Enlightening Spaces: Optimizing Lighting Design for Geriatric Clinic to Promote Good Health and Well-being

Along with the increasing of elderly population in the world, Indonesia has entered the ageing population phase where about one in ten of the population is elderly. The quality of life can be maintained as their well-being improved, since the aging process, diseases, and decreased function of the bodies can affect their condition. Good health and well-being are part of Sustainable Development Goals (SDGs) 3 that also can be achieved through designing a geriatric clinic as a healthcare facility. Lighting has been identified as a significant environmental aspect to promote physical and mental health of elderly which influences in perceiving spaces. It also conveys a sense of security and comfort to enhance visual perception. How to create a lighting design that suitable for the user in geriatric clinic? Lighting design is supported with technology to meet the needs of users in a geriatric clinic while creating an atmosphere that satisfies visual needs and affect the mood of the elderly. This research conducted in qualitative research to study the requirement of lighting design based on literature data, site visit and interview to related party. The purpose of this study is to recommend lighting design that not only meet healthcare requirements but also enhances the overall well-being of patients and staff as the user to enhance a healthy environment for the elderly. It is hoped through lighting design in geriatric clinic, it will enhance a healthy environment to promote a good health and well-being for the society.


Introduction
The world population for ageing population continues to increase, this is due to the increasing of life expectancy and the decline birth rates in many countries.In addition, this is a proof that improvement of human well-being in line with the advancement of technology, especially in the field of health sciences.This condition will increase especially in developing countries, such as Indonesia.Based on data from the Central Bureau of Statistic (BPS) Indonesia, the amount of ageing population in DKI Jakarta in 2022 are 1.083.720people [1].World Health Organization (WHO) included in the elderly category is the population aged between 60 years old to 74 years old [2].Since 2021, Indonesia has entered an ageing population structure, where about one in ten residents are elderly [3].
Sustainable Development Goals (SDGs) has good health and well-being as one of the goals.It aims to develop a better and sustainable future for the world [4].Governments, healthcare profession and society must contribute to achieve health improvement and quality of life among the elderly.Based on the Minister of Health of Republic Indonesia No. 9-2014, a clinic is a health facility that provides medical services, in the form of basic medical and specialist medical [5]The hospital serves a variety of 1324 (2024) 012050 IOP Publishing doi:10.1088/1755-1315/1324/1/012050 2 patient needs, where the elderly does not have specific treatments related to their condition.Their conditions may have weakened, need assistance, slow response and limited mobility.The purpose of designing lighting for elderly clinic with focus on environmental health and well-being is essential to create a comfortable and supportive healthcare environment.
The elderly experience a decrease in physical function that affects the balance, focus and visual impairment.This condition needs to be understood to minimize the elderly spatial difficulties [6].The elderly's quality of life can be maintained as their well-being improved, since the aging process, diseases, and decreased function of the bodies can affect the condition of the elderlies.According to Hurlock's theory of human development, it is stated that the problems that arise in elderly are: 1).Physical disabilities that lead to dependance on others, 2).Economic uncertainty that requires a complete change in life, 3).Finding new friends to get a replacement for deceased or moving, 4).Developing new activities to fill the spare time, 5).Learn to treat children who grown up [7].To encourage improvements in health of the elderly, family support is very necessary.Family members are expected to provide more attention, love, and affection to elderly members of the family.In research conducted by Fauzia Nur Qonita in 2021, it is known that improving quality of life can be done through the role of the family [8].
They will have partial difficulties in distinguishing colors for example green, blue, and violet.Apart from differences in color perception, decreased vision can affect the ability to walk and mobility for the elderly.Therefore, support is needed to direct the elderly mobility, by using handrails or signage as an identity of the place to be find.In addition, color consideration that applied in lighting design must be studied for quality, quantity, and distribution of lighting to reduce the rate of accidents and physical injuries in elderly.Color integration must be done in harmony with other lighting design principles to create a supportive and functional environment for healthcare needs, including for elderly users.
Lighting is identified as a significant environmental attribute to promote physical and mental health of the elderly [9].Although natural daylight can be maximized by creating larger windows and skylight in common area and patients' room, the lighting design must comply with relevant healthcare and accessibility standards.Lighting in general serves to help humans to complete their tasks, feel safe, identify surroundings environment, and read direction and information as well [10].It is also found that lighting technologies provide huge flexibility in creating ambience that is not only satisfy the visual needs, buy also improve people's well-being.Apart from that, lighting can also affect the mood of the elderly, when they are in a care center.Pleasant and relaxing ambiance is expected to counteract negative moods such as anxiousness and sadness [11].

Methods
This research is conducted in qualitative research method using a design process in lighting design for elderly clinic.As shown in Figure 1 below, started from determine the topic, identify the problems, determine the goals and benefits of the design, then follow with determining scope of design supported with collected data through literature data, site visit and interviews with related party.Data analysis will be continued to create the concept and apply it through selected of lighting design technique which implement to presentation drawing.

Result and Discussion
Although everyone's lighting criteria may seem the same due to aging process visual needs can change.
The elderly experience decreased visual abilities, glare sensitivity, and reduce light-dark adaptation [[9].
Elderly eyes tend to be more sensitive to glare than adults' eyes and cloudiness of images can occur, and it is more difficult to distinguish objects.In addition, certain eye-related disease can change the visual criteria in different age of groups.In this case for example, the illumination requirements for an 80-year-old person are ten times the illumination requirements for an average adult.

Light affects the quality of life.
An adequate lighting provides a key to maximize self-sufficient and accident-free living as much as possible and helps people with their illness to manage their symptoms which also encourage independence and mobility.Meanwhile, poor lighting technique may have a long impact for elderly by causing other problem such sleeping disorder, depression, and lack of social interaction.Moreover, the vision impairments generally occur in the elderly especially those with dementia.
There are three aspects of lighting technique that need to be considered for healthcare for elderly, namely: 1).Increase the lighting, 2).Avoid the effects of glare, 3).Avoid changes in light intensity that are too contrasting [12].An elderly clinic must have inviting and safe environment by using a sufficient level of level illumination that warm and glare-free for the user.The lack of adequate lighting may cause disturbance in sleep that relates to confusion in circadian rhythms.Circadian rhythm is a biological clock process, present in all living things that regulate the body functions such as releasing hormones and sleep cycles according to daytime exposure [13].This also leads to weight gain, slower thinking, and psychological problems such as depression [14].Light influences in perceiving space in terms of dimensions, colors, materials, and atmosphere, which must convey a sense of security and comfort to enhance visual perception.Here are some important factors for good lighting according to Derungs Medical Lighting [15].

Glare Control
The eyes of the elderly are more sensitive to glare than the eyes of adults.Light is emitted in different ways in the eyes of the elderly, so there may be deposits in the eye that can cause clouding by forming layers on the retina.This layer can be uncomfortable and potentially dangerous for elderly individuals to distinguish between object or colours.Minimize glare can be achieved by using glare-reducing fixtures, diffusers and anti-reflective surfaces.

Reflection Control
Reflections on shiny surfaces are unsafe and cause strain on the eyes of the elderly.Lustrous surfaces may be found in adult care facilities, for example on tables, metal panels, mirrors, glass cabinet doors, images in glass frames, shiny floors, and so on.Reflected interference occurs when a bright light source is reflected on the line of sight.

Shadow Control
The combination of light and shadow is very important to be able to observe objects in space.A focused light source creates a sharp and deep contrast.This results in a sharp contrast resulting in dark shadows.Using radially diffused light sources such as indirect lighting creates lighting with subtle shadows.

Light Distribution
By using light to illuminate the walls, narrow spaces such as hallways will look wider.Maximize natural daylight can be applied by combining large windows and skylight in common areas and patient rooms.The use of natural light can improve mood and circadian rhythms in elderly.Indirect lighting will make the room look more inviting and open, while task lighting should be adjustable to specific needs.Controllable lighting systems allow for flexibility in lighting levels, it can empower patients to adjust lighting to their preferences and needs.

Lighting in Health-care Facility
Lighting in a health facility or clinic should create an inviting and safe environment by using light from a sufficient level of illumination but warm and glare-free for the elderly.

Light Colours
The colour of lighting describes the impression of light called colour temperature.Warm colours temperature 2700 K to 3000 K is a standard for general ambient lighting.It creates comfortable and calming atmosphere which beneficial for elderly.Lighting fixtures with high Colour Rendering Index (CRI) is the most accurate in representing colours.This lighting is necessary when providing adequate lighting for steps, entrances and exits or serious activities in the public space.Fluorescent lamps are available in a variety of light colours, from warm white to daylight white [17].

Lighting Standards
To provide functional lighting that applies multiple lighting components, lighting levels should not dominate the entire room but rather the right balance.Below is lighting standard needed in elderly clinics which divides into several areas according to Derung Medical Lighting.

The Application of Lighting Design for Elderly's Clinic 3.3.1. Design Concept
The interior concept is in Bahasa Indonesia Derana Senja Bersahaja, it means the sunset atmosphere is calming but still sturdy.The sunset atmosphere represents the aging process, while the shades of twilight color represent the firmness and maturity of the elderly who already have been through a lot of experiences.
The atmosphere to be created must have cleanliness and associated with the function of the clinic.It still assisted by warm accent colors that are used for emphasis, to enhance color scheme and to liven up to an otherwise monochromatic space.The selected colors are predominantly white and cream, sub-dominant brown dan for the accent colors are red, orange, and purple.

Lighting Design Concept for Geriatric's Clinic
Translating from the interior concept above, the lighting type that applied to the elderly clinic are adjusted to the need of each space, namely general lighting, and accent lighting.The combination of two types of lighting is expected to create a warm and friendly atmosphere.Indirect lighting applied on the ceilings and walls with LEDs to maximize the light distribution while the accent lighting used for direct lighting for corridors and toilet.As shown on the Figure 4 below, the lighting mood-board for geriatric clinic has cleanliness and tranquility ambiance.The purpose of having this ambiance is to create an inviting and safe environment that warm and glare-free for the elderly.The colors used are neutral and warm to create calm and relaxed atmosphere.The intensity requires minimum 100-200 lux in all clinic area such as corridors and toilet, up to 200-400 lux in area that has specific activities namely pharmacy and administration.The combination of direct and indirect lighting is good energy efficiency, almost no shadows, almost no reflections, good glare control, the room appears bright, and homogeneous, overtime transitions due to double reflections.

The Application of Lighting Design for Geriatric Clinic
As seen in the figures below, the result of lighting design applied direct lighting and indirect lighting.The Figures 5 and 6, shown direct lighting is applied in most area of elderly clinic as general lighting to remain bright and fit the function of the activities in the area, meanwhile indirect lighting can be seen from the ceiling at the administration desk area which uses LED lights to create vocal points so that the elderly patients can easily identify important areas in the clinic.In addition, LEDs are also placed on the wall as vertical lighting source.Therefore there are no dark parts and hidden area in the clinic.The Figure 7, shown the nurse's station area has LED applied in a huge half-circular shape, the purpose of this treatment is to make the nurse station area becomes a vocal point.Similar treatment shown in Figure 8, consulting room which the combination of indirect lighting and direct lighting creates a warm impression with bright atmosphere throughout the room.The application of combining direct and indirect lighting techniques create ambient lighting for the user by providing an atmosphere of daylight in the geriatric clinic.The room is not glaring and shadowless, this creates space that feels clean and safe.A bright atmosphere that resembles condition during the day in the room, can provide convenience for the elderly in activities.Spacious circulation provides easy accessibility, safety, and comfort for the elderly both who use walkers such as canes or wheelchair.

Conclusion
The results of implementing lighting in geriatric clinic interior are to identify the lighting design and visual environment for the user, specifically the patients and staff.The various aspects in lighting design can enhance safety, comfort and mental health while promoting healthy aging.It creates a warm and glare-free for the elderly with combination of direct and indirect lighting.Thoughtful lighting design for geriatric clinic may significantly contribute to overall well-being of the patients, that relates to the Sustainable Goals Development (SDG) No. 3the good health and well-being.Through the study that have been carried out in designing lighting in geriatric clinic, it is expected that this study recommend lighting design that encourage activities and programs to promote healthy aging and behaviours that support sustainability and raise the awareness among healthcare providers, profession and society about

Figure 5 .Figure 7 .Figure 8 .
Figure 5. 3D rendering for implementation of indirect lighting on the wall in reception area as the accent lighting (Source: Wijaya, 2023) Figure 6.3D rendering for implementation of indirect lighting on the wall and ceiling as the general lighting (Source: Wijaya, 2023)

Table 1 .
Lighting Standard for Elderly Clinic