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Environmental Pollutants, Limitations in Physical Functioning, and Frailty in Older Adults

  • Environment and Aging (A Peters, Section Editor)
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Abstract

Purpose of Review

Frailty is an age-related syndrome characterized by reductions in strength, endurance, and physiologic function that increase an individual’s vulnerability for developing dependence or death. Extensive research is currently being conducted to determine preventable risk factors and mechanistic pathways of frailty. This review summarizes the existing evidence on the potential associations between environmental pollutants, limitations in physical functioning, and frailty among older adults.

Recent Findings

We found only a few studies evaluating the association between specific environmental pollutants and frailty. Cross-sectional studies suggest an association between second-hand smoke and lead exposure with the prevalence of functional limitations and frailty in older adults; they also suggest a link between cobaltum exposure and walking problems. One longitudinal study found an increased risk of frailty after PM2.5 exposure among individuals hospitalized with a myocardial infarction, while another found an inverse association between cadmium and phthalate exposure and hand-grip strength.

Summary

There is a clear need for more studies to assess the effects of environmental pollution on physical functioning decline, frailty development, and its progression. Environmental and geriatric epidemiologists should work together to address important research challenges.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. The 2015 Revision of World Population Prospects. 2016. https://esa.un.org/unpd/wpp/. Accessed 15 Jul 2016.

  2. World Health Organization. World Report on Ageing and Health. http://www.who.int/ageing/events/world-report-2015-launch/en. Accessed 20 Jul 2016.

  3. Legrand D, Vaes B, Mathei C, Adriaensen W, Van PG, Degryse JM. Muscle strength and physical performance as predictors of mortality, hospitalization, and disability in the oldest old. J Am Geriatr Soc. 2014;62(6):1030–8.

    Article  PubMed  Google Scholar 

  4. Seidel D, Brayne C, Jagger C. Limitations in physical functioning among older people as a predictor of subsequent disability in instrumental activities of daily living. Age Ageing. 2011;40(4):463–9.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2):M85–94.

    Article  CAS  PubMed  Google Scholar 

  6. Cooper R, Kuh D, Cooper C, Gale CR, Lawlor DA, Matthews F, et al. Objective measures of physical capability and subsequent health: a systematic review. Age Ageing. 2011;40(1):14–23.

    Article  PubMed  Google Scholar 

  7. Kuh D. A life course approach to healthy aging, frailty, and capability. J Gerontol A Biol Sci Med Sci. 2007;62(7):717–21.

    Article  PubMed  Google Scholar 

  8. •• Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752–62. This paper offers a nice overview of the pathophysiology and epidemiology of frailty.

    Article  PubMed  Google Scholar 

  9. Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14(6):392–7.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Rodriguez-Manas L, Feart C, Mann G, Vina J, Chatterji S, Chodzko-Zajko W, et al. Searching for an operational definition of frailty: a Delphi method based consensus statement: the frailty operative definition-consensus conference project. J Gerontol A Biol Sci Med Sci. 2013;68(1):62–7.

    Article  PubMed  Google Scholar 

  11. Garcia-Garcia FJ, Carcaillon L, Fernandez-Tresguerres J, Alfaro A, Larrion JL, Castillo C, et al. A new operational definition of frailty: the frailty trait scale. J Am Med Dir Assoc. 2014;15(5):371.

    Article  PubMed  Google Scholar 

  12. Vermeulen J, Neyens JC, Van RE, Spreeuwenberg MD, de Witte LP. Predicting ADL disability in community-dwelling elderly people using physical frailty indicators: a systematic review. BMC Geriatr. 2011;11:33.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56.

    Article  CAS  PubMed  Google Scholar 

  14. Graham JE, Snih SA, Berges IM, Ray LA, Markides KS, Ottenbacher KJ. Frailty and 10-year mortality in community-living Mexican American older adults. Gerontology. 2009;55(6):644–51.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Song X, Mitnitski A, Rockwood K. Prevalence and 10-year outcomes of frailty in older adults in relation to deficit accumulation. J Am Geriatr Soc. 2010;58(4):681–7.

    Article  PubMed  Google Scholar 

  16. Bandeen-Roche K, Seplaki CL, Huang J, Buta B, Kalyani RR, Varadhan R, et al. Frailty in older adults: a nationally representative profile in the United States. J Gerontol A Biol Sci Med Sci. 2015;70(11):1427–34.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Mackenbach JP, Avendano M, Andersen-Ranberg K, Aro AR. First results from the survey of health, ageing and retirement in Europe. In: Borsch-Supan A, Brugiavini A, Jürges H, Mackenbach JP, Siegrist J, Weber G, editors. Health, ageing and retirement in Europe. Mannheim: Mannheim Research Institute for the Economics of Aging; 2005.

    Google Scholar 

  18. Ilinca S, Calciolari S. The patterns of health care utilization by elderly Europeans: frailty and its implications for health systems. Health Serv Res. 2015;50(1):305–20.

    Article  PubMed  Google Scholar 

  19. Rodriguez-Artalejo F, Rodriguez-Manas L. The frailty syndrome in the public health agenda. J Epidemiol Community Health. 2014;68(8):703–4.

    Article  PubMed  Google Scholar 

  20. Geller AM, Zenick H. Aging and the environment: a research framework. Environ Health Perspect. 2005;113(9):1257–62.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Moon K, Guallar E, Navas-Acien A. Arsenic exposure and cardiovascular disease: an updated systematic review. Curr Atheroscler Rep. 2012;14(6):542–55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Moritsugu KP. The 2006 report of the surgeon general: the health consequences of involuntary exposure to tobacco smoke. Am J Prev Med. 2007;32(6):542–3.

    Article  PubMed  Google Scholar 

  23. Akhtar WZ, Andresen EM, Cannell MB, Xu X. Association of blood cotinine level with cognitive and physical performance in non-smoking older adults. Environ Res. 2013;121:64–70.

    Article  CAS  PubMed  Google Scholar 

  24. • Garcia-Esquinas E, Navas-Acien A, Rodriguez-Artalejo F. Exposure to secondhand tobacco smoke and the frailty syndrome in US older adults. Age (Dordr). 2015;37(2):26. This study evaluates for the first time the association between an environmental pollutant and frailty using the phenotypic approach developed by Fried et al. It suggests that second-hand smoke may be a risk factor of frailty.

    Article  Google Scholar 

  25. • Myers V, Broday DM, Steinberg DM, Yuval DY, Gerber Y. Exposure to particulate air pollution and long-term incidence of frailty after myocardial infarction. Ann Epidemiol. 2013;23(7):395–400. First prospective study evaluating the association between exposure to air pollution and risk of frailty.

    Article  PubMed  Google Scholar 

  26. Garcia-Esquinas E, Navas-Acien A, Perez-Gomez B, Artalejo FR. Association of lead and cadmium exposure with frailty in US older adults. Environ Res. 2015;137:424–31.

    Article  CAS  PubMed  Google Scholar 

  27. Ji JS, Elbaz A, Weisskopf MG. Association between blood lead and walking speed in the National Health and Nutrition Examination Survey (NHANES 1999-2002). Environ Health Perspect. 2013;121(6):711–6.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Khalil N, Faulkner KA, Greenspan SL, Cauley JA. Associations between bone mineral density, grip strength, and lead body burden in older men. J Am Geriatr Soc. 2014;62(1):141–6.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Grashow R, Spiro A, Taylor KM, Newton K, Shrairman R, Landau A, et al. Cumulative lead exposure in community-dwelling adults and fine motor function: comparing standard and novel tasks in the VA normative aging study. Neurotoxicology. 2013;35:154–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Lang IA, Scarlett A, Guralnik JM, Depledge MH, Melzer D, Galloway TS. Age-related impairments of mobility associated with cobalt and other heavy metals: data from NHANES 1999–2004. J Toxicol Environ Health A. 2009;72(6):402–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Kim KN, Lee MR, Choi YH, Lee BE, Hong YC. Associations of blood cadmium levels with depression and lower handgrip strength in a community-dwelling elderly population: a repeated-measures panel study. J Gerontol A Biol Sci Med Sci. 2016;31

  32. Charles LE, Burchfiel CM, Fekedulegn D, Kashon ML, Ross GW, Sanderson WT, et al. Occupational and other risk factors for hand-grip strength: the Honolulu-Asia Aging Study. Occup Environ Med. 2006;63(12):820–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. World Health Organization. Global burden of disease due to indoor air pollution. http://www.who.int/indoorair/health_impacts/burden_global/en/ Accessed 20 Jul 2016.

  34. World Health Organization. Public health, environmental and social determinants of health (PHE). http://www.who.int/phe/health_topics/outdoorair/databases/background_information/en. Accessed 20 Jul 2016.

  35. U.S.Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress. A Report of the Surgeon General. 2014.

  36. Vital signs: nonsmokers’ exposure to secondhand smoke—United States, 1999–2008. MMWR Morb Mortal Wkly Rep 2010 Sep 10;59(35):1141–6.

  37. World Health Organization. Ambient (outdoor) air quality and health. http://www.who.int/mediacentre/factsheets/fs313/en. Accessed 20 Jul 2016.

  38. Cesaroni G, Forastiere F, Stafoggia M, Andersen ZJ, Badaloni C, Beelen R, et al. Long term exposure to ambient air pollution and incidence of acute coronary events: prospective cohort study and meta-analysis in 11 European cohorts from the ESCAPE Project. BMJ. 2014;348:f7412.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Shah AS, Langrish JP, Nair H, McAllister DA, Hunter AL, Donaldson K, et al. Global association of air pollution and heart failure: a systematic review and meta-analysis. Lancet. 2013;382(9897):1039–48.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Cai Y, Zhang B, Ke W, Feng B, Lin H, Xiao J, et al. Associations of short-term and long-term exposure to ambient air pollutants with hypertension: a systematic review and meta-analysis. Hypertension. 2016;68(1):62–70.

    Article  CAS  PubMed  Google Scholar 

  41. Li MH, Fan LC, Mao B, Yang JW, Choi AM, Cao WJ, et al. Short-term exposure to ambient fine particulate matter increases hospitalizations and mortality in COPD: a systematic review and meta-analysis. Chest. 2016;149(2):447–58.

    Article  PubMed  Google Scholar 

  42. Shah AS, Lee KK, McAllister DA, Hunter A, Nair H, Whiteley W, et al. Short term exposure to air pollution and stroke: systematic review and meta-analysis. BMJ. 2015;350:h1295.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Bell ML, Zanobetti A, Dominici F. Who is more affected by ozone pollution? A systematic review and meta-analysis. Am J Epidemiol. 2014;180(1):15–28.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Shumake KL, Sacks JD, Lee JS, Johns DO. Susceptibility of older adults to health effects induced by ambient air pollutants regulated by the European Union and the United States. Aging Clin Exp Res. 2013;25(1):3–8.

    Article  PubMed  Google Scholar 

  45. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489–95.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Eckel SP, Louis TA, Chaves PH, Fried LP, Margolis AH. Modification of the association between ambient air pollution and lung function by frailty status among older adults in the cardiovascular health study. Am J Epidemiol. 2012;176(3):214–23.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Nordberg GF, Bruce AF, Nordberg M, Riberg LT. Handbook on the Toxicology of Metals. 3rd ed. 2007.

  48. Stover PJ. Influence of human genetic variation on nutritional requirements. Am J Clin Nutr. 2006;83(2):436S–42S.

    CAS  PubMed  Google Scholar 

  49. Ter BS, Verlaan S, Hemsworth J, Mijnarends DM, Schols JM, Luiking YC, et al. Micronutrient intakes and potential inadequacies of community-dwelling older adults: a systematic review. Br J Nutr. 2015;113(8):1195–206.

    Article  Google Scholar 

  50. Leone N, Courbon D, Ducimetiere P, Zureik M. Zinc, copper, and magnesium and risks for all-cause, cancer, and cardiovascular mortality. Epidemiology. 2006;17(3):308–14.

    Article  PubMed  Google Scholar 

  51. Malavolta M, Giacconi R, Piacenza F, Santarelli L, Cipriano C, Costarelli L, et al. Plasma copper/zinc ratio: an inflammatory/nutritional biomarker as predictor of all-cause mortality in elderly population. Biogerontology. 2010;11(3):309–19.

    Article  CAS  PubMed  Google Scholar 

  52. Mocchegiani E, Malavolta M, Lattanzio F, Piacenza F, Basso A, Abbatecola AM, et al. Cu to Zn ratio, physical function, disability, and mortality risk in older elderly (ilSIRENTE study). Age (Dordr). 2012;34(3):539–52.

    Article  CAS  Google Scholar 

  53. Gaier ED, Kleppinger A, Ralle M, Mains RE, Kenny AM, Eipper BA. High serum Cu and Cu/Zn ratios correlate with impairments in bone density, physical performance and overall health in a population of elderly men with frailty characteristics. Exp Gerontol. 2012;47(7):491–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Beck J, Ferrucci L, Sun K, Walston J, Fried LP, Varadhan R, et al. Low serum selenium concentrations are associated with poor grip strength among older women living in the community. Biofactors. 2007;29(1):37–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Lauretani F, Semba RD, Bandinelli S, Ray AL, Guralnik JM, Ferrucci L. Association of low plasma selenium concentrations with poor muscle strength in older community-dwelling adults: the InCHIANTI Study. Am J Clin Nutr. 2007;86(2):347–52.

    CAS  PubMed  PubMed Central  Google Scholar 

  56. Chen YL, Yang KC, Chang HH, Lee LT, Lu CW, Huang KC. Low serum selenium level is associated with low muscle mass in the community-dwelling elderly. J Am Med Dir Assoc. 2014;15(11):807–11.

    Article  PubMed  Google Scholar 

  57. Smit E, Winters-Stone KM, Loprinzi PD, Tang AM, Crespo CJ. Lower nutritional status and higher food insufficiency in frail older US adults. Br J Nutr. 2013;110(1):172–8.

    Article  CAS  PubMed  Google Scholar 

  58. Jackson BP, Taylor VF, Karagas MR, Punshon T, Cottingham KL. Arsenic, organic foods, and brown rice syrup. Environ Health Perspect. 2012;120(5):623–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Adult blood lead epidemiology and surveillance—United States, 2008–2009. MMWR Morb Mortal Wkly Rep 2011 60(25):841–5.

  60. Environmental Protection Agency (EPA). How People are Exposed to Mercury. 2016. Report No.: 23.

  61. Tellez-Plaza M, Jones MR, Dominguez-Lucas A, Guallar E, Navas-Acien A. Cadmium exposure and clinical cardiovascular disease: a systematic review. Curr Atheroscler Rep. 2013;15(10):356.

    Article  PubMed  Google Scholar 

  62. Navas-Acien A, Guallar E, Silbergeld EK, Rothenberg SJ. Lead exposure and cardiovascular disease—a systematic review. Environ Health Perspect. 2007;115(3):472–82.

    Article  CAS  PubMed  Google Scholar 

  63. Zheng LY, Umans JG, Yeh F, Francesconi KA, Goessler W, Silbergeld EK, et al. The association of urine arsenic with prevalent and incident chronic kidney disease: evidence from the Strong Heart Study. Epidemiology. 2015;26(4):601–12.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Navas-Acien A, Tellez-Plaza M, Guallar E, Muntner P, Silbergeld E, Jaar B, et al. Blood cadmium and lead and chronic kidney disease in US adults: a joint analysis. Am J Epidemiol. 2009;170(9):1156–64.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Payton M, Riggs KM, Spiro III A, Weiss ST, Hu H. Relations of bone and blood lead to cognitive function: the VA Normative Aging Study. Neurotoxicol Teratol. 1998;20(1):19–27.

    Article  CAS  PubMed  Google Scholar 

  66. Shih RA, Hu H, Weisskopf MG, Schwartz BS. Cumulative lead dose and cognitive function in adults: a review of studies that measured both blood lead and bone lead. Environ Health Perspect. 2007;115(3):483–92.

    Article  CAS  PubMed  Google Scholar 

  67. Weisskopf MG, Wright RO, Schwartz J, Spiro III A, Sparrow D, Aro A, et al. Cumulative lead exposure and prospective change in cognition among elderly men: the VA Normative Aging Study. Am J Epidemiol. 2004;160(12):1184–93.

    Article  PubMed  Google Scholar 

  68. Park SK, Elmarsafawy S, Mukherjee B, Spiro III A, Vokonas PS, Nie H, et al. Cumulative lead exposure and age-related hearing loss: the VA Normative Aging Study. Hear Res. 2010;269(1–2):48–55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Schaumberg DA, Mendes F, Balaram M, Dana MR, Sparrow D, Hu H. Accumulated lead exposure and risk of age-related cataract in men. JAMA. 2004;292(22):2750–4.

    Article  CAS  PubMed  Google Scholar 

  70. Giulivo M, Lopez de AM, Capri E, Barcelo D. Human exposure to endocrine disrupting compounds: their role in reproductive systems, metabolic syndrome and breast cancer. A review Environ Res. 2016;151:251–64.

    Article  CAS  PubMed  Google Scholar 

  71. Kim KN, Lee MR, Choi YH, Hwang H, Oh SY, Park C, et al. Association between phthalate exposure and lower handgrip strength in an elderly population: a repeated-measures study. Environ Health. 2016;15(1):93.

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Esther García-Esquinas.

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García-Esquinas, E., Rodríguez-Artalejo, F. Environmental Pollutants, Limitations in Physical Functioning, and Frailty in Older Adults. Curr Envir Health Rpt 4, 12–20 (2017). https://doi.org/10.1007/s40572-017-0128-1

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