Air pollution increases the likelihood of people becoming frail in middle and old age, according to an international review of studies.
People are living longer and, while this is often painted as a challenge to healthcare systems, it is also something to celebrate. There are many opportunities to increase the quality of life in old age, maximise independence and minimise the amount time spent being ill.
Dr Zahra Jafari, from Dalhousie University and coauthor of the review, said: “Frailty is a critical health outcome that demands urgent attention, particularly with an ageing population. It is linked to heightened vulnerability, loss of independence, and higher healthcare costs. Importantly, frailty is not inevitable; it can be delayed, prevented, or even reversed.”
The review team found 10 studies that looked at outdoor air pollution and frailty. The people studied came from 11 countries including China, the UK, Sweden, South Africa and Mexico. Two of the studies showed that men were more vulnerable than woman, with a stronger association between particle pollution and frailty.
The risk of frailty increased with outdoor particle pollution. For the UK, this could mean about 10-20% of frailty cases are attributable to air pollution.
Exposure to secondhand smoking was the environmental factor that presented the greatest risk of frailty. The risk of frailty was increased by about 60% for people who breathed other people’s smoke at home.
Using solid fuels for cooking or home heating also carried an extra risk of frailty. This was about half the risk of living with a smoker, based on studies from six countries.
Otto-Emil Jutila from the University of Edinburgh, who was not involved in the review, said: “Ensuring cleaner air, clean household energy, and smoke-free environments, especially in highly exposed communities is key. Since frailty can be reversible, reducing these exposures may extend years of independence and ease the strain on health and social services.”
The review adds to the evidence of the preventable health burden that air pollution places on older people.
In 2023 a government advisory committee found evidence that air pollution was adding to the burden of dementia. It called for an audit of existing policies to fast-track actions that reduce exposure to air pollution throughout people’s lives, including low-pollution school zones and the development of dementia-friendly communities. The report also called for health, and specifically brain health, to be part of net zero strategies.
A UK study of 360,000 people aged between 40 and 69 found an association between living in a polluted area and having more than one chronic disease. This was an extra 20% chance of multiple long-term illnesses for those living with particle pollution.
Other studies have found that air pollution is accelerating osteoporosis in postmenopausal women.
