Climate Resilience of Care Settings

As a result of global climate change, the UK is expected to experience hotter and drier summers and heatwaves are expected to occur with greater frequency, intensity and duration. According to recent climate change projections by the MetOffice, increases in mean daily temperatures could be up to 5.4 deg. C during the summer months and 4.2 deg. C during winter by 2070 under a High emissions scenario. In 2003, 2,091 heat-related deaths were reported in the UK alone as a result of the European heatwave, meaning future temperature increases could lead to a parallel rise in heat-related mortality.

The UK also currently has a rapidly growing number of old people, with people aged 75 or over expected to account for 13% of the total population by 2035, compared with 8% in 2012. Older populations are more vulnerable to climate-induced effects as they are more likely to have underlying, chronic health complications, making them more vulnerable to heat stress. The 2003 heatwave demonstrated that older people in care settings are at the highest risk of heat-related mortality.

People aged over 65 years spend more than 80% of their time in residential environments or care settings, and people aged over 85 years more than 90%. Therefore, the indoor environment is a huge moderator of heat exposure in older populations: Poor building design and the lack of effective heat management in care settings may contribute to increased indoor heat exposure with detrimental health impacts falling on the most vulnerable residents. Care facilities function as both a home for residents and a workplace for staff, meaning that the people sharing those spaces can have diverging needs and preferences making overheating prevention measures difficult to enforce. Interactions between staff and residents play an important role in preventing overheating in care settings and it has previously been noted that staff are often made to prioritise warmth due to wide recognition of the detrimental effect cold weather can have on old-age health, leading to overheating risks being overlooked.

Understanding factors that contribute to indoor summertime overheating in care homes is crucial in developing methods to prevent overheating and the subsequent negative health impacts. Previous research by the applicants has indicated that care facilities are already overheating even under non-extreme summers, highlighting the need to develop timely prevention measures given the way temperatures are expected to rise in the UK over the next century. A key target for climate adaptation in care settings is to limit such risks by introducing passive cooling strategies via building design and occupant behaviour. Development of passive cooling strategies will reduce the likelihood of uptake of mechanical cooling, which would undermine government efforts to reduce greenhouse gas emissions.

Therefore, the principal aim of the project is to undertake preliminary work to develop methods that will support a system of care provision in the UK that is adequately prepared for rising heat stress under climate change. The project will undertake pilot work in five care settings in the UK to monitor the thermal environment and conduct surveys with residents, frontline care staff and care home managers. Within these buildings, it will test novel approaches for understanding the comfort levels of the residents and relating this to the thermal environment. It will also test novel measurement techniques for assessing impact of heat on the health of the residents. Via detailed modelling work, it will then test methods to assess future overheating risks and to evaluate the effectiveness of overheating mitigation strategies. Throughout the project the work will bring together multidisciplinary research perspectives with those of care home practitioners and other stakeholders. Via these packages of work, plans for the large-scale project that is so urgently needed in this area will be developed.

Direct beneficiaries of the research project are UK policymakers, such as Government departments and other regulatory agencies, who are responsible for developing and introducing climate mitigation and adaptation policies, and policies for the improvement of the social care sector in the UK. Developing a number of effective policy interventions aims to protect the UK from the challenging effects rising temperatures will impose on UK infrastructure and the health and social care system. Further policymakers, such as Local Governments, will also benefit from the work as responsibility for local care settings fall under their remit and, therefore, protecting the health of the vulnerable individuals in said settings is of utmost priority.

There is currently wide recognition of the negative health effects associated with exposure to cold weather in older populations, meaning overheating risks can be overlooked. Given the way external temperatures within the UK are expected to rise due to climate change, there may be large impending health effects if the research area remains neglected, causing a future strain on the national health system. Thus, public health professionals will also benefit indirectly from the work as they aim to protect the wider population health, specifically that of vulnerable communities within society, such as the target population. Understanding factors which contribute to overheating in care settings using a holistic approach (e.g. considering building characteristics, occupant behaviour and interactions between staff and residents) allows for the development of effective mitigation strategies which can be implemented into care settings in a timely manner. Targeted interventions are more cost-effective, reducing the financial costs needed to implement policies and the subsequent health burden on the national health system. The built environment research sector also stands to benefit from the work as it will contribute to the understanding of measures which reduce overheating risk, specifically in the care sector but also applicable more generally to other domestic buildings.

The ultimate beneficiaries of the project, supported by the introduction of appropriate policies, will be the target population who live in care settings and are currently at risk of being exposed to high indoor temperatures leading to detrimental effects on health. Further details of the project beneficiaries and associated pathways to impact are provided in our Pathways to Impact section.

Multiple routes will be pursued to maximise stakeholder benefit and allow for effective sharing of expertise as part of our Pathways to Impact Plan. Specific Investigator and PDRA resources, and a whole Work Package are dedicated to our research impact activities that will help translate our research findings into meaningful outputs for policymakers, co-create knowledge and identify optimum pathways for dissemination amongst other relevant stakeholders. We will also assemble a Project Advisory Board (PAB) including representatives of each stakeholder group and organise three PAB meetings combined with stakeholder workshops throughout the duration of the project. This will create an interdisciplinary, collaborative environment between our research team, policymakers and practitioners that will encourage two-way conversations. It is expected that the project outputs will be used to inform and update current industry standards, such as CIBSE guidance, and public health risk assessment approaches, such as the CQC inspection processes. Other platforms of dissemination include our planned closed collaboration with the UKRI UK Climate Resilience Champion, the MetOffice, the CQC, PHE, CIBSE, the UCL Public Engagement Unit, the UCL Media Relations team and the Bartlett Strategic Communications team, who will support engagement activities between our research group, interest groups outside academia and the wider public.