What are the impacts?

Can a cold home be a killer?

Elderly people are extremely vulnerable to the impacts of fuel poverty for several reasons. A key difference is they may already be frail with age or other chronic conditions, and the impacts of cold can be a tipping point. So yes, a cold home can play a role in their demise.

Winter is always a dangerous time for the elderly as their level of immunity is naturally reduced, leaving them more prone to cold, flu and viral infections. As in young children, low immunity in older people is linked to the reduced amounts of subcutaeneous fat.

Other health issues specific to elderly people living in cold homes include the triggering or exacerbating of chronic bone-related conditions such as rheumatism and arthritis and higher incidence of osteoarthritic pain, which is commonly associated with knee problems and hip fractures. While it difficult to measure how often these conditions are specific to cold homes, in an impact evaluation for the UK’s Warm Front fuel poverty programme 24.5% of respondents reported easing of such chronic conditions once energy efficiency interventions had been applied to their homes.

Both cold homes and poor indoor air quality have also been linked to elderly people having increased rates of falls and other accidental injuries in the home. Additionally, many have reduced mobility, which may make the physical act of managing heating and moving safely around the home for routine activities more difficult.

Another key factor puts elderly people at double risk for fuel poverty and its associated health risks. Quite simply, without the daily routine of going to school or work, they tend to spend a much higher percentage of their time at home, which puts them between a rock and a hard place. Their all-day heating requirements push energy bills up, but if they cannot afford the warmth they need, they will spend more time exposed to the cold, damp conditions.

These conditions cause of significant hardship for many elderly people, involving flow-on impacts of discomfort, financial cost and increased social isolation (COLD@HOME will investigate the social impacts of fuel poverty in an upcoming blog).  The fact that many elderly people live alone also heightens their risk: if chronic cold begins to undermine their health, it may be the case that no one notices, including the person suffering.

But let's come back to the tipping point problem. The combination of conditions described above puts elderly people at much higher risk of a mild to moderate illness being pushed to severe by chronic cold. In fact, a large body of evidence links fuel poverty to ‘excess winter deaths’ in the elderly population.

Data on death rates clearly show a marked increase during the winter period (defined as December to March in the Northern Hemisphere; as June to September in the Southern Hemisphere) compared against the average number of deaths occurring in the non-winter months. Statisticians and epidemiologists consider this difference as an indicator of the impact of cold temperatures on health.

In some places during some winters, excess winter deaths have been as much as 70% higher than in the corresponding summers (just before or just after). The health conditions associated with fuel poverty are strongly linked to winter spikes for specific causes of death. Mortality from cardiovascular disease in the United Kingdom  is 22.9% higher in winter, while circulatory disease accounts for about 40% of excess winter deaths and respiratory illness about one-third.

In the winter of 2013/14 an estimated 18 200 excess winter deaths occurred in England and Wales, 75% of which were among people aged 75 years or older. This is, however, the lowest number recorded since the UK began tracking this trend in 1950. Experts say the reason – or more likely multiple reasons – for the decline was not easy to determine: it could be an indication of a less severe winter or of incremental success in efforts to reduce the impacts of fuel poverty in the United Kingdom. 

But in January 2016, The Guardian newspaper reported a massive increase: despite a mild winter in 2014/15, an estimated 43 900 excess winter deaths occurred – a rise of 140% and the worst statistics since 1999-2000. Female deaths leapt nearly 150% in a single year, from 10 250 to 25 500 between 2013/14 and 2014/15.

Clearly, elderly people need to be a priority for fuel poverty programs: it's a matter of saving lives.