First, do no harm

One in five older adults suffer from insomnia, contributing to cognitive decline, depression and falls. Sedative medication is over-prescribed in long-term residential care despite little evidence that it improves sleep, while many of the most commonly-used drugs increase mood swings and risk of falls - Optimizing Sleep for Residents in Long-term Care Without Sedatives. These issues are compounded by errors when carers give out the drugs, with one study finding an average of six administration errors per resident per week. This chaotic situation isn’t just bad for patients. Potentially Inappropriate Medication accounts for up to 17.5% of the medication bill in a residential care home - AU$410 to $470 per year - Costs of potentially inappropriate medication use in residential aged care facilities.

So, finding a way to help patients get to sleep naturally makes good business sense - Dementia Enlightened?! A Systematic Literature Review of the Influence of Indoor Environmental Light on the Health of Older Persons with Dementia in Long-Term Care Facilities.

Lighting is the obvious solution, with a growing number of studies demonstrating the potential of a regular cycle of bright days and dark nights to support a healthy body clock in older adults. This trial found nighttime wandering, the number of daytime naps cut by over half. Time asleep went up by 90 minutes and time out of bed went down by over an hour - Biodynamic lighting effects on the sleep pattern of people with dementia.

So what’s in the gap? Current lighting guidelines for Healthcare (LG2) and Communal Residential Buildings (LG9) do not consider these non-visual effects, a situation compounded by current energy codes for connected loads that, when taken literally, preclude delivering the light levels needed for circadian entrainment. Lighting professionals have no input at all to window coverings and darkness at night, arguably as important as daytime conditions

But, as this impassioned review by Professors Sean Cain and Andrew Philips point out, if doctors have information about a situation that may be harming their patient but fail to act, they risk breaking their Hippocratic Oath that states “first, do no harm” -?Do no harm: the beginning of the age of healthy hospital lighting.

Perhaps the same should apply to other building professionals too?