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Population ageing, extreme weather, and high energy costs are the current and future global scenarios. The present study analyses the factors affecting the thermal comfort of older adults and evaluates their thermal perceptions and preferences in nursing homes in a Continental Mediterranean climate during winter, through environmental measurements and surveys on site. The sample consists of 1065 occupants. Results of this study revealed that the neutral temperature of older adults in nursing homes in cold winter climates is 24.9°C, 2.3°C higher than what PMV predicts. Results also highlight that older adults feel more comfortable in those spaces with higher CO2 concentrations than recommended by regulation. The analysis of factors affecting thermal comfort revealed that the most relevant factors affecting the thermal comfort of older adults in cold winter climates are (i) the type of room, which indirectly implies the metabolic rate of the occupants, the type of ventilation, and the CO2 level; (ii) the occupancy density; and (iii) the relative humidity of the room. These results will help to develop more accurate thermal comfort and indoor environmental quality regulations for older people that improve their health and quality of life. The modification of temperature setpoints in nursing homes based on the results of this study could influence energy use and should be carefully considered by policy makers and facility managers. [ABSTRACT FROM AUTHOR]