Optimal lighting levels for stair safety: Influence of lightbulb type and brightness on confidence, dynamic balance and stepping characteristics.

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Poor lighting has been associated with stair falls in young and older adults. However, current guidelines for illuminating stairs seem arbitrary, differ widely between sources, and are often difficult to interpret. Here we examined the influence of real-world bulb illumination properties on stair descent safety in young and older adults, with a view to generating preliminary evidence for appropriate lightbulb use/stair illumination. Stair tread illumination (lx) was measured in a standard UK home (2.23m ceiling) from a low (50W; 630lm) and a high (103W, 1450lm) power compact fluorescent lamp (CFL) bulb from the time they were turned on until they reached full brightness. This enabled modelling of their illumination characteristics during warm up. Illumination was also measured from a low (40W, 470lm) and a high (100W, 1521lm) power LED bulb at first turn-on. Computer-controlled custom lighting then replicated these profiles, in addition to a Bright control (350lx), on an instrumented staircase descended (3×trials per light condition) by 12 young (25.3±4.4years; 5 males), 12 higher ability older (HAOA: 69.6±4.7years; 5 males) and 13 lower ability older (LAOA: 72.4±4.2; 3 males) healthy adults. Older adults were allocated to ability groups based on physiological and cognitive function. Stair-specific confidence was assessed prior to the first descent in each new lighting condition, and whole-body 3D kinematics (Vicon) quantified margins of stability and foot clearances with respect to the step edges. Mixed ANOVAs examined these measures for within-subject effects of lighting (×5), between-subject effects of age (×3) and interactions between lighting and age. Use of CFL bulbs led to lower self-reported confidence in older adults (20.37%, p=.01), and increased margins of stability (12.47%, p=.015) and foot clearances with respect to the step edges (10.36%, p=.003). Importantly, using CFL bulbs increased foot clearance variability with respect to the bottom step (32.74%, p=.046), which is where a high proportion of falls occur. Stair-tread illumination from CFL bulbs at first turn on leads to less safe stair negotiation. We suggest high powered LED bulbs may offer a safer alternative.