Penn State researchers have received a National Institutes of Health (NIH) grant expected to provide about $3.6 million over five years to test whether a smart lighting system can improve sleep and behavioral and psychological symptoms among nursing home residents living with dementia.
The project, funded by the National Institute on Aging, is co-led by Ying-Ling Jao, associate professor in the Ross and Carol Nese College of Nursing, and Julian Wang, professor of architectural engineering in the College of Engineering.
The researchers previously developed and piloted an ambient lighting intervention designed to support the circadian rhythms of people with dementia with funding from a previous $411,982 grant, also from the National Institute on Aging. Building on the results of that research, the new study will test an updated version of the intervention, called Smart Environmental Light, or SmartEnLite, in a larger randomized controlled trial in residents with dementia across multiple nursing homes in Pennsylvania.
Circadian rhythm is the body's roughly 24-hour internal clock, which helps regulate sleep and wakefulness. Light plays an important role in regulating this cycle, but nursing home residents with dementia may not receive sufficient exposure to daylight.
Disruptions to the circadian rhythm can contribute to sleep problems and behavioral and psychological symptoms of dementia. Those symptoms, including agitation, depression, apathy and more, affect up to 90% of people with dementia, according to the researchers. Sleep disturbances also affect most people with dementia who live in nursing homes, and can contribute to worsening symptoms and functional decline.
SmartEnLite is a lighting system developed by Jao and Wang that uses tunable LED lighting, photosensors and automated controls to provide brighter, more circadian-stimulating light during the day and dimmer, less circadian-stimulating light at night. It also responds automatically to changing levels and spectrum of daylight, allowing the system to support circadian health without requiring staff to continually adjust it.
"Daylight varies throughout the day and with the seasons, weather and design of a building," Wang said. "SmartEnLite is designed to account for those changes automatically, with the goal of making this type of lighting intervention easier to incorporate into nursing home environments."
In their pilot study, the researchers showed that the smart lighting system could be installed successfully and used as intended in a nursing home setting. The study also produced preliminary evidence of improvements in behavioral and psychological symptoms.
"The pilot study gave us promising early results, and we are excited to now evaluate SmartEnLite with a much larger group of nursing home residents," Jao said. "Ultimately, we hope this research can help identify a practical, nonpharmacological way to improve sleep and dementia-related symptoms."
The researchers plan to enroll approximately 300 nursing home residents with dementia at 10 nursing homes in Pennsylvania. SmartEnLite will be tested in participants' bedrooms and designated dining and activity areas. During the 13-week study, groups of participants will receive both SmartEnLite and their usual lighting condition at different times, allowing the researchers to compare outcomes under each condition. Participants will wear devices that allow the researchers to measure their individual light exposure and sleep.
The study will assess whether SmartEnLite improves behavioral and psychological symptoms, as well as sleep. Additionally, the researchers will examine whether changes in sleep help explain any differences in behavioral and psychological symptoms.
Jao and Wang said the findings could inform larger-scale studies, as well as future nursing home design and lighting standards for long-term care.
The project, "SmartEnLite: A Smart Environmental Lighting Intervention to Improve Behaviors and Sleep for Nursing Home Residents Living with Dementia," will run through April 2031. The research team also include co-investigators Marie Boltz, professor of nursing, associate dean for research and innovation and interim associate dean for graduate education; Diane Berish, associate research professor of nursing; Anne-Marie Chang, associate professor of biobehavioral health; Mosuk Chow, research professor of statistics; and Margaret Calkins, president of Innovative Designs in Environments for an Aging Society.
Research reported in this publication is supported by the National Institute on Aging of the National Institutes of Health under award number R01AG100732. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.
