Light up: an intervention study of the effect of environmental dynamic lighting on sleep–wake rhythm, mood and behaviour in older adults with intellectual disabilities

M. N. Böhmer*, A. Oppewal, M. J. Valstar, P. J.E. Bindels, E. J.W. van Someren, D. A.M. Maes-Festen

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Background: Evidence-based interventions to improve the sleep–wake rhythm, mood and behaviour in older adults with intellectual disabilities (ID) are limited. Increasing light exposure has been shown to be effective in improving the sleep–wake rhythm, mood, and behaviour in other populations. The current study investigates the effect of installing environmental dynamic lighting in common living rooms of care facilities on sleep–wake rhythm, mood, and behaviour in older adults with ID. Methods: A non-randomised, non-concurrent, multiple baseline study was performed from October 2017 to May 2018. Fifty-four participants [mean (SD) age of 63.42 (8.6) years, 65% female] in six care facilities were included. All participants had three baseline measurements (Weeks 1, 5 and 9). Dynamic lighting was installed in Week 10, after which three intervention measurements took place (Weeks 12, 17 and 24). Sleep characteristics and the sleep–wake rhythm were assessed using actigraphy (GENEActiv). Mood was measured with the Anxiety, Depression and Mood Scale (ADAMS) and behaviour with the Aberrant Behaviour Checklist (ABC). Results: Mixed-effect regression analysis showed a worsening of the primary outcome interdaily stability (P = 0.001). This could be attributed to one care facility, whereas interdaily stability did not change in the other care facilities (P = 0.74). Dynamic lighting led to earlier mid-sleep (P = 0.003) and sleep onset (P <.0001) and improved mood as indicated by lower scores on the ADAMS depression (−0.64 SD, P < 0.001) and social avoidance (−0.47 SD, P = 0.004) subscales. The prevalence of screening above cut-off for depression decreased from 23 to 9.8% (OR =.16, P = 0.003). For behaviour, a decrease was seen in hyperactivity (−0.43 SD, P < 0.001), lethargy (−0.35 SD, P = 0.008) and irritability (−0.33 SD, P <.001) as measured with the ABC. No adverse effects were reported. Conclusion: Installing dynamic lighting in common living areas for older adults with ID improved the mood and behaviour of the residents up to 14 weeks after placement. Integrated dynamic lighting is a promising, undemanding and potentially effective addition to improve mood and behaviour in care organisations for people with ID, but does not seem to do so by improving sleep or sleep–wake rhythms.

Original languageEnglish
Pages (from-to)756-781
Number of pages26
JournalJournal of Intellectual Disability Research
Volume66
Issue number10
Early online date25 Aug 2022
DOIs
Publication statusPublished - Oct 2022

Bibliographical note

Funding Information:
The authors want to thank the participants, their families and professional care takers and the care provider Middin for their collaboration with this study. Dr Mariëlle P.J. Aarts and Prof Alexander L.P. Rosemann of the Building Lighting Group at Eindhoven University of Technology, the Netherlands, are thanked for their advisory contribution in this project. The authors would like to thank Light Technology Netherlands for the supply of the light installations used in this project. Advice on statistical analysis was provided by Grigorios Papageorgiou of the Department of Biostatistics at Erasmus MC, University Medical Center Rotterdam. All authors made substantial contributions to the design of this study and/or were involved in the interpretation of the data. All authors drafted the work, and reviewed and revised the manuscript critically. All authors approved the final version to be published.

Publisher Copyright:
© 2022 The Authors. Journal of Intellectual Disability Research published by MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Keywords

  • chronotherapy
  • circadian rhythm
  • depression
  • elderly
  • intellectual disabilities
  • sleep problems

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