Link between air quality, residents’ lung health seen in European nursing homes

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in, Journal of Active Aging, Cancer Today, Kaiser Health News, the Connecticut Health I-Team and other outlets. She is a senior fellow at the Center for Health Policy and Media Engagement at George Washington University and co-produces the HealthCetera podcast.

Isabella Annesi-Maesano

Isabella Annesi-Maesano

Like the United States, most European nations face an increasingly aging population, with more elderly living in some type of long-term care facility or nursing home. A new study in the March 12 online issue of the European Respiratory Journal indicates that indoor air quality in these nursing homes has a serious effect on the lung health of elderly residents.

The research describes the negative effects of poor air quality in nursing homes across several countries. U.S. journalists may want to use this study as background to investigate similar issues at nursing homes in their communities.

Investigators from the EU-funded Geriatric study in Europe on health effects of air quality in nursing homes (GERIE) collected data on five indoor air pollutants: particulate matter known as PM10 (large particles) and PM0.1 (ultra-fine particles), formaldehyde, nitrogen dioxide and ozone. These pollutants come from a range of sources including heaters, building materials, furniture, cleaning products, disinfectants and cooling systems. They studied levels of the pollutants at 50 nursing homes in seven countries: Belgium, Denmark, France, Greece, Italy, Poland and Sweden.

A total of 600 residents aged 65 and older, with a mean age of 82 years, participated in the study. Each participant underwent several clinical tests, including lung function testing and a health questionnaire. The results showed that even at low pollutant levels, indoor air quality affected respiratory health in elderly people living in nursing homes. The effects were modulated by ventilation.

In addition, exposure to high levels of PM10 and nitrogen dioxide was “significantly associated” with breathlessness and cough. High levels of PM0.1 were associated with wheeze during the last year of life and high concentrations of formaldehyde were linked with chronic obstructive pulmonary disease (COPD). The associations were even seen with moderate concentrations of indoor air pollutants that did not exceed existing international guidelines. Findings were magnified in homes with poor ventilation and among residents over the age of 80.

“Our findings have shown an independent effect of several indoor air pollutants on the lung health of the elderly living in nursing homes,” lead author Isabella Annesi-Maesano, director of the Department of Epidemiology of Allergic and Respiratory Diseases (EPAR) at the French Institute of Health and Medical Research (INSERM), the French equivalent of the National Institutes of Health, said in a statement. “This is a worrying problem since the body’s ability to cope with harmful air pollutants decreases as we age.”

Annesi-Maesano said the respiratory health of residents should also be checked on a regular basis, and nursing homes should do more to prevent indoor air pollution by limiting its sources and improving ventilation in their buildings.

Study co-author Dan Smyth, chairman of the European Lung Foundation, agrees. “The majority of lung diseases are preventable, therefore we must focus on strategies that target the risk factors linked to these diseases,” Smyth said. “These findings add to a body of evidence confirming that indoor air pollution is one of these risk factors.”

The authors said additional nursing homes in other countries should be studied. Intervention studies to assess which prevention methods are most successful also are needed, they said.


AHCJ data include 16,806 nursing home deficiencies: AHCJ’s latest update to nursing home inspection data (February 2015) gives members three years of the most severe deficiencies found during inspections and the current star ratings assigned by the U.S. Centers for Medicare and Medicaid Services.

Using Nursing Home Compare: Tip sheet by Charles Ornstein of ProPublica offers ideas on using the government’s site to evaluate nursing homes.

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