Effect of Light on Dementia Patients: A Literature Review

This literature review explores the impact of light on dementia patients. It discusses how lighting can improve cognitive function, reduce falls, and regulate circadian rhythms. The review also provides recommendations for lighting modifications to improve the quality of life for dementia patients.

Running head: DEMENTIA
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Name of the Student
Name of the university
Author’s note

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Effect of light on the dementia patients
Introduction
Dementia is a neurodegenerative disorder that occurs mostly in the older adults due to the
death of the nerve cells due to several factors. The dementia care is a significant growing health
care need with the growing aged population. There are almost no pharmacological treatments for
dementia and management of dementia mainly involves enhancing the mood and cognition of
the patient, helping them in social engagement and fostering a safe environment for them. The
key strategy to manage dementia in patients includes regular monitoring of the patient's health
and cognition and initiation of the pharmacologic and the non pharmacological treatment. Apart
from all these there are several environmental modifications that can bring about better cognitive
outcomes in patients (Chaudhury et al. 2013, p. 223-229). Poor sleep quality and falls are some
of the problems faced by the elderly suffering from dementia. People with dementia needs more
light as the as people grow older the visual capacity of the eye changes and more light is required
for the visual functions. Hence my chosen topic of research would be light, and how it impacts
on the patient's care. The rationale for this topic will be evidenced by a literature review
followed by a plan of action. A summary statement will be provided describing about the
achievements after the evaluation of the interventions followed by a succinct conclusion.
Literature review
Chong et al.(2013, p. 565) have stated the adequate lighting have a positive impact on
people suffering from dementia, as it has a positive impact on the biological clock and sleep
patterns of the older adults with dementia. Absence of adequate light can cause confusion in the
daily routine and reduces the activity and the alertness and in turn increases the frequency of the

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daytime napping. If the right quantity of light enters the retina then it can synchronize the cardiac
rhythms to the 24 hours day and night cycle (Bedrosian et al. 2012). This is referred to as the
non visual system. Circadian disruption might occur if the indoor lightings are not dark enough
or of the appropriate color for activating the circadian system (Baird et al. 2012, p.988).
Biodynamic lighting has been found to enhance the perceptual, visual and biological needs of the
older patients with dementia as they help them to stay independent in their homes and
contributing to the better quality of life (Fonken and Nelson 2014, p. 667-669). Researches
regarding light and health have shown that biological lighting that mimics natural lighting can
has a high beneficial effect on the physiological, biological and the psychological well being of
people with dementia (Bedrosian et al. 2013, p.988). Biodynamic lighting can not only reduce
the running cost but can also help to maintain healthy bones. Increase of the visual fictions will
help to reduce trips and falls in the older adults (Fonken and Nelson 2014,p. 667-669).
Although nothing is as useful as natural day light, natural daylight is always not feasible
for the persons living in the indoors. Illuminating the indoors pose a threat from the point of
environment sustainability and energy consumption. Proper utilization of the lightings can use
less energy and result in cooling energy saving for the buildings (Ellis et al.2014). In the
architectural design the main challenge in to provide the daylight or mimic the daylight using the
artificial light sources and ensuring that color temperature change and the lighting levels sync
with the nature's rhythm (Chong et al. 2013, p.565). The timing of the light and the wavelength
of the light absorbed by the body are the two most important factors for the biological effect.
Circadian rhythms are normally regulated by the exposure of the body towards the blue and the
green spectrum (Ellis et al. 2014,p. 223-245). At noon there is a high intensity of the blue light
region, the late afternoon provides the red and the orange light and as the sun sets it becomes

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dark (Coogan et al. 2012. p. 333-339). According to Coogan et al. (2013. p. 333-339) blue light
triggers the level of serotonin in the body that increases the cognitive performance and alertness.
According to Ellis et al.(2014,p. 224-245) the emergence of the chronobio-engineering
can actually provide a new paradigm in the field of health care sciences. The main aim is to
manage the symptoms of dementia by considering the attention of the patient, changing the
vision due to the ageing eye, limited mobility and wandering due to the Alzheimer’s diseases,
limited mobility and the effects of sun downing and wandering (Bedrosian and Nelson
2013).According to Figueiro et al. (2013.p. 1527) bright light therapy in dementia patient
improves the cognitive function as it is related to increased scores in the mental state
examination, used for measuring the cognitive status. According to Ellis et al. (2014) bright light
therapy involves the exposure of the patient to about 10,000 lux of light. Figueiro et al. (2013.
p.1527.) have stated that bright light can also improve the posture stability and control. He has
stated that strips of LED place around the door frames can decrease the risk of falls.
All these facts provide a strong rationale for the choice of modifications for people suffering
from dementia.
Discussion
The aim was to regulate stimulation, maximize the orientation, to increase the sense of
safety and autonomy in patients, to regulate the circadian cycles and maintaining the biological
clock, to improve the behavioral functioning in the patient and improve the cognitive status in
patients with dementia, to increase the visual functioning in the patients and avoid slips and falls.
The plan of action involved the fixtures of automated LED lights and light colored shades in the
living room. Dementia patients often suffer from sun-downing. I have found that bright light in

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the living room had brought about a decrease in the anxiety and depression among the people
with dementia. It had also been found that bright light reduces the symptoms of sun-downing and
have decreased the risk of night wandering and daytime napping. It has been found that there is
direct linkage between bright light and circadian rhythm. My interventions have brought about a
regulated circadian rhythm in the people. Auto tuning day lights has been effective in creating a
more naturalistic environment and improve the cognitive functioning in patients. The color
rendition of these LED lights is auto tuned for the older adults. It can dim itself to the red
spectrum for allowing the residents to go to sleep and provide illumination levels to the
caregivers to continue working. The arrangement have been made in such a way such that the
schedule slowly increases the lighting levels for the rest of the day for improving the visual
activity and the light intensity slows down such that it sets to a low level "red" during the
nighttime hours. The bright light set in the community and the corridors have decreased the risk
of slips and other sentinel events related to the dementia patients.
Conclusion
The evaluation strategies could prove that changes in the lighting designs can improve
the quality of life of the dementia patients by fostering a safe environment for them and
providing an ideal working environment for the caregivers.
This idea of modification in the external environment can be disseminated to the other
caregivers or the supervisors or the managers such that they can arrange things like automated
lighting with the sensory motors as that has to be done in presence of the technicians. The idea of
effective lighting can be disseminated through social media, one on one interview with the stake
holders, group discussion with peers, newsletters and leaflets. Oral presentation during group

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discussion can be an effective method of dissemination. During my course of action, it became
really difficult on my part to implement the automated lights. On my next venture I would like to
work with the implementation of signs for improving the dwelling of the dementia patients.
Recommendation
 Fixtures of florescent lights in the corridors and the washrooms.
 Using high lux levels and use of transitional lights between the rooms to avoid sudden
light change.
 Use of diffuse lighting and indirect lighting to avoid the glare.
 Color of the furniture in the dwelling room should be in high contrast.
 The color rendition should be high to differentiate objects.

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References
Baird, A.L., Coogan, A.N., Siddiqui, A., Donev, R.M. and Thome, J., 2012. Adult attention-
deficit hyperactivity disorder is associated with alterations in circadian rhythms at the
behavioural, endocrine and molecular levels. Molecular psychiatry, 17(10), p.988.
Bedrosian, T.A. and Nelson, R.J., 2013. Sundowning syndrome in aging and dementia: research
in mouse models. Experimental neurology, 243, pp.67-73.
Chaudhury, H., Cooke, H. and Frazee, K., 2013. Developing a physical environmental evaluation
component of the Dementia Care Mapping (DCM) Tool. Environmental gerontology: Making
meaningful places in old age, pp.153-174.
Chong, M.S., Tan, K.T., Tay, L., Wong, Y.M. and Ancoli-Israel, S., 2013. Bright light therapy as
part of a multicomponent management program improves sleep and functional outcomes in
delirious older hospitalized adults. Clinical interventions in aging, 8, p.565.
Coogan, A.N., Schutová, B., Husung, S., Furczyk, K., Baune, B.T., Kropp, P., Häßler, F. and
Thome, J., 2013. The circadian system in Alzheimer’s disease: disturbances, mechanisms, and
opportunities. Biological psychiatry, 74(5), pp.333-339.
Ellis, E.V., Gonzalez, E.W., Kratzer, D.A., McEachron, D.L. and Yeutter, G., 2014, March.
Auto-tuning daylight with LEDs: sustainable lighting for health and wellbeing. In ARCC
Conference Repository.

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Figueiro, M.G., Plitnick, B.A., Lok, A., Jones, G.E., Higgins, P., Hornick, T.R. and Rea, M.S.,
2014. Tailored lighting intervention improves measures of sleep, depression, and agitation in
persons with Alzheimer’s disease and related dementia living in long-term care facilities.
Clinical interventions in aging, 9, p.1527.
Fonken, L.K. and Nelson, R.J., 2014. The effects of light at night on circadian clocks and
metabolism. Endocrine reviews, 35(4), pp.648-670.
Garre‐Olmo, J., López‐Pousa, S., Turon‐Estrada, A., Juvinyà, D., Ballester, D. and Vilalta‐
Franch, J., 2012. Environmental determinants of quality of life in nursing home residents with
severe dementia. Journal of the American Geriatrics Society, 60(7), pp.1230-1236.
Hanford, N. and Figueiro, M., 2013. Light therapy and Alzheimer's disease and related dementia:
past, present, and future. Journal of Alzheimer's Disease, 33(4), pp.913-922.
Lin, C.C. and Huang, Y.C., 2012. Exploration of Long-Term Care Institution Managers'
Perceptions of Institutional Indoor Environment Quality and Ease of Administration. Care
Management Journals, 13(3), p.121.
Zhou, Q.P., Jung, L. and Richards, K.C., 2012. The management of sleep and circadian
disturbance in patients with dementia. Current neurology and neuroscience reports, 12(2),
pp.193-204.