By Anna Hazard
In general, as one ages, eyesight tends to have less visual acuity for details, reduced contrast and color discrimination (which makes it more difficult to distinguish the sharpness between different colors, between light & dark shades, and in general makes the eye take longer to properly adjust between different levels of light), as well as an increased sensitivity to glare (due to the eye lenses naturally becoming more opaque with age). This is before even taking into account eyesight health issues such as glaucoma, cataracts, increased floaters, or presbyopia (natural loss of near focusing ability with age which causes blurriness in viewing nearby objects) that tend to be more numerous among the elderly.
Due to many factors such as the eye's lenses growing thicker and more opaque with age along with increasing protein deposits which can cause more and more dark spots known as "floaters" to appear in one's vision, in general a senior citizen of age 75+ will require nearly twice as much light to properly see compared to the normal recommended standard (ie the normal minimum illuminance of 50 lux with 100 lux for paths & stairways, and up to 500 lux for normal work areas such as counters & desks) which ends up being nearly 4x the minimum required for a 20 year old. In addition to these requirements, elderly eyes take longer to adjust to light levels (and can be outright painful during large adjustments) which will require more uniform lighting with gradual illumination changes.
Types of Light
The best type of lighting for seniors is an increased overall ambient light that is both diffused (and thus not prone to causing glares) and uniform throughout the general area of the household (which will help reduce difficulties with the eyes adjusting to changes in light). Lighting transitions should be smooth and more gradual when decreasing or increasing levels. Dark spots or pools of shadows within a room should be avoided as much as possible as they can be disorienting particularly for those with degrading eyesight or people with dementia or Alzheimer's. Besides having similar light levels between the rooms, it is also optimal to match the exterior lighting and entrance/threshold lighting to the lighting level that will be encountered within the house (which can be further adjusted between day and night levels).
Studies have also shown that brighter lighting during the day and dimmer lighting at night may help regulate circadian rhythms and stabilize abnormal sleep patterns that can be particularly prominent amongst Alzheimer's & dementia patients. In particular exposure to blue lighting (in the range of 460-500 nm) during the morning is particularly recommended for maintaining normal sleep cycles.
Long lasting LED bulbs are recommended for easy maintenance, particularly in overhead fixtures or in any spots that are awkward to reach or that may pose a tripping or falling risk during installation. These can normally last up to 50,000 hours with long lifespan ones not requiring replacement for 10+ years. LED bulbs generally have brighter lights than incandescent bulbs while both consuming less energy and running at cooler temperatures, thus posing less of a burn risk if they are accidentally touched while in use and less of a fire risk if extraneous material should come into contact with them for an extended amount of time. In addition LEDs are less likely than other types of lighting to cause damage or fading to any collectibles, furniture, paintings or other items that are exposed to them for extended periods.
For normal household lighting, LED bulbs with an overall warm tone of 2700-3000K are recommended as the easiest light tone on the eyes. In addition, they should have a high color-rendering index of 90 which will help those seniors who have the common difficulty with distinguishing between shades of green, blue, and gray.
All lights installed within the household should be properly shielded so as to provide sufficient illumination through diffused lighting to help eliminate shadows without creating undue glare or painful bright spots. In particular, light glare becomes an increasing problem with age due to the rising amount of eye floaters (clumped microscopic fibers within the vitreous liquid of the eye causing shadowed spots to appear in one's vision) that scatter light within the eye. Besides glare issues, naked bulbs can also cause problems with vision contrast, throwing disorienting shadows, as well as being painful to view for a senior whose eyes has trouble adjusting to changing light levels.
For lower maintenance, bulbs should be covered in opaque diffusers or glass, vinyl, or heat resistant plastic shades instead. These will help eliminate glare while also being easier to clean than cloth or fabric based shading. The shades should be either opaque, tinted, or darkened enough that they help disperse light and should be large and well-fitted enough to block direct line of sight to the bulb from all visible directions.
Rocker or touch type light switches should be installed, particularly for those with arthritis or hand strength & dexterity issues that might make manipulating normal flip switches more difficult. Switches should also glow-in-the-dark for easier visibility at night. Optimally switches should be able to vary the brightness/dimness of the light receptacles that it controls to better be able to create uniform lighting throughout the house with gradual brightness transitions. Pre-set day & night options for light controls would also increase their operating convenience.
Otherwise, other options besides standard light switches would include motion based lights (including the clap-on variety which requires a trigger instead of automatically turning on & off) as well as various variations of smart home technology which can control light switches through remotes or via apps on the phone.
The light switches and other control panels should always be situated within accessible areas. This includes switches remaining within reach of someone in a wheelchair or scooter, thus no more than 48" from the floor. Clear paths to the controls that can be traversed easily while using a walker or other mobility are also required which would include clear access space of at least 30" by 48" in front of each switch. For hard to reach receptacles, motion or sound based light controls (such as clap-on technology), remotes, or smart technology controlled through phone apps or voice equipment can be substituted.
Uniform lighting should be spread throughout the house which includes light receptacles with at least two bulbs (in case of one bulb burning out at an importune moment, the user won't be left completely in the dark) in vital, well-used, or other locations that may present a high risk of tripping hazards (such as thresholds, exits & entrances, stairs, and the bathroom). These normal house lights should be positioned so that they are shining straight down vertically instead of horizontally in order to prevent creating confusing shadows that may increase the risk of tripping (and which tend to be particularly disorientating for dementia and Alzheimer's patients). Light installations should be installed away from shiny surfaces in order to prevent causing reflected glare.
Besides normal diffused lighting, location specific task lights can be added to areas where high visuality is needed for viewing details or performing specific tasks. This would include reading areas, doorways with locks, over sinks, and work areas such as desks, kitchen counters, and workbenches. Optimally these task lights should be adjustable, not only in brightness but with the ability to pivot and direct their light beams exactly where needed. Other task lights include under-cabinet lighting for the kitchen, garage, laundry room or other places with installed cupboards.
Floor level lighting can also be helpful for avoiding falls by helping with proper feet placement (especially beneficial for those who tend to drag their feet or have other mobility issues). This would include toe board lighting in places such as under the kitchen counters, recessed hall lighting along the floor or lower walls, as well as stair tread lighting. For greater safety, motion based lighting should be installed along thresholds, stairways, and other problematic areas of the household that pose a high probability of a tripping or falling risk if navigated in the dark. While motion based lighting requires no further manual input from the user, manual back-up switches should also be present in these high danger areas in case of a malfunction.
These are also many of the same areas that should have nightlights installed for maneuvering in the dark, which includes the bedroom (which should also have a manual lamp or light switch within easy reach of the bed in case of a nightlight or security light malfunction), as well as the hallways, bathroom (in case of nocturia, a common problem within the elderly of needing to frequently urinate at night), kitchen (for any potential water or midnight snack forays), and other popular areas traversed at night.
View the Rest of the Series
Part 1 - Introduction
Part 2 - Exterior
Part 3 - Landscaping & Gardens
Part 4 - Patio, Porch, & Deck
Part 5 - Garage & Carports
Part 6 - Entrances, Exits, & Thresholds
Part 7 - Exterior Steps & Ramps
Part 8 - Threshold Lighting & Windows
Part 9 - Interior Doors & Halls
Part 10 - Interior Steps & Staircases
Part 11 - Interior Stairlifts
Part 12 - Interior Elevators
Part 13 - Living Room
Part 14 - Kitchen