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: 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
• 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/10649432
• 关键词: Address; Adverse event; Age Years; Alzheimer' s disease related dementia; Ambulatory Care; Assisted Living Facilities; Body Weight decreased; Cessation of life; Cognitive; Cross-Over Trials; Cues; Dangerousness; Dementia; Development; Elderly; Enrollment; Environment; Equilibrium; Event; Family; Family Caregiver; Floor; Hip Fractures; Hospitalization; Impaired cognition; Impairment; Incidence; Individual; Injury; Intervention; Laboratories; Lighting; Modification; Monitor; Musculoskeletal Equilibrium; Nursing Homes; Persons; Phototherapy; 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; Work; awake; community living; cost; dementia care; effectiveness evaluation; effectiveness testing; experience; fall injury; fall risk; falls; functional status; intervention effect; light effects; 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.

项目总结/摘要 患有阿尔茨海默氏病或相关痴呆症，能够走动，夜间醒来构成了一种 这是危险坠落的秘诀增加一个照明系统，促进姿势的稳定性，并可能避免跌倒。 这正是我们最近的NIH R21探索性/发展性随机交叉试验所做的， 我们发现--福尔斯下降了34%，这是由于一种新的照明干预。拟议项目将建立在 初步的努力;如果结果是有希望的建议，这种实用的被动照明系统， 为无数患有阿尔茨海默病和相关疾病的人减少福尔斯和相关后遗症的潜力 痴呆症，并成为一种新的护理标准。 福尔斯是65岁及以上老年人致命和非致命伤害的主要原因。痴呆 是福尔斯的主要危险因素，而辅助生活（AL）社区是住宿护理的主要提供者 对于患有痴呆症的能走动的老年人，使AL成为减少福尔斯的关键环境。四十二 在美国超过811，000名AL居民中，有84%患有中度或重度痴呆症， 超过三分之一的人在六个月内经历过跌倒，使他们成为AL的15% 每年发生髋部骨折或其他严重跌倒相关伤害的居民。福尔斯是造成- 所有AL居民住院的三分之一，由此产生的伤害可能导致一连串的事件，包括 功能恶化转去疗养院死亡 这些福尔斯中有相当一部分发生在晚上和夜间的卧室里，这时AL工作人员不在。 这限制了他们的干预能力。然而，许多福尔斯摔倒的原因-- 夜间视力和相关的姿势不稳定--这表明了一个有希望的干预途径。具体来说， 不需要工作人员的干预，目标是晚上的方向和姿势稳定性 而夜间照明较差，居民可能还没有完全清醒，有很大的潜力，以减少福尔斯在AL。 该项目将测试一种新的干预措施的有效性，包括不引人注目的，低强度，水平 以及垂直的灯，它们勾勒出浴室或居民房间入口门框的轮廓，并提供视觉提示 以促进姿势稳定性。该照明系统是特别有吸引力和实用的，因为它成本低， 不需要员工参与，并且可以很容易地安装在新建筑物或改造现有建筑物。 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，并对他们进行一次随访。 一年，比较夜间福尔斯的发病率在照明条件下， 控制条件;其次，它将决定干预效果是否以及在多大程度上被修改， 居民和环境层面的风险因素，以及对照明系统的满意度。我们预计 照明系统很有希望构成痴呆护理和福尔斯减少的新标准， 适用于阿尔茨海默病和相关痴呆患者居住的所有环境。