Key lighting elements for an aging population.
One of the most common and dangerous health problems for the elderly are falls. According to the National Safety Council, these accidents are the leading cause of injury-related death among those 75 years and older. Almost without exception, falls can be linked to some deficiency in the immediate environment, with improper or inadequate lighting being cited as the most common element.
Light also can be a factor in the body's ability to recover should a fall occur. Sunlight on the skin is a key source of vitamin D, necessary for the absorption of calcium into bones and other body tissue. Although diet and vitamin supplements help, they cannot compensate entirely for a lack of exposure to sunlight.
In addition, the human body depends on light to regulate its internal clock, or circadian rhythm. Light falling on the retina stimulates the brain's pineal gland, influencing the body's production of melatonin, a hormone that regulates the sleep cycle. Studies have shown that some light-deprived nursing home residents wake up and fall asleep as many as 37 times a night, and often suffer from depression as well.
Recent studies also have established direct links between the quality of light and the quality of life for older people. Living in an appropriately lighted residence has been shown to improve social contact, appetite, mood, self-confidence and anxiety levels. Furthermore, proper lighting can allow the elderly to function more independently -- especially important for the increasing number of residents of assisted living facilities.
Oregon was the first state to establish lighting requirements specifically conceived for nursing facilities. The purpose statement of the regulations notes that, due to the normal aging process, lighting needs for facility residents are more specialized than for the general population. "Proper lighting," it continues, "is important in promoting
Recent studies also have
established direct links
between the quality of light and the
quality of life for older people.
personal independence, psychosocial well-being, minimizing need for staff intervention and preventing accidents." Robert Dupuy, senior lighting design specialist for Interface Engineering, Inc., and Eunice Noell, president of the Center for Design for an Aging Society, helped write the Oregon licensing code.
A common misconception of designers, according to Dupuy, is that they can't create the proper lighting environment without sacrificing atmosphere. Architects and designers want a 'residential' look that most believe can only be achieved through incandescent fixtures, says Noell. "They're using a light source as a design object."
Budgetary restrictions are another familiar obstacle. "Quite often the budget is established before we ever show up," Dupuy says. "The dollar signs start to add up and we have a real battle on our hands as to why they should make a design change."
Nonetheless, Noell believes that changes in awareness on the part of facility architects, designers, developers and owners are not only necessary but inevitable. "The fact that we're on the cutting edge of trying to educate people," says Noell, "will hopefully make it easier for the next wave of designers trying to tackle this problem."
According to the Center of Design for an Aging Society, designers should concentrate on three key aspects of lighting when designing for an aging population: quantity, quality and consistency.
The amount of light necessary for normal regulation of the body's circadian rhythm is considerable -- about 10 times that of ordinary vision. What's more, as the human eye ages, it requires ever-increasing amounts of light to maintain a consistent visual acuity. The average 60-year-old needs two to three times the light of a 20-year-old to attain an equivalent level of vision, while the average nursing home resident, 86 years of age, may require light levels five times higher.
Exposing facility residents to daylight can be as simple as designing decks or balconies directly off residents' rooms, says Noell. Use of light shelves or other means of bouncing daylight indirectly into interior spaces also can be effective, and at the same time reduce the need for artificial light sources.
The quality of light conveyed to the interior space is equally significant. Dupuy and Noell recommend the use of indirect sources, natural and artificial, to provide ambient lighting while simultaneously avoiding glare. Bare light bulbs or tubes are not acceptable under any circumstances, as the glare they produce can be not only annoying but physically painful for aging eyes.
Fluorescent fixtures are the most effective way of maintaining a high level of diffused light but they don't have to be ugly or expensive, according to Dupuy. Inexpensive fluorescent strip lighting can be set into architectural elements such as coves and valances, providing an economical source of ambient light. He stresses the importance of using color-corrected lamps whenever possible. "We can't replicate incandescent light," he says, "but we can get a warm tone that makes people feel comfortable."
Fluorescent fixtures originally developed to fight glare on workplace computer screens now are being manufactured in designs suitable for residential use. "That was the first application where people started really addressing glare," Noell says. "Now we've started to get some that look not quite so 'corporate'."
High contrast between shadow and light can create confusion and disorienting patterns for those with failing vision. For this reason, all interior spaces should be lit at a consistent and even level, floor to ceiling and wall to wall. Older people seldom walk down the center of a corridor, according to Dupuy, because they're afraid of falling. "If the wall is not illuminated properly, that does not give them a lot of confidence," he says.
This does not, however, preclude the use of specialty and accent lighting. "That's very important to put into a space," Dupuy says. "Art is an essential ingredient in these facilities, and residents often don't know it's there if it doesn't get some attention." The key, he says, is to ensure that the light doesn't reflect in the glass protecting the artwork.
Over the next 35 years, the number of American citizens 65 years and older will increase by nearly 90 percent. Although some have begun to see the potential design-related challenges and work toward solutions, Dupuy and Noell believe design professionals are still in the education phase of the process. New demands are being made on designers and architects to create environments that enhance quality of life and meet the needs of diminishing physical capabilities. The future health and well-being of the world's aging population will rest in part with the skills of sympathetic and knowledgeable designers and architects.
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