Inspiring Change: The Cozy Project makes older patients more comfortable
Tina Weitzel MA, RN-BC

January 2011 
Volume 41  Number 1
Pages 18 - 19
  PDF Version Available!

WHILE ROSEMARY MULLER, 82, was hospitalized with pneumonia, she often complained about feeling cold. One evening she told her nurse that she couldn't go to sleep because she was too cold. The temperature of her room was 23[degrees] C (74[degrees] F), but Mrs. Muller was still uncomfortable, despite being covered with three blankets.In an effort to help her relax and sleep, her nurse gave her a p.r.n. sedative. During the night, Mrs. Muller woke up because she needed to urinate. Feeling light-headed and confused, she fell when she got out of bed to go to the bathroom.The Professionals Improving Care for Health System Elders (PICHE) group at our hospital recognized that being cold was a risk factor for older adults such as Mrs. Muller. We questioned why hospitalized older adults are dressed in short-sleeved, open-backed gowns that cover far less of the body than clothing worn at home.The amount and type of clothing selected by older adults may be related to changes in thermoregulation, which cause them to feel cold in an environment that's comfortable for younger people. The PICHE nurses decided to investigate.The first step was to review the literature to better understand physiologic changes that contribute to older adults feeling cold. We discovered that their response to cold is affected by a decrease in their abilities to produce and conserve heat.Age-related changes in the temperature-regulating center in the hypothalamus as well as decreased vasoconstrictor response lead to less heat production and decreased ability to maintain body heat in cooler environments.1 Researchers compared older adults with younger adults and measured each group's response to decreases in ambient room temperature.Although core body temperature remained stable for the younger subjects, older subjects experienced progressively lower core temperatures.2 Other researchers found that increasing skin temperature as little as 0.4[degrees] C led to decreased nocturnal wakefulness.3Hospitalized

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