Reducing Falls by Upgrading Lighting in Nursing Homes

Abstract

•Falls are exceedingly common in post-acute and long-term care residents and a leading cause of injuries, deaths, and worry for residents, families, and caregivers. Fall prevention strategies are resource intensive and multimodal interventions done at the resident level. There is little evidence to date to support environmental modifications to reduce falls. •Does an upgraded, dynamic lighting system reduce the rate of falls in long-term nursing home residents? Reference: Grant LK, St Hilaire MA, Heller JP, Heller RA, Lockley SW, Rahman SA. Impact of Upgraded Lighting on Falls in Care Home Residents. J Am Med Dir Assoc 2022;23:1698–1704.e2. This observational study looked at two pairs of long-term care nursing homes. One member of the pair underwent an upgraded, dynamic lighting system and was compared with the other member who continued standard lighting. The rate of falls was reduced by 43% in the lighting upgrade group versus the standard group. Falls are a common but pathologic part of aging and a classic geriatric syndrome. Many different contributing factors combine to result in a fall. However, falls are preventable through the practice of high-quality geriatric care, which looks to optimize modifiable risk factors, encourage adequate nutrition, stop offending medications, and advocate for participation in exercise and restorative care programs. Despite the success of reducing falls on an individual level, successful fall prevention programs in clinics or nursing homes have low success rates. When a study is published reporting that the fall rates in nursing homes can be reduced by almost 50% with a one-size-fits-all approach, it deserves a closer look. The authors of this study wanted to see what effect an “upgraded” lighting system would have on “care home residents.” Compared with the conventional solid-state lighting, where light has a constant wavelength and brightness, the upgraded lighting had changing intensity and increased blue light exposure during the day and reduced blue light exposure at night. The theoretical benefit of an improved lighting system that illuminates the room is obvious: it will make areas more visible for residents and staff. The health benefits of alternating blue light on improving alertness, cognition, and sleep are less known. This study compared two pairs of long-term care nursing homes owned by the same parent company with the same standardized policies and protocols. The company selected one site from each pair for a lighting upgrade while the other kept its solid-state lighting (fluorescent lamps). The researchers collected data one year before and after the lighting upgrade. To determine fall rates, the researchers reviewed the medical record as documented by the facility staff using the standard reporting tool in the site’s medical record system. There were important differences between the control and experimental groups after they underwent lighting upgrades. First, the experimental group had a higher rate of patients with dementia (42% vs 30%). Second, the experimental group also had more residents and more resident-days, suggesting longer stays in those facilities (146 vs. 98 resident-days, respectively; compared with 151 vs. 126 resident-days before the upgrade). This study found that the rate of falls was about 43% lower in the lighting upgrade sites; the experimental group went from 6.94 to 4.82 falls per 1,000 resident-days compared with the control group, which went from 6.62 to 8.44 falls per 1,000 resident-days. Perhaps of greater interest was that the distribution of falls went from a majority at night to a majority during the day after the lighting upgrade. There was no difference in fall frequency based on time of day in the control sites. These results are exciting in that they suggest a simple lighting upgrade may significantly reduce the rate of falls in nursing homes with minimal to no harm to the residents and little to no ongoing effort from staff. In addition, the early indication is that this fall reduction is perhaps due to improved sleep cycles, which may help in deprescribing potentially dangerous sleep aids. However, caution is needed in interpreting the results. The fall reduction rate is due partly to decreased falls in the experimental group and partly to increased falls in the control group. This may indicate uncaptured differences between the two groups, especially given that the owners selected the sites they wanted to upgrade. In addition, the reduced number of resident-days may reflect that the control groups focused on “short stay” residents undergoing skilled rehabilitation, who may be more likely to fall given their dynamic functional levels. This study is intriguing and warrants additional research to examine the effect of upgraded lighting solutions in nursing homes. If these results can be replicated, there may be a safe, cost-effective solution to prevent falls and their negative consequences for residents. Dr. Salaami is a geriatrician and SNFist with Scripps Clinic in San Diego, CA.