Light therapy is applied as treatment for a variety of problems related to health and ageing, including dementia. Light therapy is administered via light boxes, light showers, and ambient bright light using ceiling-mounted luminaires. Long-term care facilities are currently installing dynamic lighting systems with the aim to improve the well-being of residents with dementia and to decrease behavioural symptoms. The aim of this chapter is to provide an overview of the application of ceiling-mounted dynamic lighting systems as a part of intelligent home automation systems found in healthcare facilities. Examples of such systems are provided and their implementation in practice is discussed. The available, though limited, knowledge has not yet been converted into widespread implementable lighting solutions, and the solutions available are often technologically unsophisticated and poorly evaluated from the perspective of end-users. New validated approaches to the design and application of ambient bright light are needed.
Top1. Introduction
Light therapy is increasingly administered and studied as a non-pharmacological treatment for a variety of health-related problems including dementia. It is applied in a variety of ways, ranging from being exposed to daylight, to being exposed to light emitted from electric sources both at the own home and in institutional healthcare facilities (Aarts et al., 2014; Aries et al., 2013; Ellis et al., 2013; van Hoof et al., 2013). The systems used for light therapy include light boxes, light showers, and ambient bright light. Ambient bright light is one of the ways to administer light therapy by using electric lighting. It encompasses the increase of the general illuminance levels in buildings using special luminaires, light sources, and control technology for the luminaire. It does not include luminance or shading devices. Some ambient bright light solutions expose occupants to dynamic lighting scenarios that mimic the natural daylight cycle. Light therapy covers an area in medicine where medical sciences meet the realms of physics, engineering and technology (van Hoof et al., 2012). This article deals with therapy by electric light sources only.
Light therapy is an emerging therapy within the domain of dementia care. Dementia can be caused by a number of progressive disorders that affect memory, thinking, behavior, and the ability to perform everyday activities. Alzheimer’s disease is the most common cause of dementia. Recent research indicates that the quality of life of people with dementia can be improved, and that dementia could be slowed down by treatments that reset the body’s biological clock (and one’s circadian rhythmicity), light therapy in particular. This kind of research started with the work by van Someren et al. (1997), who conducted a study on the effects of ambient bright light emitted from ceiling-mounted luminaires on rest-activity patterns. In a randomised controlled study by Riemersma-van der Lek et al. (2008), brighter daytime lighting was applied to improve the sleep of persons with dementia, and to slow down cognitive decline. A full overview of effects is given by van Hoof et al. (2010; 2013). At the same time, the scientific basis for ambient bright light, as seen from a medical perspective, is still weak. Forbes et al. (2009) concluded that due to the lack of randomised controlled studies, there are no clear beneficial outcomes of light therapy for older persons. Also, Shikder et al. (2012) concluded that the implementation of therapeutic aspects of lighting in buildings is still debatable due to insufficient relevant investigations and robustness of their findings. At the same time, many light therapy studies are methodologically flawed from an engineering perspective, too (van Hoof et al., 2012).
Still, the rationale for applying light therapy in dementia care is clear. Persons with dementia do not venture outdoors as much as healthy younger adults, due to mobility impairments. When institutionalised, going outside is no longer part of one’s daily routine and mostly depends on time and effort of the family. Indoors, older persons are exposed to light levels that are not sufficient for proper vision, let alone yielding positive outcomes to circadian rhythmicity and mood (Sinoo et al., 2011; Aarts and Westerlaken, 2005; Aries et al., 2013). Using light as a care instrument does not only apply to people with dementia, it also applies to ageing in general.