*Strategic Planning and Transformation, HSE. ^ Energy Action - - PowerPoint PPT Presentation

• Dr. Anne O’Farrell* ,Mr. Charles Roarty^ and Greg Straton~

*Strategic Planning and Transformation, HSE. ^ Energy Action Ireland, Dublin ~Department of Health

What are excess winter deaths (EWDs):

 These are deaths which are directly related to cold

weather.

 These occur among people who generally have

underlying health problems who die in winter but would have not have been expected to die during this period.

 This is why we call them “excess winter deaths”.

Background:

 EWD has been observed in Ireland and in

• ther European countries.1

 Previous studies found EWDs are greatest in

• lder persons with respiratory and

cardiovascular conditions.

• McAvoy H. (2007) All-Ireland Policy paper on Fuel Poverty and
• Health. Dublin: Institute of Public Health of Ireland.

Background:

 A recent UK study* found that those with

Alzheimer’s Disease or Related Dementia (ADR D) are also at greatest risk of dying during winter.

 For e.g. in the UK

 40% more persons aged >75 yrs or over with ADRD

die in winter than at any other time of the year.

*Liddell, C. (2013) http://news.ulster.ac.uk/releases/2013/6869.html.

Possible pathways contributing to excess winter deaths related to ADRD:

Source: Gray et al (2015) Excess winter deaths among people living with Alzheimer’s Disease or related dementias.

Aim:

 Determine whether this excess winter

deaths in Alzheimers disease and related dementia (ADRD) is present in Ireland.

 Our study used updated data from 2010-2015.  Our study based on those aged ≥ 65 yrs.

Method:

 All deaths (all causes) and also deaths with principal

cause of death recorded as Alzheimer’s Diease and Related Dementia (ADRD) by month of death was

• btained from the Central Statistics Office (CSO):

 ≥65 years

 Alzheimer’s Disease and Related Dementia (ADRD) deaths were

identified using: ICD-10 Codes: *F00 - Dementia in Alzheimer’s Disease *F01 - Vascular dementia *F02 - Dementia in other diseases classified elsewhere. *F03 - Unspecified dementia *G30 - Alzheimer’s Disease

Analysis:

Statistical analyses were carried out

in:

SPSS JMP StatsDirect.

Excess winter deaths WHO calculation:

 Winter deaths = deaths occurring in the 4 months of

winter (Dec-Mar)

 Non-Winter deaths = deaths occurring the 4 months

preceding (Aug-Nov) the Winter period and the 4 months following on from the Winter (Apr-July)

Excess Winter Death Index:

 EWDI = the excess winter deaths expressed as a

percentage of the average number of deaths in non-winter months.

• 95% CI = EWM index ± 1.96 x (EWM Index / √ #

EWM)

Excess winter mortality, all causes in those ≥ 65yrs 2010-2015:

N=6,664 excess deaths for those aged 65yrs and over in 5 year study period.

1097 1205 1380 1179 1803 200 400 600 800 1000 1200 1400 1600 1800 2000 2010/11 2011/12 2012/13 2013/14 2014/15

Excess winter mortality index for those aged ≥65 years, all cause mortality by year:

* 24.1% excess winter mortality for all ages in 2014/15 vs. 15.6% in 2010/11

15.6 16.9 18.4 15.7 24.1

0.0 5.0 10.0 15.0 20.0 25.0 30.0

2010/11 2011/12 2012/13 2013/14 2014/15 % Excess deaths

Excess winter deaths from ADRD by year of death in ≥ 65years:

N=672 excess winter deaths from ADRD in Ireland over 5 year study period.

91 129 108 172 172

20 40 60 80 100 120 140 160 180 200 2010/11 2011/12 2012/13 2013/14 2014/15

• No. of Deaths

Year of death

Excess winter mortality index for ADRD deaths, by year of death, ≥ 65yrs

33.7 39.3 24.7 36.1 32.8 5 10 15 20 25 30 35 40 45 2010/11 2011/12 2012/13 2013/14 2014/15 % excess winter deaths

Results:

 Excess winter mortality from all causes

among those aged 65 + years still exists in Ireland today:

 Increased from 1097 in 2010/11 in 2009 to

1,803 in 2014/15

 15.6 % excess mortality in 2010/11 vs. 32.8%

in 2014/15

Results:

 Excess winter mortality from ADRD among

those aged 65 + years Ireland today:

 Increased from 91 in 2010/11 in 2009 to 172

in 2014/15

 33.7% excess mortality in 2010/11 vs. 24.1%

in 2014/15

Results – New Findings:

 Excess ADRD-related winter deaths evident in

Ireland.

 Higher % than for excess winter deaths for all

cause mortality but.....

 The % of excess ADRD-related winter deaths lower in

Ireland than UK.

Limitations:

 This traditional method of measuring excess winter

mortality in Europe has been questioned.

 If majority of cold days occur between December

and March (few or none in autumn or spring), then the classic EWDi method is likely to be fit for purpose.

 If majority of cold days occur in non-winter months

the classic EWDi method is likely to under-estimate the number of cold-related deaths.

Summary of new findings:

These findings suggest that people

living with ADRD have an excess risk of dying in the winter.

Discussion:

 The causes of the excess winter mortality

among those with dementia still need further research as it is likely to be multi-factorial.

 Many of these deaths are likely to be avoidable.  Norway vs. Ireland.

 Relative excess winter mortality from cardiovascular

disease in Ireland is 2.1 times that in Norway.

 Housing stock in Norway much better.

What can be done and what is being done here in Ireland?

 Energy Action Ireland:

 In latter years, Energy Action Ireland has

provided a free home insulation service to qualifying households*.

 Low-income households  Elderly households  Vulnerable households*

 Improve the energy efficiency and comfort

conditions of homes.

*Those receiving either winter fuel allowance, job seekers allowance for over 6 months (and

with children <7yrs); those receiving family income support.

What can be done and what is being done here in Ireland?

Warmth and Wellbeing Pilot

 Partnership Approach:

Department of Communications, Climate Action and Environment; Sustainable Energy Authority of Ireland; Health Services Executive; and the Department of Health

 900+ homes in Community Health Office 7  Focus on Chronic Obstructive Pulmonary Disease and

Children with chronic Pulmonary conditions

 Rollout = Opportunity to increase scope to other

causes of excess winter mortality

Recommendations:

Ageing population will lead to increase in

incidence of ADRD – likely to be major problem unless good policies in place.

Public awareness of vulnerability of

those with dementia to excess winter mortality:

Discharge care plan for all persons with

dementia

Recommendations:

 Energy audit of homes for those who are

diagnosed with dementia.

 Those with dementia added to priority list for

free home insulation service.

Further research:

 Identify reasons for big difference between

Ireland and UK.

 Analysis of EWDs in those with dementia by:

 Place of residence  Nursing home vs. own home  Presence of co-morbidities  Social inclusion

Acknowledgements:

 CSO for the data  Communications