Zimmerman Sheryl, Sloane Philip D, Preisser John S, Ward Kimberly, Wretman Christopher J, Davis Scott A, Figueiro Mariana G
The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
J Am Med Dir Assoc. 2024 Oct;25(10):105227. doi: 10.1016/j.jamda.2024.105227. Epub 2024 Aug 22.
OBJECTIVES: To determine the feasibility of conducting a trial of a novel nighttime lighting system designed to support postural stability in assisted living (AL) residents, and to estimate intervention effectiveness by comparing the incidence of nighttime falls during the novel lighting condition to that in a control condition featuring a standard nightlight. DESIGN: Randomized crossover trial. The intervention consisted of 3 custom-designed linear arrays of amber light-emitting diodes (LEDs) arranged in strips: 1 strip aligned horizontally across the top of the bathroom/entry doorframe containing 68 LEDs and 2 strips of 140 LEDs each aligned vertically down the sides of the doorframe. The control condition was 1 standard nightlight in the bedroom and 1 in the bathroom. Residents were randomized to treatment sequences, receiving each condition for 1-2 quarters. SETTING AND PARTICIPANTS: Five AL communities serving exclusively residents with dementia or having separate units for residents with dementia, with at least 30 beds and at least 5 residents in private rooms. Residents were eligible if they had dementia, were ambulatory, did not share a bedroom, were not on hospice or expected to die within the year, and were not expected to transfer to another setting within the year. METHODS: Outcomes included recruitment, retention, incident falls, and satisfaction. RESULTS: Thirty-eight residents of the 5 communities participated (56% recruitment rate), and 24 family members completed surveys about their satisfaction with the lighting system. Cameras captured falls data for 92% of 8591 resident nights. The incidence density for falls was 34% lower in the intervention condition than the control condition (incidence density ratio 0.66, 95% CI 0.35, 1.22), which did not reach statistical significance (P = .18). CONCLUSIONS AND IMPLICATIONS: This low-cost intervention was feasible with high satisfaction. Building on these results, the intervention is being evaluated in a larger clinical trial. A novel lighting system to reduce falls could ultimately benefit millions of older adults across all settings.
目的：确定开展一项旨在支持辅助生活（AL）居民姿势稳定性的新型夜间照明系统试验的可行性，并通过比较新型照明条件下与配备标准夜灯的对照条件下夜间跌倒的发生率来估计干预效果。 设计：随机交叉试验。干预措施包括3个定制设计的琥珀色发光二极管（LED）线性阵列，呈条状排列：1条水平排列在浴室/入口门框顶部，包含68个LED，另外2条各有140个LED，垂直排列在门框两侧。对照条件是卧室有1个标准夜灯，浴室有1个标准夜灯。居民被随机分配到治疗序列，每种条件接受1 - 2个季度。 地点和参与者：五个专门为患有痴呆症的居民服务或设有痴呆症患者单独单元的辅助生活社区，至少有30张床位，至少5名居民住在单人房间。符合条件的居民需患有痴呆症、能够行走、不共用卧室、未处于临终关怀状态或预计在一年内死亡，且预计在一年内不会转至其他场所。 方法：结果包括招募、留存、跌倒事件和满意度。 结果：5个社区的38名居民参与（招募率56%），24名家庭成员完成了关于他们对照明系统满意度的调查。摄像头记录了8591个居民夜间中的92%的跌倒数据。干预条件下跌倒的发生率密度比对照条件低34%（发生率密度比0.66，95%置信区间0.35，1.22），未达到统计学显著性（P = 0.18）。 结论与启示：这种低成本干预可行且满意度高。基于这些结果，该干预正在一项更大规模的临床试验中进行评估。一种新型的减少跌倒的照明系统最终可能使所有环境中的数百万老年人受益。
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