1. Effects of Air Pollution on the Health of Older Adults Mickey Leland National Urban Air Toxics Research Center and the EPA June 15, 2005

2. Changes in Physiology: Nathan Shock,1960 Courtesy of Dr. Ed Masaro

3. Air Quality and Human Health As people age, their bodies are less able to compensate for the effects of environmental hazards. An important indicator for environmental health is the percentage of older adults living in areas that have measured air pollutant concentrations above the EPA established standards.

4. Indicator 27--Air Quality Air pollution can aggravate heart & lung disease, leading to increased medication use, more visits to health care providers, admissions to emergency rooms and hospitals, and even death. Ozone, even at low levels, can exacerbate respiratory diseases such as chronic obstructive pulmonary disease (COPD) or asthma.

5. Ozone and Particulate Matter Ozone and particulate matter (PM) (especially smaller, fine particle pollution called PM 2.5) have the greatest potential to affect the health of older adults. PM has been linked to premature death, cardiac arrhythmias and heart attacks, asthma attacks, and the development of chronic bronchitis.

7. Ozone in 2000 and 2002 In 2002, 46 % of people age 65+ lived in counties with poor air quality for ozone compared with 26% in 2000. The hot, dry 2002 summer climate was particularly conducive to the formation of ground-level ozone, and this, in turn, may have contributed to the higher ozone measurements in 2002.

8. Population 65 Living in Areas with Poor Air Quality The percentage of people 65+ living in counties that experienced poor air quality for any air pollutant increased from 41% in 2000 to 49% in 2002. This increase was largely due to the increased number of areas that experienced poor air quality for ozone in 2001 and 2002. Air quality varies across the US, thus, where people live can affect their health risk.

9. Older Adults and PM A comparison of 2000 and 2002 shows a reduction in PM 2.5. In 2000, 27 percent of people age 65 and over lived in a county where PM 2.5 concentrations were at times above the EPA standards compared with 19 percent of people age 65 and over in 2002.

11. Older Americans 2004: Key Indicators of Well-Being

12. Economic Burden of Chronic Diseases Heart disease, stroke & chronic lung diseases are exacerbated by air pollution. In 2002, we spent $250 billion on these conditions on direct medical costs. $9 billion in lost productivity. Source: Morbidity & Mortality: 2002 Chart book on Cardiovascular Lung and Blood Diseases, National Institutes of Health, NHLBI, May 2002

13. Air Pollution Can Exacerbate the Health of Older Adults Particle pollution has been linked to asthma attacks, chronic bronchitis, changes in heart rate, arrhythmias and heart attacks, among other health problems. Ozone presents an increased risk to older adults because it can aggravate pre-existing respiratory diseases. Older adults experience reduced sensitivity to symptoms of ozone; therefore, early warning signs of the harmful effects of ozone may be ignored. Older adults most at risk have underlying cardiovascular and respiratory diseases. Each year, tens of thousands of older adults die prematurely due to air pollution in the US.

14. NAS Workshop, December 2002 Cardiovascular Effects of Particulate Matter Particulate matter can cause inflammation in the lungs. Combustion particles penetrate into the blood and reach the heart and liver. Particles can lower heart rate variability which is a risk factor for arrhythmia. Hundreds of studies have demonstrated that day-to-day changes in particles are associated with day-to-day changes in mortality. Most of those excess deaths are cardiovascular deaths, not respiratory deaths.

15. Deaths per 1,000,000 population Under 5 Asthma deaths by age, 1999-2000 Source: National Vital Statistics System, CDC, NCHS. Obj. 24-1 a-e 5-1415-34 35-64 65 and over Years of age 2010 Target19992000

16. CA: Older Adults: Highest rate of daily or weekly symptoms

17. COPD COPD is the 4 th leading cause of death in the US, claiming 119,000 lives each year In 2000, COPD was responsible for 726,000 hospitalizations, 1.5 million hospital emergency room visits and 8 million doctor visits.

18. Environmental Triggers: What You Can Do Avoid tobacco smoke and Smoke from wood-burning stoves Reduce mold, dust mites & cockroaches in your home Keep pets out of sleeping areas Check furnaces and heating units annually Fix water leaks promptly Check the air quality index http://www.epa.gov/airnow http://www.epa.gov/airnow

19. Older Adults and COPD According to the National Health Interview Survey in 1999, about 3.1 million persons over 65 years of age reported having COPD. The COPD mortality rate per 100,000 was 1.8 for persons between the age of 50-54 and 7.6 for persons 75-85 years of age.

20. Chicago Heat Wave July 14-July 20, 1995 1,000 excess hospital admissions due to heat stroke, dehydration, heat exhaustion, renal failure and electrolytic imbalances 739 Chicago residents died

21. Unequaled mortality Chicago has no equal in the record of US heat disasters 739 more people died than during a typical week in July. The proportional death toll from a heat wave was unprecedented The victims were primarily older adults (73% were over 65 years of age).

22. Mortality by Sex 55% men 45% woman Age-adjusted death rate men were more than twice as likely as woman to die These figures confused many gerontologists because they knew that women are more likely to live alone

23. Mortality by Race Blacks had highest proportional death rate of any ethnic group 1.5:1 in the total age-adjusted population Deaths were concentrated in low income, elderly, black and violent regions of the city

24. Aging and Dying Alone Not Just in Chicago The number of persons living alone is increasing everywhere in the world making it one of the major demographic trends Between 1930 and 1995, households with one person increased from 7% to 25% and the percentage of people living alone rose from 2% to 10% during this same period. (Census)

25. North Lawndale “Dangerous ecology of abandoned buildings, open spaces, commercial depletion, violent crime, degraded infrastructure, low population density, and family dispersion undermines the viability of public life and strength of local support systems.”

26. Little Village “Busy streets, heavy commercial activity, residential concentration, and relatively low crime promote social contact collective life, and public engagement …provide particular benefits for the elderly who are more likely to leave home when they are drawn out by nearby amenities.”

27. Matching pairs North Lawndale: 19 deaths, rate of 40/100,000 Little Village: 3 deaths, rate of 4/100,000 Same characteristics

28. Resources You are invited to visit the EPA Aging Initiative Website www.epa.gov/agingwww.epa.gov/aging Please join our Aging list serve that can be found on the homepage of the website. A fact sheet on environmental triggers can be found in English, Spanish, Chinese, and Vietnamese at http://www.epa.gov/aging/resources/epareports. htm#facts http://www.epa.gov/aging/resources/epareports. htm#facts

29. Resources Federal Interagency Forum on Aging- Related Statistics. Older Americans 2004: Key Indicators of Well-Being. Washington, D.C. US Government Printing Office. November 2004 Heat Wave, A Social Autopsy of Disaster in Chicago, University of Chicago Press, 2002

30. Other Resources COPD Coalition website http://www.uscopd.com/http://www.uscopd.com/ CDC MMWR Article Chronic Obstructive Pulmonary Disease Surveillance --- United States, 1971--2000 http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5106a1.ht m#tab1 NHLBI Fact Sheet - What is COPD? http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_W hatIs.html