Designing Our Futures: Winter Warmth Visual Research Report
Chloe Fong 12837126
DP 261: Product Research
Module Leader: Dr Eddy Elton
Table of contents
Literature Review
Table of Contents
Introduction
1
2
Personas
Image Board
Evaluation
8
9
10
3-4
Research Methods
Research Findings
5
6-7
User Requirement Specifications
References
11
12
Introduction
In the UK, thousands of people die in the winter due to the cold, many of which are older people (65+), with the continue rise of gas prices, many older people are becoming at risk. This report investigates the root of the problem through primary and secondary research by firstly looking at the physiological causes, the risks in older people in a literature review, then looking into the attitudes and behaviours older people have towards the cold using primary research methods. The aim of the report present the initial research findings and to gain insights into the problem area.
24,000
excess winter deaths in England and Wales in 2011
19,500
were in people aged 75+
Office for National Statistics, 2012
2
Winter Mortality in Older People A literature review
The above figure is for all homes in England. However, figures Multiple studies have concluded that countries with milder may be higher in older populations as the net income on a winters paradoxically have a higher excess winter mortality rate. pension was £291 per week (Department of Work and pensions, A reason for such differences would be the discrepancy in 2011) and the national average full time earnings in the same housing regulation across countries. Clinch & Healy (2000) year was £501 (Office for National Statistics, 2011) compares Norway and Ireland where mean winter outdoor temperatures are minus 1.1˚C and 5˚C respectively. Yet the Causes of death difference between winter and summer deaths in Ireland is 15% It is agreed that the main physiological cause of winter deaths and 5% in Norway. They argued that this is due to poor housing is from coronary and cerebral thromboses (Keatinge, 2002, Bull insulations standards: Roof insulation requirements in Norway is and Morton, 1975, Neild et al, 1994), causing fatal heart attacks, twice as thick compared to that of Ireland, more than 3x for wall strokes and pulmonary embolisms. (NHS, 2011) In cold weather, thickness and 6x for floor insulation thickness. the nervous system restricts blood flow to the surface of the skin to reduce heat loss and keep the internal organs functioning. (Stocks et al, 2004). This process is vital for human survival but Roof also poses great health risks to older people. Keatinge (2002) 200 100 points out that the large volume of blood “…overloads the central organs of the body with blood, and the 125 Wall 40 excess volume is then disposed of by removal of salt and water from the blood, party by the kidneys as urine, partly into general 150 Floor 25 inter-cellular space”
Regional Differences
Fig. 1 Minimum residential insulation thickness in Norway and Ireland (mm)
Clinch & Healy, 2000
Since the 1970s there has been extensive research into winter mortality in older people and its causes. In this review, the term “older people” is defined as persons aged 65 or above and “excess winter deaths” (winter mortality) is the difference between the amount of deaths in the winter months compared to the other seasons (Age UK, 2012). According to one study, there are 30,000 to 60,000 excess deaths during winter in the United Kingdom (Clinch & Healy, 2000) due to the cold. Wilkinson et al (2004) further points out that: “This is apparent at all ages but the greatest in relative and absolute terms in elderly people. Much of the excess seems to be related to the cold”
This causes an increase in concentration of blood cells by 10% According to British Standard BS7915:1998 (1998): and the blood viscosity by 20%. Coupled with the thickening of “Cooling of the hands leads to a reduction in manual dexterity. blood vessels in older people (atheroma), increases the chances Once the skin temperature falls below 20C, the ability to carry of a blood clot forming significantly. out delicate movements with the fingers is markedly reduced, with greater effects from 15C downwards” A blood clot in the heart (coronary thrombosis) causes heart Coupled with the high prevalence of arthritis in older people, attacks (NHS Choices, 2012); a clot in the brain causes strokes which leads to decreased motion and mobility issues (Frontera (NHS Choices, 2011) and a clot in the artery which carries blood et al, 2008 pp.91-95), cold indoor temperatures could potentially from the heart to the lungs (Pulmonary embolism) can be fatal lead to a delay in life saving tasks such as calling an ambulance, (NHS Choices, 2011) as it requires finger dexterity. Respiratory illness is the second biggest cause of winter Rising prices of gas is also a major contribution to lower indoor mortality in older people. Of which bronchitis and pneumonia temperatures. Wilkinson et al (2004) reports that are the most common (Bull and Morton, 1975). Collins (1986) “Around 1.4 to 2 million households in England are in fuel found that “Below 16C, resistance to respiratory infections may poverty- that is, they would have to spend more than 10% of be diminished”. He also found that the increase in humidity in the their income to heat the home to an adequate temperature” winter months is related to higher rates of morbidity.
3
Roberts (2006) and Keatinge (2002) point out that thromboses and respiratory illnesses are not perceived as the main causes of death in the public eye due to the delay between cold exposure and death. Death from heart attacks peak 2 days after cold exposure, strokes 3-4 days, and respiratory illness related deaths occur often 12 days after initial exposure to cold weather.
temperatures, certain behaviours can be observed such as shivering, vasoconstriction, pilloerection (goose bumps) etc. (Stocks et al, 2004).
Autonomic thermoregulation deteriorates with aging, making older people more vulnerable to winter deaths (Collins et al,1977, Macey et al, 1993, Centers for Disease Control, 1985). Collins et al (1977) studied 47 older people’s thermoregulatory responses and Contrary to popular belief, accidental hypothermia, compared those of younger people. They found that deep body temperature below 35C, is not the some subjects did not have normal vasoconstriction main cause of excess winter mortality, but Collins responses (narrowing of the blood vessels to reduce et al (1977) also state it is dangerous as it can surface heat loss) and only 5 displayed normal spontaneously occur in relatively fit older people. They shivering responses (movement increases body concluded that the reasons for this may be due to temperature). They concluded that “early signs of impaired temperature homoeostasis (regulating body autonomic and thermoregulatory dysfunction may temperature) with aging. be recognised”. This can be further illustrated in a study done by Degroot and Kenny (2007) concluding that with mild ambient cooling, body temperatures Risk factors in older people There a few risk factors making the elderly more dropped in older people but not in the younger susceptible winter mortality. First of all, metabolic rate subjects. decreases with age (Boston, 2013), with a slower metabolism and therefore less heat is produced to Conclusion keep older people warm (Someren, 2006) Many older people die in the UK every winter despite having relatively mild winters; this may be due to the thinner insulation standards in the country as well as rising gas prices. Contrary to popular belief, hypothermia is not a major cause of winter mortality; the causes of death are mainly from thromboses and respiratory illness. It is harder for older people’s bodies to compensate to the cold due to degradation of thermal homoeostasis. Therefore, it is important The problem with the lack of temperature discrimination to raise awareness of the effects of cold in both the poses a great threat to the health of older people, public’s eye and in the eyes of older people in order putting them at a greater risk of winter mortality. to reduce the heath implications due to cold weather Regulation of temperature in the body is controlled by in Britain. the autonomic nervous system (Martini et al 2011 pp. 452-463) and when the body is exposed to cold A study done by Collins et al (1981) tested a pool of 17 elderly subjects and compared it to that of 13 young adults. They found that “About a quarter of the elderly subjects show very poor temperature discrimination, while they also reported less discomfort in cold environments”
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Questionnaires The aim was to gather a brief overview of the attitudes and behaviours of older people towards winter warmth. As there were 26 participants, the questions were devised to not take too much of their time. They were geared to measure how concerned older people were about the cold, their views on the current “gas price crisis”, and what they do to combat cold weather.
Research Methods Rationale and procedures
Diary Study
Diary studies were given out to a random sample of the questionnaire participants, a total of 10 were asked to do the study. The aim was to find out the longer term habits of older people such as if they turn their heating on at night, how long for and how they dressed over a period of 3 days. The diaries tried to bridge the gap between reported and actual behaviour and were used to create personas.
Three methods of gathering primary research were used to gather data. They were questionnaires (quantitative), Diary studies (qualitative) and cultural probes (qualitative).Due to time constraints the study was carried out on an opportunity sample, in which a random sample was taken for qualitative research. The aim was to find out the attitudes and behaviours of older people regarding staying warm in the winter. The research was undertaken in 3 centres. Somerset Day Centre, Patching Lodge and New Larchwood centre. Questionnaires were used for 26 participant to gain a better understand of the target market without going in depth. Diary studies were used to better understand older people over an amount of time to track their behaviours and create an accurate persona. Due to lack of response from the diary studies, a cultural probe was used in order to gauge the dressing behaviours of older people.
Cultural Probes A “Dress a mannequin” probe was devised to better understand the dressing habits of participants. As the sample was from participants of a community art group, the probe was designed to be visual based. Paper cut outs of items of clothing such as jumpers, socks, vests, shirts where given to participants and they had to dress the “mannequin” by sticking the cut outs, as layers of clothing, onto the man. There were 2 scenarios: outdoor and indoor.
5
Population
Over 65
Behaviours
It’s snowing outside, what would you wear?
Never Rarely Sometimes
How often do you feel cold in the winter?
Most of the time
Research Findings Facts and Figures based on primary research
All the time
“ I don’t go out when its snowing, I get my kids to do my shopping for me” have a cup of tea
hot water bottle turn up the thermostat
put on a jumper
1
Males
2
3
The first thing you would do when you felt cold?
6
Under 65
Females Size proportional to frequency
“I get winter fuel allowance, but I save it up for my grandchildren”
“I for get ou me my tsid in ch e” the ildre w n to int er do so th I d e sh on o ’t h pp av ing et og o
I n he r w ate ” on t w per ng ho ea ati a ch he use it’s the to. I use n tu r e d e c a nly ne e b “I o utely ot tl l b so
ab
“The buil ding I walls, bu live in doesn’t ha ve cavity t heating bills are r idiculous ly high”
ATTITUDES What older people think the biggest health risks associated with the cold (word size frequency)
proportional
bills eating h o s ls r pane a concern” la o s “I have at much of th aren’t
“My heating in included in my rent, so I can turn it on for as long as I like”
High Risk
Low Risk
What are you most concerned about this winter? (icon size proportional to frequency)
Key Observations Participants who said they never felt cold were all male
Public transport disruptions
Being too cold in the winter
CLOSED
Some of the participants never referred to themselves as old
Do you think the current gas prices are too high?
Death was rarely mentioned, serious injury was used often
Trouble getting to shops
Yes
There was a large range of cognitive ability within the population Many of the participants did not go out in the snow at all
Delay in emergency services
No
7
to
via Business and Professional Women’s Foundation (2013)
via Huffington Post
General Ruth
Name
Phillip
76
Age
79
Gender
Female
Personas Fictional caricatures Created to represent The user population
The two personas, Ruth and Phillip, were created from data collected in the diary study as well as personal observations speaking to the participants. Two different personas were created due to the observed gender bias in both the questionnaires and conversations.
Male
Background Lives at home alone in Brighton with her dog. Used to live with her husband until he died of a fatal stroke last winter.
Living Circumstances
Kind, friendly, loves to help others, but gets annoyed by the loud student house next door and doesn’t mind showing it.
Personality
Enjoys spending time with her dog, meeting up with friends and doing arts and crafts. She takes her dogs on long walks in the downs.
Hobbies
Likes western films, has the complete collectors set of all the Clint Eastwood films. He enjoys playing darts with the other residents.
Widowed with a son and daughter, who live in London. They try to take turns visiting her on weekends but sometimes work doesn’t permit. 3 young grandchildren.
Family
Never married, ex-army officer. Has a nephew up north who sometimes comes to visit him with his wife and children.
Generally healthy except for hypertension. She has been quite down after the death of her husband and the GP has prescribed her antidepressants. Winter is a particularly hard time for her.
Health
Diabetic, type 2. Does not require insulin, but he has to watch what he eats. Considers himself not to be old and frail and will not admit that sometimes he feels cold.
Lives in retirement home, rent is paid for by his army pension. Sociable courteous, gallant, will “take it for the team”. Believes that younger people nowadays do not have enough manners.
Winter Warmth Winter fuel allowance?
Yes Likes warmth, will turn the heating on most days.
8
Heating habits
No (not eligible, in retirement home) His bills are included in his rent but he does not like to turn it on as he “never feels cold”
Image board Link: vimeo.com/78922306 Password: Snowmen
9
Social Desirability bias Another validity concern would be the social desirability bias. All of the primary research methods were based on self-reported behaviour and attitudes which could be different to the actual behaviour (King and Burner, 2000)Evidence suggests men perceive seeking medical attention as effeminate, as it undermines hegemonic masculinity (Noone & Stevens, 2008) and during the course of the primary research, there was an observable gender bias where males were more likely to say they did not feel cold and did “not need the (central) heating on”.
Questionnaires Out of the 26 participants, 16 were from a supported day centre for older people from more disadvantaged backgrounds. Most of them did not have enough literacy skills to read the questionnaire or the motors skills to write down the answers. The method used to collect the data was by asking the group to put up their hands to indicate their response, this led to errors in the results as some of the participants could not hear the questions, others could not remember the choices on the questionnaire, and some participants lost interest during the course. If there was a larger sample size, these participants would have been excluded.
Evaluation
Future questionnaires would also avoid leading questions. For example a question was phrased “Do you pay attention to the weather report?” Many of the respondents said yes, but when asked the temperature of the day, they did not know. Another adaptation would be to reduce the number of choices in each question to reduce the burden of short term memory retention.
Evaluation of research methods and improvements
Cultural Probes During the dress a mannequin exercise, participants picked very bright colours for their clothing choices despite wearing darker colours and muted tones. This could be due to the oversimplified presentation of the paper clothes, and the lack of choice of coloured markers. It was observed through conversation that they chose clothes that looked nice and not necessarily clothes that they owned and would wear. Due to time, geographical and budget constraints, the sample size was small and did not accurately represent the population of users aged 65+ in the UK, leading to statistically insignificant results. Further problems also arose with nature of the population, as some of the participants could not accurately answer all of the questions due to diminished hearing, deterioration of motor skills, dementia, and lack of literacy skills. Their results were not excluded due to the small sample size.
Diary Studies There were many uncontrolled variables in the diary study: Each participant did not fill in the diary same day, whether they had insulation in the house or double glazed windows were not known, some of the participants had electric heating etc. Furthermore, only 2 of the 10 diaries given out were filled in time for this report, this could be due to the fact that some of the participants agreed to the study out of politeness and did not return the diary after initial agreement If the study was to be repeated, it would be done during the colder months of winter over a longer period of time with a larger sample size. It would also be beneficial to first build a relationship with the participants beforehand to increase the rate of participation. Further questions could also be asked to determine the insulation within the house.
Possible improvements could include a wider range of clothes and more explicit instructions so the participants fully understand the task.
Further Development In the future, primary research could be better structured in a way where information gathered from quantitative results drives the design of qualitative results: for example, picking out insights from the questionnaire feedback to devise diary studies and cultural probes. As this is not the end of the research phase, further investigations could also be useful to better understand the target users.
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Specification
User Requirement Specification User requirements Based on primary and Secondary results
Rationale
A1
Product must raise awareness in the public on causes of winter Literature review (see page 3-4), questionnaires (see appendix B/ mortality in both younger and older generations. page 7- presentation of attitudes)
A2
Product must alert older people of temperature drop
Literature review: older people have trouble with thermoregulation (pp.3-4)
A3
Product must not portray older people as frail and/or useless.
Observations from conversations with questionnaire participants (see notes on questionnaires in appendix B)
A4
Product must appeal to both genders by not being overly masculine Observed gender bias with participants: questionnaires (see or feminine by not having stereotypical features such as floral prints or appendix B) and cultural probes (see page 7/appendix D) overly bold graphics
A6
Product must not cost too much to run and seek to be as economical Questionnaires “what do you think about the gas price crisis?”. as possible (Appendix B). Literature review: many homes are in fuel poverty (see page 3)
A7
Product must not a large have set up/ acquisition cost
Questionnaires “what do you think about the gas price crisis?”, (see appendix B). Literature review: many homes are in fuel poverty (pp.3)
B1
Product should not be irrelevant to younger people
Younger people do not know what the causes for winter mortality in older people are. (see image board, pp 9)
B2
Product should be accessible to younger people through technology Younger people do not know what the causes for winter mortality via a website or similar in older people are. (see image board, pp 9)
B3
Product should help older people keep warm indoors
Many older people do not go outdoors in cold weather (see key observations, pp 7)
C1 Product could have government or NGO funding for start up and running Questionnaires “what do you think about the gas price crisis?” costs Showing a concern with older people regarding gas prices. Literature review: many homes are in fuel poverty (see pp 3) C2 Product cold empower younger people to help educate older people Younger people do not know what the causes for winter mortality on winter health in older people are. (see image board, pp 9)
A= Primary Specifications
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B=Secondary Specifications
C=Optional Specifications
In Literature Review
Keatinge, W.R., 2002 ‘Winter Mortality and Its Causes’ International Journal of Circumpolar Health, 61. pp.292-299
Age UK, 2012. The Cost of Cold.[PDF] London: Age UK. Available at: < http://www.ageuk.org.uk/get-involved/spreadthe-warmth/the-blog/blog/2012/11/the-cost-of-cold/> [Accessed: 12 Oct 2013]
Macey, S. M., Schneider, D. F., 1993. ‘Deaths from Excessive Heat and Excessive Cold Among the Elderly’. The Gerontologist, 33(4). pp. 497-500
Boston, G., 2013. ‘Basal metabolic rate changes as you age’. Washington Post, [Online] 5 March. Available at : < http://articles.washingtonpost.com/2013-03-05/ lifestyle/37466447_1_bmr-metabolic-rate-muscle-mass> [Accessed 19 October 2013] British Standards Institute, 1998. BS7915:1998 Ergonomics of the thermal environment – Guide to design and evaluation of working practice for cold indoor environments. London:BSI.
References
Bull, G.M. and Morton, J., 1975. ‘Relationships of Temperature with Death Rates from All Causes and from Certain Respiratory and Arteriosclerotic Diseases in Different Age Groups’ Age and Aging, 4. pp 232-246 Centres of Disease Control, 1985. “Hypothermia-associated deaths- United States, 1968-1980” Morbidity and Mortality Weekly Report 34 (50), 753-4. Clinch, J.P. and Healy, J.D., 2000. ‘Housing standards and excess winter mortality’. Journal of Epidemiology and Community Health. 54,pp.719-720 Collins, K.J., Dore, C., Exton-Smith, A.N., Fox, R.H., MacDonald, I.C. & Woodward, P.M., 1977. ‘Accidental hyprothermia and impaired temperature homoeostasis in the elderly’ British Medical Journal. vol. 1, pp. 353-356 Collins, K. J., 1986. ‘Low Indoor Temperatures and Morbidity in the Elderly’. Age and Aging, 15. pp. 212-20 Collins, K. J., Exon-Smith, A. N., Doré, C., 1981. ‘Urban Hypothermia: Preferred temperature and thermal perception in old age’ British Medical Journal, 282. DeGroot, D.W. and Kenney, W.L., 2007. ‘Impaired defence of core temperature in aged humans during mild coldstress’ American Journal Physiology- Regulator, Integrative and Comprehensive Physiology. Vol 292 no. R103-R108 doi: 10.1152/ajpregu.00074.2006 Department of Work and Pensions, 2012.The Pensioners’ Income Series 2010-2011.London: Department of Work and Pensions. Forntera, W.R., Silver, J.K., Rizzo, T.D (2008) Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia: Saunders, an imprint of Elsevier Inc.
Martini, F.H., Timmons, M. J., Tallitsch, R., 2011. Human Anatomy. San Francisco: Benjamin Cummings Neid, P.J., Syndercombe-Court, D., Keatinge, W. R., Donaldson, G.C., Mattock, M., Caunce, M, 1994. ‘Cold-induced increses in erythrocyte count, plasma cholesterol and plasma fibrinogen of elderly people without comparable reise in proterin C or factor X’ Clinical Science, 86. pp. 43-48. NHS Choices, 2011.Coronary Heart Disease-Causes [Online]. Available at: http://www.nhs.uk/conditions/coronary-heartdiseases.aspx [Accessed 16 October 2013] NHS Choices. (2012). Heart Attack. Available at: http://www. nhs.uk/Conditions/Heart-attack/Pages/Introduction.aspx. Last accessed 19th Oct 2013 NHS Choices. (2011). Stroke-Causes. Available at: http://www. nhs.uk/Conditions/Stroke/Pages/Whoisatriskpage.aspx. Last accessed 19th Oct 2013 NHS Choices. (2011). Pulmonary Embolism. Available at: http://www.nhs.uk/Conditions/pulmonary-embolim/pages/ introduction.aspx. Last accessed 19th Oct 2013 Office of National Statics, 2011. 2011 Annual Survey of Hours and Earnings (SOC 2000). s.l.: Office for National Statistics. Roberts, M., 2006. ‘Why more people die in the winter’ BBC News, [Online]27 October. Available at: http://news.bbc.co.uk/ go/pr/fr/-/1/hi/health/5372296.stm Stocks, J.M., Tipton, M.J., Greenleaf, J.E. ‘Human physiological responses to cold exposure’. Avaition, Space and Environmental Medicine. 75(5). pp. 444-457 Van Someren, J.W., 2007. ‘Thermoregulation and aging’ American Journal Physiology- Regulator, Integrative and Comprehensive Physiology. Vol 292 no. R99-R102 doi: 10.1152/ajpregu.00557.2006 Wilkinson, P., Pattenden, S., Armstrong, B., Fletcher, A., Kovats, R. S., Mangtani, P., McMichael, A.J., 2004. ‘Vulnerability to winter mortality in elderly people in Britain: population based study’ British Medical Journal Availiable at: http://dx.doi.org/10.1136/ bmj.38167.589907.55 [Accessed 12 Oct 2013]
Other sources Noone, J. H., Stephens, C., (2008). ‘Men, Masculine Identities, and health care utilisation’ Sociology of Health & Illness. vol. 30 no. 5 King, M. F., Burner, G. C., (2000) ‘Social Desirability Bias: A Neglected Aspect of Validity Testing’ Psychology & Marketing. vol 7 no 2