A Pragmatic Crossover Trial to Test the Effectiveness of a Novel Lighting System to Reduce Nighttime Falls in Persons with Alzheimer’s Disease and Related Dementias

一项务实的交叉试验，旨在测试新型照明系统在减少阿尔茨海默病和相关痴呆症患者夜间跌倒方面的有效性

• 批准号: 10649432
• 负责人: Sheryl Zimmerman
• 金额: $ 129.29万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10649432
• 关键词: Address; Adverse event; Age Years; Alzheimer' s disease related dementia; Ambulatory Care; Assisted Living Facilities; Body Weight decreased; Cessation of life; Cognitive; Cross-Over Trials; Cues; Dangerousness; Dementia; Development; Elderly; Enrollment; Environment; Equilibrium; Event; Family; Family Caregiver; Floor; Hip Fractures; Hospitalization; Impaired cognition; Impairment; Incidence; Individual; Injury; Intervention; Laboratories; Lighting; Modification; Monitor; Musculoskeletal Equilibrium; Nursing Homes; Persons; Phototherapy; Pilot Projects; Posture; Preventive; Privatization; Provider; Randomized; Recipe; Recording of previous events; Research; Residential Treatment; Risk Factors; Sampling; System; Time; United States National Institutes of Health; Vision; Visual; Visual impairment; Work; awake; community living; cost; dementia care; effectiveness evaluation; effectiveness testing; experience; fall injury; fall risk; falls; functional status; intervention effect; light effects; novel; posture instability; residence; satisfaction; sleep pattern; standard of care

Project Summary/Abstract Having Alzheimer's disease or a related dementia, being ambulatory, and awakening in the night constitute a recipe for a dangerous fall. Add a lighting system that promotes postural stability, and the fall may be avoided. That is exactly what our recent NIH R21 exploratory/developmental randomized crossover trial did, and exactly what we found -- a 34% decrease in falls due to a novel lighting intervention. The proposed project will build on that preliminary effort; if the results are as promising as suggested, this pragmatic passive lighting system has the potential to reduce falls and related sequelae for countless persons with Alzheimer's disease and related dementias, and to become a new standard of care. Falls are the primary cause of fatal and non-fatal injuries among persons 65 years of age and older. Dementia is a major risk factors for falls, and assisted living (AL) communities are the primary provider of residential care for ambulatory older adults with dementia, making AL a critical setting in which to reduce falls. Forty-two percent of the more than 811,000 AL residents across the U.S. have moderate or severe dementia, 84% are ambulatory, and more than a third experience a fall in a six-month period, putting them among the 15% of AL residents who suffer a hip fracture or other serious fall-related injury each year. Falls are responsible for one- third of all hospitalizations of AL residents, and the resulting injuries may lead to a cascade of events, including worsening function, nursing home transfer, and death. A significant number of these falls occur in the bedroom during the evening and night, when AL staff are not present, thereby limiting their ability to intervene. However, the cause of many of these falls -- impaired nighttime vision and related postural instability -- suggests a promising avenue for intervention. Specifically, an intervention that does not require staff effort, and that targets orientation and postural stability in the evening and night when lighting is poor and residents may not be fully awake, has great potential to reduce falls in AL. This project will test the effectiveness of a novel intervention consisting of unobtrusive, low-intensity, horizontal and vertical lights that outline the bathroom or entry way doorframe in residents' rooms and provide visual cues to promote postural stability. The lighting system is particularly attractive and pragmatic because it is low cost, requires no staff involvement, and can be easily installed in new buildings or retrofitted to existing buildings. Specifically, this pragmatic crossover trial will enroll 390 AL residents with dementia and follow them for one year, comparing the incidence of nighttime falls during the lighting condition to the incidence of falls during the control condition; secondarily, it will determine whether and to what extent the intervention effect is modified by resident- and environmental-level risk factors, and satisfaction with the lighting system. We expect that the lighting system holds great promise to constitute a new standard of dementia care and falls reduction, appropriate for use in all settings in which persons with Alzheimer's disease and related dementias reside.

项目摘要/摘要 患有阿尔茨海默氏病或​​相关痴呆症，是卧床和觉醒的夜晚 危险跌倒的食谱。添加一个促进姿势稳定性的照明系统，并且可以避免跌落。 这正是我们最近最近的NIH R21探索性/发展性随机分频试验所做的，正是 我们发现的 - 由于新型的照明干预，跌倒下降了34％。拟议的项目将基于 那个初步的努力；如果结果如所建议的那样有希望，则这种务实的被动照明系统具有 减少无数阿尔茨海默氏病及相关患者的跌倒和相关后遗症的潜力 痴呆症，并成为新的护理标准。 跌倒是65岁及以上的人中致命和非致命伤害的主要原因。失智 是跌倒的主要风险因素，辅助生活（AL）社区是住宅护理的主要提供商 对于痴呆症患有痴呆症的门诊老年人，使Al成为减少跌倒的关键环境。四十二 在美国的811,000多名AL居民中，百分比中等或重度痴呆症，84％为 卧床，超过三分之一的经历在六个月的时间内跌倒，使他们成为AL的15％ 每年遭受髋部骨折或其他严重跌倒有关的居民。瀑布负责一个 AL居民的所有住院中的三分之一以及由此受伤的人可能会导致一系列事件，包括 功能恶化，疗养院转移和死亡。 这些瀑布中有很大一部分发生在晚上和晚上，当时Al员工不在 现在，从而限制了他们干预的能力。但是，其中许多跌倒的原因 - 受损 夜间视觉和相关的姿势不稳定 - 提出了有希望的干预途径。具体而言，一个 不需要员工努力的干预措施，并且在晚上定向和姿势稳定 晚上照明较差，居民可能无法完全清醒，减少AL跌倒的潜力很大。 该项目将测试新的干预措施的有效性，该干预措施包括不引人注目的低强度，水平 垂直灯概述了居民房间中浴室或入口门框并提供视觉提示 促进姿势稳定。照明系统特别有吸引力和务实，因为它是低成本， 不需要员工参与，可以轻松安装在新建筑物中或改装为现有建筑物。 具体而言，这项务实的跨界试验将招募390名AL居民患有痴呆症，然后跟随他们 一年，将照明状态期间夜间跌倒的发生率与在 控制条件；其次，它将确定干预效果是否以及在何种程度上由 居民和环境级别的风险因素，以及对照明系统的满意度。我们期望 照明系统构成痴呆症护理的新标准和减少的新标准， 适用于患有阿尔茨海默氏病和相关痴呆症患者的所有环境中使用。