By Heather Deering, Registered Associate Nutritionist and Harriet Smith, Registered Dietitian
During winter months, there is a rise in the prevalence of infectious diseases such as colds and flu viruses (1). Cold weather can also exacerbate pre-existing health conditions, particularly in elderly or vulnerable populations (2). With this in mind, winter is an ideal time to encourage patients to develop sustainable, healthy habits to optimise their health and wellbeing.
This article shares five top tips for winter wellbeing, taking into consideration current lockdown restrictions relating to the coronavirus pandemic.
Get Enough Vitamin D
Vitamin D supports the regulation of calcium and phosphate levels in the body. Therefore, it is crucial for the maintenance of healthy bones, teeth and muscles (3).
Vitamin D is mainly synthesised in the skin through exposure to UVB rays in the sunlight. In the UK, from late March to September, most people are able to obtain sufficient vitamin D through sunlight exposure and to a lesser extent, by following a healthy, balanced diet (4). However, during the autumn and winter months, it is difficult to get sufficient vitamin D from sunlight exposure alone (5).
In light of this, the UK government recommends that from October to March, all adults should consider taking a daily 10 microgram vitamin D supplement (4). Individuals who have limited exposure to the sun due to mobility or clothing, or who belong to an ethnic minority group with dark skin are advised to supplement throughout the year. It is worth noting that people with certain medical conditions may have additional supplementation requirements.
There is insufficient evidence to support claims that vitamin D can prevent or treat coronavirus. However, vitamin D does play an important role in supporting overall health, and deficiency has been associated with increased risk of infections such as pneumonia (6) and upper respiratory tract infections (7). Supplementation in those with deficiency may help protect against such infections (8). You can read more about the link between vitamin D and respiratory disease here.
The ability to thermoregulate body temperature declines with age. Additionally, colder weather can put a strain on the cardiovascular, circulatory, and immune systems (9). Therefore, it is important to encourage the older population to stay warm during the winter months.
Practical suggestions for keeping warm include:
- Staying active - even small, short bursts of activity will have a beneficial effect.
- Wrapping up warm - especially if venturing outside, layers are important, along with donning a hat and gloves (and possible thermals when it’s really cold). When in the house, encourage patients to keep extra blankets, hot water bottles, and woolly socks handy.
- Heating the house - homes should be heated to a steady, comfortable degree, with windows closed at night when the temperatures are lowest. Age UK have advice for accessing help with heating bills, such as the Winter Fuel Payment and Cold Weather Payment.
The flu vaccine is safe and reduces the risk of catching and becoming seriously ill from flu, especially in older and vulnerable populations (10). In the UK, the flu vaccine is available on the NHS to those who:
- Are 50 and over
- Have certain long-term medical conditions or are in long-stay residential care
- Are pregnant
- Are a carer or receive a carer’s allowance
- Live with someone on the NHS shielded patient list
Eligible patients can access their free flu vaccine via their GP or local pharmacy (11). However, anyone can get the flu vaccine at a pharmacy offering a vaccination service for a small fee. The ideal time to get the flu vaccine is autumn, but it’s better late than never.
Rollout of the COVID-19 vaccine has also begun in the UK. Those most at risk from coronavirus, such as the over-80s, care home residents and front-line healthcare professionals are being vaccinated as a priority and it is only available through the NHS (12). Eligibility for the vaccine will change as the mass vaccination scheme evolves. Those who are eligible will be contacted directly through the post or through their GP surgery.
The COVID-19 vaccine reduces the risk of developing the virus, and makes symptoms milder if it is caught, so patients should be encouraged to take up the offer of the vaccine when they are invited (13).
Get Enough Sleep
Older adults are likely to sleep for a shorter period of time (an average of 5 to 7 hours) and are more likely to experience disturbed sleep compared with younger adults (14). Though poor sleep is not inevitable, sleep problems such as insomnia and sleep apnea are also common among the elderly (15). Poor sleep can contribute to ill health, with sleep deficiency linked to a weakened immune system, increased risk of conditions such as diabetes and heart disease, and poor mental wellbeing (16).
Tips for getting a good night’s sleep include:
- Following a regular sleep schedule - going to bed and getting up at the same time every day.
- Avoiding napping during the day.
- Taking time to relax and unwind before bed by reading or listening to soothing music.
- Trying not to watch TV or use electronics in bed, as the blue light from these devices can make it more difficult to fall asleep.
- Avoiding eating a large meal close to bedtime.
- Steering clear of caffeine in the afternoons.
Staying adequately hydrated and eating well is important throughout the year, but even more so during this winter lockdown. Consuming a healthy and balanced diet provides the body with all of the vitamins, minerals, and other nutrients required to stay well and optimise immunity; malnutrition and nutritional deficiencies can impair the body’s immune response (17).
Sarcopenia is a progressive and generalised skeletal muscle disorder, characterised by low muscle strength, low muscle quality or quantity, and low physical performance, and it is associated with the ageing process (18). However, sarcopenia can be prevented by maintaining good nutrition and an active lifestyle.
It is recommended that healthy older people should eat 1.0-1.2g of protein per kilogram body weight each day in order to maintain muscle strength and function, with that amount rising to 1.2-1.5g in adults who are malnourished or at risk of malnutrition (18).
To support and optimise nutritional status, encourage patients to:
- Eat regular and balanced meals.
- Include high-energy, high-protein foods at meal and snack times (e.g. oily fish, lean meat and poultry, dairy products, eggs, nuts and seeds etc.)
- Choose meals and snacks in line with their preferences - where possible they should be involved in meal planning and preparation.
- Stay hydrated and monitor for signs of dehydration (e.g. dry lips, thirst, confusion, tiredness etc.)
- If appetite is reduced, encourage them to eat little and often, consuming smaller, more frequent meals, snacks and nourishing drinks.
Patients who are unable to meet their nutritional requirements through an oral diet alone may require oral nutritional supplements. You can read more about managing malnutrition during lockdown here.
- Fares A. Factors Influencing the Seasonal Patterns of Infectious Diseases. Int J Prev Med. 2013;4(2):128-132.
- How to stay well in winter [Internet]. nhs.uk. 2021 [cited 10 January 2021]. Available from: https://www.nhs.uk/live-well/healthy-body/keep-warm-keep-well/
- Vitamins and minerals - Vitamin D [Internet]. nhs.uk. 2021 [cited 10 January 2021]. Available from: https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/
- PHE publishes new advice on vitamin D [Internet]. GOV.UK. 2021 [cited 10 January 2021]. Available from: https://www.gov.uk/government/news/phe-publishes-new-advice-on-vitamin-d
- Webb A, Kazantzidis A, Kift R, Farrar M, Wilkinson J, Rhodes L. Meeting Vitamin D Requirements in White Caucasians at UK Latitudes: Providing a Choice. Nutrients. 2018;10(4):497.
- Zhou Y, Luo B, Qin L. The association between vitamin D deficiency and community-acquired pneumonia. Medicine. 2019;98(38):e17252.
- Ginde A, Mansbach J, Camargo C. Association Between Serum 25-Hydroxyvitamin D Level and Upper Respiratory Tract Infection in the Third National Health and Nutrition Examination Survey. Archives of Internal Medicine. 2009;169(4):384.
- Martineau A, Jolliffe D, Hooper R, Greenberg L, Aloia J, Bergman P et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ. 2017;:i6583.
- Conlon K, Rajkovich N, White-Newsome J, Larsen L, O’Neill M. Preventing cold-related morbidity and mortality in a changing climate. Maturitas. 2011;69(3):197-202.
- de Lusignan S, Correa A, Ellis J, Pebody R. Influenza vaccination: in the UK and across Europe. British Journal of General Practice. 2016;66(650):452-453.
- Flu vaccine [Internet]. nhs.uk. 2021 [cited 09 January 2021]. Available from: https://www.nhs.uk/conditions/vaccinations/flu-influenza-vaccine/
- Coronavirus (COVID-19) vaccine [Internet]. nhs.uk. 2021 [cited 09 January 2021]. Available from: https://www.nhs.uk/conditions/coronavirus-covid-19/coronavirus-vaccination/coronavirus-vaccine/
- Coronavirus (COVID-19) vaccine | NHS inform [Internet]. Nhsinform.scot. 2021 [cited 09 January 2021]. Available from: https://www.nhsinform.scot/healthy-living/immunisation/vaccines/coronavirus-covid-19-vaccine
- Gooneratne N, Vitiello M. Sleep in Older Adults. Clinics in Geriatric Medicine. 2014;30(3):591-627.
- Rodriguez J, Dzierzewski J, Alessi C. Sleep Problems in the Elderly. Medical Clinics of North America. 2015;99(2):431-439.
- Why lack of sleep is bad for your health [Internet]. nhs.uk. 2021 [cited 10 January 2021]. Available from: https://www.nhs.uk/live-well/sleep-and-tiredness/why-lack-of-sleep-is-bad-for-your-health/
- Chandra R. Nutrition and the immune system: an introduction. The American Journal of Clinical Nutrition. 1997;66(2):460S-463S.
html editor 5
- Deutz N, Bauer J, Barazzoni R, Biolo G, Boirie Y, Bosy-Westphal A et al. Protein intake and exercise for optimal muscle function with aging: Recommendations from the ESPEN Expert Group. Clinical Nutrition. 2014;33(6):929-936.