21

22 Turner et al Br J Ophthalmol November; 92(11): 1439–

23 Therapeutic light 2 Hours bright light in AM 2 Hours bright light in AM Improved sleep efficiency in NH residents Improved sleep efficiency in NH residents Fetveit et al, 2003 Fetveit et al, minutes sunlight for five days 30 minutes sunlight for five days Decreased napping Decreased napping Increased participation Increased participation Alessi et al, 2005 Alessi et al, 2005 Daytime bright light Daytime bright light Improved sleep/wake cycle in persons with dementia (van Someren et al,1997) Improved sleep/wake cycle in persons with dementia (van Someren et al,1997) 23

24 Riemersma-van de Lek et al JAMA /12 Homes randomized for lighting intervention Installed fluorescent fixtures, both real and sham 1000 lux horizontal at eyes in intervention Caregivers unaware which arm randomized to Melatonin randomized by patient 3.5 year follow up 24

25 Riemersma-van der Lek, R. F. et al. JAMA 2008;299: MMSE, Depression 25

26 Schedule change: Shift work Light at night (LAN) Light at night (LAN) Nurses Health Study (Willet, PI) Nurses Health Study (Willet, PI) Effects of Light at Night on Circadian System in Nurses (Schernhammer, PI, RO1-OH008171) Effects of Light at Night on Circadian System in Nurses (Schernhammer, PI, RO1-OH008171) 26

27 Circadian phase shifters Can have negative effects on health Can have negative effects on health Abrupt: jet lag, shift work Abrupt: jet lag, shift work Gradual: institutionalization Gradual: institutionalization Timed light exposure: reset clock Timed light exposure: reset clock Sensitivity age-related Sensitivity age-related Bright light in morning advances the clock Bright light in morning advances the clock Bright light in evening delays the clock Bright light in evening delays the clock Delays easier than advances Delays easier than advances 27

28 Circadian Lighting in Long- term Care: A feasibility study 28

29 Methods 3 participants, residents of Ward 62B 3 participants, residents of Ward 62B Lighting: GE fluorescent ceiling lamps 14,000 K Lighting: GE fluorescent ceiling lamps 14,000 K Instruments Instruments Sleepwatch-L © (AMI, Ardsley, NY) Sleepwatch-L © (AMI, Ardsley, NY) Neuropsychiatric Inventory-Nursing Home Version Neuropsychiatric Inventory-Nursing Home Version Daysimeter TM (Lighting Research Center, Rensselear Polytechnic Institute) Daysimeter TM (Lighting Research Center, Rensselear Polytechnic Institute) 29

30 Methods/Instrumentation for Sleep/Light Data Subject wore Sleep Watch-L © for 7 days Subject wore Sleep Watch-L © for 7 days Wrist-worn electronic measure of body movement and light Wrist-worn electronic measure of body movement and light Software calculates activity/inactivity and light Software calculates activity/inactivity and light © Ambulatory Monitoring Inc 30

31 31

32 Lighting Installation VAMC safety standards VAMC safety standards 1 st phase: 3 blue lamp prototypes by GE: 8000 Kelvin (K); 14,000K;16,000K 1 st phase: 3 blue lamp prototypes by GE: 8000 Kelvin (K); 14,000K;16,000K 2 nd : 13 standard fluorescent lighting ceiling light fixtures in Dayroom 2 nd : 13 standard fluorescent lighting ceiling light fixtures in Dayroom 7 of 13 changed to 14,000 K ( K) 7 of 13 changed to 14,000 K ( K) Timer controlled blue lighting on, 8a-6p Timer controlled blue lighting on, 8a-6p Lighting after 6pm: sufficient for visual acuity Lighting after 6pm: sufficient for visual acuity 32

33 33

34 Mean of light measurements taken at eye level (horizontally) at 8 points in the room in the 4 cardinal directions, using PMA 2200 Photoradiometer, SnP Meter Photopic SL , S/N 9829 Light Conditions Photopic (cones) Lux Scotopic (rods) LuxS/P Ratio RatioBrightness Visual Effectiveness all on ,000 K only standard all off

35 Results & Conclusions Wrist actigraph well accepted Wrist actigraph well accepted Light sensor on wrist covered much of the time by clothing? Light sensor on wrist covered much of the time by clothing? New blue lighting well received New blue lighting well received 3 subjects exposure to blue lighting (time in Dayroom/ 10 hr period): 3 subjects exposure to blue lighting (time in Dayroom/ 10 hr period): 77 minutes, 371 mins, 373 mins 77 minutes, 371 mins, 373 mins Next time: Change installation pattern?, use Daysimeter TM Next time: Change installation pattern?, use Daysimeter TM 35

36 Rest-Activity and Light Exposure Patterns in the Home Setting: A Methodological Study P. Higgins, T. Hornick, M. Figueiro American J Alzheimers Disease and Other Dementias,

37 Purpose Assess the feasibility and reliability of using a circadian light meter (Daysimeter TM ) in a field setting and use the human circadian phototransduction models analyses to provide clinically relevant results Assess the feasibility and reliability of using a circadian light meter (Daysimeter TM ) in a field setting and use the human circadian phototransduction models analyses to provide clinically relevant results 37

38 Dyad Caregiver – Wife, 73 years, good health, no vision problems, no sleep-aid meds. Primary caregiver Caregiver – Wife, 73 years, good health, no vision problems, no sleep-aid meds. Primary caregiver Elder – Husband, 80 years, vascular dementia plus multiple co-morbidities, continent, needed assistance for all ADLs and IADLs, multiple meds included antidepressant but no sleep-aid Elder – Husband, 80 years, vascular dementia plus multiple co-morbidities, continent, needed assistance for all ADLs and IADLs, multiple meds included antidepressant but no sleep-aid Elder received all primary care from the Cleveland VA Geriatrics Clinical team. Elder received all primary care from the Cleveland VA Geriatrics Clinical team. 38

39 Methods Procedure - Light exposure and rest- activity data were collected over 7 consecutive days in November, 2007 Procedure - Light exposure and rest- activity data were collected over 7 consecutive days in November, 2007 Instruments Instruments Assessment of sleep quality and habits Assessment of sleep quality and habits Home visit Home visit Sleepwatch-L © (AMI, Ardsley, NY) Sleepwatch-L © (AMI, Ardsley, NY) Daysimeter TM (Lighting Research Center, Rensselear Polytechnic Institute) Daysimeter TM (Lighting Research Center, Rensselear Polytechnic Institute) 39

40 Daysimeter TM Research prototype Research prototype Two light meters measure photopic and circadian light exposure Two light meters measure photopic and circadian light exposure Actigraph measures movement Actigraph measures movement 40

41 Results 41

42 Built Environment Independent living complex for seniors Independent living complex for seniors Apartment: 640 square feet Apartment: 640 square feet Brown paneling and beige paint and carpet Brown paneling and beige paint and carpet One south facing window in bedroom One south facing window in bedroom Sliding glass door onto porch (south facing) Sliding glass door onto porch (south facing) Standard florescent lighting: kitchen and bath Standard florescent lighting: kitchen and bath Incandescent lighting: floor and table lamps Incandescent lighting: floor and table lamps 42

43 Ambient light exposure/24 hrs when out of bed (lux) Light Norms (in lux)* Sunlight /reflective surfaces 150,000 Overcast Day1,000 Avg nursing home50 Avg living room Twilight10 Full Moon1 *From Turner, Br J Opthalmology Range Mean mins: > 20 lux > 20 lux > 500 lux > 500 lux >1000 lux >1000 luxElder Caregiver Dyad data 43

44 ACTIGRAPHY Caregiver wife Demented husband Sleep-rest - Mean sleep efficiency % - Mean sleep efficiency % - Mean night sleep (mins) - Mean night sleep (mins) - Mean sleep latency (mins) - Mean sleep latency (mins) - Mean wake after sleep onset [WASO] (mins) - Mean wake after sleep onset [WASO] (mins) - Mean napping/24 hr (mins) - Mean napping/24 hr (mins) Intra-daily variability (0-2) Inter-daily stability (0-1)

45 Caregiver Elder 24-hour Sleep and Light 45

46 Caregiver 46

47 47 Entrained vs Disrupted EntrainedDisrupted Human

48 Conclusions Daily light levels are very low Daily light levels are very low Little variation in light levels Little variation in light levels Sleep Sleep Neither caregiver or elder sleep well Neither caregiver or elder sleep well Caregiver: poor circadian entrainment Caregiver: poor circadian entrainment Sleep disruption causes Sleep disruption causes Low lighting, little contrast Low lighting, little contrast Frequent wake times at night Frequent wake times at night 48

49 Support VISN 10 GRECC, Cleveland VAMC VISN 10 GRECC, Cleveland VAMC Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH Lighting Research Center, Rensselear Polytechnic Institute, Troy NY Lighting Research Center, Rensselear Polytechnic Institute, Troy NY General Electric Company, Nela Park, East Cleveland, OH General Electric Company, Nela Park, East Cleveland, OH 49

50 Team Tom Hornick, MD 1,2 Tom Hornick, MD 1,2 Patricia Higgins, PhD 1,2 Patricia Higgins, PhD 1,2 Mariana Figueiro, PhD 3 Mariana Figueiro, PhD 3 Mark Rea, PhD 3 Mark Rea, PhD 3 Andy Bierman, MS 3 Andy Bierman, MS 3 John Bullough, PhD 3 John Bullough, PhD 3 Bill Biers, PhD 4 Bill Biers, PhD 4 Mark Duffy, PhD 4 Mark Duffy, PhD 4 Ed Yandek, BS 4 Ed Yandek, BS 4 1 Case Western Reserve University 1 Case Western Reserve University 2 Cleveland Veterans Affairs Medical Center 2 Cleveland Veterans Affairs Medical Center 3 Lighting Research Center, Rensselaer Polytechnic Institute 3 Lighting Research Center, Rensselaer Polytechnic Institute 4 General Electric Lighting, Nela Park 4 General Electric Lighting, Nela Park 50

51 Next Steps Methodology issues in a tailored light treatment for persons with dementia" R01 – M. Figueiro, PI 51

52 Wikipedia, accessed 5/

53 53


Download ppt "Rest-Activity and Light Exposure Patterns in Older Adults: Methodological Implications Thomas Hornick MD Patricia Higgins RN, PhD 1."

Similar presentations


Ads by Google