To understand the influences and decisions of vulnerable older people in relation to keeping warm in winter.
A qualitative study incorporating in-depth, semi-structured individual and group interviews, framework analysis and social marketing segmentation techniques.
Rotherham, South Yorkshire, UK.
50 older people (>55) and 25 health and social care staff underwent individual interview. The older people also had household temperature measurements. 24 older people and 19 health and social care staff participated in one of the six group interviews.
Multiple complex factors emerged to explain whether vulnerable older people were able to keep warm. These influences combined in various ways that meant older people were not able to or preferred not to access help or change home heating behaviour. Factors influencing behaviours and decisions relating to use of heating, spending money, accessing cheaper tariffs, accessing benefits or asking for help fell into three main categories. These were situational and contextual factors, attitudes and values, and barriers. Barriers included poor knowledge and awareness, technology, disjointed systems and the invisibility of fuel and fuel payment. Findings formed the basis of a social marketing segmentation model used to develop six pen portraits that illustrated how factors that conspire against older people being able to keep warm.
The findings illustrate how and why vulnerable older people may be at risk of a cold home. The pen portraits provide an accessible vehicle and reflective tool to raise the capacity of the NHS in responding to their needs in line with the Cold Weather Plan.
What factors influence older vulnerable people keeping warm and well in winter?
How do these factors interrelate in different people in order to increase the risk an older person is cold at home?
How can this be represented by a social marketing segmentation model?
Knowledge and awareness of safe temperatures, the health impact of cold and how to use heating efficiently were low across the study participants.
Older people's values and beliefs can interact with the contextual factors and barriers in such a way that they often end up being cold at home.
The segmentation model can illustrate the diversity of older people at risk of living in a cold home. It can be used as a reflective tool at a clinical and strategic level to identify and refer vulnerable older people.
Strategic responses are required to help bring about the required partnership, systems, boundary spanning approaches and capacity development in staff and communities needed to reduce excess winter deaths.
Greater focus is needed to ensure affordable warmth interventions achieve the desired outcome of safe indoor temperatures for older and other vulnerable people.
Strengths and limitations of this study
The study has provided understanding of the complex environment within which vulnerable older citizens live and the factors that conspire against them being able to keep warm.
The study provides some insight into why older people at risk of being cold are not always able to make decisions to keep them warm. It reinforces and expands the findings of others.
The study has generated a segmentation model and pen portraits that can be used as a reflective tool at a clinical and strategic level to identify and refer vulnerable older people.
The main limitation of the study is that it was conducted on a single site.