Professor June Andrews, Dementia Services Development Centre, University of Stirling, UK lays emphasis on the need for the right heating and lighting systems to treat dementia and offers insights on how to make a living space comfortable for patients with dementia
As dementia is increasing with the ageing population, so is awareness in the UK that businesses which supply services to the general older population need to make adjustments for customers living with dementia. This is one of the elements of the UK Prime Minister’s Challenge on dementia, an important health policy. A major energy company approached the Dementia Centre at Stirling to train their staff in how to support customers with dementia. Staff and customers needed authoritative guidance, in plain English, but based on research about what works. This guide, written as a short booklet, has been provided to customers of that company and forms the basis of staff training. It is expected that this will improve the welfare of these people and reduce the burden they place on health and social care services.
The booklet is about heat and lighting and their importance for older people living with dementia. ‘Carers’ are people who support a person living with dementia, either as a relative, friend or paid helper, including housing officers or home care workers, who need to notice and take action on problems in someone’s home.
Many older people in the UK worry about rising energy bills. In June 2014, AgeUK produced a report ‘Reducing fuel poverty – a scourge for older people’ which said that 1.14 million older people in England live in fuel poverty attributed to rising energy prices, leaky and inefficient housing and low incomes. This poses a health risk.
People living with dementia have particular requirements for heat and light. It is vital to help without causing distress or making anyone feel undermined. The structure of the booklet is to share ten hints about dementia, because very many people find it hard to find information about what it is and how to respond to it, followed by ten hints on lighting and ten on temperature control. This article outlines the hints that are given on lighting and temperature, which in the UK focuses mainly on keeping warm.
Ten hints on light
- Increase the light level to help communication. It will also help people with dementia to do everything else they want to do, for example;
- Find their way more easily
- Move about safely
- Maintain hobbies and interests like reading or sewing
- See to eat as well as possible
Make the most of natural light. Keep windows clean, pull the curtains right back, open blinds and go outside whenever possible. Cut down vegetation that blocks the light. For windows facing outside walls, paint the wall white to reflect light back inside. Lighting may comprise 25 per cent of the electricity bill so lights should be off when not in use. Light coloured décor may reduce the need for electric lights. Movement sensors can switch off lights automatically when the person leaves.
- To maintain diurnal rhythms older people need natural light, especially morning light, either by looking out of the window or going outside. This will help to ensure better sleep at the right time.
- Choose bulbs carefully. Compact fluorescent light bulbs (energy saving light bulbs) last longer and are efficient but can get dimmer to around 50 per cent of initial output over time. Older people may not be aware how poor the lighting level has become. The bulbs are also slow to light up when switched on and Royal National Institute for the Blind recommends you don’t use compact fluorescent light bulbs in potentially hazardous areas such as stairwells.
Other types to consider:
- Tungsten Halogen, which are more like the old fashioned tungsten bulb that older people are used to
- LED lights, which cost more but last a long time. Although the light output may be equal to other types, the light source is more direct and intense and will generally need a diffuser to prevent glare, particularly in bathrooms and above kitchen surfaces.
Quality is variable and the cheapest are not always the best. At present tungsten halogen seem to be a reliable purchase for the home.
- Check that all light bulbs are still working, particularly if you only visit in daylight. People living with dementia may not notice or forget to tell you.
- Watch out for glare that reduces visibility. Sunlight reflected from furniture like glass-topped tables can be uncomfortable. Translucent nets or blinds may help without cutting too much light. That’s difficult in winter in some countries when the sun comes in at a low angle. Take care to pull them back later so natural light can penetrate the room as much as possible.
- Some activities need additional light. Is there plenty of light on the kitchen work surfaces? Is there a good, bright light for reading? Getting washed and dressed, cooking – all need plenty of lighting. The person may forget to put the light on which is why making controls easy to see is crucial, though if judgement is impaired, some controls may need to be hidden and automated.
- Finding and using the toilet requires light and this varies depending on the layout of the house. If the bedroom has an en-suite toilet, a continuous low light in the toilet can be helpful at night. Others may prefer the light to come on when they get out of bed. A passive infrared movement detector achieves this. If the toilet is outside the bedroom, movement detectors in the bedroom or the hall can switch on that light as a guide. Light in the toilet itself is important.
- When natural light levels are reduced people in northern countries may experience Seasonal Affective Disorder (SAD). Special lights can be purchased that contain a lot of blue (morning) light since it seems that SAD is connected with the body clock not working well. Getting outside is good because light levels there are very much higher than indoors, even when conditions are cloudy.
- Clearly the use of lights needs to be economical. Painting rooms with light colours to maximise light reflectance and using light coloured curtains will all help with light levels in a room. Using light fittings that cast light upwards to a white ceiling will also help. Light coloured lampshades will transmit more light than dark ones.
- Make sure that the light switches and power sockets are easy to see and use. A contrasting colour against the wall, with contrasting switches would be very helpful as can illuminated switch surrounds.
Environmental temperature and dementia
Dehydration is dangerous in dementia. It increases confusion and lethargy and leads to constipation and urine infections, which make people with dementia very unwell, perhaps bad enough to go to hospital. Older people don’t adjust well to heat and cold; and dementia means the person may be unable to tell you that they are too hot or too cold or to do anything about it.
Even in the UK it is easy for someone with dementia to fail to understand how dehydrated they are becoming in the heat. Ensure they are drinking enough by leaving plenty of attractive drinks very visible.
The Dementia Centre
The Dementia Services Development Centre (the Dementia Centre), an organisation supported by charity at the University of Stirling, has been working for over 25 years to improve services for people with dementia and their carers. Knowledge from research and expert consensus about what makes a difference in the care of people with dementia is translated into tools and resources for families, care workers, and professionals. For example this might be training programmes for unqualified staff, distance learning degree modules for professionals, informal advice for families, or books and publications in simple language for people to use unaided
Being too cold makes existing health conditions worse. Cold affects breathing, heart and circulation and blood pressure as well as making someone more confused and affecting mental health. Hypothermia can result in death. Thrifty older people constantly worry about fuel bills and turn heating down or off altogether. They are at risk.
What to do depends on how active the person is, how plump they are, what they wear, how sensitive they are to temperature, and what they are used to. Many older people have always been frugal with fuel and are adapted to cooler rooms. They would put on more clothes before putting on the heating which is fine as long as they are warm enough.
- Use a thermometer. If the person with dementia insists on a high temperature, check for dehydration. If they let the temperature drop below a safe level, in the UK you can ask social services about technology which links a thermometer to the phone system and alerts someone when the temperature gets dangerously low.
- More active people need less heat because they generate it by movement that keeps their circulation working well. They may overheat if the house/ main room is hot. People who are inactive can get very cold, even in a reasonably warm house.
- The position of the house or appartment can have a significant effect on how warm or cold it is.
- Have the windows been painted shut or are they easy to open? An occupational therapist may be able to advise if the person is finding windows difficult to open for fresh air.
- Consider draft-proofing or replacing the windows. Doors too can be a source of draughts.
- Thick window curtains preserve heat and can also be put over ill- fitting doors; but ensure they are generally of a light colour to avoid cutting out too much reflected light and that they can be pulled fully back to allow natural light in during the day
- Even if avoiding draughts people need fresh air coming into the room. Good air quality is key to remaining as alert as possible. If the old person avoids opening the window, do so when the person is not in the room to improve the air quality.
- Obviously clothes need to be the kind they prefer and should be comfortable and light. Fleeces are often lighter than wool and wash easily. Layers can help with warmth. Longer sleeved vests and tops will keep arms warmer. It is a good idea to leave suitable clothes for cold weather where the person can see them rather than tidied up and put away – make sure they are easy to see.
- Rooms need different temperatures. For example, people may spend most time in the kitchen, then prefer a colder bedroom and wear socks and a hat in bed. Some turn everything off at night and ignore thermostats or timers. Consider whether the person is able to properly use the controls. A room thermostat and thermostatic radiator valves are needed to be economical, but warm. Unused need not be heated, other than at a low safe level to prevent any pipework from freezing. This will save costs for someone who does not use every room.
- Bedding can be complicated when the person is incontinent and they are using mattress protectors, pads etc. some of which can make the bed very hot and the person dehydrated in the mornings.
The research undertaken by the Dementia Centre would be of little value if it does not give rise to benefits for people with dementia, and this practical advice, spread via businesses rather than health professionals, is an important adjunct to the care and support that is given formally.