house dementia
There are currently no rules to ensure that aged-care facilities provide a comfortable indoor environment.

Everyone knows how bad it feels when the temperature is uncomfortably hot or cold. For most of us it doesn’t last long as we can take simple steps to get comfortable, such as putting on clothes, opening a window, or switching on a heater.

But what happens when you can’t control the temperature where you live? This problem is faced by many residents of aged care facilities, and can be particularly difficult for those living with dementia. To find out how these residents cope we recently carried out a three-year research project on the effects of indoor environment in aged care facilities in south-eastern NSW. This was part of a broader program of University of Wollongong research on the impact of indoor environment on elderly people.

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Dementia and agitation

Dementia is a collection of symptoms that affect people’s behaviour, thinking, and their ability to communicate and perform everyday tasks. Sometimes people with dementia can become agitated or distressed, which can be disturbing for other people around them. This often happens for no clear reason.

This is a big issue for the aged care sector since approximately half of all residents in aged care facilities have dementia.

While current rules governing the accreditation of aged care facilities in Australia do make reference to the need to provide ‘comfortable internal temperatures and ventilation’ there is no specific reference to what temperature ranges are considered comfortable. We set out to find whether this should be remedied and whether there is a relationship between agitation among residents living with dementia and the indoor temperatures to which they are exposed.

Dr Federico Tartarini (right) led the study that found that indoor temperatures in aged care centres have a dramatic impact on the wellbeing of residents, particularly those living with dementia. Photo: University of Wollongong. Author supplied, CC BY

Tracking the temperature

Firstly we set up a network of sensors in six aged care facilities to monitor indoor environmental conditions, such as air temperature, humidity, air velocity and noise.

In collaboration with the care staff of one particular facility we then assessed the frequency and intensity of a range of agitated behaviours exhibited by residents living with dementia over the course of a year.

The most important finding of this study was that the frequency and intensity of agitated behaviours of residents with dementia significantly increased when they were exposed to uncomfortable air temperatures.

A statistically significant correlation was found between rates of agitation of residents and their cumulative exposure to temperatures outside their comfort zone of between 20°C and 26°C.

More generally, the data collected from the hundreds of temperature sensors across all our case study facilities over a one-year period showed that some facilities were often uncomfortably hot or cold (below 19°C in winter and over 30°C in summer) for significant periods.

Poorly designed buildings

This was attributable to many different factors including poor thermal design of the buildings and poor control of the heating and cooling systems. Interestingly, our analysis showed staff were significantly less tolerant of variations in indoor temperature than residents, probably because they were generally more active than the residents (i.e. moving around and working), and therefore had higher metabolic rates. They may have also had higher thermal comfort expectations than the residents.

Regulations can help

The evidence appears to suggest that maintaining a comfortable temperature will reduce the behavioural and psychological symptoms of dementia.

There is a clear need for new regulations that ensure aged care facilities provide comfortable indoor environmental conditions, particularly for elderly residents, but also for the staff working in these facilities.

The aged care sector needs good indoor environmental rating tools, built on recent research evidence, to guide the design of their facilities and to audit their operations.

This type of approach has already been successfully applied in the commercial building sector, where mandatory disclosure of the real energy consumption of larger offices, for example, is required of owners wishing to sell or lease their property.

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Publicly available ratings of the actual indoor environment provided to aged care residents and staff would alert architects, managers and staff to the importance of thermal comfort and help elderly people, and their families, make a more informed choice as to the best facility in which to live.

Paul Cooper, Senior Professor and Director of the Sustainable Buildings Research Centre (SBRC), University of Wollongong; Federico Tartarini, Associate research fellow, University of Wollongong, and Richard Fleming, Professorial Fellow and Executive Director, Dementia Training Australia, University of Wollongong

This article was originally published on The Conversation. Read the original article.

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  1. Very important story that as people age and dementia heightens anxiety to many things, increasing temperature is a lurking killer, as seen in Europe across to Japan.

    As I have stated in several Fifth Estate articles, in hot climates radiation is the issue to be addressed.

    Insulating materials that specifically target radiation is paramount.

    Bu scientific agreement, the trigger point for human discomfort occurs when ceilings exceed a temperature of 32degC, radiating downwards onto occupants. So the best “adaptation” technique is to find insulation products that ensure ceilings do not exceed 32degC.

    Insulation materials need to be tested in-situ or by mechanical simulation (not laboratory tests of 23deg) to be ‘fit for purpose’ for a range of warm, hot and humid climates, where roof cavities are commonly 50-70degC.

    Aluminium foil reflective insulations do the job brilliantly, whereas the tired old mantra from the fibre batt industry “thicker is better” is false and quite frankly idiotic, because the batts are heat absorbers not radiant heat repellers. Its blindingly obvious.

    Very soon the building codes via the ABCB, will be forced to front up and change the regulations and the testing methods within the key insulation standard.

    Can you believe it if I told you that the imminent revised standard has purged every single mention of ‘radiation’ out of the existing standard AS/NSZ 4859? And the relevant committee stonewalls against anybody who tries to question or change the testing methods. And they will keep doing this even if hundreds of people die. 347 people mostly elderly died during one week in January 2009, and Standards said nothing. The ABCB says nothing about rising temperatures and whether insulation standards are actually ‘fit for purpose’. Oh, by the way, the ABCB had voting position on the insulation standards. Getting the picture? Sort of doesn’t add up, does it.

    You don’t put 10 blankets over car windscreens in the blazing heat, foil shields are used to repulse radiation.
    Everyone knows that. So why put blankets (batts) up in roof spaces pretending it’s going to be the best thing to do in hot weather?

    A modest of amount of bulk insulation is definitely needed in ceilings for mild to cold winter climates against rising “convected heat” (eg max R3.5) but ANY hot climate must have radiant heat barriers made of durable foil lamination. Many foils today delaminate and peel away after 10-15 years, as proven in a 2018 test report to the standards committee which the public don’t know about.

    So, for all those Aged Care places, particulatly if cooling ducts are in the roof spaces, if the roofs have no existing foil sarkings, then quickly go hunting for durable strongly bonded proven laminated foils suitable for retrofitting to roof rafters (poly laminates are stronger than water based adhesives). And cooling costs will drop as will the ceiling surface temperatures. Segmented ‘foil batt style’ products are the most feasible retrofit products to use, and the first invention was in 1992.

    Then add in slow rotating ceiling fans to gently move the air. Result: an energy efficient aged care facility, rather than uncontrolled cooling costs.

    If ceiling temperatures are not controlled then cooling thermostats will likely not function, cooling systems get overworked and finally fail, resulting in not only high summer power bills, but the horror end scenario of the ‘hot box syndrome’, where the building is overwhelmed by absorbed radiation energy into the entire building fabric. And during a heat wave, if there are batts alone in the ceiling and no foil sarking, the batts get heat saturated, and will have zero chance of cooling down overnight, being recharged day after day of relentless heat, that the batts were never tested for.

    Then the real horror is what happens to all residential buildings, including aged care and child care centres, if black outs happen? I contend that buildings without foil radiant heat barrier insulations, will see a rapid rise in deaths from heat stroke or heat exhaustion.

    Ring Standards Australia for their explanation. By the way, the imminent revised standard has utterly incomprehensible and totally unexplained “thermal formulas” inserted in lieu of stripping away of the central word ‘radiation’.

    I predict it will take a spate of deaths that will force the ABCB and Standards Australia to act. Or a miracle when readers join me in demanding a open and public discussion about the physics of heat flow and what insulations work best for the climate they are in.

    Thank you for reading this ‘never-ending story’.