Information for healthcare professionals caring for older people during cold weather

Deaths and illnesses during the winter months are significantly higher than at other times of the year. Direct cold exposure can result in death or severe illness due to hypothermia, although deaths where hypothermia is the primary cause are relatively rare.

Exposure to cold can lead to direct effects including:

• Increase the risk of blood clots forming in the body, in turn increasing the risk of heart attacks and strokes.
• Increase susceptibility to chest infections.
• Worsen breathing problems.
• Increase the risk of falls.

Cold exposure can also result in indirect effects such as increased risk from mental health conditions such as depression and anxiety. Cases of carbon monoxide poisoning typically increase during the winter months. This is because people are more likely to use cooking or heating systems at home that worsen indoor air quality and are less likely to ventilate their homes as they would during warmer weather.

Other factors also contribute to increased risks to health during cold weather. These include fuel poverty, poor-quality housing and particularly cold homes. The risk of exposure to an underheated home is greater among those on low incomes, and those who are housebound.

Adverse Weather and Health Plan

In order to protect individuals and communities from the health effects of the increasing number of adverse weather events and build community resilience, the UK Health Security Agency (UKHSA) published the Adverse Weather and Health Plan earlier in the year.

The plan outlines the areas where public sector, independent sector, voluntary sector, health and social care organisations and local communities can work together to maintain and improve arrangements for planning and response to deliver the best health outcomes possible during adverse weather.

Weather-Health Alerting System

To support the Plan, the Weather-Health Alerting System was launched by the UKHSA in partnership with the Met Office. The Weather-Health Alerting System is made up of the Cold-Health Alerts (CHA) and Heat-Health Alerts (HHA). The core season for CHAs runs from 1 November to 31 March, with the core alerting system for HHAs running from 1 June to 30 September. The alerts provide the health and social care sector, responder community, voluntary and community sector and government departments an early warning when adverse temperatures are likely to impact on the health and wellbeing of the population.

CHAs will be issued to those who have signed up to the system when the weather conditions have the potential to impact the health and wellbeing of the population. The alerts will be given a colour (yellow, amber or red) based on the combination of the impact the weather conditions could have, and the likelihood of those impacts being realised. These assessments are made in conjunction with the Met Office when adverse weather conditions are indicated within the forecast.

Once the decision is made to issue an alert, these will be cascaded to those registered to receive the alerts and made available on the new dedicated web platform. Alerts will be issued with as much lead time to the event as possible to allow users time to make their local assessments and to initiate all appropriate actions to reduce harm to health. Users should review every alert when issued to ensure they fully understand the potential impacts and how likely they are to occur.

UKHSA has been encouraging stakeholders, including healthcare professionals, to sign up to the alerts so they are aware of the risk to their vulnerable and/or elderly patients and the potential impact on the health system, and can therefore prepare and respond appropriately.

Guidance

As part of the Plan, guidance has been developed on how to care for vulnerable people, including those over the age of 65, in cold weather.

This article will lay out UKSHA’s guidance on how healthcare professionals can best prepare for cold weather and how to look after patients during cold snaps.

Supporting vulnerable people before and during cold weather: healthcare professionals

The below is a summarised version of the guidance is for healthcare professionals working in community, care home or hospital environments, including those working in managerial and in patient-facing roles.

You can reduce the risks associated with cold weather for those you care for by:

1. Knowing who is at risk

Many people are vulnerable to the effects of cold weather. These include:

• People who have chronic medical conditions.
• Those living with learning and/or physical disabilities that may prevent them being able to keep warm (for example because they are unable to move around) or leave them at greater risk of developing chest infections.
• Those who cannot afford to keep warm enough during the winter months.

Those at risk include:

• Older people (aged 65 and over).
• People with cardiovascular conditions.
• People with respiratory conditions (in particular, chronic obstructive pulmonary disease and childhood asthma).
• People with mental health conditions.
• People with learning and/or physical disabilities.
• Young children (particularly those aged under 5).
• Pregnant women.
• People on a low income.

People who are sleeping rough are also at greater risk from cold exposure. Further guidance is available for those working with people sleeping rough.

2. Managing cold-related illnesses

Hypothermia is defined as a core body temperature less than 35^°C. However, best practice clinical guidance is available on how to recognise and manage those suffering from hypothermia, for whom signs and symptoms may include:

• Shivering.
• Cognitive impairment.
• Changes in pulse and respiratory rates.
• Changes in blood pressure levels.
• Frostbite.

The National Institute for Health and Care Excellence (NICE) offers advice on early recognition of, and action on, complications of cold exposure including strokes, heart attacks and pneumonia.

Older people are at greater risk of falls during periods of adverse cold weather, especially when these are accompanied by snowfall and/or ice. The Office for Health Improvement and Disparities (OHID) has produced guidance for health and care professionals on measures to reduce the risk of falls and fractures in older people in the community.

3. Preparing for cold weather

Preparation for cold weather should occur year-round, and plans for managing adverse cold weather events should be agreed and distributed before 1 November each year. The Adverse Weather and Health Plan outlines nine important areas for action that healthcare organisations and their partners can consider when developing local cold weather plans.

Make as much use as possible of existing care plans to assess which individuals are at particular risk, and to identify what extra help they might need. Where possible, involve their family and any informal carers in these arrangements.

The action card for healthcare providers includes recommended actions under different CHA levels, spanning preparedness and response.

If you are advising, visiting, supporting, or caring for someone in the community, the following steps should be taken before adverse cold weather happens to reduce health risks to the public.

There are particular actions you should take all year round.

If you are in a managerial role you should:

• Establish methods to identify, alert and monitor individuals most vulnerable to cold-related illnesses on your caseload.
• Consider seeking specialist advice from clinical teams if you are unsure how to determine whether someone is at risk.
• Ensure data sharing agreements or protocols are in place to allow organisations to share data or intelligence, including details of the most vulnerable people where appropriate.

If you are in a patient facing role you should:

• Consider the needs of carers, the support they can continue to give during periods of adverse cold weather, and what additional support they may need to fulfil their roles during periods of adverse cold weather.
• Develop approaches to include risk in care records and consider whether changes might be necessary to care plans in the event of cold weather.
• Ensure plans are in place to be able to monitor room temperature and, in clinical settings, body temperature, pulse rate and blood pressure.

There are actions you should take during the winter months.

If you are in a managerial role you should:

• Support staff training and capacity development by ensuring staff are aware of and understand business continuity plans and/or cold weather plans that apply in their setting, and what actions they may need to take if they are activated.
• Support staff to complete training, where available, to help identify those most likely to be at risk from adverse cold weather, for example by drawing on resources such as UKHSA’s ‘Helping People Living in Cold Homes’ e-learning module.
• Test out systems and ensure that local dissemination systems for the CHAs are fully operational and effective and that colleagues you work with understand what actions to take when they receive them. This may include reviewing and updating relevant distribution lists for information and weather alert cascades.

If you are in a patient facing role:

• Help to identify and protect those at risk by ensuring that you have identified all those vulnerable to cold weather on your caseload and that arrangements are in place to support and protect them appropriately. This may include developing and maintaining a register of the most vulnerable individuals to ensure they can be offered appropriate support where required.
• You should ensure that you offer COVID-19 and/or flu vaccinations to all those who are eligible, as a preventive measure to reduce the risk of respiratory infections during winter.
• For those working in hospital settings, ensure prompt identification of those at risk from adverse cold weather on admission, and put in place plans to enable discharge to warm accommodation.
• You should ensure that appropriate home checks are being carried out when visiting clients, for example, checking temperatures in rooms (such as living rooms and bedrooms) in which people spend most of their time at home and reviewing medication stocks and food supplies.
• Establish where relevant, referring those that you identify as being at risk from a cold home to local services (for example housing services), who may be able to help improve their living conditions.
• Ensure carers are receiving advice and support, for example on signs and symptoms to look out for suggesting that those vulnerable to cold are becoming unwell, or on sources of additional clinical or financial support where necessary.
• Advise on support measures or about how to stay warm and well during cold weather, namely by signposting to the following:
  • Met Office guidance on how to get your home and property winter ready and keeping your home warm this winter.
  • GOV.UK page on help for households.
  • Age UK’s website or call 0800 169 6565 and quote ‘WINTER’.
  • NHS England information on how to stay well in winter.

If you are working in a managerial or a patient-facing role, you can protect yourself by getting vaccinated against COVID-19 and/or flu as a preventive measure to reduce the risk of respiratory infections during winter. You can check whether you are eligible for flu vaccination and book an appointment with your employer occupational health service, your pharmacy or your GP, provided that you are eligible. For COVID-19, the NHS will contact you if your records suggest you may be eligible for vaccination.

4. Responding to cold weather

If a CHA is issued, you should:

Implement general measures

If you are working in a patient facing role, you should:

• Ensure local actions for the vulnerable are being carried out such as arranging daily contacts or visits.
• Ensure that appropriate home checks are carried out when visiting clients, for example, room temperature, checking medications and food supplies and ensuring carers are receiving appropriate advice and support to help them continue providing care.
• Ensure that rooms, particularly living rooms and bedrooms, are kept warm (for those in care, residential and nursing home facilities, and in the community).
• Advise carers to contact nominated clinical leads if they have concerns regarding the health of a patient or client.
• Identify and actively monitor high-risk individuals during cold weather episodes, checking that individuals most vulnerable to cold-related illnesses have visitor or phone call arrangements in place.

Consider extra care needs

If you are working in a patient facing role, ensure:

• The person can contact the primary care team if one of their informal carers is unavailable.
• Their care plan contains contact details for their GP, other care workers and informal carers.
• There are adequate arrangements for food shopping and other essentials, to reduce the need for them to go out in adverse cold weather.
• There are mechanisms for escalating the level of care and support available if there is a sudden increase in needs during a period of adverse cold weather.

5. Protecting yourself

Whether you are working in a managerial or a patient-facing role, day-to-day practice may be disrupted during adverse cold weather. You may find it difficult to commute to work, or to reach service users through street outreach work. Staff absences may also be more likely during this time due to, for example, respiratory illness. Business continuity plans may therefore need to be implemented.

You should consider:

• Whether you have any vulnerabilities that you may need to take into account in planning your own work, or supporting staff in your teams.
• General advice given in UKHSA’s keeping warm and well guidance.
• Advice from the Health Safety Executive guidance on temperature in the workplace.

Further information

The above guidance is for healthcare professionals, separate guidance for social care managers can be found on the UKHSA website.

You can also find UKHSA’s hot weather guidance on our website