Older Adults’ Thermal Comfort in Nursing Homes: Exploratory Research in Three Case Studies

Round 1

Reviewer 1 Report

The paper faces an interesting and promising filed of research dealing with thermal sensation of aged people (and more generally to the difference of thermal perception according to age groups), however the manuscript does not meet the rigorous scientific standards and structure of the journal.

The introduction section does not provide a sufficient state of art review about previous studies and particularly the relation between thermal perception, climate conditions and the characteristics of the building (whatever is the age of the occupants). Additionally, the authors state that the scope is to “evaluate the thermal comfort of the occupants of nursing homes for older adults, through the study of comfort gaps and adaptive behavior to project future research related to the well-being of older adults”, but the limitation to work with nursing homes was not explained and the results are not fully meeting the scope.

The methodology section completely lacks to explain which is the structure of the methodology, which the assumptions, which the deriving actions, which the protocols (i.e. there is no discussion of why the probes were located in a specific point against the building characteristics), which the assessment of results, which the expected outcomes. This section is mainly a description of the case studies while the methodology must be described to make it replicable whatever the case studies are.

Accordingly, the results have a quite limited significance especially considering that their larger impacts in terms of potential action for improving the living conditions or the building characteristics (i.e. insulation or systems) do not emerge.

Introduction: ageing population is not a trend everywhere in the world. To provide a more realistic background context please specify to which world region this is referred and possibly support the sentence with adequate statistical references. The conclusion cannot be simply assuming that the occupants add another clothing layer to gain their comfort condition but providing comprehensive strategy at building or system level for the purpose.

In the present form the paper is not worth of publication.

Some additional punctual remarks:

Line 37: typo

Lines 37-39: please associate the possible pathologies with the winter or summer climate stress condition respectively.

Line 41: delete the Spanish adjective eficazemente

Line 69: there is a logical jump as the nursing homes are introduced without being defined as a specific typology for investigation in the previous paragraphs.

Table 1: does not provide any significant information (just three images). Please add some details such as the surface, the volume, the number of occupants and caregivers, or any useful climatical data!

Table 2: the wall section must be specified (Mansory of what? Stones, bricks, ??) the roof section is missing. Please avoid the use of Spanish words (vidriado) and possibly add technical details such as the U value.

Table 4: avoid the use of Spanish words.

Author Response

We would first like to thank you for your highly pertinent comments, which have certainly helped improve our paper. We will answer each question and comment point by point, describing the changes that have been made.

 

The introduction section does not provide a sufficient state of art review about previous studies and particularly the relation between thermal perception, climate conditions and the characteristics of the building (whatever is the age of the occupants).

 

We agree with your remark. Therefore, we included a revision of the state od the art, focusing on the relation between thermal perception, climate conditions and the characteristics of the building in the introduction citing to other papers that present this topics in detail. Please refer to the changes made in lines 30 - 349.

 

 

The authors state that the scope is to “evaluate the thermal comfort of the occupants of nursing homes for older adults, through the study of comfort gaps and adaptive behavior to project future research related to the well-being of older adults”, but the limitation to work with nursing homes was not explained and the results are not fully meeting the scope.

 

Thank you for your comment. Indeed, the limitations were not clearly described in the first version of the paper. We enhanced the description of the occupants and their limitations in line 447 – 483. We also included a reflection on the limitation in lines 1114 – 1118.

 

 

The methodology section completely lacks to explain which is the structure of the methodology, which the assumptions, which the deriving actions, which the protocols (i.e. there is no discussion of why the probes were located in a specific point against the building characteristics), which the assessment of results, which the expected outcomes. This section is mainly a description of the case studies while the methodology must be described to make it replicable whatever the case studies are.

Thanks for pointing this issue out. We included figure 1 explaining the Study conceptual framework (line 200). We also cited the corresponding norm that defines measurements protocols and was used in this research (ISO 7726) in line 435 – 438. Figure X was also included in line 296-697, showing an example of questions.

 

 

The results have a quite limited significance especially considering that their larger impacts in terms of potential action for improving the living conditions or the building characteristics (i.e. insulation or systems) do not emerge.

 

This study was designed to evaluate the thermal comfort of the occupants of nursing homes for older adults, not to reflect on possible retrofitting strategies. As stated before, this exploratory research should lead to further studies. The comment you made about retrofitting seems a logic step forward. Therefore, we included it on the future work in lines 865 – 867.

 

 

Introduction: ageing population is not a trend everywhere in the world. To provide a more realistic background context please specify to which world region this is referred and possibly support the sentence with adequate statistical references.

To clarify this, we included a paragraph explaining ageing at a global scale and its impact on Latin America. Please refer to lines 32 – 38.

 

 

The conclusion cannot be simply assuming that the occupants add another clothing layer to gain their comfort condition but providing comprehensive strategy at building or system level for the purpose.

Thank you for your comment. We reorganized the conclusions and included more information. The differences in thermal preference have been described and explained in detail in lines 826 – 842. We also included further research in lines 851-854 and commented on some limitations of the study in lines 855-859

 

Line 37: typo

Thanks for pointing this out. We corrected the typo.

 

Lines 37-39: please associate the possible pathologies with the winter or summer climate stress condition respectively.

Thanks for your suggestion, we included them in lines 57-62

 

Line 41: delete the Spanish adjective eficazemente

The text has been translated to English in line 61.

 

Line 69: there is a logical jump as the nursing homes are introduced without being defined as a specific typology for investigation in the previous paragraphs.

Indeed, we included a definition in lines 95-98.

 

 

Table 1: does not provide any significant information (just three images). Please add some details such as the surface, the volume, the number of occupants and caregivers, or any useful climatical data!

Table 1 was updated to include u value and total number of residents and care givers for each case study.

 

 

Table 2: the wall section must be specified (Mansory of what? Stones, bricks, ??) the roof section is missing. Please avoid the use of Spanish words (vidriado) and possibly add technical details such as the U value.

Table 2 was updated to include wall main material. U value is informed in table 1.

 

Table 4: avoid the use of Spanish words.

Table 4 was updated and translated in its integrity

Author Response File: Author Response.docx

Reviewer 2 Report

The objective of this exploratory research is to determine to what extent the range of thermal comfort differs between older adults and caregivers in three nursing homes of Gran Concepción. Indoor and outdoor temperature and relative humidity were monitored during winter and spring. Simultaneously, a thermal sensation and preference survey was applied while clothing insulation, metabolic activity and adaptive responses were observed. Neutral temperature was calculated using Griffiths' method for both groups to determine comfort ranges and compare them.

 

 

I think there is a big difference in thermal comfort between the older adults and caregivers. Firstly, the age is different. And they are in different physical health. Secondly, they are in different activities.  The nursing workers are in heavy physical labor.  Whether the author considers the difference of activity in the research?

 

Author Response

We would first like to thank you for your highly pertinent comments, which have certainly helped improve our paper. We will answer each question and comment point by point, describing the changes that have been made.

 

I think there is a big difference in thermal comfort between the older adults and caregivers. Firstly, the age is different. And they are in different physical health. Secondly, they are in different activities. The nursing workers are in heavy physical labor. Whether the author considers the difference of activity in the research?

  

We thank you for your insightful comment. We included more details on this topic in the description of table 10, lines 734 to 738. It is also mentioned in lines 860 to 863.

Author Response File: Author Response.docx

Reviewer 3 Report

Dear Authors,

I really apprecciated your research, methods and results, I have just two remarks:

a) are you wure that ederly understand your survey? how do you do survey and questions? some of these are effect on alzheimer or dementia? 

The experience about indoor thermal comfort perception focusing on children, show a main role of to self-understanding questionnaire. 

In other world ask just if do you feel cold or hot it is not enough in not-adult people. Please, report an example of questionnaire or explain the role of the cognitive state about survey. You report a sentence about it but if do you reply your research in other case study how do you think to resolve this cognitive-gap? Please improve your discussion or conclusion. 

 

b) following above remarks, I suggest to improve scientific literature about thermal comfort survey in other plase as hospital, school, children, elderly. 

Table 15 Mximum instead of Maximum

 

Regards

Author Response

Author reply round 1

We would first like to thank you for your highly pertinent comments, which have certainly helped improve our paper. We will answer each question and comment point by point, describing the changes that have been made.

 

Are you aware that elderly understand your survey? how do you do survey and questions? some of these are effect on Alzheimer or dementia?

 

Thanks for your comment, we clarified the selection process of the respondents in lines 390 to 394, and explained the process used to apply the survey in lines 395 to 407.

On the same topic we included a paragraph about the limitation that arises when not surveying all occupants in lines 946 to 950.

 

The experience about indoor thermal comfort perception focusing on children, show a main role of self-understanding questionnaire. In other world ask just if do you feel cold or hot it is not enough in not-adult people.

 

Thanks for your comment. The survey included follow up questions as explained in lines 442 to 446. And shown in figure 3.

 

 

Please, report an example of questionnaire or explain the role of the cognitive state about survey.

 

Thanks for your suggestion. An example of questionnaire is given in figure 3 and in annex 1 the whole questionnaire is included.

 

 

You report a sentence about it but if do you reply your research in other case study how do you think to resolve this cognitive-gap? Please improve your discussion or conclusion.

 

Thanks for this insightful comment. We included a paragraph about the limitation that arises when not surveying all occupants in lines 946 to 950.

 

 

1. b) following above remarks, I suggest to improve scientific literature about thermal comfort survey in other plase as hospital, school, children, elderly.

Thanks for this remark, we included two paragraphs in lines 85 to 94.

 

 

Table 15 Mximum instead of Maximum

 

Thanks for pointing out this typo, it was corrected in table 15 line 804.

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

The authors put some effort in improving the paper according to the first review round especially with reference to the introduction, context and background, however the section materials and methods still lacks a clear explanation of which is the theoretical structure of actions in response to the detected gap in the field (and stated as scope of the study), how these actions provide an advancement (which are the methods and tools adopted and why), how the process is driven (i.e. on site measurement are used as baseline/check values against the values reported in the surveys) and how the gained outcomes are assessed and validate.

Figure 1. is nice to look but does not add any real explanation about the process. A more meaningful graphical representation (see Pert diagram) is recommended.

This section is not intended as the description of the case study/ies but of the logical sequence driving the process wherever it is applied. This is an essential part of the article to let the study can be verified and then replicated elsewhere if needed.

Figure 3 is in Spanish language.

Author Response

Reviewer 1:

 

We would first like to thank you for your comments:

 

Comment 1:

The authors put some effort in improving the paper according to the first review round especially with reference to the introduction, context and background, however the section materials and methods still lacks a clear explanation of which is the theoretical structure of actions in response to the detected gap in the field (and stated as scope of the study), how these actions provide an advancement (which are the methods and tools adopted and why), how the process is driven (i.e. on site measurement are used as baseline/check values against the values reported in the surveys) and how they gained outcomes are assessed and validate.

Author response 1:

Comments have been considered to improve the material and methods section as well as the particular aspects mentioned.

 

Comment 2:

Figure 1. is nice to look but does not add any real explanation about the process. A more meaningful graphical representation (see Pert diagram) is recommended.

We have made a pert diagram.

 

Comment 3:

This section is not intended as the description of the case study/ies but of the logical sequence driving the process wherever it is applied. This is an essential part of the article to let the study can be verified and then replicated elsewhere if needed.

is answered in comment 1

 

Comment 3:

Figure 3 is in Spanish language.

corrected and translated into English

Author Response File: Author Response.pdf

Round 3

Reviewer 1 Report

In the opinion of this reviewer, the new version does not fully solve the remarks on the methodology section.