SNPG955: Clinical Investigation for Light Stimuli in Dementia Care

This report presents a clinical investigation into the use of light stimuli to improve the environment and care for individuals with dementia. The investigation focuses on the rationale for modifying the environment, specifically lighting, to address issues such as sleep disturbances, agitation, and depression commonly experienced by dementia patients. The action plan involves encouraging elderly residents in a nursing home to participate in sunlight therapy for one hour daily, evaluating the impact on their mental and physical health, circadian rhythms, and agitation levels using tools like the Cohen-Mansfield Agitation Inventory (CMAI) and the Cornell Scale for Depression in Dementia (CSDD). The expected outcomes include improved sleep-wake patterns, reduced agitation and depression, and enhanced overall well-being. The discussion highlights the benefits of bright light therapy, supported by existing studies, in improving circadian rhythms, cognitive functions, and sensory input, ultimately reducing falls and improving the quality of life for dementia patients. The report concludes with a summary of achieved improvements and their implications for dementia care.

Seeing The Sun ‘Light’: A Clinical Investigation For Improving Light Stimuli In Environment
For People With Dementia
Subject Outline: SNPG955 Dementia Care Across Settings
© University of Wollongong 2018/1/31. All rights reserved.
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Introduction
What is Dementia and how modified environment and can be applied in dementia care?
Dementia is a multifactorial condition that results in affecting the functions of the brain. Brain
dysfunction causes loss of memory, problems with reasoning and communication, mood changes and
decreased ability in carrying out activities of daily life (Lash, 2014). It can be said that dementia
affects social, physical as well as emotional health of an individual. Prevalence of dementia is rising
with the growing number of aging population. Bringing changes to the physical environment is
increasingly become very significant and important aids for providing care to people with dementia
(Ganguli, 2017). Modified environment can also be considered as the therapeutic resources to
promote functionality and well-being of people suffering with dementia. Study of Fleming et al
(2016) also explains that quality of the environment provided to people suffering with dementia can
significantly improve the quality of their lives. The link between the environment and the people
suffering with dementia can be established through environmental cues and sensory stimuli.
What are sensory stimuli and how the sensory stimulation through light can improve the health of
an individual with dementia?
There is a significant inter-relation between the personal competence of the individuals facing
dementia and the environmental demands that they experience (Dewing, and Dijk, 2016). There is a
very significant demand of the combination of pharmacological, behavioural and environmental
approaches for improving the well-being of such people (Yates-Bolton et al, 2012). Sensory
stimulation is also considered as an important part of increasing senses and evoking positive feelings.
Sensory stimuli could be anything in the environment that results in influences or arouse one or more
the senses (sight, smell, touch, hearing and taste) of the individual. Sensory stimulation can help in
improving the mood, self-esteem and well-being of the individual suffering with dementia, because it
allows such individuals to connect with their current environment and develop a sense of belonging
(Maseda et al, 2014).
Bright light is considered as very effective in sensory stimulation and also very important in
managing behavioural problems among people with dementia (Strøm, Ytrehus, and Grov, 2016).
Light is the most easily accessible stimulus and can be easily adapted in providing care to elderly
people suffering with dementia (Talebzadeh, and Lang, 2017). Evidences have shown that a building
Subject Outline: SNPG955 Dementia Care Across Settings
© University of Wollongong 2018/1/31. All rights reserved.
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environment could be more than a shelter and support, as it can provide many therapeutic
approaches. Improving the light in the living areas of old people have resulted in improving self
reported quality of life (Figueiro, 2017).
Elderly living in residential care also have higher level of sleep and behavioural problems in
comparison to community dwellers. This is because elderly living in residential homes are exposed
to very limited light which is very less bright to improve circadian rhythm and vitamin D (Barton et
al, 2016; Munch et al, 2017). According to the study of Hanford and Figueiro (2013), “in mammals,
circadian rhythms are generated and regulated by an internal biological clock located in the
suprachiasmatic nuclei (SCN) of the hypothalamus of the brain” (p. 913).
The biological clock of the humans is affected and improved through light and dark patterns and also
help in synchronizing the behavioral and physiological rhythms with external environment (Hanford
and Figueiro, 2013). A recent visit to the local nursing home for the elderly people suffering with
dementia, it was found that the physical environment lack proper lighting. Therefore, a hypothetical
rationale could be implemented in the nursing home in order to encourage the elderly residents to sit
outside under the sun light for at least one hour every day. This will help in reducing the sleep and
behavioural problems (agitation and depression) among the elderly people and will also improve
circadian rhythms (Giménez et al, 2017).
Assignment 1: Action Planning Template
Brief Description of the aspect to be modified and the current impact on people with dementia
Improving the quality of life for the people suffering with dementia is a very significant aspect of
providing care to them. Modifying the physical environment by improving the lighting can help to
improve their health and reduce risk of falls. People facing dementia often suffer from the problem
of sleep disturbance that negatively affect their daytime functions and also increases depression
and agitation (Hanford and Figueiro, 2013). The modifications will be carried out in terms of
improving the lighting and exposure to sun. It is very significant for the people living with
dementia, to see their environment and make sense of it. With the use of sun light therapy the
social, physical and psychological condition of the dementia patients can be improved. Deficiency
of vitamin D can result in rapid progression of disease. Therefore, daily exposure to sunlight can
help in gaining environment orientation and also improves the physical well-being.
Subject Outline: SNPG955 Dementia Care Across Settings
© University of Wollongong 2018/1/31. All rights reserved.
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Aims of Goals (maximum of 3 goals)
1. Elderly patient will be encouraged to participate in sun-light therapy
2. To improve the mental and physical health of the dementia patients and increasing their
alertness during day time.
3. To reduce the risk of falls and agitation by increasing Circadian Rhythms
Key steps and activities to be taken to achieve aim/goals (include timescales and others who can
offer support).
Key steps and activities Resources (including
personnel) Timeline
1) Discussion about the therapy will
be done with the local dementia care
home and the potential benefits will
be discussed.
-Management of Nursing
Home
- Involvement of Staff
members
-Evaluator
Initial discussion and
consultation prior to the
planning of intervention
2) Organizing the activity of one hour
sun light exposure every day at 10 am
time of brunch
-Involving nursing staff to
encourage patients
-Promoting the sun-light
therapy
Activity will be
conducted every day at
10 am for two weeks.
3) Agitation symptoms will be
evaluated to understand if symptoms
have reduced by the use of Cohen-
Mansfield Agitation Inventory
(CMAI). Cornell Scale for Depression
in Dementia (CSDD) will be used to
identify decrease in rate of depression.
Circadian Rhythms will be measured
at night.
-Nurses will maintain the
diary for recording the sleep
and wake time of the
patient.
-Experienced healthcare
professional will measure
CMAI and CSDD.
Circadian Rhythms can
be checked every night,
while CMAI and CSDD
will be measured after
two weeks.
4) Report will be prepared to find the - Data collected from This will be done after
Subject Outline: SNPG955 Dementia Care Across Settings
© University of Wollongong 2018/1/31. All rights reserved.
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improvements in patient’s condition
after application of intervention or
activity.
the nurses
- Objective Data will
be collected through
survey of patients,
by asking them that
what physical,
emotional and
mental improvement
they have
experienced through
the activity.
the completion of the
activity of two weeks and
collecting all the
recordings of data.
Criteria for Evaluation (identify up to 5 aspects by which you can measure your success; one of
which should be around people with dementia)
1. Patients participated everyday in the activity at the time of brunch and spent one hour every
under the sun light to receive sun light therapy.
2. Participants were able to have sounder sleep at night, and total wake time significantly
reduced. Sleep duration also increased.
3. CMAI and CSDD scores of the patients had improved and patients displayed very low signs of
agitation or depression.
4. Participants felt more happy and satisfied and did not display signs of discomfort in the
modified environment. Participants also felt themselves to be more emotionally and physically
active.
5. Circadian rhythms of the patient had significantly improved.
Subject Outline: SNPG955 Dementia Care Across Settings
© University of Wollongong 2018/1/31. All rights reserved.
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Summary Statement of what was Achieved
Improvements achieved through sun-light therapy are:
- Sleep- wake patterns had improved (circadian rythms)
- Rate of agitation and depression were also reduced among dementia patients.
- Overall mental and emotional behaviour of the dementia patients had improved.
- Dementia patients informed about holistic improvement in overall health.
- Stress among the staff members, family carers and patients had also reduced.
Discussion of the Results
The sun light exposure of individuals suffering with dementia was increased. This exposure to direct
sun light was done for an hour everyday for two weeks. However, the therapeutic intervention was
not employed by the investigator, even though investigator acknowledges the requirement of
applying the therapeutic intervention in the local nursing home.
Various studies have focused on using light therapy for reducing symptoms of dementia among
elderly and for improving their quality of life (Maseda et al, 2014; Hanford and Figueiro, 2013;
Forbes et al, 2014). Studies have also explained that morning bright sun light is very beneficial in
improving the social, physical and psychological health of the people suffering with dementia. Light
therapy has also significant effect on reducing the agitated behaviour among elderly demented people
(Figueiro et al, 2014). High intensity light has found to be beneficial for improving circadian rhythm.
Improvements in agitated behaviour and depression post intervention through sun light therapy
Bright light is found to be a significant treatment possibility for controlling agitated behaviour
among the people suffering with dementia. Late morning light therapy (between 10AM to 12PM) has
found to be very beneficial as the brightness of this light is 10,000 lux brings significant
improvement in CMAI scores when the patients were exposed to such light every day for two weeks
(Hanford and Figueiro, 2013). Study of Munch et al, (2017) explained that exposure to bright light
improves natural external view, enhances the recognition of place, and also improves activity and
Subject Outline: SNPG955 Dementia Care Across Settings
© University of Wollongong 2018/1/31. All rights reserved.
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social interactions. The results of this intervention also displayed improvement in CMAI scores of
patients and proved the earlier findings of impact of bright light in reducing agitated behaviour.
Light therapy also displayed positive effects on reducing depression and depressive symptoms
among individuals suffering with dementia (Figueiro, 2017). Cornell Scale for Depression in
Dementia (CSDD) scores of the patients in long term care facilities have shown that bright light
therapy reduces depression and improves social interactions among elderly. Cognitive and non-
cognitive functions of the elderly people are improved. This cognitive improvement also reduces the
incidence of falls among elderly (Tamrat, Huynh-Le, and Goyal, 2014). Improvement in the visual
system through bright light provides sensory information about location of objects, self position and
external environment. Therefore, bright light improves the sensory input from the vestibular and
somatosensory systems, and helps patients in maintaining their balance, thus reducing falls (Tamrat,
Huynh-Le, and Goyal, 2014; Hanford and Figueiro, 2013).
After the completion of the sun light therapy intervention, it was found that agitation and depression
had reduced among elderly dementia patients CMAI and CSDD results also displayed positive
behavioural and psychological change. Although, the study of Wu et al, (2015) has found that bright
light can have negative effect on psychological factors and can increase depressive symptoms among
elderly suffering with dementia. However, most of the studies have asserted that bright light is
beneficial in improving social and physical health as well as overall well-being of elderly (Barton et
al, 2016; Tamrat, Huynh-Le, and Goyal, 2014).
Effect of Bright sun light therapy on sleeping pattern (circadian rhythms) among dementia
patients
Bright sun light improves the circadian rhythms among patients, as they are helpful in improving the
sensory stimuli and re-establishing the biological clock. This improvement is associated with stable
sleep-wake pattern of patients. Bright light exposure during late morning hours has shown to
improve the sleep-wake pattern, night time sleep, increasing attention and wakefulness during day
time and reducing evening agitation behaviour (Fleming et al, 2016; Hanford and Figueiro, 2013;
Wu et al, 2015). This intervention carried for bright sun light therapy also improved the self reported
health outcomes for the participants. Exposure to bright sun light improved the functioning and
social interaction of participants.
Conclusion
Subject Outline: SNPG955 Dementia Care Across Settings
© University of Wollongong 2018/1/31. All rights reserved.
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This paper focused on discussion the environmental modification to improve health and well-being
of people suffering with dementia. The sun light therapy has been discussed that was employed in the
local nursing home providing care facility to dementia patients. It can be concluded that bright light
therapy and exposure to sun light in late morning hours can be very beneficial for dementia patients,
as it can reduce agitation and depression and can improve length and quality of sleep.
References
Subject Outline: SNPG955 Dementia Care Across Settings
© University of Wollongong 2018/1/31. All rights reserved.
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Barton, C., Ketelle, R., Merrilees, J. and Miller, B., 2016. Non-pharmacological management of
behavioral symptoms in frontotemporal and other dementias. Current neurology and
neuroscience reports, 16(2), p.14.
Dewing, J. and Dijk, S., 2016. What is the current state of care for older people with dementia in
general hospitals? A literature review. Dementia, 15(1), pp.106-124.
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.
Figueiro, M.G., 2017. Light, sleep and circadian rhythms in older adults with Alzheimer's disease
and related dementias. Neurodegenerative disease management, 7(2), pp.119-145.
Fleming, R., Goodenough, B., Low, L.F., Chenoweth, L. and Brodaty, H., 2016. The relationship
between the quality of the built environment and the quality of life of people with dementia in
residential care. Dementia, 15(4), pp.663-680.
Forbes, D., Blake, C.M., Thiessen, E.J., Peacock, S. and Hawranik, P., 2014. Light therapy for
improving cognition, activities of daily living, sleep, challenging behaviour, and psychiatric
disturbances in dementia. The Cochrane Library.
Ganguli, M., 2017. The times they are a-changin’: cohort effects in aging, cognition, and
dementia 1. International psychogeriatrics, 29(3), pp.353-355.
Giménez, M.C., Geerdinck, L.M., Versteylen, M., Leffers, P., Meekes, G.J., Herremans, H.,
Ruyter, B., Bikker, J.W., Kuijpers, P.M. and Schlangen, L.J., 2017. Patient room lighting
influences on sleep, appraisal and mood in hospitalized people. Journal of sleep research, 26(2),
pp.236-246.
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.
Lash, E., 2014. What is Dementia?. The Law and Ethics of Dementia, p.1.
Maseda, A., Sánchez, A., Marante, M.P., González-Abraldes, I., Buján, A. and Millán-Calenti,
J.C., 2014. Effects of multisensory stimulation on a sample of institutionalized elderly people
with dementia diagnosis: a controlled longitudinal trial. American Journal of Alzheimer's Disease
& Other Dementias®, 29(5), pp.463-473.
Munch, M., Schmieder, M., Bieler, K., Goldbach, R., Fuhrmann, T., Zumstein, N., Vonmoos, P.,
Scartezzini, J.L., Wirz-Justice, A. and Cajochen, C., 2017. Bright Light Delights: Effects of Daily
Subject Outline: SNPG955 Dementia Care Across Settings
© University of Wollongong 2018/1/31. All rights reserved.
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Light Exposure on Emotions, Restactivity Cycles, Sleep and Melatonin Secretion in Severely
Demented Patients. Current Alzheimer Research, 14(10), pp.1063-1075.
Strøm, B.S., Ytrehus, S. and Grov, E.K., 2016. Sensory stimulation for persons with dementia: a
review of the literature. Journal of clinical nursing, 25(13-14), pp.1805-1834.
Talebzadeh, A. and Lang, A., 2017. Sensory for dementia, light and sound in long term care
environment.
Tamrat, R., Huynh-Le, M.P. and Goyal, M., 2014. Non-pharmacologic interventions to improve
the sleep of hospitalized patients: a systematic review. Journal of general internal
medicine, 29(5), pp.788-795.
Wu, M.C., Sung, H.C., Lee, W.L. and Smith, G.D., 2015. The effects of light therapy on
depression and sleep disruption in older adults in a long‐term care facility. International journal
of nursing practice, 21(5), pp.653-659.
Subject Outline: SNPG955 Dementia Care Across Settings
© University of Wollongong 2018/1/31. All rights reserved.
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