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

项目摘要/摘要 患有阿尔茨海默氏症或相关的痴呆症、能走动以及在夜间醒来是一种 危险跌倒的秘诀。增加一个促进姿势稳定的照明系统，就可以避免摔倒。 这正是我们最近的NIH R21探索性/发育随机交叉试验所做的，也正是 我们发现，由于一种新的照明干预措施，跌倒的几率减少了34%。拟议的项目将建立在 这一初步努力；如果结果如所说的那样有希望，这种实用的被动照明系统 无数阿尔茨海默病及其相关患者减少跌倒和相关后遗症的可能性 痴呆症，并成为一种新的护理标准。 跌倒是65岁及以上老年人致命性和非致命性伤害的主要原因。痴呆症 是跌倒的主要危险因素，而辅助生活(AL)社区是住宿护理的主要提供者 对于患有痴呆症的非卧床老年人，AL成为减少跌倒的关键环境。四十二个 在全美超过811,000名AL居民中，有84%患有中度或重度痴呆症， 非卧床的，超过三分之一的人在六个月内经历过跌倒，使他们跻身于15%的AL 每年遭受髋部骨折或其他与跌倒相关的严重伤害的居民。瀑布造成了一起- 第三，AL居民的住院，以及由此造成的伤害可能导致一系列事件，包括 功能恶化、养老院转院和死亡。 其中相当多的跌倒发生在晚上和夜间的卧室里，而AL工作人员不在 因此限制了他们的干预能力。然而，其中许多跌倒的原因--受损 夜间视力和相关的姿势不稳定--暗示了一种有希望的干预途径。具体地说，一个 不需要工作人员努力的干预，目标是在晚上保持姿势和姿势稳定 夜间光线不佳，居民可能没有完全清醒时，有很大的潜力减少AL的跌倒。 该项目将测试一种新的干预措施的有效性，该干预措施由不显眼的、低强度的、水平的 和垂直灯光，勾勒出卫生间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。照明系统特别吸引人和实用，因为它成本低， 无需工作人员参与，可轻松安装在新建筑中或改装到现有建筑中。 具体地说，这项务实的交叉试验将招募390名患有痴呆症的AL住院患者，并对他们进行一次跟踪 年，比较照明条件下夜间跌倒的发生率与 控制条件；其次，它将决定是否以及在多大程度上改变干预效果 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中。

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.