Updated: Jun 24, 2021
It may seem a simple thing, but lighting can have a significant impact on people with dementia. It is one of the first things you should consider when designing a dementia friendly home and can even be an important part of dementia therapy. The proper lighting will make the person safer and happier, generally improving their quality of life.
Creating a dementia friendly home
The most important aspect of lighting in a dementia friendly home is a combination of safety and atmosphere. A person with dementia may have poor vision and distorted perception, alongside the other eye problems that often develop with age. Bright lighting ensures space is easier to navigate and reduces potential sources of confusion, minimising the risk of trips and falls. It can also create a warmer, more welcoming aura that makes the room a more comfortable place to live.
Obviously, for any person to be safe and happy in their home, they need to be able to find their way through that environment. For most people, this means adequate lighting to identify rooms, doors, furniture and other obstacles, as well as being able to read any signage or labels. Lighting also helps communication by making people and body language more visible.
Deteriorating eyesight is a common side effect of ageing, but it can be made even worse when someone has dementia. The ability to detect colour and contrast can diminish, making it difficult for the person living with dementia to perceive their surroundings or interpret them. People with dementia can also be easily confused and distressed because of shadows or reflections, both of which can be magnified by the wrong kind of lighting. People with dementia must have regular eye tests to monitor any deteriorating vision.
Flexibility can also be important, especially if people with differing needs are living in the same space. Any lighting plan needs to be discussed with everyone involved to attempt to incorporate their various requirements. It is crucial that everyone can feel in control of their lighting, just as they do their home in general. This will improve comfort as well as safety.
Daylight is the best kind of light and should be utilised as much as possible. This means making sure that windows and doors are large and kept clean. Trim hedges and move furniture to allow light clear passage, and make use of gardens and balconies. Curtains and blinds should be closed after dark to prevent reflections in the glass, but during the day, left open where possible to maximise light.
Not only is daylight bright, better at distinguishing colour and good over larger areas, it means you can maintain the natural cycle of day and night, improving the body's rhythms and encouraging nighttime sleep. Daylight is also an essential source of vitamin D and can help improve mood, so people living with dementia should try and spend regular time in the sun.
Where artificial lights are utilised, they should be bright (make sure bulbs are changed regularly, as soon as they start to dim) and well-dispersed through the room to avoid shadows and reduce glare. Consistent intensity of lighting can also help avoid confusion and distress. Older energy-efficient lightbulbs sometimes take too long to reach full strength, but this is less of a problem with more modern versions.
Ensure that important and potentially dangerous areas, such as stairwells, kitchens and bathrooms, are well lit, but avoid too much bright light in restful areas like the bedroom. You can target lighting for specific tasks. This may include on keyholes at exterior doors, strip lighting for kitchen counters situated under overhead cabinets, or shower areas.
Automatic sensors can switch lights on automatically either when it gets dark or when they detect movement. These may make it easier to manage light levels without relying on memory. Any light switches should be easy to find and use, possibly by being painted a different, contrasting colour to the surrounding wall.
Does light affect dementia?
Lighting is not just about creating a safe and welcoming environment for a person with dementia to live. Some forms of dementia therapy utilise lighting, particularly through what is known as bright light therapy (also known as phototherapy). This type of therapy requires the person living with dementia to sit in front of a lightbox for a certain amount of time every day. This lightbox can be as much as 30 times brighter than a standard office light, though it starts at five times more.
Traditionally, light therapy has been used to treat the seasonal affective disorder (SAD) and other types of depression. It has also been used to help people with problems with their circadian rhythms (the body's "internal clock") to establish more "normal" sleep patterns. Sleep patterns and mood are both things that can be negatively impacted by dementia.
While the research into how bright light therapy can be utilised with dementia patients is still in its early stages, preliminary studies suggest it may help people with dementia sleep better at night, alleviating restlessness and reducing daytime sleeping. It may also reduce depressive symptoms and some aggression, as well as improving cognition. Other studies suggest it may reduce wandering behaviour, although again, these studies are small and inconclusive.
Bright light therapy does not have the same side effects as many of the medications used to manage dementia and sleep disorders. Therefore, it may be a complementary therapy that you wish to consider, although it may not be appropriate in all cases. Some patients may find the bright light distressing or struggle to sit still long enough for it to work. Any new therapy should first be discussed with your doctor.
What is sundowning for dementia patients?
Sometimes, people with dementia will show particularly pronounced changes in mood or behaviour through late afternoon and early evening, as dusk falls and natural light diminishes. This is known as sundowning. It often involves an increase in anxiousness or irritation. Other known symptoms include pacing, shouting and more general confusion. For example, the dementia patient may try to attend a non-existent appointment. This can, in turn, lead to disrupted sleep and difficulties the next day for both the person with dementia and their family or caregivers.
Sundowning is the effect of a combination of factors. It may be part of the larger disruption of the natural body clock caused by dementia's physical changes to the brain. Sometimes it is simply to do with tiredness, which obviously increases through the day. Dehydration, hunger, boredom, depression and physical pain can also contribute. As the world darkens, most people are settling down, but if people with dementia believe they are in the wrong place, they will be unable to do the same.
There are ways to avoid or at least reduce the impact of sundowning:
• Establish a daily routine. This should include plenty of activities enjoyed by the person with dementia.
• Incorporate mild exercise into that routine, such as going for a walk, even if it is just going to the shop. Avoid activities that are too strenuous and tiring.
• Create an evening routine as well, but ensure it is calm and quiet, as sudden loud noises can disturb a person with dementia. That means moderating the television and radio.
• Reduce daytime napping to encourage nighttime sleep.
• Cover mirrors and other reflective surfaces to reduce potential sources of distress.
• Avoid caffeine and alcohol.
• Avoid large evening meals.
• Switch on lights and close curtains before it is fully dark so it will be easier to adjust to approaching night. This can also reduce reflections and shadows.
• Keep conversation simple and direct, with easy to follow instructions, to reduce confusion.
There are also ways to manage sundowning during the evening:
• Keep your speech slow and calming, with a soothing tone, when talking to someone with dementia.
• Offer physical comfort if desired, such as handholding or sitting close by (obviously, do not do this if it causes them more distress).
• If they do seem distressed, ask them what is wrong and listen carefully to the answer.
• Create distractions, such as having a drink or snack, or moving to a different room. You may want to play some gentle music, although nothing too loud or potentially upsetting. An evening walk may also help.
• If problems persist or become too difficult to manage, your doctor may be able to help. There is medication that may be able to help someone with dementia relax, but it may have side effects (you should also check that sundowning symptoms are not aggravated by existing medication).
If you need help and support in deciding how to utilise lighting to help you or your loved one manage their dementia, please contact our experts at Catalyst Experience. Our years of experience and professional service allow us to provide comprehensive advice in designing dementia friendly care homes, including using lighting that is both stylish and practical. We will work with you to ensure your care home is a space that is safe, comfortable and beautiful.