Brian LiebelReducing the number of falls in long term care facilities is a goal for everyone. Current strategies to reduce falls typically include complex, multicomponent interventions requiring significant resources, staff time, and resident education. To be sure, these measures help mitigate the risk and reduce the number of falls at nursing homes and senior care facilities; but there is one novel approach that has been theorized over the last decade that has been recently validated through research and come to light.

126,000+ Patient-Days of Data Tell the Tale

A recent study designed by Midwest Lighting Institute (MLI), funded by the Wisconsin Department of Health Services, and conducted by Brigham & Women’s Hospital Division of Sleep and Circadian Disorders—a division of Harvard University—has been published in The Journal of American Medical Directors Association, focused on how the positive effects of lighting on alertness, cognitive function, and sleep might affect falls. The study demonstrated that dynamic, tunable lighting systems reduced falls by 43 percent as compared to facilities that retained traditional lighting. The promising results of this study provide a method for reducing falls that is noninvasive, safe, passive, and relatively inexpensive.

The study compared two pairs of facilities, one control pair with typical fluorescent lighting and one intervention pair with tunable LED circadian lighting protocol (lights designed to change color based on time of day). Data was collected from all four facilities for one year prior to the intervention, where it was determined that there was no difference in the fall rates between the control facilities and the intervention facilities. After the new lighting was installed in the intervention facilities, a full year’s worth of data was collected to compare the number of falls in the control facilities to those of the intervention facilities, making this the largest study of its kind with over 126,000+ patient-days of data.

The results were illuminating, and the ramifications show a bright future ahead.

First, the reduction of falls is a significant improvement for the life and well-being of residents given that injuries and hospitalizations from falls can lead to higher morbidity and long-term complications. Second, when residents experience improved alertness and cognitive function during the day and better sleep at night, it not only improves their well-being, but also improves the working conditions for staff. Third and importantly, compared to many fall intervention methods, these tunable lighting systems don’t require additional labor costs and reduce the costs of staffing that would otherwise be attending to these falls.

The Sound Science of Light

How does lighting reduce falls in long term care facilities? First, we must explore lighting beyond our visual needs. Since the discovery of a novel photoreceptor in the eye more than 20 years ago, the intrinsically photoreceptive Retinal Ganglion Cell (ipRGC), researchers have made significant discoveries about the non-visual effects of lighting. These photoreceptors have been shown to affect alertness, cognitive function, and sleep, all of which are well-known factors associated with the risk of falls in older individuals. But for lighting to affect these positive outcomes, it must mirror our human evolution by mimicking the higher light level blue sky during the day; lower-level, warmer colored fire light in the evening; and extremely low light levels at night. For people who seldom get outside to experience daylight, this natural 24-hour cycle is missing, yet it is critical to their overall wellbeing.

How does this work? This natural diurnal cycle of light is received by the ipRGC photoreceptors that trigger melatonin suppression during the day when we are awake and alert, and darkness deactivates this response that then allows melatonin production to help us sleep. It’s important to realize that both phases—the awakened period and the sleep period—are critical components for improved sleep quality.

Digging a little deeper, it's important to analyze the three main variables in an automatic tunable lighting system that promote this diurnal cycle: light level, light spectrum, and time of day scheduling. Most importantly, the lighting system used in the MLI study provides a variation of lighting throughout the day that mimics the natural world to set and reset our circadian clocks to fit the naturally occurring 24-hour cycle. Typical electric lighting systems in long term health care facilities do not have any variation in light level or spectral composition and are kept at the same light-level day and night, resulting in too little light during the day and/or too much light at night. The key to successful lighting is to vary the lighting intensity and spectrum to keep people alert and awake during the day so they have a full daytime experience, in combination with lowered light in the evening that then allows them to sleep better at night. In other words, tuning the resident’s lighting to meet the needs of their natural circadian rhythms.

Minimal Investment for Maximum Results

In my nearly three decades designing lighting systems and studying the effects of lighting, I can say that this research conducted by Brigham & Women’s University may be one of the most impactful on the positive effects light can have on human health. But the study also brings the promise of other significant benefits from a health care provider perspective. Operationally, LED tunable lighting reduces energy and maintenance costs—in this study, an independent verification through the US Department of Energy GATEWAY project determined that this facility had a 60 percent overall reduction in lighting energy consumption! From a staffing perspective, reducing falls and improving the lighting creates a better environment and safer working conditions, and any reduction in falls will most certainly lower the liability for health care providers.

As our aging population begins entering skilled nursing or long term care facilities, it is important to consider not only the reputation of the clinical and medical staff, but the facility’s integrity and its use of today’s latest technologies. Minimal investments in tunable circadian lighting protocols can offer long term benefits for patients and staff while adhering to new environmental and societal initiatives. The benefits of these LED lighting systems in long term care facilities are compelling and have now been proven through sound, peer-reviewed science that is reliable and relatable.

Brian Liebel is the director of research at the Midwest Lighting Institute. Previously, Liebel was the director of standards and research at the Illuminating Engineering Society and has been involved with research investigating the effects of lighting spectrum on vision for more than 25 years. He can be reached at