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

智能环境强光对患有阿尔茨海默病和相关痴呆症的疗养院居民的影响

• 批准号: 10508641
• 负责人: Ying-Ling Jao
• 金额: $ 29.33万
• 依托单位: PENNSYLVANIA STATE UNIVERSITY, THE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-15 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10508641
• 关键词: Address; Administrator; Adverse effects; Affect; Agitation; Alzheimer' s disease related dementia; American; Antipsychotic Agents; Area; Behavioral Symptoms; Caregivers; Caring; Circadian Dysregulation; Circadian Rhythms; Clinical; Consensus; Data; Dementia; Discipline of Nursing; Employee; Engineering; Enrollment; Ensure; Eye; Hour; Individual; Institutes; Intervention; Interview; Light; Lighting; Link; Maintenance; Measurement; Measures; Melatonin; Mental Depression; Methods; Monitor; Nurse Administrator; Nurses; Nursing Homes; Participant; Pennsylvania; Persons; Pharmacological Treatment; Phase; Population; Procedures; Randomized; Randomized Controlled Trials; Recommendation; Reporting; Research Personnel; Sampling; Schedule; Scheme; Site; Societies; Stimulus; Stress; Surveys; Symptoms; System; Testing; Work; Workload; base; circadian; cost; design; dosage; effective intervention; evidence base; experience; implementation strategy; inclusion criteria; interest; intervention effect; nursing intervention; pilot test; poor sleep; post intervention; psychological symptom; recruit; sensor; sleep quality; suprachiasmatic nucleus

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.

抽象的 多达90％的阿尔茨海默氏病和相关痴呆症（ADRD）的人至少有一种行为 和痴呆症的心理症状（BPSD）。搅动是最常见和挑战BPSD之一， 特别是在ADRD的护士住宅（NH）居民中。这是确定有效的，非药理的 减少搅拌和其他BPSD的干预措施至关重要。照明对ADRD的人很重要，尤其是 那些居住在NHS的人，因为他们没有接触到足够的日光。照明干预措施（LIS）调节 核上核能，保持稳定的昼夜节律并减少搅动。 lis不是侵入性的，有 最小的不良影响，使其成为ADRD患者的理想干预措施。有证据表明 LIS对ADRD患者的搅动和其他BPSD显示出改善。但是，LIS并未被广泛广泛 在“现实世界”护理环境中实施。传统方法使用需要ADRD的人的轻盒 坐着并保持眼睛朝着明亮的灯光朝向，导致了合规性和工作量问题。更有效 运送LI的方法是必要的。在设计NHS的能力方面引起了兴趣 环境lis。尽管一些研究报告了环境LI对搅拌的积极影响，但这些研究是 在设置的情况下进行窗帘，以最大程度地减少日光。建立环境照明作为可行的 和有效的干预措施，需要解决一些基本差距：1）可行的实施方法 到周围的LI和2）干预保真度（确保参与者收到的照明达到目标）。这 拟议的研究旨在开发智能的环境明亮光（SABL）干预措施，以提供自动控制的， 一致的室内照明包含自然日光。此SABL包含可调的LED灯， 光电传感器和控制器。 SABL系统具有预先编程的24小时控制时间表 照明设置以模仿自然的亮黑色周期，并将自动调整灯光以容纳 日光效应最小化员工燃烧并最大化LI效果。 SABL将安装在参与者中 餐厅和活动室的卧室和指定区域4周。每个p板块都会佩戴 个人照明监视器测量每个参与的照明剂量。这项研究将解决三个 目的：1）试点测试SABL对减少ADRD的搅动的影响，2）评估 SABL交付和3）评估实施SABL的可行性。该研究将在两个NHS中进行 在宾夕法尼亚州。对于目标1和2，我们将使用跨界，群集随机对照试验（RCT），并将注册 40名居民有狂热和躁动。对于AIM 3，我们将使用混合方法设计，并将采访16 NH 员工/管理员评估干预措施的可接受性，可行性和适当性。这是 将日光纳入环境光干预措施的第一项研究，以及第一个针对的研究 照明干预措施的测量，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的人的搅动。