Every winter, thousands of older people in the UK experience ill-health or even die as a result of the cold. This winter as many as 25,000 older people could die needlessly because of the temperature. That’s around 200 preventable deaths a day.
A range of factors affect older people during the winter months, from health problems exacerbated by the cold to increased isolation as the nights draw in.
This article will set out current good practice to show how, with a little preparation and a helping hand from those who are out in the community supporting older people every day, more people in later life should be able to stay healthy, safe and comfortable this winter.
Preventing the chill indoors
It is really important for older people to keep warm, both inside and outside the home. Being cold causes a massive increase in the risk of associated health problems such as chest infections and respiratory problems, heart attacks, strokes, pneumonia, chilblains, worsening arthritis and increased accidents at home (associated with loss of strength and dexterity in the hands). We know that this ill-health and the associated deaths are preventable and excess winter deaths are higher in the UK than in some much colder countries, such as Finland, Germany and Denmark.
Older people’s behaviour towards keeping their homes and themselves warm is influenced by a number of issues. These include struggling to pay high energy bills, as well as a lack of awareness of how the cold can negatively affect health, or that susceptibility to cold-related illness increases with age.
Nurses can help by making older people aware of the dangers of the cold and the simple things people can do to keep warm and well. Most of the following will reinforce information and advice that nurses will already know, but when seeing or visiting older people for whatever reason during the winter months, keep your eyes and ears open, take a look around, ask questions and be aware if the home feels cold or draughty. The ideal temperature for the main living room is 70°F (21°C) and for the bedroom it is 64°F (18°C). The bathroom and kitchen should not be icy cold, and closing the curtains at dusk will help keep the heat in. Some people believe in keeping the window slightly open at night, but in the cold weather windows should be kept closed to keep out the draught and keep the warmth indoors.
Several layers of clothes will also keep people warmer than one thick layer, and thermal underwear will make a difference. For bedtime, ask about what clothes are being worn - thermals, bed socks and a hat can help. Hot water bottles and electric blankets can be used to warm the bed, but never together. The local Age UK and local trading standards departments often offer free electric blanket testing which should be carried out every three years.
Once you have checked with a thermometer that the home is being kept warm, make sure that your older patients are eating and drinking enough, with plenty of food and essentials stocked up for the winter ahead. Meals for one can be stored in the freezer and you may want to see if your patient is interested in ‘meals on wheels’ or a similar service, which can be arranged privately or through social services. Older people should be taking in plenty of fluids, so check they are drinking enough and regularly – can they access fluids easily? Could they keep a flask nearby for top up hot drinks throughout the day? Hot meals and drinks help older people to stay warm, so at least one hot meal during the day is essential along with hot drinks.
People over 65, and carers of older people, are eligible for a seasonal flu jab, so ensure both you and your patient have had one, as well as the one-off ‘pneumo’ jab for over 65s which protects against pneumonia, meningitis and septicaemia.
With the onset of winter, older patients should be stocked up with necessary medication in preparation. For example, are there plenty of cold and flu remedies to hand? Do they have plenty of hearing aid batteries at home? Make sure patients know how to order repeat prescriptions in advance of bad weather.
It is worth making older people aware that they don’t always need to make the trip to the pharmacy or GP, as many pharmacists offer a repeat prescription delivery service and most GPs will offer phone consultations. C
heck that patients have the phone numbers of their local pharmacy and GP, as well as the NHS Direct number or NHS 111 information.
Out and about
Going outdoors in the cold can be dangerous for some. If older patients do need to come and visit you, have a look at what they are wearing – a hat, scarf and gloves should be worn, even when people pop out for short intervals.
Winter can bring with it the increased risk of falling.
If older people don’t have grab rails fitted by the front and back door, you could advise contacting the local Age UK or local authority to see if they could help. Also take a look at older people’s footwear, as thermal boots with non-slip soles will be warmer and safer on slippery ground.
If people can’t get out and about, advise them not to sit for prolonged periods and get up and walk about where possible to help keep warm.
Loneliness and isolation
Winter can be particularly difficult for people who are disabled, in poor health or lonely. Many older people become isolated and more vulnerable in the colder months, and loneliness can have negative health impacts, so look out for the signs which may include poor sleep, lack of appetite and lethargy – so do tactfully ask people when they last saw friends and family.
Be aware of what activities are available for older people in the local area, from lunch clubs to craft clubs and befriending services. Lots of local Age UK branches and other organisations can help.
Reach out to older people
It is really important for nurses to go the extra mile and play their part in ensuring older people are healthy and safe at this notoriously difficult time of year as this can make a real difference. You can help by finding out what potentially life-changing services are available locally and sharing that information with an older person who could do with a bit of extra support.
Make sure you know what local voluntary organisations are doing this winter, from emergency winter warmth packs to lunch clubs and Christmas meals.
If you are really concerned about the wellbeing of an older person, with their consent, you can alert social services or suggest the older person contact specialist agencies or charities such as Age UK.
Being older shouldn’t mean being cold. By taking a little more time this winter with older patients you could help save lives.
To find out more about what Age UK is doing to help older people this winter and to order free copies of the ‘Winter wrapped up’ guide with a free thermometer, call Age UK Advice free on 0800 169 6565. Alternatively visit www.spreadthewarmth.org.uk to download the guide, get more information about ‘Spread the Warmth’ and find out where the local Age UK office is.
Nurses can refer to the Department of Health’s Cold Weather Plan for England 2012, which sets out plans for severe winter weather and includes action cards for health professionals at www.dh.gov.uk/health/2012/10/cwp-2012.
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