Luminous Facilities Management for Older People in Care and Attention Homes


Student thesis: Doctoral Thesis

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Awarding Institution
Award date23 Sep 2021


An aging society has been a universal challenge, and it is expected that older people, aged 65 and above, will occupy an increasing proportion of the total population. In Hong Kong and Mainland China, the population of older persons aged 65 and over will rise from 18.3% and 13.5% of the total population in 2020 to 26.5% and 18.7% in 2030. In contrast to young adults, older people often show emotional disorders (e.g., depression, anxiety, and hallucinations, etc.), physical impairment (e.g., sight impairment, muscle stiffness, trembling of limbs and slowness, etc.), cognitive impairment (e.g., memory loss, person, spatial and/or time disorientation, etc.), and dysfunctional behavioral patterns (e.g., sleeping disorder, declined activity of daily living, and poor alertness, etc.). In addition, the majority of people with blindness and visual impairment are over 50 years old, as the prevalence of visual deficits in people over 70 years old is 40 times higher than people aged between 40 and 59. Older people may have special requirements of luminous facilities management (LFM) and luminous environment (LE). Due to the limited mobility and visual deficits, older adults living in care and attention (C&A) homes spend most of the time indoors. The LFM and LE in C&A homes play an important role in their quality of life (QoL). However, most of the C&A homes were built without considering the special needs of older residents. Therefore, it is essential to investigate the effects of the LFM and LE on the QoL of older people.

To ensure the reliability and validity of the study, the research triangulation with multiple research methods was applied in this study, including the quantitative methods (i.e., questionnaire survey) and qualitative ones (i.e., case study and interview study). The study was initiated with an extensive literature review of facilities management, lighting, luminous environment, quality of life, and so on. Based on the extensive literature review, a conceptual LFM/LE–QoL model was proposed to explain the complicated interactions between the LFM and the LE in C&A homes and the QoL of older persons. It hypothesized that the LFM (i.e., space management, lighting services, and supporting facilities) and the LE (e.g., light level, color, uniformity, glare, and shadow) in the C&A homes influenced the QoL (i.e., physiological, physical, psychological, behavioral, cognitive, and social aspects) of older residents.

A questionnaire survey was administered to older residents living in the C&A homes in Hong Kong and Mainland China to investigate the relationships between the LFM, LE, and QoL. The questionnaires for this study were conducted face-to-face in residents’ familiar environments (e.g., their bedrooms) to ensure that they fully understood the questions and were able to freely express their opinions. In total, 197 questionnaires were collected from older residents living in C&A homes, including 50.8% from Hong Kong and 49.2% from Mainland China. Multiple statistical analysis methods were adopted to analyze the quantitative data, including factor analysis, reliability test, one-way analysis of variance, multiple regression analysis, and structural equation modeling. The primary models were developed based on the relationships confirmed by the structural equation modeling.

In order to cross-validate and verify the results found in the previous questionnaire survey, seven case studies, including four C&A homes in Hong Kong and three C&A homes in Mainland China, were conducted to collect qualitative and quantitative data. To objectively understand the existing environment in each home, the LFM and the LE of seven C&A homes were observed and measured. The personal interview and questionnaire survey were carried out among 40 older residents and 33 staff members in seven homes, using the standardized set of questions and identical procedures. In addition, the direct observation method was used to observe and record 53 older residents’ levels of alertness, facial affect expressions, behaviors, etc., and the illuminance and color temperature were measured and recorded at the same time during the observation periods.

Twenty professionals, including facility managers, architects, building service engineers, surveyors, interior designers, lighting designers, therapists, a nurse, related researchers, etc., were purposely invited to participate in the interview study for further cross-verifying the LFM/LE–QoL model. The qualitative data collected from the interviews were subjected to a content analysis through open coding, creating categories, and an abstraction process. The subjective relationships between the LFM and LE factors and the QoL of older people identified by the professionals were abstracted and summarized. The practical suggestions to improve the LFM and LE proposed by the professionals were also revealed and listed. The results found in the interview study were used to revalidate the relationships between the LFM and LE in the C&A homes and QoL of older people. The final LFM/LE–QoL model was established based on the findings from the quantitative and qualitative data analyses through the questionnaire survey, case study, and interview study. The final model confirmed the following: 1) the space positively affected social relations of older people; 2) appropriate corridors reduced the injuries of older people in the C&A homes; 3) view out had a positive relationship with the positive emotions of older residents; 4) one lighting services factor, lighting control, had a positive effect on the behavior pattern of older people; 5) the curtain or louver in the C&A homes positively influenced the injuries of older residents; 6) the furniture negatively impacted the memory loss and positively impacted the homelike feeling; 7) the finishes were negatively associated with older adults’ cognitive function and positively associated with their memory loss; 8) the well-designed handrails in C&A homes improved their functional vision; 9) the appropriate light level enhanced their cognitive function; 10) the satisfaction of the glare positively influenced not only their overall physiological health but also their general vision, functional vision, and visual acuity, and the psychological health of residents was also related to their satisfaction of the glare; 11) surprisingly, the satisfaction of the shadow had negative effects on the psychological health and the cognitive function of older people and a positive effect on their confusion.

Practical recommendations were proposed according to the findings in the study, such as 1) ensuring adequate natural lighting in the common areas for the daily activities of older residents; 2) illuminated walls to extend the space visually; 3) view out with natural scenery, greenery, aesthetical scene, and broad perspective; 4) the artificial green wall with dynamic lighting; 5) night lights installed near the floor in the corridors; 6) two-grade lighting design; 7) using dimmers, sensor control (e.g., motion, sound, touch, and infrared) and smart control with context aware for the artificial lighting; 8) two-layer curtains with remote control; 9) auto-controlled curtains connected with the light sensor; 10) noticeable furniture for wayfinding; 11) auxiliary lighting in furniture (e.g., closet, cabinet, wardrobe, etc.); 12) color codes of finishes for their wayfinding; 13) continuous handrails with high color contrast and strip lights; 14) circadian lighting for their identification of the time of a day; 15) lighting schedule to help residents form healthy habits; 16) using soft, indirect and warm lighting to improve the visual comfort; 17) anti-glare glasses to reduce excessive sunlight from windows; 18) no main light design for bedrooms; and 19) showing shadow changes with time (e.g., holes on the outside wall), and so on. The limitations and further studies were also addressed finally. This study provided valuable insights into improving the LFM and LE in C&A homes to enhance the QoL of older people.