Main Causes of Hospitalisations Over Christmas
Discover why hospitals face increased pressure over Christmas due to winter illnesses, infections, and lifestyle factors.
Christmas brings joy and celebration, but it also places immense pressure on hospitals worldwide. Cold weather, festive indulgences, and seasonal infections lead to a surge in admissions, particularly for vulnerable groups like the elderly and young children. While emergency department visits may not always spike dramatically, the severity of cases often results in longer hospital stays and strained resources.
Winter hospital admissions
During winter, hospital admissions rise due to conditions worsened by cold temperatures. Although A&E attendances might decrease slightly, the proportion of patients requiring admission increases significantly. These cases often involve longer lengths of stay, reducing staff flexibility to handle demand.
Key risk groups include:
- Older people: More susceptible to hypothermia, falls, and exacerbations of chronic conditions.
- People with serious medical conditions, especially respiratory issues like asthma or COPD.
- Very young children: Prone to infections and dehydration from illnesses.
Studies confirm a ‘holiday effect’ where December admissions show greater clinical complexity, including higher frailty, cognitive impairment, and socioeconomic factors like social deprivation and low income. Patients admitted over holidays tend to be older, with worse outcomes such as prolonged stays and higher early mortality.
Infectious diseases
Cold, dry air doesn’t directly cause infections but facilitates their spread by weakening immune responses and promoting indoor crowding. Hospitals see a marked increase in viral illnesses during Christmas.
Flu
Influenza, a highly contagious respiratory virus, is a leading cause of winter hospitalisations. Complications like pneumonia can turn mild cases life-threatening, especially in the elderly and those with comorbidities. Flu season often surges over holidays, with strains like A H3N2 causing severe outcomes in older adults.
- Symptoms: Fever, cough, sore throat, body aches.
- Risk factors: Unvaccinated status, age extremes, chronic illnesses.
- Prevention: Annual flu vaccination, hand hygiene, avoiding crowds.
COVID-19
The SARS-CoV-2 virus spreads rapidly in winter due to indoor gatherings and lower ventilation. Severe cases lead to pneumonia, respiratory failure, and ICU admissions, peaking when vaccination rates lag. Holiday travel and parties amplify transmission, overwhelming primary care and hospitals.
Table: Comparison of Flu vs. COVID-19 Hospital Risks
| Aspect | Flu | COVID-19 |
|---|---|---|
| Severity in Elderly | High (pneumonia common) | Very High (long COVID risks) |
| Transmission | Droplets, contact | Aerosols, highly contagious |
| Vaccine Efficacy | 60-70% against severe disease | 80-95% with boosters |
| Winter Peak | December-January | November-February |
Respiratory diseases
Respiratory conditions dominate excess winter deaths (EWD), accounting for about 40% in England and Wales during 2019-2020. Cold air irritates airways, reduces lung function, and exacerbates chronic issues.
Chronic lower respiratory diseases, including asthma and COPD (combining emphysema and chronic bronchitis), see 55% more deaths in winter. Pneumonia deaths rise by 68%.
- Asthma: Airways constrict due to cold air, allergens, or infections, causing flare-ups.
- Emphysema: Damaged air sacs reduce oxygen absorption.
- Chronic bronchitis: Inflamed airways produce excess mucus.
- Pneumonia: Lung infection filling sacs with fluid; often secondary to flu.
Colder weather strains the heart and lungs, restricting blood flow and causing inflammation. Those with pre-existing conditions face heightened hospital risks.
Cardiovascular disease
Cold weather constricts blood vessels, raising blood pressure and heart workload. Cardiovascular diseases contribute 20-21% of EWD. Existing patients are frequently hospitalised over Christmas.
- Heart failure: Heart can’t pump adequately; worsened by viruses and cold.
- Heart attacks: Increased pressure from vasoconstriction triggers myocardial infarction, peaking Christmas Eve and New Year’s.
- Strokes: Elevated pressure and clotting risks from cold lead to ischemic events.
Holiday stressors like overeating, alcohol, and emotional strain compound risks. Heart problems are among top ER causes, linked to indulgence and weather.
Dementia and Alzheimer’s disease
Cognitive impairments like dementia and Alzheimer’s worsen in winter. Confusion increases with shorter days, infections, and isolation. Holiday periods see more admissions for delirium, falls, and dehydration in elderly patients.
Patients with greater clinical complexity, including cognitive decline, show poorer outcomes during holidays. Behavioral factors like inappropriate diet and low income correlate with admissions.
Other common causes
Beyond illnesses, accidents spike:
- Falls while decorating: Ladders and lights cause fractures.
- Cuts and lacerations: Knife injuries from cooking.
- Burns: From ovens, candles, hot liquids.
- Foodborne illness: Undercooked turkey, unrefrigerated leftovers.
- Alcohol-related emergencies: Overconsumption leads to poisoning, accidents.
Medical errors also rise due to staffing shortages and fatigue, mimicking a ‘weekend effect’ with delayed care.
Frequently Asked Questions (FAQs)
Q: Why do hospital admissions increase over Christmas?
A: Cold weather exacerbates respiratory and cardiovascular conditions, while infections spread easily indoors. Holiday behaviors like rich foods and alcohol add risks, straining hospitals.
Q: Who is most at risk during winter?
A: Older adults, young children, and those with chronic illnesses like COPD or heart disease face higher hospitalisation chances.
Q: How can I prevent flu-related hospital trips?
A: Get vaccinated, wash hands frequently, and stay home if symptomatic. High-risk groups should consider antivirals early.
Q: Does cold weather directly cause heart attacks?
A: No, but it constricts vessels, raises pressure, and stresses the heart, especially with overindulgence.
Q: Are hospitals understaffed over holidays?
A: Yes, leading to longer waits and higher error risks, contributing to the ‘holiday effect’.
Staying safe this Christmas
To avoid hospital visits:
- Dress warmly in layers to prevent hypothermia.
- Get flu and COVID vaccines early.
- Manage chronic conditions with medications.
- Decorate safely: Use stable ladders, secure lights.
- Cook hygienically: Check temperatures, refrigerate promptly.
- Limit alcohol; stay hydrated.
- Monitor elderly relatives for confusion or falls.
Hospitals prepare for surges, but personal vigilance reduces burden. Understanding these causes empowers better holiday health.
References
- Clinical complexity and hospital admissions in the December holiday period — Rossi G et al. 2020-06-01. https://pmc.ncbi.nlm.nih.gov/articles/PMC7289422/
- What are the main causes of hospital admissions over Christmas? — Patient.info. 2021-12-03. https://patient.info/features/general-health/what-are-the-main-causes-of-hospitalisations-over-christmas
- Why Medical Errors and Malpractice Spike During the Holidays — SSKB Law. Undated. https://sskblaw.com/holiday-hospital-dangers-why-medical-errors-increase-and-what-patients-should-know
- Holiday Health Hacks – Avoiding the ER — St. Francis. Undated. https://www.mystfrancis.com/news-stories/news/top-causes-of-er-visits-during-the-holidays
- Flu season surged in the US over the holiday — Our Midland. Undated. https://www.ourmidland.com/news/article/flu-season-surged-in-the-us-over-the-holiday-and-21277481.php
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