Elsevier

Annals of Epidemiology

Volume 28, Issue 1, January 2018, Pages 1-7.e3
Annals of Epidemiology

Original article
Can we identify older people most vulnerable to living in cold homes during winter?

https://doi.org/10.1016/j.annepidem.2017.11.008Get rights and content

Highlights

  • Which individual factors predict whether older people are living in cold homes?

  • Does living in a cold home predict mortality in older adults?

  • In our study of older men, manual social class, social isolation, and poor respiratory health showed the strongest associations with self-reported cold home during winter.

  • Self-reported cold home was associated with a relative risk of 2.85 of dying within two years.

  • Identifying older people who find it hard to keep warm in winter and have an increased mortality risk is possible using a self-report questionnaire.

Abstract

Purpose

Living in a cold home increases the risk of dying in winter, especially in older people. However, it is unclear which individual factors predict whether older people are living in cold homes.

Methods

Thousand four hundred two men aged 74–95 years from a U.K. population–based study reported difficulties in keeping warm during winter, answering four simple “yes/no” questions. Associations between individual's characteristics and each of the four self-reported measures of cold homes were estimated using logistic regression models. Next, we investigated whether measures of cold homes predict mortality over the subsequent 2.1 years.

Results

Manual social class, difficulties making ends meet, and not being married were each associated (P < .05) with each of the four measures of cold homes (adjusted odds ratios ranged from 1.61 to 4.68). Social isolation, poor respiratory health, and grip strength were also associated with reports of cold homes. Hundred twenty-six men died; those who reported the presence of at least three measures cold homes had increased mortality (adjusted hazard ratios 2.85 [95% confidence interval, 1.11–7.30, P = .029]).

Conclusions

Older people who find it hard to keep warm in winter, and have an elevated mortality, could be identified using a self-report questionnaire.

Section snippets

Background

Excess winter mortality in the United Kingdom has been partially attributed to cold housing [1], [2], with an extra 5500 more deaths occurring annually in the coldest homes than would occur if those homes were warm [3]. Greater susceptibility of older people to cold has been suggested [4] as they have worse cardiovascular and respiratory profiles at lower indoor [5] and outdoor [6] temperatures. However, it is unclear how to identify older people who particularly find it hard to keep warm in

Sample

The British Regional Heart Study (BRHS) is a prospective, population-based cohort study following up 7735 men (99% Caucasian) recruited from primary care practices in 24 British towns in 1978–1980. In 2014, 2820 surviving men aged 74–96 years were invited to complete a comprehensive health status and life style questionnaire including self-reported measures of cold homes [14]. Thousand six hundred fifty-five men responded (99% between April and October), and 1402 had complete data on all

Results

We found (1) 288 (20.7%) men had difficulties in meeting the heating/fuel costs; (2) 173 (12.4%) stayed in bed longer to stay warm; (3) 47 (3.3%) could not keep comfortably warm in the living room, and (4) 130 (9.4%) turned heating off because of worries about the costs. Manual social class, increasing financial difficulties, poor health in general, and being not married were more common in men who were having difficulties in meeting the heating/fuel costs (Table 1). Similar findings were found

Discussion

To our knowledge, this is the most comprehensive investigation of associations of individual factors (sociodemographic, economic, health, and house conditions) with self-reported measures of cold homes in older men and reports of cold homes related to mortality.

Conclusions

Identifying older people who find it hard to keep warm in winter and have an increased mortality risk is possible. Increasing financial difficulties and lower social class are not the only factors that increase older people's difficulties in keeping warm during winter. With an increasing aging population, U.K. policies need to tackle the adverse effect of multiple risk factors that increase with age and are more common in people living in cold homes, such as social isolation, poor respiratory

Acknowledgments

This article presents independent research funded by the National Institute of Health Research School for Primary Care Research (NIHR SPCR grant reference number 281). The NIHR programme grant was awarded to R.W.M. and supported C.S. and P.T. D.S.L is funded by the NIHR Oxford Biomedical Research Centre. The British Regional Heart study is supported by a British Heart Foundation programme grant (RG/13/16/30528). The funders had no role in the design and conduct of the study; collection,

References (29)

  • V. Burholt et al.

    Keeping warm? Self-reported housing and home energy efficiency factors impacting on older people heating homes in North Wales

    Energy Policy

    (2006)
  • B.J. Freund et al.

    Alcohol Ingestion and Temperature Regulation during Cold-Exposure

    J Wilderness Med

    (1994)
  • Marmot Review Team

    The health impacts of cold homes and fuel poverty

  • National Institute for Heath and Care Excellence (NICE) guidelines

    Excess winter deaths and illness and the health risks associated with cold homes

  • K.B. Dear et al.

    The health impacts of cold homes and fuel poverty

    BMJ

    (2011)
  • P. Wilkinson et al.

    Vulnerability to winter mortality in elderly people in Britain: population based study

    BMJ

    (2004)
  • I. Shiue

    Cold homes are associated with poor biomarkers and less blood pressure check-up: English Longitudinal Study of Ageing, 2012-2013

    Environ Sci Pollut Res Int

    (2016)
  • C. Sartini et al.

    Relationship between outdoor temperature and cardiovascular disease risk factors in older people

    Eur J Prev Cardiol

    (2017)
  • M. McCartney

    Margaret McCartney: can doctors fix cold homes?

    BMJ

    (2015)
  • A. Tod et al.

    Barriers to keeping warm in later life

    Nurs Older People

    (2013)
  • C.N. Grey et al.

    The short-term health and psychosocial impacts of domestic energy efficiency investments in low-income areas: a controlled before and after study

    BMC Public Health

    (2017)
  • P. Wilkinson et al.

    Cold comfort: the social and environmental determinants of excess winter death in England, 1986–1996

    (2001)
  • Department for Business, Energy & Industrial Strategy

    Annual fuel poverty statistics report

  • Z. Kmietowicz

    GPs should identify and visit people at risk from cold homes, says NICE

    BMJ

    (2015)
  • Cited by (0)

    The authors report no relationships that could be construed as a conflict of interest.

    View full text