Cold-Weather Health Risks for Older Adults

Why cold is harder on older adults

• Less body heat: lower muscle mass, slower metabolism and reduced shivering response.
• Reduced awareness of cold: the senses of temperature dull with age, diabetes, nerve damage and dementia; see peripheral neuropathy and balance.
• Circulation: narrowed arteries, heart disease and low blood pressure reduce warmth to the hands and feet.
• Higher blood pressure and thicker blood in cold weather raise heart attack and stroke risk; see hypertension home care guide and stroke warning signs and the first hour.
• Breathing: cold, dry and polluted air triggers cough, wheeze and breathlessness in asthma and COPD; see COPD at home guide and pollution season plan for seniors.
• Infections spread more indoors: influenza, colds, pneumonia; see pneumonia in older adults: prevention and recovery.
• Joint stiffness and pain worsen; see arthritis at home: a complete guide for older adults and families.
• Dry, itchy, cracked skin; see itchy, dry and fragile skin in older adults.
• Low mood and less activity in dark, short days.
• Falls on cold, dim, wet floors and from stiffness; see falls risk assessment at home.
• Conditions and medicines such as an underactive thyroid, poor nutrition, some sedating medicines, and alcohol can lower the body's defence against cold; see thyroid problems in older adults.

Warming the home safely

• Aim for a living room of about eighteen to twenty-one degrees and a bedroom around eighteen where possible; check with a room thermometer. Do not let rooms feel icy.
• Heat one room well rather than the whole house, and keep the person in it, with the door closed.
• Block draughts: curtains, door and window gaps, a rug or door snake; see temperature and ventilation at home.
• Let sunshine in during the day and close curtains at dusk.
• Fit heaters safely: see safe use of heaters and geysers. Keep them away from bedding, curtains and walkways, never dry clothes on them, and turn them off when leaving the room or sleeping if they are not thermostat-protected.
• Never burn coal, charcoal, wood or dung cakes in a closed room. They produce carbon monoxide, which is invisible, odourless and deadly. Do not sleep in a closed room with a brazier or unvented gas heater.
• Ventilate gas geysers and bathrooms: gas water heaters in small, closed bathrooms are a known killer; see smoke and gas safety for older adults.
• Check electrical items and avoid overloaded extension boards.
• Use fireplaces and open flames with caution, with loose clothing kept away.
• Plan for power cuts in winter with blankets and a charged phone; see power cuts and older adults.

Keeping the person warm

• Layers: a vest, a shirt, a woollen sweater, a shawl, with a scarf, cap, socks and gloves; thin layers trap air better than one thick garment. Cover the head, neck and feet.
• Bed: warm but not overheated bedding; a quilt or blankets in layers; warm socks. Do not let your parent sleep with a hot water bottle or heating pad that could burn skin, particularly if they have reduced sensation; see cold-weather warmth, hot packs and layers and hot pack safety for older skin.
• Warm water: bathing with warm, not scalding, water, in a warm, draught-free bathroom, and drying quickly; see hot water and scald safety for older skin and bathing safely with a shower chair. On very cold mornings, a wipe-down in a warm room may be safer than a full bath.
• Bedridden people lose heat fast; check hands, feet and room temperature, and avoid damp sheets and clothes; see positioning a bedridden parent.
• Dry clothes quickly: wet clothes chill rapidly.
• Footwear: warm, non-slip shoes or socks with grip; see choosing shoes for older feet.

Food and drink for winter

• Regular hot meals and warm drinks. Soups, khichdi, dal, porridge, milk with turmeric, vegetable stews and tea give warmth and fluids; see indian meals for high-protein seniors.
• Keep drinking. Thirst falls in cold, so offer warm fluids through the day; see hydration for older adults: how much and how to remember.
• Avoid alcohol as a warming drink; it increases heat loss, raises fall risk and interacts with medicines; see alcohol and medicines in older adults.
• Vitamin D: low sun exposure in winter; ask the doctor about testing; see vitamin D deficiency in India.
• Diabetes: keep regular meals and sugar checks; cold feet may hide injuries; see diabetic foot care at home.

Protecting chest and heart

• Vaccines: influenza and pneumococcal vaccines before winter, and others as advised; see vaccines for older adults in India: a practical schedule.
• Avoid going out in dense fog, smog and the coldest hours; if necessary, cover the nose and mouth with a scarf or mask, and walk slowly.
• Gentle indoor activity as the day warms; see chair exercises for seniors and exercise at home for seniors: a starter guide.
• Avoid sudden exertion in the cold, such as shovelling or rushing, particularly with heart disease.
• Use inhalers, heart and blood pressure medicines exactly as prescribed; do not change doses because of the weather. Check blood pressure regularly; see how to measure blood pressure at home accurately.
• Clean air: keep windows closed during smog and use air-cleaning devices if advised; see indoor air quality for older lungs.
• Do not use steam inhalation recklessly: scalds are common; see steam inhalation safety.
• Know the warning signs of heart attack, stroke and chest infection, below.

Skin, joints and mood

• Skin: moisturise after bathing, avoid very hot water, use mild soap, and protect hands and feet from cracks; see itchy, dry and fragile skin in older adults.
• Joints: warmth, gentle movement and layers help; see heat or cold for joint pain.
• Mood: get morning daylight, keep routines, stay in touch with family; see depression in older adults and loneliness and isolation in older adults. If your parent seems very low or talks of not wanting to live, seek help the same day; Tele-MANAS (14416) is India's national mental health helpline (check the current number), and 112 is the emergency number.

Recognising hypothermia

Hypothermia means the body's core temperature falls below about thirty-five degrees. It can happen indoors in an unheated room, especially in frail people.

Early signs: cold skin, shivering, pale or blue lips and fingers, tiredness, slow or slurred speech, confusion, clumsiness, irritability. Later signs: shivering stops, drowsiness, slow breathing and pulse, stiffness, loss of consciousness.

What to do: 1. Call 112 if the person is confused, drowsy, shivering has stopped, or you suspect hypothermia. 2. Move them gently to a warm room, handle with care, and remove any wet clothing. 3. Wrap them in dry blankets, including head and neck; warm the trunk first. Place a layer between the person and the cold floor. 4. If awake and able to swallow, give warm (not hot) sweet drinks. 5. Do not rub the limbs, give alcohol, use hot baths, or apply direct heat such as heaters or hot water bottles to the skin; this can cause burns or harmful shifts in blood circulation. 6. Monitor breathing and alertness; begin CPR if they stop breathing and follow the call handler's instructions.

A low-reading thermometer may be needed; ordinary clinical thermometers may not register very low temperatures; see digital thermometers: choosing and using them for older people.

Carbon monoxide poisoning

Headache, dizziness, nausea, tiredness and confusion when a heater, brazier or geyser is running may signal carbon monoxide. Move everyone into fresh air at once, open doors and windows, turn off the source and call 112, even if people feel better outside.

Other emergencies in winter

Call 112 for: chest pain, pressure or tightness; severe breathlessness; face droop, arm weakness or speech difficulty; fainting; blue lips; high fever with confusion; sudden severe headache; a fall with injury or inability to get up; and burns from heaters or hot water; see how to get up after a fall and stroke warning signs and the first hour.

When to ask a professional

Ask the doctor before winter about vaccines, chronic condition reviews and medicine plans. Ask a pharmacist about inhalers and storage. Ask an electrician or gas agency to check heaters, geysers and wiring. Seek urgent help for hypothermia, carbon monoxide symptoms or any emergency sign.