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Behind Older Eyes — Determining and Creating Appropriate Lighting for Seniors
What do older residents see when they walk around living facilities or even their own homes? The answer may surprise you because it is often more difficult for seniors and people with disabilities to clearly see in lighting that may be adequate for others.
It seems to be common sense that in order to live safely and independently, seniors need to be able to see their surroundings easily and clearly. Unfortunately, sometimes lighting is the last aspect considered when designing, building, and remodeling living spaces for older residents. A recent interview with long-term care designer, Margaret P. Calkins, Ph.D., president of IDEAS, Inc., and board chair of the IDEAS Institute, addresses the importance of lighting.
The article suggests that in order to self-test a building’s lighting, try wearing a pair of sunglasses smeared with a little petroleum jelly or lip balm. Then spend three hours walking around or, even better, sitting in a wheelchair, to experience the environment as older residents do. Noticing glares, having difficulty recognizing faces or reading signs, and getting a headache or tired eyes are all indicators that the building’s lighting probably needs to be updated.
Calkins offered practical recommendations on lighting improvement during the interview for Nursing Homes/Long Term Care Management.
When asked why she feels that lighting is such an important quality-of-life issue in long-term care settings, Calkins explained that as people age, changes in vision occur that affect the ability to perceive and understand the world around them. “For instance, there are normal age-related changes in the pupils (less light can enter the eye), the eyes’ accommodation speed decreases (it takes longer for eyes to transition to different light levels), and color perception weakens (yellowing of the lens makes it difficult to distinguish greens from blues).”
She also notes that older eyes become more sensitive to glare—both direct glare (from a directly visible lighting source, such as an unshielded bulb) and indirect glare (a consequence of bright light bouncing off reflective surfaces, such as shiny floors). “Compounding the problem is that many older adults develop diseases such as glaucoma, macular degeneration, and cataracts,” Calkins adds.
Calkins explains that so much information about our surroundings comes directly from vision. “I recently heard a surgeon relate a conversation he had with a patient. When he advised her to leave her eyeglasses at home, she said, ‘I need my glasses to hear you—I look at your face and your mouth when you speak, and then I can understand what you say to me.’
In regards to facility lighting—Calkins says that tweaking it can actually sometimes compensate for visual deficiency. On the most basic level, the goal of lighting design for older adults is to increase foot-candles, which are units of illumination on a surface, without increasing glare. “An excellent way to accomplish this when ceiling heights are sufficient (generally a minimum of 8’6”, preferably 9’, for indirect lighting) is through cove or indirect light that is bounced off the ceiling.” She adds that this indirect lighting provides even, low-glare illumination—however, because the ceiling absorbs some of this light, it requires more foot-candles to achieve adequate lighting.
But it is also very important that bulbs meet the appropriate Color Rendering Index (CRI), so that colors appear natural (i.e., as they are seen in sunlight). Calkins explains, “For a long time fluorescents have been the only color-correct, energy-efficient alternative to expensive incandescent bulbs—but now color-correct metal halide bulbs are available. These bulbs provide cost-savings because of their long life and energy efficiency.” She adds that these bulbs often take up to five minutes to “warm up” to achieve full light output. The benefit of this is that the eyes, especially older eyes, have an opportunity to gradually adjust to the light level.
Although they vary from facility to facility, certain areas of a facility can often be identified as in need of improved lighting. Calkins believes that common problem areas include hallways where ceiling lights are set too far apart, creating deceptive alternating light/dark patterns as a person walks down the hall. In addition, poorly lit dining rooms can result in insufficient nutritional intake and a variety of other consequences, simply because residents cannot see their food. “We recently conducted a research project in which the dining room provided only five foot-candles of light at the table, which is well below the 50 foot-candle recommendation. It’s no wonder that all the residents in this facility need assistance with eating,” she adds.
Transitional areas also present lighting challenges for older people. For example, on a bright day, a person entering a building from outdoors might have to stop and wait up to 90 seconds for his or her eyes to adjust to the lower light levels indoors. Bathrooms and treatment rooms also need to have appropriate lighting because in these areas people frequently change body positions and need to navigate safely.
To address the visual challenges of seniors, new technologies have been applied to long-term care lighting. Calkins says that metal halide bulbs are probably the hottest new technology in lighting for older adults. Also, a number of remote and automatic-sensing systems are available, although not widely used. She explains, “These include motion sensors that automatically turn lights on when someone enters a room. The problem is that they also automatically turn lights off if no movement is detected within a certain period of time. Consequently, they are best used in rooms or areas, such as bathrooms or utility rooms, where people don't spend too much time.”
Other technologic advances include voice-command light switches, which are available through many home technology catalogs, but are not widely used in long-term care facilities as yet.
According to Calkins, one of the most common lighting problems that can be easily and affordably corrected is replacing those switch plates that are the same color or pattern as the walls. “Often they are covered in the same wallpaper to provide continuity with the wall. These switch plates become virtually invisible to anyone with any vision loss. By color contrasting the switch plates with the walls, it makes them easier for older adults to locate.”
She also suggests paying close attention to the location of switches. “Obviously they should be positioned low enough for someone seated in a wheelchair to reach easily. Double-switching fixtures so they can be turned on from several locations in the room can also give an older person more control over the lighting in his or her environment.”
As technology advances, Calkins envisions the day when lights will not be hardwired to switches, thus allowing greater flexibility in locating switches to suit different users' preferences. In addition, presently only a few manufacturers are incorporating new, improved light-bulbs into their fixtures. Calkins concludes, “I’d like to see more innovation in this area. There also needs to be a conscious effort on the part of manufacturers to develop low-cost fixtures, because the reality is, that’s what most facilities will end up using. For example, many existing lamps can be retrofitted with the color-correct metal halide bulbs at very little cost. Even a simple improvement in lighting is an improvement in quality of life for residents.
