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QUESTION: It would have been interesting to have information about how these recommendations are modified as people move through the 7 stages of AD.

Jennifer Brush: It’s important to look for solutions that maximize a person’s ability to continue to participate in daily activities for as long as possible. Everyone likes to feel productive and useful. Thus, environmental modifications should meet the needs of both the individual with dementia and the caregiver. Because things can change rapidly- what wasn’t an issue yesterday is one today- and because the person with dementia may not even realize there’s a new problem, caregivers play a critical role in the lives of people with dementia. The modifications you recommend will impact the caregiver as much as the person with dementia. The environment should give the caregiver opportunities for passive monitoring. Solutions to problems with dementia always have to be customized to the situation of the individual, his or her caregiver or caregivers, and the environment in which they live. Because of progressive deterioration, it is often better to make changes early on when the person with dementia has a better chance of learning how to use or adapt to the modification. It’s also better if changes are made, or at least introduced to the person with dementia, incrementally. Making substantial changes that require the person to do a task in a totally different way is likely to be overwhelming, and can cause a significant amount of agitation.

QUESTION: when you say improved lighting can you tell how what type of light was used?

Jennifer Brush: We used fluorescent lighting in the study I mentioned. Good illumination is often based on the appropriate placement of the light. Better illumination will both brighten up the visual environment and will enhance the functional abilities of residents with limited vision. It will also increase safety and help residents with poor vision to get around more easily in the environment. It is important to have even and consistent lighting to avoid producing frightening or confusing shadows. However, some shadows are necessary to help understand the environment. Since the ability to see edges is diminished with Alzheimer’s disease, it is important to provide some direct lighting to create shadows to help visually define edges in rooms where residents perform tasks. Many care communities have switched to using more indirect lighting systems such as indirect pendant and cove lighting for higher levels of even ambient illumination. However, the exclusive use of indirect lighting provides a very flat light. Shadows that define the edges of items are less visible in indirect lighting. Light from other sources should be added by using table and floor lamps. Look at your care community with the light meter to check for even illumination. Move the meter around the room to see if the illumination value remains reasonably constant throughout. You may be amazed by how much lighting levels fluctuate in the room.

Fluctuations in lighting levels by 25 foot candles or more within a room indicate that there is room for improvement.