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Ageing, circadian rhythms and falls

With around a third of people aged 65 and over, and around half of people aged 80 and over in England falling at least once a year, falls are a common and serious health issue. Falling is a cause of distress, pain, injury, loss of confidence, loss of independence and mortality, and also disruptive and expensive to both the NHS and care providers.

Whilst there are numerous potential causes of falls, studies have concluded that the incidence of falls in older adults both follows a circadian variation and can be linked with ageing-associated functional and cognitive decline, circadian rhythms, and age-related vulnerability to sleep disorders.

Sleep disorders exacerbate cognitive symptoms in subjects with increased risk of developing neurodegenerative diseases, accelerating the rate of cognitive decline in such patients. A more recent study has shown, for the first time, how sleep disturbances giving rise to circadian disruption contribute to development of Alzheimer’s disease.

With ageing, the human circadian system weakens and production of hormones critical to the sleep-wake cycle is affected. The hormone melatonin is an important physiological sleep regulator in humans and its production is closely tied to light, the most potent external synchronisation stimulus for the human circadian cycle. In response to darkness, the pineal gland in the brain initiates production of melatonin, but light exposure slows or halts that production. We now understand how this process works and what frequencies of light are good for stimulus as well as which are potentially disruptive, depending on the time of day.

Changes in the body’s hormonal rhythms are exacerbated in dementia, particularly Alzheimer’s disease where the severe circadian dysfunction is one of the most important factors leading to institutionalisation. Indeed, some of the strongest evidence to link disruption of the circadian clock and sleep disturbance has come from studies in people living with dementia.

A direct link between sleep quality, falls risk and melatonin has been shown (Goswami et al., 2020). For instance, sleep disturbances have been evidenced to be associated with increased risk of falls in older men. By improving sleep in older persons, the regulation of melatonin could play an important role in falls prevention in older persons. The study found that circadian disruption leading to sleep-wake cycle disruption commonly caused orthostatic intolerance or dizziness and even loss of consciousness when standing up.

A circadian cycle-supportive lighting regime using the latest technology can provide circadian stimulus for older adults without regular daily access to good sunlight. Just as importantly, the system needs to ensure there is no disruption from inappropriate lighting for the body’s natural hormonal cycle.

At Circadacare our systems do just that and we continue to develop them as the scientific knowledge in this field evolves.