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Literature review

Discuss about the Dementia for Visual and Biological Needs. 

Dementia is a neurodegenerative disorder that occurs mostly in the older adults due to the death of the nerve cells due to several factors. The dementia care is a significant growing health care need with the growing aged population. There are almost no pharmacological treatments for dementia and management of dementia mainly involves enhancing the mood and cognition of the patient, helping them in social engagement and fostering a safe environment for them. The key strategy to manage dementia in patients includes regular monitoring of the patient's health and cognition and initiation of the pharmacologic and the non pharmacological treatment. Apart from all these there are several environmental modifications that can bring about better cognitive outcomes in patients (Chaudhury et al. 2013, p. 223-229). Poor sleep quality and falls are some of the problems faced by the elderly suffering from dementia. People with dementia needs more light as the as people grow older the visual capacity of the eye changes and more light is required for the visual functions. Hence my chosen topic of research would be light, and how it impacts on the patient's care.  The rationale for this topic will be evidenced by a literature review followed by a plan of action. A summary statement will be provided describing about the achievements after the evaluation of the interventions followed by a succinct conclusion.

Chong et al.(2013, p. 565) have stated the adequate lighting have a positive impact on people suffering from dementia, as it has a positive impact on the biological clock and  sleep patterns of the older adults with dementia. Absence of adequate light can cause confusion in the daily routine and reduces the activity and the alertness and in turn increases the frequency of the daytime napping. If the right quantity of light enters the retina then it can synchronize the cardiac rhythms to the 24 hours day and night cycle (Bedrosian et al. 2012).  This is referred to as the non visual system. Circadian disruption might occur if the indoor lightings are not dark enough or of the appropriate color for activating the circadian system (Baird et al. 2012, p.988). Biodynamic lighting has been found to enhance the perceptual, visual and biological needs of the older patients with dementia as they help them to stay independent in their homes and contributing to the better quality of life (Fonken and Nelson 2014, p. 667-669). Researches regarding light and health have shown that biological lighting that mimics natural lighting can has a high beneficial effect on the physiological, biological and the psychological well being of people with dementia (Bedrosian et al. 2013, p.988). Biodynamic lighting can not only reduce the running cost but can also help to maintain healthy bones. Increase of the visual fictions will help to reduce trips and falls in the older adults (Fonken and Nelson 2014,p. 667-669).

Discussion

Although nothing is as useful as natural day light, natural daylight is always not feasible for the persons living in the indoors. Illuminating the indoors pose a threat from the point of environment sustainability and energy consumption. Proper utilization of the lightings can use less energy and result in cooling energy saving for the buildings (Ellis et al.2014). In the architectural design the main challenge in to provide the daylight or mimic the daylight using the artificial light sources and ensuring that color temperature change and the lighting levels sync with the nature's rhythm (Chong et al. 2013, p.565). The timing of the light and the wavelength of the light absorbed by the body are the two most important factors for the biological effect. Circadian rhythms are normally regulated by the exposure of the body towards the blue and the green spectrum (Ellis et al. 2014,p. 223-245). At noon there is a high intensity of the blue light region, the late afternoon provides the red and the orange light and as the sun sets it becomes dark (Coogan et al. 2012. p. 333-339). According to Coogan  et al. (2013. p. 333-339) blue light triggers the level of serotonin in the body that increases the cognitive performance and alertness.

According to Ellis et al.(2014,p. 224-245) the emergence of the chronobio-engineering can actually provide a new paradigm in the field of health care sciences. The main aim is to manage the symptoms of dementia by considering the attention of the patient, changing the vision due to the ageing eye, limited mobility and wandering due to the Alzheimer’s diseases, limited mobility and the effects of sun downing and wandering (Bedrosian and Nelson 2013).According to Figueiro et al. (2013.p. 1527) bright light therapy in dementia patient improves the cognitive function as it is related to increased scores in the mental state examination, used for measuring the cognitive status. According to Ellis et al. (2014) bright light therapy involves the exposure of the patient to about 10,000 lux of light. Figueiro et al. (2013.  p.1527.) have stated that bright light can also improve the posture stability and control. He has stated that strips of LED place around the door frames can decrease the risk of falls.

All these facts provide a strong rationale for the choice of modifications for people suffering from dementia.

The aim was to regulate stimulation, maximize the orientation, to increase the sense of safety and autonomy in patients, to regulate the circadian cycles and maintaining the biological clock, to improve the behavioral functioning in the patient and improve the cognitive status in patients with dementia, to increase the visual functioning in the patients and avoid slips and falls. The plan of action involved the fixtures of automated LED lights and light colored shades in the living room. Dementia patients often suffer from sun-downing. I have found that bright light in the living room had brought about a decrease in the anxiety and depression among the people with dementia. It had also been found that bright light reduces the symptoms of sun-downing and have decreased the risk of night wandering and daytime napping.  It has been found that there is direct linkage between bright light and circadian rhythm.  My interventions have brought about a regulated circadian rhythm in the people. Auto tuning day lights has been effective in creating a more naturalistic environment and improve the cognitive functioning in patients. The color rendition of these LED lights is auto tuned for the older adults. It can dim itself to the red spectrum for allowing the residents to go to sleep and provide illumination levels to the caregivers to continue working. The arrangement have been made in such a way such that the schedule slowly increases the lighting levels for the rest of the day for improving the visual activity and the light intensity slows down such that it sets to a low level "red" during the nighttime hours. The bright light set in the community and the corridors have decreased the risk of slips and other sentinel events related to the dementia patients.

Conclusion

Conclusion

The evaluation strategies could prove that changes in the lighting designs can improve the quality of life of the dementia patients by fostering a safe environment for them and providing an ideal working environment for the caregivers.

This idea of modification in the external environment can be disseminated to the other caregivers or the supervisors or the managers such that they can arrange things like automated lighting with the sensory motors as that has to be done in presence of the technicians. The idea of effective lighting can be disseminated through social media, one on one interview with the stake holders, group discussion with peers, newsletters and leaflets. Oral presentation during group discussion can be an effective method of dissemination. During my course of action, it became really difficult on my part to implement the automated lights. On my next venture I would like to work with the implementation of signs for improving the dwelling of the dementia patients.

  • Fixtures of florescent lights in the corridors and the washrooms.
  • Using high lux levels and use of transitional lights between the rooms to avoid sudden light change.
  • Use of diffuse lighting and indirect lighting to avoid the glare.
  • Color of the furniture in the dwelling room should be in high contrast.
  • The color rendition should be high to differentiate objects.

References 

Baird, A.L., Coogan, A.N., Siddiqui, A., Donev, R.M. and Thome, J., 2012. Adult attention-deficit hyperactivity disorder is associated with alterations in circadian rhythms at the behavioural, endocrine and molecular levels. Molecular psychiatry, 17(10), p.988.

Bedrosian, T.A. and Nelson, R.J., 2013. Sundowning syndrome in aging and dementia: research in mouse models. Experimental neurology, 243, pp.67-73.

Chaudhury, H., Cooke, H. and Frazee, K., 2013. Developing a physical environmental evaluation component of the Dementia Care Mapping (DCM) Tool. Environmental gerontology: Making meaningful places in old age, pp.153-174.

Chong, M.S., Tan, K.T., Tay, L., Wong, Y.M. and Ancoli-Israel, S., 2013. Bright light therapy as part of a multicomponent management program improves sleep and functional outcomes in delirious older hospitalized adults. Clinical interventions in aging, 8, p.565.

Coogan, A.N., Schutová, B., Husung, S., Furczyk, K., Baune, B.T., Kropp, P., Häßler, F. and Thome, J., 2013. The circadian system in Alzheimer’s disease: disturbances, mechanisms, and opportunities. Biological psychiatry, 74(5), pp.333-339.

Ellis, E.V., Gonzalez, E.W., Kratzer, D.A., McEachron, D.L. and Yeutter, G., 2014, March. Auto-tuning daylight with LEDs: sustainable lighting for health and wellbeing. In ARCC Conference Repository.

Figueiro, M.G., Plitnick, B.A., Lok, A., Jones, G.E., Higgins, P., Hornick, T.R. and Rea, M.S., 2014. Tailored lighting intervention improves measures of sleep, depression, and agitation in persons with Alzheimer’s disease and related dementia living in long-term care facilities. Clinical interventions in aging, 9, p.1527.

Fonken, L.K. and Nelson, R.J., 2014. The effects of light at night on circadian clocks and metabolism. Endocrine reviews, 35(4), pp.648-670.

Garre?Olmo, J., López?Pousa, S., Turon?Estrada, A., Juvinyà, D., Ballester, D. and Vilalta?Franch, J., 2012. Environmental determinants of quality of life in nursing home residents with severe dementia. Journal of the American Geriatrics Society, 60(7), pp.1230-1236.

Hanford, N. and Figueiro, M., 2013. Light therapy and Alzheimer's disease and related dementia: past, present, and future. Journal of Alzheimer's Disease, 33(4), pp.913-922.

Lin, C.C. and Huang, Y.C., 2012. Exploration of Long-Term Care Institution Managers' Perceptions of Institutional Indoor Environment Quality and Ease of Administration. Care Management Journals, 13(3), p.121.

Zhou, Q.P., Jung, L. and Richards, K.C., 2012. The management of sleep and circadian disturbance in patients with dementia. Current neurology and neuroscience reports, 12(2), pp.193-204.

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