You stop by your mother's house on a January afternoon and find the thermostat set low to save on heating. She's wrapped in a blanket, moving slowly, and seems confused about what day it is. She insists she's fine, just tired.
Those can be signs of hypothermia. Many people think of it as something that happens to hikers lost in the snow, but older adults can develop it at home. Here's what families should know.
What hypothermia is
Hypothermia is a dangerously low body temperature, below 95°F (35°C)1. It happens when the body loses heat faster than it can make it. As body temperature drops, the heart, nervous system and other organs can't work normally. Left untreated, hypothermia can lead to heart and breathing failure and death4.
For older adults, even mildly cool temperatures can cause problems over time. A home that feels a little chilly to a younger visitor can be dangerous for a frail parent who sits for long periods2.
Why older adults are at higher risk
With age, the body becomes less able to sense and respond to cold. Older adults often have less body fat, slower circulation and a lower metabolism, so they make and hold heat less well. Many don't feel cold even when their body temperature is falling2.
Certain conditions raise the risk further, including diabetes, thyroid problems, Parkinson's disease, stroke, arthritis that limits movement, and memory loss2. Some medicines, including some sedatives, antidepressants and drugs for anxiety, can affect how the body controls temperature2. Alcohol makes it worse by causing the body to lose heat faster. Poor nutrition and dehydration also play a role; see when an elderly parent isn't eating.
Warning signs
| Early signs | Later signs |
|---|---|
| Cold, pale skin | Slowed breathing or heart rate1 |
| Shivering | Shivering that stops |
| Slowed or slurred speech | Severe confusion or drowsiness |
| Clumsiness, stumbling | Loss of consciousness |
| Unusual sleepiness, irritability | Weak pulse |
Confusion, drowsiness, pale and cold skin, uncontrollable shivering, weakness and loss of coordination are common symptoms1. In older adults, shivering may be weak or absent, and confusion may be mistaken for dementia getting worse. A sudden change in behavior in cold weather is a reason to check body temperature with a thermometer. Confusion that comes on suddenly can also have other causes; see delirium in older adults.
What to do in an emergency
If you think your parent has hypothermia, call 911. While you wait for help, move them to a warm, dry place, remove any wet clothing, and wrap them in blankets, especially the chest, neck, head and groin. If they're alert and can swallow, give warm, sweet drinks that don't contain alcohol or caffeine.
Don't use direct heat such as hot water, a heating pad or a heat lamp to warm the person, and don't give them alcohol1. Don't rub their arms and legs. Handle them gently. Don't assume someone found lying motionless in the cold is already dead1; keep trying to get help.
Keeping the home warm
Set the thermostat to at least 68 to 70°F when an older adult is home; even mildly cool temperatures can lead to hypothermia2. If heating the whole house is too costly, keep the rooms your parent uses warm and close off unused rooms. Close curtains at night, and seal drafts around doors and windows.
Space heaters need care: keep them three feet from anything that can burn, use models that shut off if tipped, and never use a stove or oven to heat the home. Make sure the home has working smoke and carbon monoxide detectors, especially with fuel-burning heat. See home modifications for the elderly.
Dressing warmly
Several loose layers trap heat better than one thick layer. A hat, scarf and gloves help outdoors, and socks and slippers help indoors. At night, warm pajamas, socks, a hat and extra blankets help, since body temperature can drop during sleep. Keep blankets within easy reach of your parent's favorite chair.
Food and fluids
The body needs fuel to make heat. Encourage regular meals and warm drinks, and keep easy-to-make foods on hand for days when cooking feels hard. If your parent has lost weight, they lose some natural insulation too. Limit alcohol, which can make the body lose heat faster. Make sure your parent drinks enough fluids in winter, since dry indoor air and less thirst can lead to dehydration; see dehydration in the elderly.
Going outside in winter
Cold, wind and wet clothing speed up heat loss. Encourage your parent to limit time outdoors on very cold days, dress in layers, and change out of wet clothes quickly. Icy sidewalks raise the risk of falls, and a fall outside in winter can quickly lead to hypothermia if your parent can't get up. Shoes with good traction and help with snow removal can make a real difference; see fall prevention for the elderly.
Falls and hypothermia
A fall can turn a cool house into an emergency. An older adult who falls and can't get up may lie on a cold floor for hours. A medical alert system lets your parent call for help quickly, and some detect falls automatically. Daily check-ins by phone or a neighbor are a simple backup.
If your parent has dementia
A parent with dementia may not dress for the weather, may turn the heat down, or may wander outside in the cold. Check the thermostat often, consider a lockable thermostat cover, and lay out warm clothes. Watch for wandering, especially at night; see dementia wandering. Confusion from hypothermia can be hard to tell apart from the disease, so trust your sense that something is different.
Checking in
During cold snaps, check in daily. Ask what the thermostat is set to, whether your parent has eaten a warm meal, and how they feel. Listen for slurred speech or confusion. If you live far away, a neighbor or friend can stop by; our guide to long-distance caregiving explains how to build a local support network. A smart thermostat or a remote temperature sensor can alert you if the house gets too cold.
Power outages and winter storms
Winter storms can knock out power and heat. Make a plan in advance: where your parent will go, who will pick them up, and how to stay warm. Stock blankets, flashlights, batteries, water and easy food. If your parent uses medical equipment that needs electricity, tell the utility company and plan for backup power. Never use a generator, grill or camp stove indoors, since they can cause carbon monoxide poisoning.
Help with heating costs
The Low Income Home Energy Assistance Program, or LIHEAP, helps eligible households with heating and cooling bills, energy crises and some home weatherization3. Each state runs its own program. Many utilities also offer payment plans or rules that limit shutoffs in winter. Weatherization programs may help seal drafts and improve insulation. The local area agency on aging can explain how to apply5.
In assisted living or a nursing home
Ask care communities how they keep rooms warm, how quickly heating problems are fixed, and what their plan is if the heat fails. Check that your parent has warm clothing and blankets, and that their room isn't drafty. If you notice a cold room or a resident who seems unwell, tell staff right away. If problems persist, the long-term care ombudsman can help.
Medicines and health conditions
Ask your parent's doctor or pharmacist whether any medicines raise the risk of hypothermia, especially sedatives, sleep aids, some antidepressants and medicines for anxiety2. Don't stop any medicine without talking to the doctor first, but do ask whether doses or timing should change in winter. Our guide to polypharmacy in the elderly explains how to review a long medication list.
Health conditions matter too. An underactive thyroid, diabetes, and conditions that limit movement, such as Parkinson's disease or a past stroke, make it harder to stay warm2. People who are bedridden or sit for long periods produce less body heat. If your parent has any of these, be extra careful about indoor temperature and check in more often during cold weather.
When your parent won't turn up the heat
Many older adults keep the house cold because they worry about bills, or because they grew up being careful with every expense. Lecturing rarely works. Instead, explain that a cool house is a real health risk for them now, not just discomfort, and offer practical help: applying for energy assistance, checking for drafts, or splitting the cost of a smart thermostat. Some families agree on a minimum temperature that the parent can live with. If your parent is resisting help more broadly, see when an elderly parent refuses help. Small steps, like a warm throw and an electric mattress pad with an automatic shutoff, can also make the home feel more comfortable without turning the heat up as high.
An example
When James visited his father in February, he found the house at 62°F and his father drowsy and slurring words. James called 911. At the hospital, his father's temperature was below normal and he was warmed slowly. Afterward, James helped him apply for LIHEAP heating help, installed a smart thermostat set to 70°F, and arranged daily calls with a neighbor. This is an illustration; your parent's situation will differ.
