Cold-Weather Warmth for Older Adults: Hot Packs, Layers and Safety

Why older people feel the cold more

• Lower heat production. Muscle mass and metabolic rate fall with age.
• Poorer circulation. Blood flow to the skin and the hands and feet is reduced.
• Thinner skin and less fat under it, which means less insulation.
• Blunted sensation. Older adults may not feel cold until the body temperature drops significantly.
• Medical conditions. Diabetes, thyroid disease, heart disease, anaemia, Parkinson's disease, dementia and poor nutrition all increase risk.
• Medicines, such as some sedatives, antidepressants and blood pressure tablets, can affect temperature regulation.
• Low activity. Sitting still for hours produces little heat.
• Poor housing. Cold, damp, draughty homes.

Cold affects health before it reaches hypothermia. Cold raises blood pressure and blood clotting, increasing the risk of heart attack and stroke; it stiffens joints and muscles; and it lowers resistance to chest infections; see cold-weather health risks for seniors.

How warm should the home be?

Health guidance for older people suggests:

• Living rooms at about 21 degrees Celsius.
• Bedrooms at about 18 degrees Celsius, or comfortably warm.
• Keeping rooms in use warm during the day, and avoiding large temperature differences between rooms.

In India, where central heating is rare, aim for a comfortably warm room, not shivering, and use layers and bedding. A simple room thermometer shows the temperature and is more reliable than feeling; see digital thermometers, though a room thermometer is a different product. If the room feels cold, the person is probably colder.

Layers and clothing

Dress in layers. Several thin layers trap warm air better than one thick layer and can be adjusted. A typical system:

• Base layer: soft cotton, wool or thermal underwear next to the skin.
• Middle layer: a jumper, cardigan or fleece.
• Outer layer: a shawl, coat or jacket for going out, wind-proof if possible.

Protect the extremities. A cap or scarf (much heat is lost through the head and neck), gloves or mittens, warm socks and closed shoes. Avoid tight socks that restrict circulation.

Keep clothes dry. Wet clothing chills quickly. Change promptly.

Easy to wear. Choose clothes that are simple to put on, with large buttons or Velcro for arthritic hands; see dressing aids.

Night clothing. Warm night clothes and socks, and a cap if the room is cold.

Bedding and sleeping warm

• Several light blankets rather than one heavy one, so the weight does not press on the chest, which can be tiring or restrict breathing.
• A quilt and a blanket, with a sheet underneath.
• A mattress protector or warm underlay.
• Warm the bed in advance with a hot water bottle, removed before sleep; see below.
• Keep the bed away from cold walls and draughts.
• Avoid electric blankets for people who are frail, confused, incontinent or who cannot feel heat, unless the model has safety features and is used according to instructions; do not leave them on all night.
• Do not use a hot bottle or heating pad in bed overnight.

See hot packs and older skin for rules on safe use of heat.

Heaters and fires: the dangers

Charcoal braziers (angithi) and coal or wood fires indoors. They produce carbon monoxide, an odourless, colourless gas that kills. Never use them in a closed room, never sleep with one burning and ensure ventilation. Symptoms of carbon monoxide poisoning include headache, dizziness, nausea, confusion and drowsiness; the person may fall asleep and not wake. If suspected, open doors and windows, get everyone into fresh air and call emergency services (112). A carbon monoxide alarm is a wise investment where fuel is burned indoors.

Gas heaters and geysers. Need ventilation and regular servicing. Use only well-ventilated bathrooms and avoid unvented gas heaters in bedrooms.

Electric room heaters. Oil-filled radiators are safer than bar heaters. Keep them away from bedding, curtains and clothes, on a level surface and never cover them. Fan heaters dry the air. Turn off when leaving the room or going to sleep. Check cords and plugs. Choose models with tip-over and overheat shut-off.

Blowers and immersion rods. Fire hazards if misused.

Open flames and candles. Avoid.

Heat for people with dementia. Supervise; some people will touch or cover heaters.

See safe use of heaters, geysers and fans.

Hot water bottles and hot packs

• Use hot, not boiling, water, and fill two-thirds.
• Use a cover or a towel.
• Never apply directly to skin, particularly if sensation is reduced.
• Use for short periods and check the skin.
• Replace bottles every one to two years.
• Never sleep with them.

For hot packs and burns, see hot packs and older skin.

Food, drink and activity

• Eat regularly, because food produces heat. Hot meals and warm drinks help, especially soups, tea and milk.
• Avoid alcohol to "warm up"; it makes the body lose heat.
• Keep moving, with short walks indoors, stretches and standing every hour; see chair exercises for seniors.
• Stay hydrated. Cold weather reduces thirst.
• Take medicines as prescribed and tell the doctor about any new symptoms.
• Vitamin D. Winter sun is limited; ask the doctor about vitamin D if needed; see calcium and vitamin D after 60.

Going out in cold weather

• Dress warmly with several layers and a covering for the head and hands.
• Go out in the middle of the day when it is warmest, and avoid early morning fog; see walking aids and footwear for good grip.
• Take care on wet, icy or foggy roads.
• Avoid sudden exertion in the cold, which strains the heart.
• Keep a phone and an alert device within reach.

Signs of too much cold: hypothermia

Hypothermia occurs when the body temperature falls below 35 degrees Celsius. In older adults it can develop slowly indoors. Signs include:

• shivering (which may stop as it worsens);
• cold, pale or bluish skin, particularly cold to the touch on the abdomen;
• drowsiness, confusion, slurred speech or slow movement;
• slow breathing and a slow pulse; and
• in severe cases, collapse.

If you suspect hypothermia: call for urgent medical help (112). Move the person to a warm room, remove wet clothes, wrap in blankets and warm clothing, cover the head, give warm (not hot) drinks only if awake and able to swallow, and do not use hot baths, direct heat, rubbing or alcohol. Handle gently.

Other winter checks

• Blood pressure. Cold can raise it; keep to the monitoring plan; see blood pressure monitors.
• Chest infections. Watch for cough, fever, breathlessness; see pneumonia in older adults and vaccines for older adults in India.
• Joint pain. Warm up before activity; see knee supports.
• Dry skin. Moisturise.
• Check on neighbours who live alone.
• Plan for power cuts and fuel shortage.

When to ask a professional

Ask a doctor if your parent feels cold all the time, has unexplained fatigue, confusion or very slow pulse, which can be signs of thyroid disease or other illness. Ask a nurse about safe heating and skin care. Our care advisors can arrange a nurse visit, a winter home check and regular calls during cold spells.