1. Introduction
Indoor thermal comfort has become an important topic in the context of sustainable living. Providing an adequate indoor climate, especially in healthcare facilities, is important because these residential buildings accommodate people with medical conditions who are significantly affected by lower or higher temperatures [
1]. In the case of the healthcare facilities studied in the French city of Troyes, the challenge of managers is to ensure adaptive thermal comfort for patients inside the buildings in summer. Thermal comfort is defined as a state of mind that expresses satisfaction with the thermal environment [
2]. The majority of thermal comfort studies are related to healthy groups of occupants, with few studies exploring the thermal comfort of disabled people due to a lack of knowledge in this area [
3]. Similarly, the ASHRAE Standard 55-2020 [
4], as well as ISO/TS 14415 [
5], have limited information on this issue. To establish guidelines for the design and control of building systems, it is therefore necessary to determine all the environmental parameters of the healthcare facility and the thermal comfort requirements of its residents. In this paper, both objective and subjective methods are used to achieve this aim.
Thermal comfort parameters were investigated during the summer season in residential buildings managed by the Association of Parents of Disabled Children (APEI) in the French city of Troyes. These medico-social buildings accommodate people with physical (motor disabilities, multiple disabilities, etc.) and mental disabilities. Constructed in 1992, they are managed by the “APEI of Aube” located in eastern France (latitude 48.32°, longitude 4.04°). The measurement of thermal comfort in a healthcare environment is a challenging and even daunting task. The challenge is therefore to meet the thermal comfort needs of all occupants, whether patients or staff, in an optimal way [
6]. The physical environment has an impact on the health and wellbeing of occupants [
7]. Providing a good indoor climate is important not only because it makes the occupants more comfortable, but also because it reduces the building’s energy consumption. The thermal comfort of patients with physical or mental disabilities can differ from that of healthy people [
8]. It is therefore important to study the various environmental and personal parameters that affect the patient’s thermal comfort.
Adaptive thermal comfort is a topic that has interested researchers for the last 20 years [
9] because people have a natural tendency to adapt to changing conditions in their environment [
10]. The adaptive approach is often used in a naturally ventilated building because there are more opportunities for adaptation, however, it may still be valid if there are possibilities for adaptation in air-conditioned buildings. Indeed, Parkinson et al. [
11] has recently shown that adaptive comfort processes could be relevant in buildings with air conditioning.
For this purpose, ISO 14415 [
12] was designed for application along with ISO 7730 for determining the thermal comfort of people with disabilities. Adaptive thermal comfort in healthcare facilities is necessary due to the diverse comfort and health needs of patients and medical staff. People with physical disabilities may have different thermal requirements compared to healthy people. This is mainly due to thermoregulatory dysfunctions as well as technological devices such as wheelchairs [
13] used by some patients in the long term. After comparing the association between actual mean vote (AMV) and predicted mean vote (PMV) values on the one hand and age and gender on the other, Del Ferraro et al. [
14] highlighted that gender and age are important factors when evaluating thermal comfort in hospital settings. Thermal requirements should be considered on an individual level for people with physical disabilities [
15].
Hill et al. [
1] showed that the most common request among patients with physical disabilities was to be warmer, whereas staff tended to want to be cooler. The study of Hashiguchi et al. [
16] compared the thermal comfort of patients and medical staff, concluding that most patients were comfortable, while medical staff were uncomfortable, although this study did not compare subjective responses and objective measurements with PMV predictions. Khodakarami et al. [
17] reported that the user groups in a hospital setting had different thermal comfort requirements that were difficult to accommodate in one single space. Therefore, ensuring adaptive comfort for each group is necessary.
To accommodate the different thermal comfort requirements of healthcare occupants, Sattayakorn et al. [
18] determined the acceptable temperature ranges for patients, visitors, and medical staff to be 21.8–27.9 °C, 22.0–27.1 °C, and 24.1–25.6 °C, respectively. Nuria et al. [
19] investigated the thermal comfort of aging people in nursing homes in the Mediterranean summer, showing that the thermal comfort temperature for elderly residents is around 24.4 °C compared to 23.5 °C for non-elderly persons. Kim et al. [
20] indicated that indoor hygrothermal conditions should be carefully managed in healthcare facilities to improve staff comfort and satisfaction with their working environment. This indirectly brings positive health outcomes for patients.
Verheyen et al. [
8] investigated the thermal comfort of patients in a Belgian healthcare facility using objective and subjective methods for different patient groups. They concluded that PMV may adequately predict mean thermal sensation for patients. According to Sattayakorn et al. [
17], the PMV model is unsuitable for determining the thermal comfort of healthcare occupants in tropical climates, with this result being confirmed by Yau et al. [
21] who reported that the PMV model might not be suitable for tropical hospitals. Alotaibi et al. [
22] studied the thermal comfort of hospital patients in air-conditioned environments in hot climates. Their main objective was to determine to what extent the thermal environment of hospitals, often designed on standard office comfort, is suitable for hospital patients. They confirmed that the thermal sensation votes (TSV) strongly overestimated the PMV index of all patients, meaning that a warmer indoor environment was desired. Zaniboni et al. [
23] investigated the thermal comfort of patients in physiotherapy centers by comparing objective parameters and subjective measurements of thermal comfort for different groups of patients and therapists. They confirmed that the PMV was unsuitable for accurately predicting the thermal sensation of therapists and patients. Thus, the application of the PMV index for this type of population is questionable, and its efficiency is limited.
Carlucci et al. [
24], investigated the five regulatory documents that have incorporated an adaptive thermal comfort model (ANSI/ASHRAE 55, EN 15251, prEN 16798-1, ISSO 74 and GB/T 50784), results indicated that several sources of uncertainty affecting the application of the standards in practice. Pereira et al. [
25], conducted a literature review of papers published between 1968 and August 2020 on thermal comfort in hospitals, health centers, and elderly centers. The main findings of this research are as follows: (i) only 12 papers where there was a comparison TSV with PMV; (ii) an adequate thermal environment for professionals and patients is necessary; (iii) little explored study topics, such as staff productivity or consideration of patient health status in the assessment of thermal comfort.
To overcome this issue, this paper presents the adaptive thermal comfort model based on the “Black Box” theory in the residential buildings of APEI. This model is known as the adaptive predicted mean vote (PMVa) model in the adaptive comfort literature and takes into account factors such as climate, culture, as well as psychological and behavioral adaptations. It is necessary to estimate the environmental parameters of the healthcare facility and the thermal comfort requirements of its residents to establish guidelines for the design and control of building systems. This paper proposes an adaptive model of temperature to create a more sustainable environment in which disabled patients are more comfortable.
4. Conclusions
This study constitutes a first step toward understanding adaptive thermal comfort in French healthcare buildings for patients with disabilities. The research described in this paper was carried out in the APEI residential buildings in the summer of 2018. This research aims to broaden our understanding of thermal comfort in healthcare buildings by considering several factors relating to people with disabilities during the analysis phase. The results can improve the application of the current standards for vulnerable populations.
The most important conclusions of our study may be summarized as follows. First, simplifying the process of interviewing disabled persons by using pictures and simple language contributes greatly to obtaining reliable results. Second, the patients were generally dissatisfied with the thermal environment of their dwellings. Third, in the studied buildings, the neutral temperature is 23.65 °C, which is obtained by substituting PMV = 0 in Equation (1). Fourth, PMV always underestimated the thermal sensation of patients in the APEI residential buildings in summer. Fifth, the comparison between patients and staff is important to better understand the variation in comfort requirements, so that buildings can be designed to accommodate the diverse needs of all occupant groups. Sixth, this paper presents the adaptive predicted mean vote ( based on the relationship between measurements and field studies. Lastly, in the APEI residential buildings, the adaptive temperature is 25.0 °C with respectively upper and lower limits of 24.7 °C and 25.4 °C, respectively. This paper proposes recommendations for indoor temperatures in healthcare buildings for disabled patients based on the relationship between patients’ sensations and the thermal environment.
Further studies should examine the conditions of thermal comfort in health care facilities and investigate how to personalize the comfort indices to consider the disabilities, health status, and medical treatments of this population.