Poor sleep, reversed sleep/wake cycles, depression and falls are common problems in older adults. In addition, elders with dementia frequently experience late afternoon agitation, or “sundowning.” Because our residents live in a communal environment, a single individual’s agitation or late-night roaming can create a unit-wide problem for staff and other residents.
Research suggests there may be a solution that involves no medication or side effects. The answer could be the use of light.
According to Mariana Figueiro, Ph.D., professor and Light and Health program director at the Lighting Research Center at Rensselaer Polytechnic Institute, the results of the research on light are “very robust.” As she states in the January 2016 American Psychological Association Monitor, “I have no question that if you deliver the right light in Alzheimer’s patients, you improve their behavior; you will improve agitation; they will sleep better.”
Reduced ability to process light
Our bodies receive light via three different types of photoreceptors, the Monitor article explains, and it stimulates the brain in various ways to regulate sleep. As we age, the ability to process this light diminishes. In combination with age-related changes in the circadian rhythms that regulate sleep/wake cycles, reduced production of melatonin which aids slumber, and lifestyle adjustments such as decreased physical activity and exposure to outside light, this contributes to the sleep difficulties of older adults.
Some studies indicate that sleep disturbances have been associated with a buildup of beta-amyloid, a hallmark of Alzheimer’s disease. Researchers speculate that sleep helps to flush toxins such as beta-amyloid out of the brain. By improving the sleep quality of our residents, we therefore may be aiding them in many ways.
Light table
Theorizing that residents with dementia spend a great deal of time sitting around a table, Figueiro created a “light table” using an edge-lit LED television for the surface. This allows staff and residents to interact normally while receiving the appropriate amount of bluish white illumination. Her studies show a significant improvement in the quality of sleep of participants and a significant reduction in depression and agitation. Both of the latter held up fours weeks after the light source was removed.
With the start of the holiday season, it’s time for this perennial post from Dr. El:
‘Twas the Week Before Christmas…
And 83-year old Albertha assured me her family was planning to take her home for the holidays.
“Have you talked to them about it? Have they called the social worker to arrange a pass, and meds, and transportation?”
“No,” she replied, “but they’re coming to get me.”
‘Twas the week after Christmas, and Albertha was glum.
“They didn’t show up. I waited all day, but they didn’t come.”
Albertha spent Christmas day watching other people go out on pass and return, and seeing families arriving with food and gifts and smiles.
Now my residents and I start discussing the holidays a few weeks in advance, addressing wishes and practicalities, phoning families if needed, and getting the social worker involved. We set up a hierarchy of plans.
Plan A: Go home for the day.
Plan B: Go out to a wheelchair accessible restaurant with family.
Plan C: Have visitors come with food and go around the corner for coffee, if possible, just to get out.
Plan D: Stay in with visitors and food.
Plan E: Talk to family members on the telephone, discussing plans for a future visit, while sitting in a room festooned with cards and holiday decorations. Attend the nursing home holiday party.
Plan F: Have a small holiday gathering in the room with nursing home friends after the facility party.
Since then, my people know what to expect from the holidays, even if the expectation is that their family might not arrive as hoped.
With the start of the holiday season, it’s time for this perennial post from Dr. El at mybetternursinghome.com:
‘Twas the Week Before Christmas…
And 83-year old Albertha assured me her family was planning to take her home for the holidays.
“Have you talked to them about it? Have they called the social worker to arrange a pass, and meds, and transportation?”
“No,” she replied, “but they’re coming to get me.”
‘Twas the week after Christmas, and Albertha was glum.
“They didn’t show up. I waited all day, but they didn’t come.”
Albertha spent Christmas day watching other people go out on pass and return, and seeing families arriving with food and gifts and smiles.
Now my patients and I start discussing the holidays a few weeks in advance, addressing wishes and practicalities, phoning families if needed, and getting the social worker involved. We set up a hierarchy of plans.
Plan A: Go home for the day.
Plan B: Go out to a wheelchair accessible restaurant with family.
Plan C: Have visitors come with food and go around the corner for coffee, if possible, just to get out.
Plan D: Stay in with visitors and food.
Plan E: Talk to family members on the telephone, discussing plans for a future visit, while sitting in a room festooned with cards and holiday decorations. Attend the nursing home holiday party.
Plan F: Have a small holiday gathering in the room with nursing home friends after the facility party.
Since then, my people know what to expect from the holidays, even if the expectation is that their family might not arrive as hoped.
Is your work environment undermining the efforts of staff members to provide high quality services to the residents and families under their care?
Join psychologist Dr. Eleanor Feldman Barbera live on November 12th at 1pm central as she discusses the positive impact of addressing the emotional health of the workplace and offers immediately implementable tools and suggestions that will foster an emotionally healthy environment.
What you will learn:
The practical (and financial) benefits of a psychologically healthy workplace
The five different elements that contribute to a positive environment
Realistic, feasible steps toward making your workplace emotionally healthy
Who should attend this webinar:
Administrators and assistant administrators
DONs, ADONs, department heads, nursing supervisors, and charge nurses
Many readers are familiar with people with dementia who want to “go home” when staff members leave at the end of their shifts or who “shop” for belongings in the drawers of other residents. It can be challenging for staff to redirect individuals intent upon leaving and upsetting for the people who are being prevented from going where they want to. “Shopping” is likely to irritate those whose dressers are being ransacked, creating ill will between neighbors on the floor.
In the Netherlands, a facility called Hogewey or “Dementia Village,” has created an entire town set up for residents with severe dementia. They’re encouraged to wander and shop and can spend the afternoon outside, coming home at the end of the day. Their homes have different lifestyle themes, such as culture or crafts or religion, increasing the chances that elders will be living with others that share their interests.
