Data indicate that asthma-related morbidity and mortality among the elderly are increasing and that the asthma-related mortality rate among older Americans with asthma is 14 times higher when compared with cohorts aged 18-35. “Older adults also have greater risk of asthma-related respiratory impacts, since they spend up to 90% of their time in the home, where many allergens and respiratory irritants are found,” explains David A. Turcotte, ScD. “Although there is sufficient evidence that home interventions are effective in improving health of asthmatic children, the Task Force on Community Preventive Services has stated that there is insufficient evidence for the effectiveness of home interventions on asthmatic adults.”
For a study published in Annals of Allergy, Asthma & Immunology, Turcotte and colleagues evaluated the hypothesis that multifaceted home environmental interventions improve the respiratory health and reduce asthma triggers for older adults with asthma. Community health worker (CHW)-led interventions were conducted in the homes of low-income adults aged 62 or older who were diagnosed with asthma and residing in public and private subsidized housing, from 2014 to 2017. Health and environmental assessment at baseline and follow-up 1 year later included collecting data on respiratory health, quality of life, medication use, doctor/emergency room/hospital visits, using the St. George Respiratory Questionnaire and Asthma Control Test and evaluation of asthma trigger activities and exposures through questionnaires and home surveys. “Interventions included education on asthma and environmental triggers of asthma; environmental remediation including mattress/pillow covers, provision of vacuum with HEPA filters and green cleaning supplies, and some changes in home as needed: commercial cleaning, integrated pest management, gas stove replacement, mold remediation, installation/repair of exhaust fans,” says Turcotte.
Following the interventions, the study team found statistically significant reductions in self-reported environmental asthma triggers and health improvements in doctor visits, use of antibiotics for chest problems, respiratory symptoms, quality-of-life indicators, and asthma control. “This study suggests that a relatively low-cost, multifaceted environmental intervention in the homes of older adults with asthma can significantly reduce doctor visits and improve asthma control and overall health,” says Turcotte. “We would like to see physicians incorporate home visiting with CHWs into the care of this patient population.”