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Summer 2025
Summer 2025 Issue Clinical Matters: Breathe Easier The Importance of Air Quality in Geriatric Facilities and Homes About 90% of our human existence occurs indoors, based on estimates from the US Environmental Protection Agency (EPA). The degree of indoor air pollution can be just as high—or even higher—than outdoor levels. And poor indoor air quality can harm our health, especially with aging.1 “The human body can survive weeks without food, days without water, but only minutes without air. But air isn’t pure. It contains a broad spectrum of particles, molecules, and micro-organisms which can enhance or harm the body and its ability to function,” says Carl Grimes, HHS, CIEC, director of Healthy Homes at the Hayward Institute in Monterey, California, which raises awareness of home environmental exposures that can affect health. “Most young healthy people can respond, adapt, and recover from inhaling all but the worst hazards that can be in the air,” Grimes says. “But other individuals, such as the elderly, have less resilience to the normal challenges of breathing the air. An increased burden can accelerate their failings faster.” Yet, he adds, older adults may attribute any decline in their function to advanced age, without realizing they can take measures to improve indoor air quality. The Research In many places, indoor air quality has indeed become worse over time, says Iyaad Hasan, DNP, MBA, APRN, CEO of the Breathing Association in Columbus, Ohio. “Homes and buildings are built tighter now to save on energy bills, which means air doesn’t circulate as much, so dust, chemicals, and allergens get trapped inside. Also, we use more products with strong scents and chemicals like cleaners, air fresheners, and sprays, which add to indoor pollution. In Columbus, especially in older neighborhoods, a lot of homes still have outdated ventilation systems or water damage. That can lead to mold and poor air circulation.” The quality of indoor air revolves around the concentration of impurities within. Among the multitude of contaminants are airborne viruses and infectious agents. For instance, “COVID-19 spreads primarily indoors, and most severe COVID-19 outbreaks occurred in situations where people were spending large amounts of time in poorly ventilated spaces,” according to the Institute for Progress, a nonpartisan think-tank in Washington, D.C.3 Consider the Context “In general, the average concentrations of CO (carbon monoxide), CH2O (formaldehyde), and particles were greater in the dining rooms,” the study’s authors conclude, adding that this “can be attributed to the dining room’s closer location to the kitchen.” They also note that “the layout of these areas plays a significant role, as facilities with kitchens that are not separated from the dining room exhibited poorer indoor air quality.”4 Ensuring optimal indoor air quality for older adults “is vitally important, as they are more vulnerable to adverse health effects from poor air quality (increased air pollution) due to age-related changes in physiology, chronic health conditions, and reduced physiological reserves (ability to respond to changing environments),” says Loren Wold, PhD, a professor who has conducted research into particulate pollution for two decades at The Ohio State University Wexner Medical Center in Columbus. “Older adults have naturally decreased lung elasticity, weaker muscles involved in breathing, and decreased ability to clear the airways,” Wold adds. “All of these changes reduce the ability of the airway to clear foreign material and make older adults more susceptible to lung disorders, including asthma, chronic obstructive pulmonary disease (COPD), and pneumonia.” In addition, he says, older adults have a higher prevalence of chronic illnesses, including cardiovascular disease, obesity, diabetes, and respiratory conditions. Reduced air quality exacerbates these chronic ailments. Older adults also have higher cardiovascular risk to begin with, so exposure to more significant concentrations of air pollution may further interfere with the heart’s ability to function. Putting Into Action People of all ages should be aware of the EPA’s daily local air quality forecasts, the Air Quality Index (AQI), included in weather reports by various news outlets and available at AirNow.gov, says Robert Laumbach, MD, MPH, an associate professor of environmental and occupational health and justice at the Rutgers School of Public Health in Piscataway, New Jersey. “When levels of outdoor air pollutants, such as particulate matter and ozone, are elevated to levels unhealthy for sensitive groups or higher, people who are older can limit their exposure by staying indoors and limiting physical activity,” Laumbach says. “Air pollution outdoors infiltrates homes and other buildings, so using air filtration, such as portable air cleaners with HEPA filters for particulate matter can also be helpful for improving air quality indoors. And, of course, reducing indoor sources of air pollution, such as tobacco smoke, emissions from unvented gas stoves, and other combustion sources indoors, is important for patients to consider.” Wold recommends minimizing the use of strong candles, incense, and air fresheners, and choosing green or nontoxic cleaning products. His other suggestions entail improving indoor air ventilation by using exhaust fans, avoiding the blocking of air vents, and maintaining clean HVAC filters. Monitoring humidity is also important, maintaining levels between 30% to 50% to reduce mold and dust mites. Fixing leaks and mitigating water damage also decreases mold growth, as well as using a dehumidifier in damp areas. And opening windows, he notes, is helpful when air quality is good. Meanwhile, Grimes suggests maintaining a skeptical outlook toward “a plethora of products, tools, services, and gimmicks” marketed to consumers seeking to improve indoor air quality. Sometimes these products may help, “but not as a first step—maybe later to fine-tune after the easier actions have been taken,” he says. “The first principle is clean and dry. If it’s not clean, clean it. If it’s not dry, dry it. Don’t wait, but don’t panic either. That’s because “moisture and dampness are the major driving force for most of the common exposures,” Grimes explains. “Dust is the ‘universal food’ for bacteria and mold. Keep the dust down and keep the surfaces dry with air reasonably dry (below about 60% relative humidity). When surfaces get damp—and they will—stop the source and get the damp materials reasonably dry.” Checking the home or geriatric facility for lead and radon is also wise, according to the EPA.1 In the future, it’s expected that the development of advanced materials for sensors, monitoring systems for indoor air quality, and the smart home will make a difference in controlling and enhancing the air we breathe in our living quarters. This includes the introduction of mobile technologies and machine-learning applications with great capability for easy real-time monitoring of indoor air quality. — Susan Kreimer is a freelance health care journalist in New York.
Info Box
Practical Practices Novas offers the following suggestions: • Clean CPAP machines, including the water reservoir daily, and change filter and mask as scheduled by the manufacturer. Only use distilled water in the reservoir—never tap water! • If using supplemental oxygen equipment, change cannulas frequently and clean at least daily. • While we love our pets and they provide comfort and companionship, avoid sleeping with them, if possible, particularly if you struggle with respiratory illness. • It’s important for pets’ welfare, as well as yours, to bathe and groom them regularly to avoid dander build-up and minimize the number of outdoor pollutants and allergens that they bring into the home. Clean their bedding at least weekly. If you allow your pets on furniture, invest in washable covers that you can put in the laundry weekly to avoid fur and dander build-up on your soft furnishings. • Avoid synthetic fibers that attract dust and pollutants, especially in places like your bedroom. Cotton is the best. Wash all bedding weekly, and don’t forget to vacuum your mattress. • Curtains, rugs, and carpets all can harbor dust and allergens. Set up a schedule for vacuuming and washing carpets and curtains. Think about removing excessive rugs, especially if they pose an additional fall risk. • Clutter in the home also harbors dust and allergens. Strive for clutter-free safe zones in your home, especially in your bedroom and living room, where you spend the majority of your time, and keep surfaces clean and free from clutter. • Change the filters on your AC/heater per manufacturers recommendations. You may need to do this more frequently in a home with pets. Make sure that your AC/heaters are working properly and circulating air at the appropriate rate. • Dust exchange outlets weekly and consider scheduling regular vent cleaning in homes with pets. • Avoid bringing allergens and pollutants into your home. Examples would be scented candles, air fresheners, pet odor sprays, or overly perfumed detergents. • Do not mix cleaning products. Avoid products with known respiratory irritants, such as bleach and added perfumes.
References 2. Indoor air quality. National Institute of Environmental Health Sciences website. https://www.niehs.nih.gov/health/topics/agents/indoor-air. Updated March 17, 2025. 3. Cambeiro J, Potter B. Indoor air quality is the next great public health challenge. IFP website. https://ifp.org/indoor-air-quality/. Published June 29, 2023. 4. Rodríguez M. Indoor air quality in elderly care centers: a multidisciplinary approach. Building and Environment. 2024;262. |
