David Turcotte, ScD is a Research Professor and Director of the Lowell Healthy Homes Program and New England Healthy Homes Training Center at the University of Massachusetts Lowell. He is Principal Investigator/Director of two U.S. Housing and Urban Development (HUD) funded Healthy Homes Technical Studies Program grant for intervention studies and Co-Principal Investigator on the Massachusetts Department of Public Health’s (DPH) Reducing Older Adult Asthma Disparities (ROAAD) Study.
Home Environmental Interventions for Older Adults with Asthma
The World Health Organization estimates that at least 300 million people suffer from asthma. Within the United States (U.S.), over 17.7 million adults suffer from asthma compared to the 6.3 million children who are also afflicted with asthma. Older adults 65+ with asthma are the fastest growing age-group segment in the U.S. and have the greater risk to experience respiratory failure due to asthma. Older adults can spend up to 90% of their time in the home where many allergens are found. We evaluated the hypothesis that multifaceted home environmental interventions improve the respiratory health and reduce home asthma triggers for older adults with asthma. While there is sufficient evidence that home interventions are effective in improving health of asthmatic children, the Center for Disease Control (CDC)Task Force on Community Preventive Services stated that there is insufficient evidence for the effectiveness of homes interventions on adults with asthma.
Methods: We conducted interventions in the homes of 86 low-income older adults (age 62 or above) diagnosed with asthma, residing in public and private subsidized housing in a mid-size city within the Northeast region of the U.S. The two largest populations included Hispanics (45%) and Asians (20%). Health assessment included collecting data on respiratory health, quality of life, medication use, doctor/emergency room (ER)/hospital visits. Environmental assessment included evaluation of asthma trigger activities (ATAs) and exposures before and after healthy homes intervention (questionnaire, home survey, measurement of nitrogen dioxide (NO2), dust samples for rodent and cockroach allergens, biomarker for cigarette smoke exposure (urinary cotinine). Interventions included education on asthma and environmental triggers of asthma, environmental remediation included mattress/pillow covers, vacuums with High Efficiency Particulate Air (HEPA) filters, green cleaning supplies, commercial cleaning, integrated pest management, gas stove replacement, and mold remediation.
Results: Statistically significant reduction in environmental triggers and statistically significant health improvement from baseline to follow-up in the following areas: doctor visits due to asthma, symptoms and impact quality of life indicators, Asthma Control Test (ACT) score, a measure of asthma control adequacy and medication use.
Policy Implications: The findings suggest that as in the case with asthmatic children, culturally/linguistically appropriate, multifaceted home interventions decrease most measures of asthma severity and healthcare utilization in these older adults with asthma. The study demonstrates that a relatively low cost comprehensive home environmental intervention can significantly improve the health and emotional well-being of our study population of older adults. Consequently, policymakers should provide more funding to support additional studies or pilot projects that include such interventions and changes in housing conditions to further evaluate health outcome changes to older adults with asthma. The promising results of improved health and reductions in healthcare utilization could provide healthcare insurers a financial incentive to cover home visits and such intervention items as vacuums with HEPA filters and mattress and pillow covers.