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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

基本信息

批准号：
10649432
负责人：
Sheryl Zimmerman
金额：
$ 129.29万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
依托单位国家：
美国
项目类别：
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

项目摘要

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.

项目总结/文摘