October 24, 2013

It was a gathering scheduled by Drexel’s Vice Provost for Research, Deborah Crawford, PhD, that fortuitously allowed Elizabeth Gonzalez, PhD and Eugenia Ellis, PhD to meet for the first time. Gonzalez, an associate professor and the Chair of the Doctor of Nursing Practice Department, has been working with dementia patients and their caregivers since 1992. Ellis, who has an associate professor appointment at Drexel’s Westphal College of Media Arts and Design, has a background in architecture. Together, they discovered common interests that led them toward their current collaborative research project, which was recently covered in Drexel’s new Exel research magazine. “The project was interesting in terms of how it evolved. Crawford invited faculty for a forum where she presented her vision of the University’s research program,” Gonzalez asid. “I found myself sitting at a table with Ellis and we started talking about our interests.”

Gonzalez believes that, without family caregivers, dementia patients would not be able to stay at home; they would be institutionalized. “Our health care system cannot support that,” she explained. “I think the value of care from family members is critical in terms of sustaining people who are experiencing chronic disease- Alzheimer’s in particular- to be able to live in the community.” While Gonzalez is most interested in working with the people affected by dementia and Alzheimer’s disease, Ellis is curious about the structures that make up these patients’ environments. She introduced Gonzalez to her colleague, Donald McEachron, and their research team was complete. McEachron has long been studying circadian rhythms and the human biologic clock, so Ellis thought their study could expand into this area. “I thought that would be wonderful synergy and a good match,” Gonzalez confirmed.

Together, Drs. Gonzalez, Ellis and McEachron will be looking at the potential impact of light therapy to ameliorate the symptoms of dementia in longterm care facilities. “Think about what light does to our bodies,” Gonzalez said. “It regulates our sleep and waking habits.” As we age, the cells responsible for regulating sleep and activity begin to deteriorate to a certain extent. Alzheimer’s patients experience an especially high rate of sleep disturbances. Tapping into their diverse areas of expertise, the research group thought that, if they could mimic or create an artificial light that simulated normal exposure to daylight and darkness on a 24-hour schedule, they might be able to alter dementia patients’ sleep and activity for the better.

The “lumminaire,” or 24-hour programmable LED light structures, were recently finalized and are ready to be installed for two clinical applications. Exposure to light, whether from the sun or from an LED light like the ones constructed by the team, alters the production of hormones. One of these hormones, melatonin, is an important substance that synchronizes and helps coordinate the biologic clock, or what is referred to as the circadian rhythm of the body. Regardless of the presence of dementia, any individual’s natural production of melatonin will be affected if the number of hours they spend in darkness is limited. Gonzalez explained the hazard of interrupting sleep hours with light: “Melatonin is also an antioxidant that our bodies produce normally when it is dark. As an antioxidant, it neutralizes the reactive oxygen and reactive nitrogen that our cells are producing. Without neutralizing it, it causes damages to our cells.”

No one has yet studied the effects of a simulated 24-hour light on dementia patients, so Drs. Gonzalez, Ellis and McEachron are on the forefront. They hope to see outcomes among the patients that include improved global functioning, an increase in patient appetite, less interrupted sleep, and more self-care behaviors. The researchers will be collecting baseline data looking at existing behavior and mental status, while also documenting the current environmental light in longterm care facilities. The lights will be installed in the next two months, and after the first thirty days of continued use in each patient’s room, the team will measure the same outcomes again. Finally, a last set of measurements will be taken six months after the LED lights are installed. The timed lights will be used continuously throughout the entire duration of the study without interruption and they will be programmed depending on seasonal changes. When the sun naturally comes up, the LED’s green/blue lights will turn on. When the sun goes down at the end of the day, the green/blue lights will turn off and a red light will go on. Red lights are ideal for patients living in longterm care facilities because they allow the patients to see if they need to get up and move around. Red lights do not alter sleep nor the production of melatonin; green and blue lights are considered high-intensity and can disrupt physiological functioning.

“A lot of people in nursing homes aren’t exposed to daylight at all,” Gonzalez said. “They are sitting indoors, maybe in their own room or in a music room, where there is minimal lighting.” The research team is optimistic and believes that light therapy could improve the functioning of dementia patients in longterm care facilities and beyond. Gonzalez additionally said that the light aparatus could potentially be used in other environments to help people affected by Alzheimer’s or dementia who are not institutionalized. There are many potential implications for the research if the project is successful in demonstrating an impact on patient functioning.

The project was initially funded by five Drexel deans, Gloria Donnelly from the CNHP included, who each donated $3,000 from their respective colleges to set the project in motion. Funding for the development of the lumminaires comes from the Green Building Alliance Product Innovation Grant and ASID Foundation, and the two initial clinical applications of the lumminaires is supported by the American Society of Interior Designers.