A Pragmatic Crossover Trial to Test the Effectiveness of a Novel Lighting System to Reduce Nighttime Falls in Persons with Alzheimer’s Disease and Related Dementias

一项务实的交叉试验，旨在测试新型照明系统在减少阿尔茨海默病和相关痴呆症患者夜间跌倒方面的有效性

• 批准号: 10342711
• 负责人: Sheryl Zimmerman
• 金额: $ 83.02万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10342711
• 关键词: Address; Adverse event; Age-Years; Alzheimer' s Disease; Alzheimer' s disease related dementia; Ambulatory Care; Assisted Living Facilities; Cessation of life; Cognitive; Cross-Over Trials; Cues; Dangerousness; Dementia; Development; Effectiveness; Elderly; Enrollment; Environment; Equilibrium; Event; Family; Family Caregiver; Fibrinogen; Floor; Hip Fractures; Hospitalization; Impaired cognition; Impairment; Incidence; Individual; Injury; Intervention; Laboratories; Lead; Lighting; Modification; Monitor; Musculoskeletal Equilibrium; Nursing Homes; Persons; Pilot Projects; Posture; Preventive; Privatization; Provider; Randomized; Recipe; Recording of previous events; Research; Residential Treatment; Risk Factors; Sampling; System; Time; United States National Institutes of Health; Vision; Visual; Visual impairment; Weight; Work; awake; community living; cost; dementia care; effectiveness testing; experience; fall injury; fall risk; falls; functional status; intervention effect; novel; posture instability; residence; satisfaction; sleep pattern; standard of care

Project Summary/Abstract Having Alzheimer's disease or a related dementia, being ambulatory, and awakening in the night constitute a recipe for a dangerous fall. Add a lighting system that promotes postural stability, and the fall may be avoided. That is exactly what our recent NIH R21 exploratory/developmental randomized crossover trial did, and exactly what we found -- a 34% decrease in falls due to a novel lighting intervention. The proposed project will build on that preliminary effort; if the results are as promising as suggested, this pragmatic passive lighting system has the potential to reduce falls and related sequelae for countless persons with Alzheimer's disease and related dementias, and to become a new standard of care. Falls are the primary cause of fatal and non-fatal injuries among persons 65 years of age and older. Dementia is a major risk factors for falls, and assisted living (AL) communities are the primary provider of residential care for ambulatory older adults with dementia, making AL a critical setting in which to reduce falls. Forty-two percent of the more than 811,000 AL residents across the U.S. have moderate or severe dementia, 84% are ambulatory, and more than a third experience a fall in a six-month period, putting them among the 15% of AL residents who suffer a hip fracture or other serious fall-related injury each year. Falls are responsible for one- third of all hospitalizations of AL residents, and the resulting injuries may lead to a cascade of events, including worsening function, nursing home transfer, and death. A significant number of these falls occur in the bedroom during the evening and night, when AL staff are not present, thereby limiting their ability to intervene. However, the cause of many of these falls -- impaired nighttime vision and related postural instability -- suggests a promising avenue for intervention. Specifically, an intervention that does not require staff effort, and that targets orientation and postural stability in the evening and night when lighting is poor and residents may not be fully awake, has great potential to reduce falls in AL. This project will test the effectiveness of a novel intervention consisting of unobtrusive, low-intensity, horizontal and vertical lights that outline the bathroom or entry way doorframe in residents' rooms and provide visual cues to promote postural stability. The lighting system is particularly attractive and pragmatic because it is low cost, requires no staff involvement, and can be easily installed in new buildings or retrofitted to existing buildings. Specifically, this pragmatic crossover trial will enroll 390 AL residents with dementia and follow them for one year, comparing the incidence of nighttime falls during the lighting condition to the incidence of falls during the control condition; secondarily, it will determine whether and to what extent the intervention effect is modified by resident- and environmental-level risk factors, and satisfaction with the lighting system. We expect that the lighting system holds great promise to constitute a new standard of dementia care and falls reduction, appropriate for use in all settings in which persons with Alzheimer's disease and related dementias reside.

项目概要/摘要 患有阿尔茨海默氏病或​​相关痴呆症、能走动并在夜间醒来构成一种 危险跌倒的秘诀。添加可促进姿势稳定性的照明系统，可以避免跌倒。 这正是我们最近的 NIH R21 探索性/发育性随机交叉试验所做的，而且也正是如此 我们发现——由于采用了新颖的照明干预措施，跌倒次数减少了 34%。拟议的项目将建立在 初步的努力；如果结果如建议的那样有希望，那么这种实用的被动照明系统已经 为无数患有阿尔茨海默病及相关疾病的人减少跌倒和相关后遗症的潜力 痴呆症，并成为新的护理标准。 跌倒是 65 岁及以上人群致命和非致命伤害的主要原因。失智 是跌倒的主要危险因素，辅助生活 (AL) 社区是住宿护理的主要提供者 对于患有痴呆症的流动老年人来说，AL 成为减少跌倒的关键环境。四十二 美国超过 811,000 名 AL 居民中，84% 患有中度或重度痴呆症 门诊，超过三分之一的人在六个月内经历过跌倒，使他们跻身 AL 的 15% 之列 每年遭受髋部骨折或其他严重跌倒相关伤害的居民。跌倒造成的原因之一是—— 阿拉巴马州居民住院人数的三分之一，由此造成的伤害可能会导致一系列事件，包括 功能恶化、疗养院转移和死亡。 大部分跌倒发生在晚上和夜间的卧室，此时 AL 工作人员不在家。 存在，从而限制了他们的干预能力。然而，许多跌倒的原因是——受损 夜间视力和相关的姿势不稳定——表明了一种有希望的干预途径。具体来说，一个 不需要工作人员努力的干预，旨在晚上定向和姿势稳定 夜间照明较差，居民可能无法完全清醒，有很大潜力减少 AL 跌倒。 该项目将测试一种新颖的干预措施的有效性，该干预措施包括不引人注目的、低强度的、横向的 垂直灯勾勒出居民房间的浴室或入口门框并提供视觉提示 以促进姿势稳定性。该照明系统特别有吸引力且实用，因为它成本低廉， 不需要工作人员参与，并且可以轻松安装在新建筑物中或对现有建筑物进行改造。 具体来说，这项务实的交叉试验将招募 390 名患有痴呆症的 AL 居民，并跟踪他们进行一项 年，将照明条件下夜间跌倒的发生率与白天跌倒的发生率进行比较 控制条件；其次，它将确定干预效果是否以及在何种程度上被修改 居民和环境层面的风险因素以及对照明系统的满意度。我们期望 照明系统有望成为痴呆症护理和减少跌倒的新标准， 适用于阿尔茨海默病和相关痴呆症患者居住的所有环境。