"Age Wave" Demands Sea Change

Light's impact on health provides new challenges for design

Source: ARCHITECTURAL LIGHTING Magazine
Publication date: 2006-11-30

By Eunice Noell-Waggoner

"Where are my glasses?" "Please turn up the lights!" "That glare is blinding!" Do you ever hear your parents or even yourself saying these things? Sensory loss is common to the aging process, as witnessed by the number of older people wearing hearing aids and eyeglasses. The automatic response when this happens is to seek help from the medical profession, yet there is a huge role for the design community to create a physical environment that will minimize the effect of sensory loss. With the growth of the 65+ age group expected to peak at 23 percent of the total population between 2030 and 2050, all professional groups will be called upon to meet the challenges posed by this "Age Wave."1

Vision and Aging
Everyone to a greater or lesser degree experiences normal age-related changes to the eye. In addition, the prevalence of eye diseases increases with age, compounding the problems of an already impaired visual system. Visual impairment represents one of the most significant health problems of older people because of the associated dangers affecting the rest of the body, i.e. fall-related hip fractures. Falls are the leading cause of accidental death in the senior population. About 20 percent of seniors who suffer a hip fracture die within a year of the fracture.2

Discoveries in the last few years of the retinal ganglion cells, which provide input to our circadian system (keeping our sleep/wake cycle synchronized with the night/day cycle of light) and the action spectra of 446-477 nanometers as the most potent wavelength region,3 provide additional objectives for a successful lighting design project. Since this range is shifted toward the shorter wavelength, or the blue part of the spectrum (similar to the light of a blue sky), there is added incentive to increase the use of daylight within spaces used by people of all ages, and especially for the senior population.

The normal effect of age-related changes to the eye include less light reaching the retina, increased sensitivity to glare, longer adaptation time required for changes in brightness, loss of contrast sensitivity, loss of accommodation, and distortion of colors due to the yellowing of the lens. Of these six age-related changes to the eye, only one, accommodation, can be corrected by wearing glasses or corrective lenses. The other changes can best be addressed in the physical environment by providing the appropriate quantity and quality of light and increased value contrast between objects and their background, or at a change of level, i.e. the edge of a step or counter edge.

Light Quality
The prescription for quality lighting for older adults is best achieved by using layers of light combining ambient, accent, task, and glow (instead of sparkle). Some considerations to account for are:

• Ambient light must be even and consistent within a space and from one space to another, providing light on the vertical surfaces, avoiding scalloped patterns on the walls or pools of light and/or shadows on the floor. Yes, this does mean that we must end our addiction to recessed downlights.
• Glare is enemy #1! Whether the source is daylight or electric light, direct and reflected glare must be controlled and diffused.
• Provide as much balanced daylight as possible within a space. Fenestrations with diffused glazing located above the field of view are preferred, since they avoid the problems created by glare and shadows.
• It is important to use high-frequency electronic ballasts to avoid flicker and hum associated with the soon to be obsolete magnetic ballasts.
• Light sources rated high on the color-rendering index best minimize the effect of the yellowing lens of the eye. Whereas some designers (and adult children of aging parents) may consider the color of an incandescent light source in the 2700K to 3000K range more residential, older people continually request whiter light sources, especially for task lighting.
• Lighting for visual tasks must include all activities of daily living--grooming, bathing, cooking, cleaning, selecting and matching clothing, laundry, reading and paperwork, and most of all, leisure activities such as crafts and hobbies.

Light Quantity
The quantity of light needed for both task and ambient light will vary depending upon individual needs. It is generally accepted that people 60 years of age will receive only one-third the amount of light on the retina as compared to that of people 20 to 30 years of age. Given this and the extreme importance of greater independence and safety, we must begin to design for the "optimum" light level, rather than the "minimum." If you are designing a private residence, be certain to determine the lighting needs of all individuals living there. If the project is a long-term care facility, be aware that the average age of people living in assisted living facilities and nursing homes is 85 years of age. Residents in this age group will experience even greater reduction of light reaching the retina. The best guide for recommended light levels for long-term care facilities can be found in the IESNA/ANSI document: <i>RP-28-2001 Lighting and the Visual Environment for Senior Living</i>.

Indirect lighting is a great solution to providing high ambient light levels without glare. Since linear indirect luminaires are associated with commercial or institutional type building projects, the integration of lighting into architectural elements, i.e. ceiling coffers, ceiling and wall coves, and above the line of sight on top of bookcases and upper cabinets, allows for the use of long energy-efficient fluorescent lamps, while preserving the residential quality of the space. This approach requires close teamwork early on in the design process amongst the lighting designer, architect, and the other design team members.

Residential Lighting Considerations
Residential settings require a distinctly different approach to lighting for day and night use. Flexible lighting designs are important in the public areas of the home in order to accommodate a variety of uses, ranging from entertaining, group meetings where people may need to read, day-to-day living, and housekeeping. If the client is in the 60+ age range, many of their friends will be in that same age group. However, these individuals may not be familiar with the layout of the home. Using contrasting light and dark materials to define the floor and step(s), plus lighting to illuminate the step or level change, will help individuals maneuver safely in and through the space. Often, the lighting design in high-end residential settings is high contrast--dramatic lighting for cocktail parties, however, this ignores the routine visual activities of daily life.

Bedroom and bathroom areas need to be designed with different lighting options for both day and night use. Sleep disorders are a common problem for older people. As a result, many take naps off and on during the day, and use the bedroom for activities besides sleeping, such as resting, watching television, and reading. Ambient and task light are needed for these daytime activities. The room should be dark while sleeping. It is also common for older people to get up during the night to use the bathroom. In this semi-awake/sleep state, eyes are adapted to the dark, so illumination levels of night lighting should be low. A lighted switch near the bed will allow an individual to turn the light on and off as needed. Light sources, which are warm in color and located near the floor, are best for this situation. The goal is to provide just enough light for a person to safely find their way to and from the bathroom, without waking up completely due to exposure from bright light at night.

In all areas, long lamp life is essential. No matter who is responsible for changing the lamps, whether it is the maintenance staff or the older home owner, the replacement of a burned-out lamp may not happen quickly. Keeping seniors off ladders is also a safety issue.

Daylight Exposure
Sleep and activity rhythms are the most common and easily observable circadian rhythm, although core body temperature, appetite, and hormonal secretions are also included. As mentioned, sleep disorders are a problem for older people; in fact only 20 percent report that they have no difficulty with sleep.4 As people age they are less mobile, and as mobility decreases so does their exposure to daylight. Seniors living in the community receive less daylight exposure than younger people, but seniors living in long-term care facilities are the most daylight deprived. Without the necessary exposure to daylight their body clocks desynchronize, resulting in a higher percentage of sleep disorders for older people living in institutional settings than age-matched people living in the community.

Lighting Public Spaces
Retirement provides more leisure time to engage in activities outside the home, including travel, shopping, dining and volunteering. Sixty-five percent of seniors do volunteer work. The lighting in these buildings--daycare centers, grade schools, and medical facilities--should not be the barrier to keep them from enjoying their leisure time, spending their money, or donating their services.

Recently, an unexpected advocate for appropriate lighting has come to the fore. The consequences of visual impairment, i.e. fall-related hip fractures and the associated medical costs, are now attracting the attention of the federal government. United States Surgeon General Richard Carmona, MD, MPH, FACS, lists "improving lighting" along with other recommendations to reduce the anticipated risk of fractures in the 50+ population.5 With the new focus by the Center for Medicare and Medicaid Services (CMS) on home or community-based senior care, rather than the traditional nursing home or assisted living facility, there is an even greater imperative to design homes appropriately to serve the "Age Wave" that will be cresting soon.

Final Thought
To serve an older population, the design community must create lighting schemes based on perceptions other than our own. Design for the "optimum" condition rather than the "minimum", and include health factors along with traditional lighting objectives. In particular, the standard practices of residential lighting design needs to change today to meet the requirements of the current aging population. Soon enough we will join the ranks of the 65+ and become dependent upon younger people to understand our needs. How can we expect others to address these lighting deficiencies if we do not address them ourselves and take the necessary steps, today, to remedy them?

<i>Eunice Noell-Waggoner is President of the Center of Design for an Aging Society, a not-for-profit organization dedicated to improving the built environment to maximize abilities of older people. The Center recently developed and published "Lighting Your Way to Better Vision," an informational booklet for the general public. She is also the founding chair and a current member of the Lighting for Aging and Partially Sighted Committee of the IESNA.</i>

1Dychtwald K, Flower J. Age Wave--The Challenges and Opportunities of an Aging America. New York: J.P. Tarcher, 1988.
2U.S. Department of Health & Human Services Press Office. "By 2002, One in Two Americans Over Age 50 will be at Risk for Fractures from Osteoporosis or Low Bone Mass". News Release. October 14, 2004.
3Brainard GC, Hanifin JP, Greeson JM, Byrne B, Glickman G, Gerner E, and Rollag MD. "Action Spectrum for Melatonin Regulation in Humans: Evidence for a Novel Circadian Photoreceptor," J. Neurosci. 21 (2001) 6405-6412.
4Chen, CK, Sloane, PD, Dalton, MT, Sheps, CG. "Lighting and Circadian Rhythm and Sleep in Older Adults: Technical Memorandum #1007708." Palo Alto, CA: EPRI; New York: IESNA; Solon, OH: Venture Lighting International, 2003.
5See footnote 2. Ibid.