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(ADRD)患者至少经历过一次行为 痴呆症心理症状(BPSD)。激动是最常见和最具挑战性的BPSD之一， 尤其是在患有ADRD的疗养院(NH)居民中。因此，确定一种有效的、非药理学的 为减少骚动和其他BPSD而进行的干预至关重要。照明对患有ADRD的人很重要，特别是 那些生活在NHS的人，因为他们没有暴露在足够的日光下。照明干预(LIS)旨在调节 视交叉上核，维持稳定的昼夜节律，减少躁动。LIS是非侵入性的，并具有 不良反应最小，使其成为ADRD患者的理想干预措施。有证据表明， LIS显示ADRD患者的激动症和其他BPSD症状有所改善。然而，LIS并没有得到广泛的应用 在“真实世界”的护理环境中实施。使用灯箱的传统方法需要ADRD患者 坐着并保持眼睛朝向强光会导致合规和工作量问题。更高效的 交付LIS的方法是必要的。人们对设计具有通过以下方式提供LIS的能力的NHS产生了兴趣 环境光列表。虽然有几项研究报道了环境LIS对情绪激动的积极影响，但这些研究 在关闭窗帘以最大限度减少日光的设置下进行。将环境照明作为一种可行的 为了进行有效的干预，需要解决几个根本差距：1)可行的实施办法 环境LIS，以及2)干预保真度(确保参与者接收的照明符合目标)。这 提议的研究寻求开发智能环境亮光(SAPL)干预以提供自动控制， 结合自然日光的一致的室内照明。该SABL包括可调LED灯， 光电传感器和控制器。SABL系统有一个预先编程的24小时控制表， 照度设置以模拟自然的明暗循环，并将自动调整灯光以适应 日光效应，最大限度地减少员工负担，最大限度地发挥LI效应。SABL将安装在参与者的 卧室和餐厅和活动室的指定区域，为期4周。每一位参赛者都将穿着 一个个人灯光监测器来测量每个参与者接受的照明剂量。这项研究将涉及三个问题 目的：1)初步测试sabl对ADRD患者减少激越的效果，2)评估sabl的保真度。 3)评估实施《萨班斯-贝尔格莱德公约》的可行性。这项研究将在两个NHS中进行 在宾夕法尼亚州。对于AIMS 1和AIMS 2，我们将使用交叉、整群随机对照试验(RCT)并登记 40名患有ADRD和骚动的居民。对于目标3，我们将使用混合方法设计，并将访问16个NH 工作人员/管理人员评估干预的可接受性、可行性和适当性。这是 第一项将日光纳入环境光干预的研究，以及第一项针对 照明干预的测量、可行性和保真度。调查结果将建立以证据为基础的 英国国民健康保险制度中减少ADRD患者焦虑的SABL实施策略和最佳设计。

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.