Winter presents distinct challenges for older adults aging in place, with cold weather, reduced daylight, increased isolation, and seasonal hazards all converging to threaten health, safety, and independence. As occupational therapists specializing in home modifications and aging in place support, we play a critical role in preparing clients and their environments for successful winter navigation. Evidence-based winterization strategies can prevent hypothermia, reduce fall risk, maintain functional capacity, and support continued community participation during the season when older adults are most vulnerable.
Understanding Winter-Specific Health Risks for Older Adults
Older adults face disproportionate risks from winter conditions due to age-related physiological changes, chronic health conditions, and environmental factors. Understanding these risks informs our assessment and intervention priorities.
Hypothermia Vulnerability: Even mildly cool indoor temperatures (60-65°F) can lead to hypothermia in older adults due to decreased metabolic heat production, reduced subcutaneous fat, diminished shivering response, and chronic conditions that affect thermoregulation (National Institute on Aging, 2024). Hypothermia can develop gradually in home environments, making it particularly insidious. Symptoms include confusion, drowsiness, slurred speech, and shallow breathing—signs that may be attributed to other causes if hypothermia isn’t suspected.
Cardiovascular Stress: Cold weather increases blood pressure and heart rate as the body works to maintain core temperature. For older adults with cardiovascular disease, this increased demand can trigger serious events including heart attacks and strokes. Cold air also constricts airways, challenging those with respiratory conditions like COPD or asthma.
Fall Risk Escalation: Winter dramatically increases fall risk through multiple mechanisms—icy outdoor surfaces, wet indoor floors from tracked snow, reduced physical activity leading to deconditioning, bulky winter clothing interfering with balance, and reduced daylight affecting visibility and vitamin D production.
Social Isolation: Reduced mobility due to weather, shorter daylight hours, and reluctance to venture out in cold create conditions for profound social isolation. Research demonstrates clear links between social isolation and cognitive decline, depression, and increased mortality in older adults.
Evidence-Based Home Winterization Strategies
Preparing the home environment is the foundation of safe winter aging in place. Systematic winterization addresses thermal comfort, safety, and functionality.
Temperature and Heating Management
Thermostat Settings: The National Institute on Aging (2024) and AARP (2025) recommend setting home heat to at least 68°F to prevent hypothermia in older adults. This threshold is significantly higher than what younger adults may find comfortable, making education of family members essential. Smart thermostats allow remote monitoring by family members or caregivers, providing non-invasive oversight of home temperatures (AARP, 2025).
Heating System Maintenance: Schedule professional HVAC inspection before winter to ensure systems function properly and efficiently. Replace filters, check for carbon monoxide leaks, and verify adequate heating capacity. Older adults living on fixed incomes may defer maintenance due to cost; connecting them with utility assistance programs and weatherization services can prevent system failures during cold periods (Homewatch CareGivers, 2025).
Draft Elimination: Seal windows and doors using weatherstripping or caulk to prevent cold air infiltration. Place rolled towels or commercial draft stoppers at door bottoms. Install or repair window insulation film. Close blinds and curtains at night to add an insulating layer, but open them during sunny days to capture passive solar heating (National Institute on Aging, 2024; GoGo Grandparent, 2024).
Supplemental Heating Safety: If using space heaters, ensure they have automatic shut-off features, maintain three-foot clearance from flammable materials, and never leave them unattended. Avoid electric blankets or heating pads for individuals with neuropathy who may not sense dangerous temperatures.
Safety System Verification
Research shows that homes with older adults frequently lack recommended safety devices. One study found only 34% had proper smoke detectors and just 22% had carbon monoxide detectors (ScienceDirect, 2013). Winter increases risks from heating system malfunctions and supplemental heat sources.
Detector Installation and Testing: Ensure functional smoke detectors on every floor and outside sleeping areas. Install carbon monoxide detectors near sleeping areas and on each level of multi-story homes. Test monthly and replace batteries annually. For individuals with hearing impairments, recommend detectors with flashing lights or vibration alerts (Custodia, 2025).
Emergency Preparedness: Develop winter storm preparedness kits including non-perishable food, water (one gallon per person per day for three days), medications (seven-day supply minimum), flashlights, batteries, warm blankets, and battery-operated radio. Ensure clients have backup heating sources appropriate for their living situation and phone charging solutions during power outages (Homewatch CareGivers, 2025; University of Nevada Extension, 2025).
Communication Systems: Verify that landline or cell phones are accessible and charged, with emergency numbers programmed. Consider medical alert systems for individuals living alone, particularly those with fall risk or chronic conditions requiring immediate response.
Environmental Modifications for Winter Safety
Entrance and Exit Management: Create protected pathways with adequate lighting for winter conditions when exits may be used in darkness. Install motion-sensor exterior lighting to illuminate paths automatically. Ensure sturdy handrails at all exterior steps. Keep ice melt, sand, or rock salt easily accessible near exits for pathway treatment before venturing out (National Institute on Aging, 2024).
Interior Lighting Enhancement: With darkness falling early in winter, adequate interior lighting becomes critical for fall prevention. Add lighting in hallways, staircases, bathrooms, and frequently traveled paths. Motion-sensor nightlights provide hands-free illumination for nighttime movement without requiring clients to fumble for switches in the dark (GoGo Grandparent, 2024).
Bathroom Modifications: Bathrooms can become dangerously cold in winter, and temperature differentials increase fall risk. Ensure bathroom heating is adequate. Add grab bars, non-slip mats, and shower chairs to address fall risk that increases with rushing due to cold. Consider raised toilet seats for individuals with lower extremity weakness exacerbated by cold temperatures.
Flooring Considerations: Place absorbent, non-slip mats at all entrances to manage tracked snow and water. Remove loose rugs that can slide on wet floors. Ensure adequate time for wet floors to dry, or establish protocols for immediate cleanup of melted snow and ice.
Supporting Physical Activity and Functional Capacity Through Winter
Reduced physical activity during winter creates a vicious cycle of deconditioning, increased fall risk, further activity restriction, and functional decline. Occupational therapy interventions can maintain and even improve function during winter months.
Indoor Exercise Programming
Evidence shows that seniors participating in structured indoor movement programs report 45% better mobility maintenance throughout winter compared to those who don’t (Pillars of Wellness, 2025). Recommend or provide:
Chair-Based Exercise: Chair yoga, seated tai chi, and upper and lower extremity strengthening exercises accommodate various mobility levels while providing cardiovascular and strength benefits. These activities can be performed safely indoors regardless of weather.
Hallway Walking Programs: For ambulatory individuals, structured hallway walking programs with proper supports maintain cardiovascular fitness and gait mechanics. Establish specific goals (frequency, duration, distance) and track progress to maintain motivation.
Functional Task Practice: Incorporate winter-relevant functional activities into therapy—safe techniques for donning/doffing boots and coats, carrying items while maintaining balance, managing bags and packages, and navigating various surfaces. Practice these skills in controlled environments before clients encounter them in community settings.
Balance and Strengthening: Progressive balance exercises and lower extremity strengthening reduce fall risk and maintain functional capacity. Evidence demonstrates that consistent balance training improves outcomes even in older adults with chronic conditions (Empowerme, 2025).
Meaningful Activity Engagement
Winter’s reduced outdoor access can lead to occupational deprivation. Occupational therapy assessment identifies meaningful indoor activities that provide purpose, structure, and stimulation during winter months.
Adapted Hobbies and Crafts: Winter provides opportunity for indoor hobbies—crafting, quilting, woodworking, painting, or other creative pursuits. Crafting activities maintain fine motor skills and cognitive function while providing social opportunities and accomplishment. Statistics show seniors participating in regular craft activities demonstrate 30% better fine motor retention (Pillars of Wellness, 2025).
Indoor Gardening: Container gardening, herb gardens on windowsills, or caring for houseplants provide cognitive stimulation, sensory engagement, and sense of purpose. Data shows seniors engaged in indoor gardening report 40% higher satisfaction with daily life during winter months (Pillars of Wellness, 2025).
Kitchen Activities: Winter comfort food preparation offers excellent opportunities to maintain instrumental ADL skills. Recommend simple soups, stews, and baking activities modified for standing tolerance or seated options. These activities support nutritional intake while maintaining independence in valued roles (Pillars of Wellness, 2025).
Technology for Connection: Support clients in using technology for virtual social connection, online classes, video calls with family, and entertainment. While this requires initial learning, technology enables continued social participation when in-person gatherings are limited by weather or mobility challenges.
Addressing Winter-Specific Transportation and Community Access
Transportation challenges can lead to missed medical appointments, medication non-adherence, food insecurity, and social isolation during winter months.
Alternative Transportation: Connect clients with accessible transportation services including paratransit, senior shuttle services, ride-sharing programs with accessibility accommodations, and volunteer driver programs. Many communities offer specialized winter transportation for medical appointments and grocery shopping.
Delivery Services: Facilitate connection to grocery delivery, meal delivery programs (Meals on Wheels), prescription delivery, and other services that reduce need for winter travel while maintaining access to necessities. Teach clients or family members to use online ordering systems where appropriate.
Appointment Scheduling: Encourage strategic scheduling of non-urgent appointments during better weather months when possible. Cluster multiple appointments on the same day to reduce travel frequency. Request first appointments of the day before ice melts and refreezes.
Safe Travel Techniques: For clients who do travel independently in winter, provide education on safe outdoor navigation—appropriate footwear with traction, assistive devices with ice tips, techniques for safe vehicle entry/exit on icy surfaces, and awareness of balance challenges when wearing bulky winter clothing.
Nutrition and Hydration Monitoring
Winter affects nutritional status through multiple mechanisms—reduced appetite, difficulty shopping, increased heating costs competing with food budgets, and reduced thirst awareness in cold environments.
Hydration Assessment: Older adults often don’t feel thirsty in cold weather despite continued hydration needs. Dehydration impairs cognitive function, increases fall risk, and worsens constipation. Establish hydration schedules and recommend attractive beverage options (warm herbal teas, broths) that appeal in cold weather.
Nutritional Adequacy: Assess for adequate caloric and protein intake to support thermoregulation and maintain muscle mass. Screen for food insecurity and connect clients with food assistance programs, congregate meal sites, and home-delivered meals. Recommend nutrient-dense, easy-to-prepare foods for individuals with limited cooking capacity.
Vitamin D Supplementation: Reduced sun exposure during winter months decreases vitamin D synthesis, affecting bone health, immune function, and mood. Discuss vitamin D supplementation with clients’ physicians, particularly for homebound individuals.
Mental Health and Cognitive Engagement
Seasonal affective disorder, social isolation, and reduced activity contribute to depression and cognitive decline during winter months.
Light Exposure: Recommend sitting near windows during daylight hours, using full-spectrum light bulbs, or considering light therapy boxes for individuals with seasonal depression symptoms. Maximizing light exposure supports circadian rhythms and mood regulation.
Structured Routines: Help clients establish structured daily routines that provide purpose and meaning despite weather limitations. Regular wake/sleep times, scheduled activities, social contact, and self-care routines combat the tendency toward withdrawal and depression.
Cognitive Stimulation: Encourage cognitively stimulating activities—reading, puzzles, games, online classes, and learning new skills. Research demonstrates that regular sensory stimulation can reduce agitation and improve mood in older adults by up to 53% (Pillars of Wellness, 2025).
Social Connection: Facilitate maintained social connections through phone calls, video chats, virtual activities, and safe in-person gatherings when weather permits. Even brief daily social contact provides significant protective effects against isolation-related decline.
Expanding Your Aging-in-Place Practice Through Winter Services
Winter presents natural opportunities to engage clients in comprehensive home safety assessments, modification services, and ongoing support. Consider developing winter-specific service offerings:
Pre-Winter Home Safety Assessments: Comprehensive evaluation of heating adequacy, safety systems, fall hazards, emergency preparedness, and winter-specific risks with tailored recommendation reports.
Winterization Consultation Packages: Bundled services including assessment, modification recommendations, vendor referrals, and follow-up to ensure implementation.
Winter Wellness Programs: Group or individual programming addressing physical activity, nutrition, social engagement, and meaningful occupation during winter months.
Caregiver Education: Training for family caregivers on winter safety monitoring, emergency preparedness, and supporting aging in place through challenging seasons.
By positioning yourself as the expert resource for winter aging-in-place support, you provide essential services while expanding your practice during a season when older adults and their families are acutely aware of vulnerability and motivated to implement changes.
References
AARP. (2025). How family caregivers can keep loved ones safe in winter. https://www.aarp.org/caregiving/home-care/caregiver-winter-safety-tips/
Empowerme. (2025). Therapy strategies for keeping patients active & safe during winter. https://empowerme.com/resources/blog/therapy-strategies-for-keeping-patients-active-and-safe-during-winter/
GoGo Grandparent. (2024). How to transform your home into a cozy retreat this winter. https://www.gogograndparent.com/blog/how-to-transform-your-home-into-a-cozy-retreat-this-winter
Homewatch CareGivers. (2025). 5 tips for senior safety at home during the cold season. https://www.homewatchcaregivers.com/potomac/about-us/blog/5-tips-for-senior-safety-at-home-during-the-cold/
National Institute on Aging. (2024). Cold weather safety for older adults. https://www.nia.nih.gov/health/safety/cold-weather-safety-older-adults
Pillars of Wellness. (2025). Winter activities for seniors with OT. https://pillarsofwellness.ca/occupational-therapist/safe-ways-for-seniors-to-remain-active-in-winter/
ScienceDirect. (2013). Knowledge and injury prevention practices in homes of older adults. Archives of Gerontology and Geriatrics, 56(2), 250-255. https://doi.org/10.1016/j.archger.2012.
University of Nevada Extension. (2025). Winter safety for older adults. https://extension.unr.edu/publication.aspx?PubID=3236
The Home Accessibility Therapist LLC 
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