Lighting is important to people with sight loss and dementia. Good lighting can make the most of people’s capabilities and help to compensate for poor eyesight; it can assist people in finding their way around both new and familiar spaces and help them to undertake specific tasks.
What do the ticks mean?
helps or is of benefit to most people
helps or is of benefit to some people
helps or is of benefit in specific circumstances
means that this aspect of design needs to be considered carefully before being adopted
Maximisation of natural light
People benefit from high levels of natural lighting. Daylight provides higher levels of light than most domestic electric lighting; it is more diffused and lights a larger area, so can be more comfortable to work in than specific task lighting; and changes in daylight over the course of the day help to signal the passing of time and to maintain normal sleeping patterns.
Maximising the amount of natural light in buildings can have multiple benefits. For example, internal corridors need careful lighting. Windows will provide natural lighting in corridors, may also be visually stimulating for occupants, and can aid people in finding their way around.
Types of artificial lighting
There are different types of artificial lighting available and the choice of both light-bulb and light fitting can be important in terms of the quality and distribution of light. It is important to consider the types of artificial lighting that will be used in different parts of the home.
Some research participants expressed reservations about using low energy light-bulbs. They felt that, in the past, low energy bulbs had been: less effective; took time to reach full brightness; and even then provided insufficient light. This is not the case with more modern energy-efficient lighting, and people may benefit from up-to-date advice on the appropriate use of current low energy lighting products.
Positioning of lighting
Task lighting is helpful in some areas of the home. For example, strip lighting under cabinets in the kitchen helps with kitchen tasks, and lights in shower areas support independent personal care. Extra lighting for exterior doors contributes to people being able to enter and leave their homes more safely; they may also find lighted keyholes easier to use.
The positioning of lighting is important. Lighting placed directly over beds can be uncomfortable for people when resting. It may be possible to correct this through the use of appropriate shading.
It is useful to have additional electrical points available in rooms to enable further lighting to be made available when it would be helpful for specific tasks or activities needing more light, such as reading. Additional lighting can be provided through a variety of lighting types, e.g. table lamps, angle-poise lamps or standard lamps.
Intensity and uniformity of light
Lighting of an appropriate intensity supports and promotes independence. Buildings and interiors should be designed to allow a sufficient intensity of light throughout. The preferred intensity of light depends upon individual needs and preferences, as well as the tasks being undertaken.
Background lighting may sometimes be preferred to intense lighting at particular times of day. For example, at night, background lighting can be used to make it easier for people to recognise their surroundings and find their own way safely around their home.
Natural lighting helps people to be awake during the day and to sleep at night. Artificial lighting which can be varied in intensity to reflect natural light patterns helps people to maintain good sleeping patterns.
It is important to have uniformity of lighting levels in and between different rooms and spaces in the home. This is because some people with sight loss find it difficult to adapt to changing light conditions and some people with dementia may misinterpret shadows.
Control of lighting
Lighting preferences vary according to the individual. Designing homes to enable residents to have full control and choice in lighting levels can improve comfort.
Points for reflection and further consideration
Where some or all of the living space in a home is shared with others, it is important to consider how different people’s lighting requirements for the same spaces can be met.
It is important to think about whether a person has particular needs for lighting at night and, if so, how these might be met. For example, for some people leaving a bathroom light on may be helpful but only when this is independent of any extractor fan as the noise might otherwise be disturbing. Other people may prefer to rely on lighting coming in from outside to provide background light after dark.
People’s preferences and needs for lighting differ. It is important that homes are designed or adapted to be flexible in terms of lighting provision, and that people are regularly consulted to identify any changes in their individual preferences and needs.
We conducted a structured literature review which involved systematic searches of a wide range of electronic databases, complemented by consultation with expert informants who were asked to recommend materials (such as reports) that the searches might not have identified. The searches yielded 14,616 ‘hits’. 14,043 were discarded as either duplicates or not relevant, and the remaining 573 were scored for relevance on the basis of title and abstract. In total 33 publications were included for full text review: 28 based on relevance scores, and 5 items recommended by expert informants.
These were systematically evaluated using a proforma which enabled assessment of the quality of the research reported, and assembled key information regarding the subject matter, results and conclusions of each item. The quality criteria used to assess different types of research were drawn from standard protocols including Centre for Research and Development (CRD) Report No 4, Cochrane Effective Practice and Organisation of Care (EPOC) checklists and, as appropriate, Critical Appraisal Skills Programme (CASP) assessment criteria (NHS CRD 2001; Cochrane EPOC 2002; CASP undated). Each publication was rated as being of High, Medium or Low quality, based the extent to which the research as reported in the publication meets the relevant quality criteria, and an overall rating was provided for each of the sections within the guidelines. Publications rated as being of lower quality are still of evidential value, but should be regarded as providing suggestive rather than definitively evidenced findings.
We assessed the overall quality of published evidence for guidelines in this section as between Low and Medium. We based the guidelines on evidence contained in the following publications:
- Brunnström, G., Sörensen, S., Alsterstad, K. and Sjöstrand, J. (2004) ‘Quality of light and quality of life -- the effect of lighting adaptation among people with low vision’, Ophthalmic and Physiological Optics, 24(4), 274-280.
- Edgerton, E. A., & Richie, L. (2010) ‘Improving physical environments for dementia care: making minimal changes for maximum effect’, Annals of Long Term Care, 18(5), 43-45.
- Goodman, C. and Watson, L. (2010) ‘Design guidance for people with dementia and for people with sight loss’, Thomas Pocklington Trust Research Findings Number 35 [document on the internet]. December 2010 [cited 2013 Nov 29]. Available here (and full report available on request from Thomas Pocklington Trust).
- Lawrence, V., Murray, J., Ffytche, D. and Banerjee, S. (2009) ‘"Out of sight, out of mind": a qualitative study of visual impairment and dementia from three perspectives’, International Psychogeriatrics / IPA, 21(3), 511-518.
- Littlefair, P. (2010) ‘Daylighting and windows in homes of people with sight loss’, Thomas Pocklington Trust Research Findings 30 [document on the internet]. March 2010 [cited 2013 Nov 29]. Available here (and full report, available on request from Thomas Pocklington Trust).
- Long, R.G. (1995) ‘Housing design and persons with visual impairment: Report of focus-group discussions’, Journal of Visual Impairment & Blindness, 89(1), 59-69.
- Marquardt, G. (2011) ‘Wayfinding for people with dementia: a review of the role of architectural design’, Herd, 4(2), 75-90.
- Torrington, J. and Lewis, A. (2011) Extra Care Housing for People with Sight Loss: Lighting and Design Issues. Thomas Pocklington Trust Research Findings 36 [document on the internet]. December 2011 [cited 2013 Nov 29]. Available here (and final report, available on request from Thomas Pocklington Trust).
- Utton, D. (2009) ‘The design of housing for people with dementia’, Journal of Care Services Management, 3(4), 380-390.
- van Hoof, J., Kort, H., van Waarde, H. and Blom, M.M. (2010) ‘Environmental Interventions and the Design of Homes for Older Adults With Dementia: An Overview’, American Journal of Alzheimer's Disease and Other Dementias, 25(3), 202-232.
Our expert interviewees said
- Natural light is important and should be used where possible (several experts mentioned Gradmann Haus in Stuttgart as an example of good practice in relation to use of light)
- It is important to be able to control the levels of light coming through windows and to be able to control for glare
- People with dementia need significantly higher levels of lighting than the general population. They should also be exposed to a 24-hour cycle of light and dark. Two hours of exposure to bright light each day can significantly help nursing home residents with dementia and improve sleep patterns
- Good uniformity of light and avoidance of sudden changes in light level are important for people with dementia
- It is important for people with sight loss to be able to access additional lighting when undertaking tasks
- Positioning of lights is important. Night lights in bedrooms are sometimes positioned above beds and, if not adequately shaded, disturb occupants
People with dementia and with sight loss and their carers
taking part in interviews and focus groups told us
- Poor lighting is a barrier to enabling residents in care homes to make the most of their home
- In some care homes, because the light switch also activates a noisy fan members of staff do not leave a light on in the bathroom at night so people can find their way there if necessary
- Night time background lighting can be helpful for people with dementia and sight loss
- Shadows caused by non-uniform distribution of light are a problem in some care homes
- It can be difficult to accommodate individual preferences for lighting levels in the communal areas of care homes
- In some care homes staff rather than residents control the lighting levels
- Residents in some care homes have switched night lighting off only to have staff turn it back on again
- Many people had found older energy-saving bulbs unsatisfactory because they took time to reach full luminance and even then did not provide adequate levels of light
The survey found
- Out of 79 people who answered questions on this section, 74% thought that guidelines on lighting would be ‘very helpful’ and a further 24% thought they would be ‘helpful’
- When people were asked to either agree, disagree or say that they were unsure about a series of statements, the highest levels of agreement were in relation to: use of design to maximise natural light in homes (99% agreed); importance of appropriate intensity of lighting throughout homes (95% agreed); desirability of windows along corridors (92% agreed); importance in a care home context of thinking about how to meet diverse needs for lighting (92% agreed); desirability of lighting which can be adjusted to suit both the individual and the task they wish to carry out (91%)
- The highest levels of disagreement or uncertainty were in relation to: uniformity of light being important to avoid problems with slow adaptation to changes and the potential for shadows to be misinterpreted (0% disagreed, 29% not sure); preference for background night lighting and its usefulness for way finding (4% disagreed, 14% not sure); importance of designing autonomy and control over lighting into people’s home (7% disagreed, 10% not sure)
Selected quotes from people completing the survey
- ‘Anything that enhances the [person’s] own sight ability is to be encouraged, improved and maintained at all times for all, with appropriate research and feedback from all for the future.’
- ‘Whilst full control of lighting might be ideal, I believe people with dementia can cope better with a simple on/off switch. I don't know if there is any evidence that incandescent lights are better than fluorescent.’
- ‘Lighting is key and we feel that having dimmer switches in corridors and bedrooms allows for us to gradually alter the mood of the lighting, slightly increasing in a morning while people are waking up and gradually decreasing on an evening encouraging people to wind down ready for a restful night’s sleep. We have to be careful here with regards falls but generally slight alterations do make a considerable difference.’
- ‘I find creating 'pools' of light, e.g. in a day room or bedroom, can provide a focal point around cosy seating areas. This, in my experience, can help ease restlessness and agitation.’
- ‘I disagree [with the statement regarding desirability of windows in corridors] as I know someone who works in a new build dementia environment where windows in the corridor had to be changed using stencils as people with dementia were misinterpreting their reflections in the glass. So non reflective glass might work.’