The effect of "smoky" coal bans on chronic lung disease among older people in Ireland.

Globally, coal is still widely used for heating. However, there are concerns about its effect on ambient air quality and health. We estimated the effect of bans prohibiting the sale and use of so-called "smoky coal" on the prevalence of chronic lung disease in older people. Our identification strategy relied on the phased extension of smoky coal bans to Irish towns after 2010. We examined five waves of The Irish Longitudinal Study on Ageing (TILDA), a large nationally representative survey containing detailed information on health, housing, and socio-economic status. Controlling for relevant factors, smoky coal bans reduced the probability that an older person reports being diagnosed with chronic lung disease by between three and five percentage points. In models where we estimated the effect of the ban on the incidence of new cases of chronic lung disease, rather than existing cases, we found the effect was between -0.96 and -2.5 percentage points. Our findings were robust to estimating the model using different sub-samples and control variables. Furthermore, to address potential endogeneity of the ban, we examined subsamples defined by whether participants lived in towns within a range of the population threshold at which the ban was imposed. Estimating our model using these subsamples showed a consistently negative effect of the ban. We also showed parallel trends in health outcomes before the treatment, and that the treatment did not affect attrition from the sample.

Does caring for others affect our mental health? Evidence from the COVID-19 pandemic.

Despite a growing literature about the mental health effects of COVID-19, less is known about the psychological costs of providing informal care during the pandemic. We examined longitudinal data from the UK's Understanding Society Survey, including eight COVID surveys, to estimate fixed effects difference-in-differences models combined with matching, to explore the causal effects of COVID-19 among informal carers. While matching accounts for selection on observables into caregiving, multiple period difference-in-differences specifications allow investigation of heterogeneous mental health effects of COVID-19 by timing and duration of informal care. The estimates suggest that while mental health fluctuated following the imposition of social restrictions, informal carers who started caregiving during the pandemic show the largest mental health deterioration, especially during lockdowns. Policies to mitigate the psychological burden of caregiving might be more effective if targeted at those starting to provide care for the first time.

Indoor particulate air pollution from open fires and the cognitive function of older people.

Exposure to indoor air pollution is known to affect respiratory and cardiovascular health, but little is known about its effects on cognitive function. We measured the concentrations and magnetite content of airborne particulate matter (PM) in the indoor environment arising from burning peat, wood or coal in residential open fires. Highest indoor PM2.5 concentrations (60 µg/m3 i.e. 2.4 times the WHO-recommended 24-h mean) occurred when peat was burned, followed by burning of coal (30 µg/m3) and wood (17 µg/m3). Conversely, highest concentrations of coarser PM (PM10-2.5) were associated with coal burning (20 µg/m3), with lower concentrations emitted during burning of wood (10 µg/m3) and peat (8 µg/m3). The magnetic content of the emitted PM, greatest (for both PM size fractions) when coal was burned, is similar to that of roadside airborne PM. Exposure to PM, and to strongly magnetic airborne PM, can be greater for individuals spending ~5 h/day indoors with a coal-burning open fire for 6 months/year compared to those commuting via heavily-trafficked roads for 1 h/day for 12 months/year. Given these high indoor PM and magnetite concentrations, and the reported associations between (outdoor) PM and impaired neurological health, we used individual-level data from The Irish Longitudinal Study on Ageing (TILDA) to examine the association between the usage of open fires and the cognitive function of older people. Using a sample of nearly seven thousand older people, we estimated multi-variate models of the association between cognitive function and open fire usage, in order to account for relevant confounders such as socio-economic status. We found a negative association between open fire usage and cognitive function as measured by widely-used cognitive tests such as word recall and verbal fluency tests. The negative association was largest and statistically strongest among women, a finding explained by the greater exposure of women to open fires in the home because they spent more time at home than men. Our findings were also robust to stratifying the sample between old and young, rich and poor, and urban and rural.

Disabilities moderate the association between neighbourhood urbanity and cognitive health: Results from the Irish longitudinal study on ageing.

BACKGROUND: Geographical variations in cognitive health have been extensively explored, but the evidence on adult individuals with disabilities is inconclusive. While urban living is suggested as more cognitively stimulating than rural dwelling in epidemiological research, both rurality and urbanity can present barriers that may negatively impact cognitive health, the former due to limited accessibility to stimulation, and the latter because presenting environmental stressors. OBJECTIVE: To bridge this gap in the literature, we investigated geographical variations in multiple cognitive skills in adult age based on neighbourhood urbanity and having disabilities. METHODS: Data on global cognition, memory, speed of processing and executive functions, as well as reported functional limitations, was taken from 4127 individuals aged 50 + participating in the first wave of The Irish Longitudinal Study on Ageing (TILDA). Neighbourhood urbanity was measured using Census data on population density. Multivariate regression analyses controlled for socio-demographic, health and lifestyle covariates. RESULTS: Residence in medium-high densely populated areas was significantly associated with better cognitive performance across all measures, after controlling for covariates. However, having disabilities was linked to worse global cognitive functioning (MoCA, p = .005), immediate recall (p = .022) and executive functions (CTT2, p = .009) in the least and most densely populated areas. CONCLUSIONS: Living in urbanised areas may provide more mental stimulation than rural places; however, functional limitations moderate this association, suggesting potential environmental challenges both in rural and urban areas. Considering both individual and environmental circumstances can enrich investigations of geographical variations in cognitive health.

Environment and cognitive aging: A cross-sectional study of place of residence and cognitive performance in the Irish longitudinal study on aging.

OBJECTIVE: Stimulating environments foster cognitive vitality in older age. However, it is not known whether and how geographical and physical characteristics of lived environments contribute to cognitive aging. Evidence of higher prevalence of dementia in rural rather than urban contexts suggests that urban environments may be more stimulating either cognitively, socially, or in terms of lifestyle. The present study explored urban/rural differences in cognition for healthy community-dwelling older people while controlling for a comprehensive spectrum of confounding factors. METHOD: Cognitive performance of 3,765 healthy Irish people aged 50+ years participating in Wave 1 of The Irish Longitudinal Study on Aging was analyzed in relation to current location of residence-urban, other settlements, or rural areas-and its interaction with childhood residence. Regression models controlled for sociodemographic, health, and lifestyle factors. RESULTS: Urban residents showed better performance than the other 2 residence groups for global cognition and executive functions after controlling for covariates. Childhood urban residence was associated with a cognitive advantage especially for currently rural participants. CONCLUSION: Our findings suggest higher cognitive functioning for urban residents, although childhood residence modulates this association. Suggestions for further developments of these results are discussed. (PsycINFO Database Record

Seasonal and meteorological associations with depressive symptoms in older adults: A geo-epidemiological study.

BACKGROUND: Given increased social and physiological vulnerabilities, older adults may be particularly susceptible to environmental influences on mood. Whereas the impact of season on mood is well described for adults, studies rarely extend to elders or include objective weather data. We investigated the impact of seasonality and meteorological factors on risk of current depressive symptoms in older adults. METHODS: We used data on 8027 participants from the first wave of The Irish Longitudinal Study of Ageing, a population-representative cohort of adults aged 50+. Depressive symptoms were recorded using the Centre for Epidemiological Studies Depression Scale. Season was defined according to the World Meteorological Organisation. Data on climate over the preceding thirty years, and temperature and rain over the preceding month, were provided by the Irish Meteorological Service and linked using Geographic Information Systems techniques to participant's geo-coded locations at a resolution of one kilometre. RESULTS: The highest levels of depressive symptoms were reported in winter and the lowest in spring (mean 6.56 [CI95% 6.09, 7.04] vs. 5.81 [CI95%: 5.40, 6.22]). In fully adjusted linear regression models, participants living in areas with higher levels of rainfall in the preceding and/or current calendar month had greater depressive symptoms (0.04 SE 0.02; p=0.039 per 10mm additional rainfall per month) while those living in areas with sunnier climates had fewer depressive symptoms (-2.67 SE 0.88; p=0.003 for every additional hour of average annual daily sunshine). LIMITATIONS: This was a cross-sectional analysis thus causality cannot be inferred; monthly rain and temperature averages were available only on a calendar month basis while monthly local levels of sunshine data were not available. CONCLUSIONS: Environmental cues may influence mood in older adults and thus have relevance for the recognition and treatment of depression in this age group.

Water fluoridation, dentition status and bone health of older people in Ireland.

OBJECTIVE: To examine some of the potential benefits and risks of water fluoridation for older adults. METHODS: This study used 'The Irish Longitudinal Study on Ageing', to access a nationally representative sample of 4977 people aged 50 and older. The sample was used to estimate associations between the percentage of households in a respondent's local area with a currently fluoridated water supply and the probability of two binary outcomes: the respondent having all their own teeth and having normal bone density. Past exposure of individuals to fluoridated water was not assessed; the prevalence of fluoridated water in local supplies was obtained from the 2006 Census of Ireland. The Census data indicated that there was considerable variation in the proportion of households with fluoridated water supplies, especially in rural areas. Bone mineral density was estimated from a heel ultrasound of each respondent, and their number of teeth was self-reported. A range of individual variables, such as educational attainment, housing wealth, age and health behaviours, was controlled for. RESULTS: It was found that the greater the percentage of households with a fluoridated water supply in an area, the higher the probability that respondents had all their own teeth. There was no significant relationship between the proportion of households with a fluoridated water supply in an area and bone health. CONCLUSION: This study suggests that water fluoridation provides a net health gain for older Irish adults, though the effects of fluoridation warrant further investigation.