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 高达 90% 的阿尔茨海默病及相关痴呆症 (ADRD) 患者至少经历过一种行为 和痴呆的心理症状（BPSD）。激越是最常见和最具挑战性的 BPSD 之一， 尤其是患有 ADRD 的疗养院 (NH) 居民。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。照明对于 ADRD 患者很重要，尤其是 那些生活在 NH 中的人，因为他们没有接触到足够的日光。照明干预 (LI) 的作用是调节 视交叉上核，维持稳定的昼夜节律，减少躁动。 LI 不具有侵入性，并且具有 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 LI 显示 ADRD 患者的躁动和其他 BPSD 有所改善。但 LI 尚未得到广泛应用 在“现实世界”的护理环境中实施。使用灯箱的传统方法需要 ADRD 患者 坐着并让眼睛盯着明亮的光线会导致合规性和工作量问题。一个更高效的 交付 LI 的方法是必要的。人们对设计能够通过以下方式提供 LI 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 在关闭窗帘以最大程度减少日光的环境中进行。将环境照明建立为可行的 和有效的干预，需要解决一些基本差距：1）可行的实施方法 环境 LI，以及 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一种智能环境强光（SABL）干预，以提供自动控制、 融合自然光的一致室内照明。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 小时控制时间表 照度设置模仿自然的明暗循环，并会自动调整灯光以适应 日光效应可最大限度地减少员工负担并最大化 LI 效应。 SABL 将安装在参与者的 卧室以及餐厅和活动室的指定区域，为期 4 周。每位参赛者将佩戴 个人光监视器，用于测量每个参与者收到的照明剂量。本研究将解决三个问题 目标：1) 试点测试 SABL 对减少 ADRD 患者躁动的效果，2) 评估 SABL 的保真度 SABL 交付，以及 3) 评估实施 SABL 的可行性。该研究将在两个新罕布什尔州进行 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 名患有 ADRD 和躁动的居民。对于目标 3，我们将使用混合方法设计并采访 16 个 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 第一项将日光纳入环境光干预的研究，也是第一项解决这一问题的研究 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 NH 中 ADRD 患者的焦虑。