Academic journal article Environmental Health Perspectives

Air Pollution and Performance-Based Physical Functioning in Dutch Older Adults

Academic journal article Environmental Health Perspectives

Air Pollution and Performance-Based Physical Functioning in Dutch Older Adults

Article excerpt


A substantial increase in the number of older persons has been observed in many geographic regions over the past years and this increase is expected to accelerate in the near future (United Nations 2015). In Europe, the percentage of persons age 65 and older has been estimated to increase from 17% to 30% between 2013 and 2060 (European Commission 2015). These demographic changes will shape future health care use and health care expenditures (European Commission 2015). Functional limitations and disabilities in the activities of daily living are among the major causes of loss of independence and the need for long-term care (Kemper 1992). Being no longer able to live independently is a major concern for older adults and their families. Consequently, there is a growing interest in the determinants of physical functioning and well-being of older people.

Long-term exposure to air pollution is associated with a number of adverse health effects, including increased risks for cardiovascular and respiratory disease and (subclinical) pathophysiological processes that contribute to these conditions, such as hypertension and systemic inflammation (Brook et al. 2010; WHO Regional Office for Europe 2005; Health Effects Institute Panel on the Health Effects of Traffic-Related Air Pollution 2010; Pope and Dockery 2006; Wellenius et al. 2013).

Given that physical limitations are common functional consequences of these subclinical processes and chronic diseases, it is possible that long-term exposure to air pollution also influences physical functioning. Evidence for an association between ambient air pollution exposure and physical functioning is growing. A cross-sectional study among more than 45,000 adults (56 y of age on average) from China, Ghana, India, Mexico, Russia, and South Africa reported increasing levels of disability, in particular in the domains of cognition and mobility, with increasing concentrations of particulate matter smaller than 2.5 [micro]m (Lin et al. 2017). A multilevel prospective cohort study with 13,802 participants (65-105 y of age) from China suggests that exposure to high levels of air pollution, defined as a high air pollution index for the city or prefecture of residence, is associated with fewer years without functional limitations (Wen and Gu 2012). Another prospective cohort study with 6,157 participants ([greater than or equal to] 65 y of age) from Chicago, Illinois, USA, concluded that long-term exposure to nitrogen oxides (N[O.sub.x]) may be associated with a faster aging-related decline in physical functioning (Weuve et al. 2016).

This study aims to contribute to the currently limited body of evidence regarding the association between air pollution exposure and physical functioning by assessing the association of long-term exposure to ambient nitrogen oxides, soot, and particulate matter mass with performance-based (walking speed, ability to rise from a chair, putting on and taking off a cardigan, balance test) and self-reported physical functioning of older adults in the Dutch Longitudinal Aging Study Amsterdam (LASA). The Netherlands is a densely populated country with a tight network of roads and highways for motorized traffic, which are major sources of these pollutants.

Materials and Methods

Study Design and Sample

The LASA is an ongoing multidisciplinary prospective cohort study on predictors and consequences of changes in physical, cognitive, emotional, and social functioning in older people in the Netherlands (Huisman et al. 2011). In 1992 an age-stratified random sample of adults 55-85 y of age was drawn from population registries of 11 municipalities in three geographical areas (west, northeast, and south) of the Netherlands. These regions were selected to achieve an optimal representation of the older Dutch population. Starting at baseline, every three years data were collected through face-to-face interviews by specially trained interviewers. …

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