LIGHTING
First, do no harm: a focus on lighting for healthcare
Lighting design consultant, Dr Shelley James – who will speak at the one-day IHEEM ‘Innovation in Healthcare’ conference at Uttoxeter Racecourse on 11 September* – shares the latest evidence for the return on investment in lighting that supports the body clock in terms not only of improved patient health outcomes and better staff engagement, but also lower electricity bills.
New evidence shows the central role of light in setting the body clock – from neonatal to end-of-life, acute, and chronic effects, and in supporting shift work. Light is also critical to other physiological functions, including stress, mood, and appetite. Some clinicians even consider lighting to be a medical intervention, with a recent editorial suggesting that current standards constitute a violation of the hippocratic oath: ‘First, do no harm’.1 Circadian lighting mimics the natural
progression of the day-night cycle, adjusting intensity and colour temperature throughout the day to support the body’s internal clock, known as the circadian rhythm. This rhythm regulates sleep, hormone production, and other critical bodily functions. You may be familiar with the basic functions of the eye: the pupil and lense that flex to focus the light on the retina, the fragile membrane that floats at the back of the eye. These noisy signals are filtered and compressed through multiple layers of cells before reaching the top layer, which acts a relay station to fire a stream of data along the optic nerve to the visual
The author says: “New evidence shows the central role of light in setting the body clock.”
cortex, tucked away safely at the back of the head. Your brain extracts information from that dynamic data feed to generate your experience of a familiar world: faces, places, and pets.
“Provided that the electronics are correctly specified, you design, engineer, and control a lighting system to deliver many of the ‘active ingredients’ that we now know your non-visual system needs to keep your body clock on track.”
Just a small part of the picture We now know that this classic description is only a small part of the picture: around 5% of that top ‘relay station’ layer is sensitive to light in its own right. Even when there are no signals from the rods and cones, these intrinsically photosensitive cells are responding to light all on their own, thanks to a protein called melanopsin, which has a peak sensitivity of around 480 nanometers, or ‘sky blue’. This non-visual pathway sends signals directly to a cluster of glands at the top of the brain stem to drive a potent cocktail of responses: sleep, mood, emotion, and attention. As we get older, our eyes become slightly cloudy and yellow. A 10-year- old’s eyes will take in up to 100 times more light than their healthy 80-year- old grandmother’s eyes. At the same time, those critical brain structures that regulate hormones linked to sleep, such as melatonin, are shrinking. This natural shift in brain structure is worse in adults living with dementia, so the strength of that natural sleep-wake signal is weaker.2 Until very recently, the colour of a
September 2024 Health Estate Journal 33
WCS Care
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