Thermal Sensation in Older People with and without Dementia Living in Residential Care: New Assessment Approaches to Thermal Comfort Using Infrared Thermography.

Charmaine Childs,Ali Ali,Jon R Willmott,Sally Fowler-Davis,Susan Hampshaw,Jennifer Elliott,Khaled Khatab

doi:10.3390/ijerph17186932

Abstract

The temperature of the indoor environment is important for health and wellbeing, especially at the extremes of age. The study aim was to understand the relationship between self-reported thermal sensation and extremity skin temperature in care home residents with and without dementia. The Abbreviated Mental Test (AMT) was used to discriminate residents to two categories, those with, and those without, dementia. After residents settled and further explanation of the study given (approximately 15 min), measurements included: tympanic membrane temperature, thermal sensation rating and infrared thermal mapping of non-dominant hand and forearm. Sixty-nine afebrile adults (60–101 years of age) were studied in groups of two to five, in mean ambient temperatures of 21.4–26.6 °C (median 23.6 °C). Significant differences were observed between groups; thermal sensation rating (p = 0.02), tympanic temperature (p = 0.01), fingertip skin temperature (p = 0.01) and temperature gradients; fingertip-wrist p = 0.001 and fingertip-distal forearm, p = 0.001. Residents with dementia were in significantly lower air temperatures (p = 0.001). Although equal numbers of residents per group rated the environment as ‘neutral’ (comfortable), resident ratings for ‘cool/cold’ were more frequent amongst those with dementia compared with no dementia. In parallel, extremity (hand) thermograms revealed visual temperature demarcation, variously across fingertip, wrist, and forearm commensurate with peripheral vasoconstriction. Infrared thermography provided a quantitative and qualitative method to measure and observe hand skin temperature across multiple regions of interest alongside thermal sensation self-report. As an imaging modality, infrared thermography has potential as an additional assessment technology with clinical utility to identify vulnerable residents who may be unable to communicate verbally, or reliably, their satisfaction with indoor environmental conditions.

Highlights

To experience a thermally comfortable indoor environment, an older person living in residential care relies almost entirely upon decisions made by others
We have shown previously [8], as have others [41], that the feeling of being chilled tends to start in the hands or feet
What we have observed by undertaking this feasibility study, perhaps more useful to those involved in the care of older people than relying on a persons reported thermal sensation rating, is in being able to ‘see’ the physiological responses to the environment in which they live

Summary

Introduction

To experience a thermally comfortable indoor environment, an older person living in residential care relies almost entirely upon decisions made by others. This is typically the care home staff who will regulate the temperature of the communal spaces and bedrooms. For those residents with dementia, simple interventions to adjust the physical stimuli of light, noise and temperature can improve a person’s quality of life [1] experience [2] and behaviour [3]. It may well differ amongst groups of people sharing the same environment at the same time

Methods

Discussion

Conclusion