The Effect of Smart Ambient Bright Light for Nursing Home Residents with Alzheimer's Disease and Related Dementias

摘要 高达90%的阿尔茨海默病和相关痴呆症（ADRD）患者至少经历一种行为障碍。 和痴呆的心理症状（BPSD）。躁动是最常见和最具挑战性的BPSD之一， 特别是在患有ADRD的疗养院（NH）居民中。因此，确定一种有效的、非药理学的 减少躁动和其他BPSD的干预至关重要。照明对ADRD患者很重要，尤其是 那些住在NHS的人，因为他们没有暴露在充足的日光下。照明干预（LI）的工作，以调节 视交叉上核，维持稳定的昼夜节律，减少躁动。LI不是侵入性的， 最小的副作用，使其成为ADRD患者的理想干预措施。有证据表明， LI显示ADRD患者的激越和其他BPSD改善。然而，LIs并没有被广泛地 在“真实的世界”护理环境中实施。使用灯箱的传统方法需要ADRD患者 坐着并保持眼睛朝向明亮的光线，这会导致依从性和工作量问题。更有效的 提供LI的方法是必要的。人们对设计具有通过以下方式提供LI的能力的NH产生了兴趣 环境LI。虽然一些研究报告了环境LI对躁动的积极影响，但这些研究 在关闭窗帘以尽量减少日光的情况下进行。建立环境照明作为可行的 为了有效地进行干预，需要解决以下几个根本性的差距：1）可行的实施方法 2）干预保真度（确保参与者接收到的照明符合目标）。这 拟议的研究旨在开发一种智能环境亮光（SABL）干预， 一致的室内照明，包括自然光。该SABL包括可调谐LED灯， 光电传感器和控制器。SABL系统具有预编程的24小时控制时间表， 照明度设置，以模仿自然的明暗周期，并会自动调整灯光，以适应 日光效应，以最大限度地减少工作人员的负担，并最大限度地提高LI效应。SABL将安装在参与者的 睡房及饭厅和活动室的指定区域，为期4周。每位参赛者将佩戴 个人光监控器，用于测量每个参与者接收的照明剂量。本研究将探讨三个 目的：1）初步测试SABL减少ADRD患者激越的效果，2）评估 SABL交付，3）评估实施SABL的可行性。本研究将在两个国家卫生机构进行 在宾夕法尼亚州对于目标1和2，我们将使用交叉、整群随机对照试验（RCT），并将招募 40个有焦虑症和躁动的居民对于目标3，我们将使用混合方法设计，并将采访16名NH 工作人员/管理人员评估干预措施的可接受性、可行性和适当性。这是 第一项研究，将日光纳入环境光干预和第一项研究， 照明干预的测量、可行性和保真度。调查结果将建立基于证据的 SABL的实施策略和最佳设计，以减少NHS中ADRD患者的躁动。

Abstract Up to 90% of people with Alzheimer’s disease and related dementias (ADRD) experience at least one behavioral and psychological symptom of dementia (BPSD). Agitation is among the most common and challenging BPSD, especially in nursing home (NH) residents with ADRD. Thus, identifying an effective, non-pharmacological intervention to reduce agitation and other BPSDs is critical. Lighting is important for people with ADRD, especially those living in NHs, as they are not exposed to sufficient daylight. Lighting interventions (LIs) work to regulate suprachiasmatic nuclei, maintain stable circadian rhythm and reduce agitation. LIs are not invasive and have minimal adverse effects, making them ideal interventions for persons with ADRD. Evidence has reported that LIs show improvement in agitation and other BPSDs for persons with ADRD. However, LIs have not been widely implemented in “real world” care settings. Traditional methods using light boxes that required persons with ADRD to sit and keep their eyes oriented toward a bright light led to compliance and workload issues. A more efficient approach to deliver LIs is necessary. Interest has arisen in designing NHs with the capability of providing LIs via ambient LIs. While a few studies have reported positive effects of ambient LIs on agitation, these studies were conducted in settings with window shades closed to minimize daylight. To establish ambient lighting as a feasible and effective intervention, a few fundamental gaps need to be addressed: 1) a feasible implementation approach to ambient LIs, and 2) intervention fidelity (ensuring the lighting received by participants meets the targets). This proposed study seeks to develop a smart ambient bright light (SABL) intervention to provide auto-controlled, consistent indoor lighting that incorporates natural daylight. This SABL includes tunable LED lights, photosensors, and controllers. The SABL system has a pre-programmed 24-hour control schedule for illuminance settings to mimic the natural bright-dark cycle and will automatically adjust the lights to accommodate the daylight effect to minimize staff burden and maximize the LI effect. The SABL will be installed in participants’ bedrooms and designated areas in the dining rooms and activity rooms for 4 weeks. Each pparticipant will wear a personal light monitor to measure the lighting dosage each participant receives. This study will address three aims: 1) pilot test the effect of SABL on reducing agitation in persons with ADRD, 2) evaluate the fidelity of the SABL delivery, and 3) evaluate the feasibility of implementing the SABL. The study will be conducted in two NHs in Pennsylvania. For aims 1 and 2, we will use a crossover, cluster randomized control trial (RCT) and will enroll 40 residents with ADRD and agitation. For aim 3, we will use a mixed methods design and will interview 16 NH staff/administrators to evaluate the acceptability, feasibility, and appropriateness of the intervention. This is the first study that incorporates daylight in ambient light interventions and the first study that addresses the measurement, feasibility, and fidelity of lighting interventions. Findings will establish evidence-based implementation strategies and best design for SABL to reduce agitation for persons with ADRD in NHs.