For debate: The August sun and the December snow.

A growing body of evidence claims there is a pivotal role of heat temperatures and summer hot spells in the pathogenesis of exceeding morbidity and mortality among older people. The European well-known "2003 killer hot summer" has boosted many epidemiological and clinical investigations to clarify the pathogenetic correlation between hot spells and elderly mortality with new acquirements in terms of pathophysiology, preventive measures, and therapeutic approaches. However, a quite controversial issue arises: overall elderly mortality is higher in the cold winter compared with summer. The progressive development of preventive, therapeutic, and environmental measures, if targeted with promptness, has generally proven effective in coping with heat temperature, restraining elderly mortality. However, few investigations have been performed dealing with cold, with pioneeristic as well as simplistic approaches, without any conclusiveness or effectiveness in terms of prevention or therapy. Data from recent literature enlist various clinical and environmental approaches in counteracting cold-related mortality in elderly, but lack evidence-based results; a recent European collaborative study reported cold-related elderly mortality as non-negligible, deserving the growing attention of public authorities. We conducted a 4-year survey among 6 different nursing homes located in a seaside city of northern Italy so as to collect epidemiological data on stressful weather spells and elderly mortality. Our results showed that overall elderly mortality in the cold season displayed as significantly high rates as in summer, and the monthly deaths per year of observation showed higher rates in the cold season, addressing it as the most prevalent time period related to mortality in older people. Thus, research in the field is mandatory so as to draw a broader conceptual framework for the stratification of specific population risk profiling and the assessment of adequate preventive and therapeutic measures. To the present knowledge, the lack of pathophysiological understanding, the missing evidence-based data in coping with cold weather-related elderly mortality, together with policy makers' misconceptions is mounting the controversy on this emerging clinical issue.