Supporting Vulnerable People Before and During Cold Weather

Overview

This Guidelines summary covers advice for healthcare professionals on protecting vulnerable people from the health impacts of cold weather, including identifying those at risk, managing cold-related illnesses, and preparing for and responding to cold weather.

Reflecting on your Learnings

Reflection is important for continuous learning and development, and a critical part of the revalidation process for UK healthcare professionals. Click here to access the Guidelines Reflection Record.

Reducing Risks for Cold Weather Exposure

• Adverse cold weather can put people at greater risk of ill health and even death, primarily because it increases the probability of complications from existing disease and of injury due to falls
• You can reduce the risks associated with exposure to adverse cold weather for those you care for by:
  • knowing who is at risk
  • being alert to increased cardiovascular, respiratory, and other complications from cold exposure
  • adapting individual care plans to respond to adverse cold weather
  • promoting vaccination for those eligible to reduce risks from COVID-19 and flu
  • having action plans in place for your organisation and/or place of work, tailored to the local context
  • signposting people to sources of support for housing, energy bills, and other needs as appropriate, including specific support for those on low incomes.

People who are at Risk to the Effects of Cold Weather 

• 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 years 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 years)
  • 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.

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
• 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 has produced guidance for health and care professionals on measures to reduce the risk of falls and fractures in older people in the community.

How to Prepare for Cold Weather

• Preparation for cold weather should occur all year round, and plans for managing adverse cold weather events should be agreed and distributed before 1 November each year. The UK Health Security Agency’s (UKHSA) Adverse Weather and Health Planoutlines 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
• An action card for healthcare providers can be found on GOV.UK. This card covers recommended actions under different Cold Health Alert levels, spanning preparedness and response
• If you are advising, visiting, supporting, or caring for someone in the community, the steps in the following sections should be taken before adverse cold weather happens to reduce health risks to the public.

Actions to Take All Year Round

• If you are working 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
• You should develop approaches to include risk in care records and consider whether changes might be necessary to care plans in the event of cold weather
• You should ensure plans are in place to be able to monitor room temperature and, in clinical settings, body temperature, pulse rate, and blood pressure.

Actions to Take During the Winter Months

• If you are working in a patient-facing role, you should 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
• You should ensure that appropriate home checks are being carried out when visiting patients, 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
• You should 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
• You should be ensuring 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
• You should 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.

Responding to Cold Weather

Implementing 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 patients, 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. 

Considering Extra Care Needs

• Anyone in a high-risk category who is living alone is likely to need at least daily contact during adverse cold weather, by care workers, volunteers, or informal carers. Individuals at greater risk may need extra care and support
• If you are working in a patient-facing role, check that:
  • 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.

Further Resources and Information

• Keeping warm and well in cold weather guidance
• Adverse Weather and Health Plan, including supporting evidence and user guide
• Cold-Health Alert action card for providers and commissioners.