title: Challenge to long term care for the elderly: cold weather impacts institutional population more than community-dwelling population.
abstract: OBJECTIVE
  To examine whether cold weather affects the institutional population more than the community-dwelling population in terms of morbidity requiring hospital admission.
  
  
  METHODS
  Residence-based hospital discharge data were used to compile excess winter hospitalization (EWH) index for the older population (aged 65 years and above) living in institutions (residential care home for the elderly [RCHE] population) and the community-dwelling elderly population in Hong Kong. To separate the influence of influenza on the cold-related hospital admissions, episodes because of influenza were excluded from this study.
  
  
  RESULTS
  In 2009, the EWH index for the RCHE population was 22.93% (95% CI: 20.80%-25.09%), which was much higher than that for the community-dwelling population (14.09%, 95% CI: 13.11%-15.08%). The EWH index was higher among RCHE population compared with community-dwelling population across different age groups and sex (paired t-test one-tailed P= .014).
  
  
  CONCLUSIONS
  The institutional elderly population was more vulnerable to the risk of excess hospitalization in winter. There may be room for improvement in the living environment of institutions, in particular the ambient temperature and personal care, to reduce hospital admissions. Given the expanding institutional population, the limited hospital beds, and long waiting queue for accident and emergency services, prevention of cold-related hospitalization would help to reduce the medical care burden.
authors.affiliation: University of Hong Kong, Pokfulam, Hong Kong, China. phchau@graduate.hku.hk
authors.forename: Pui Hing
authors.initials: PH
authors.lastname: Chau
authors.forename: Moses
authors.initials: M
authors.lastname: Wong
authors.forename: Jean
authors.initials: J
authors.lastname: Woo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003080:Cold Temperature; D016001:Confidence Intervals; D005260:Female; D006707:Homes for the Aged; D006723:Hong Kong; D006760:Hospitalization; D006801:Humans; D007326:Institutionalization; D008134:Long-Term Care; D008297:Male; D009735:Nursing Homes