The Impact of Criteria Air Pollutants on Occurrences of Falling, Fear of Falling, and Imbalance in the Older Adults in Southwestern Iran

Background: The southwest of Iran is among the most polluted regions worldwide. The health risks associated with air pollution are a global concern, specifically for the older population. Evidence on the impact of air pollution on older adults’ falling incidents has been rather overlooked. The present study thus seeks to examine how air pollutants affect the count of falling incidents, fear of falling, and imbalance in older adults.

Materials and methods: The present cross-sectional analysis examined all the older adults in the southwest of Iran (140,215 people) and their experience of falling, fear of falling, and imbalance and how these variables were associated with standard air pollutants. Statistical analyses were performed through linear regression, ANOVA, and the Post Hoc Tukey test in IBM-SPSS v.28 and JAMOVI v.2.4.5.

Results: The cities differed in terms of fear of falling; however, this difference was not statistically significant and did not impact the incidence of falls or imbalance among the elderly (p > 0.05). Shoushtar and Abadan were similar in terms of fear of falling, while Ahwaz was distinct from them. Among the studied pollutants, only SO₂, PM_2.5, and PM₁₀ affected the fear of falling. Significant differences were observed throughout the seasons in SO₂, NO₂, PM_2.5, and PM₁₀ in Ahwaz and Shoushtar and in PM_2.5 and PM₁₀ particulates in Abadan (p < 0.05).

Discussion and conclusion: Results showed that implementing health policies and taking environmental measures in favor of the vulnerable older adults residing in polluted regions such as the southwest of Iran would be necessary.

1. Kannus P, Niemi S, Sievänen H, Parkkari J. Declining incidence in fall-induced deaths of older adults: Finnish statistics during 1971–2015. Aging Clin Exp Res. 2018;30(9):1111-1115. doi: 10.1007/s40520-018-0898-9

2. James SL, Lucchesi LR, Bisignano C, et al. The global burden of falls: Global, regional and national estimates of morbidity and mortality from the Global Burden of Disease Study 2017. Inj Prev. 2020;26(Supp 1):i3-i11. doi: 10.1136/injuryprev-2019-043286

3. Kumar A, Delbaere K, Zijlstra GAR, et al. Exercise for reducing fear of falling in older people living in the community: Cochrane systematic review and meta-analysis. Age Ageing. 2016;45(3):345-352. doi: 10.1093/ageing/afw036

4. Pluijm SM, Smit JH, Tromp EA, et al. A risk profile for identifying community-dwelling elderly with a high risk of recurrent falling: Results of a 3-year prospective study. Osteoporos Int. 2006;17(3):417-425. doi: 10.1007/s00198-005-0002-0

5. Schoene D, Heller C, Aung YN, Sieber CC, Kemmler W, Freiberger E. A systematic review on the influence of fear of falling on quality of life in older people: Is there a role for falls? Clin Interv Aging. 2019;14:701-719. doi: 10.2147/CIA.S197857

6. Lavedán A, Viladrosa M, Jürschik P, et al. Fear of falling in community-dwelling older adults: A cause of falls, a consequence, or both? PLoS One. 2018;13(3):e0194967. doi: 10.1371/journal.pone.0194967

7. Hussain N, Hansson PO, Persson CU. Prediction of fear of falling at 6 months after stroke based on 279 individuals from the Fall Study of Gothenburg. Sci Rep. 2021;11(1):13503. doi: 10.1038/s41598-021-92546-9

8. Ang SGM, O’Brien AP, Wilson A. Investigating the psychometric properties of the Carers’ Fall Concern instrument to measure carers’ concern for older people at risk of falling at home: A cross-sectional study. Int J Older People Nurs. 2020;15(4):e12338. doi: 10.1111/opn.12338

9. Gottschalk S, König HH, Schwenk M, et al. Mediating factors on the association between fear of falling and health-related quality of life in community-dwelling German older people: A cross-sectional study. BMC Geriatr. 2020;20(1):401. doi: 10.1186/s12877-020-01802-6

10. Langeard A, Desjardins-Crépeau L, Lemay M, Payette MC, Bherer L, Grenier S. Cognitive performances better identify fallers than mobility assessment among older adults with fear of falling. Aging Clin Exp Res. 2021;33(10):2709-2714. doi: 10.1007/s40520-019-01338-9

11. Landrigan PJ, Fuller R, Acosta NJR, et al. The Lancet Commission on pollution and health. Lancet. 2018;391(10119):462-512. doi: 10.1016/S0140-6736(17)32345-0

12. Hänninen O, Knol AB, Jantunen M, et al.; EBoDE Working Group. Environmental burden of disease in Europe: Assessing nine risk factors in six countries. Environ Health Perspect. 2014;122(5):439-446. doi: 10.1289/ehp.1206154

13. Lee JJ, Kim JH, Song DS, Lee K. Effect of short- to long-term exposure to ambient particulate matter on cognitive function in a cohort of middle-aged and older adults: KoGES. Int J Environ Res Public Health. 2022;19(16):9913. doi: 10.3390/ijerph19169913

14. Vallero D. Fundamentals of Air Pollution. Academic Press; 2014. doi: 10.1016/C2012-0-01172-6

15. Ghorani-Azam A, Riahi-Zanjani B, Balali-Mood M. Effects of air pollution on human health and practical measures for prevention in Iran. J Res Med Sci. 2016;21:65. doi: 10.4103/1735-1995.189646

16. Kampa M, Castanas E. Human health effects of air pollution. Environ Pollut. 2008;151(2):362-367. doi: 10.1016/j.envpol.2007.06.012

17. Yin H, Brauer M, Zhang JJ, et al. Population ageing and deaths attributable to ambient PM2.5 pollution: A global analysis of economic cost. Lancet Planet Health. 2021;5(6):e356-e367. doi: 10.1016/S2542-5196(21)00131-5

18. 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. doi: 10.1007/s40520-013-0001-5

19. Goudie AS. Dust storms: Recent developments. J Environ Manage. 2009;90(1):89-94. doi: 10.1016/j.jenvman.2008.07.007

20. Nakao M, Yamauchi K, Mitsuma S, Omori H, Ishihara Y. Relationships between perceived health status and ambient air quality parameters in healthy Japanese: A panel study. BMC Public Health. 2019;19(1):620. doi: 10.1186/s12889-019-6934-7

21. Zittis G, Almazroui M, Alpert P, et al. Climate change and weather extremes in the Eastern Mediterranean and Middle East. Rev Geophys. 2022;60(3):e2021RG000762. doi: 10.1029/2021RG000762

22. Lelieveld J, Hadjinicolaou P, Kostopoulou E, et al. Model projected heat extremes and air pollution in the eastern Mediterranean and Middle East in the twenty-first century. Reg Environ Change. 2014;14(5):1937-1949. doi: 10.1007/s10113-013-0444-4

23. Adamopoulos IP, Syrou N, Adamopoulou J, Mijwil M. Southeast Mediterranean and Middle Eastern countries are experiencing impacts from the climate crisis, extreme weather events, and the conventional method of water use: A comprehensive scoping study. 2024; Mar 3. Accessed February 14, 2025. https://ssrn.com/abstract=4746621

24. WHO Air quality guidelines for particulate matter, ozone, nitrogen dioxide, and sulfur dioxide: Global update 2005. Geneva, Switzerland: World Health Organization; 2006. Accessed February 12, 2025. https://iris.who.int/bitstream/handle/10665/69477/WHO_SDE_PHE_OEH_06.02_eng.pdf?sequence=1

25. Lusardi MM, Fritz S, Middleton A, et al. Determining risk of falls in community dwelling older adults: A systematic review and meta-analysis using posttest probability. J Geriatr Phys Ther. 2017;40(1):1-36. doi: 10.1519/JPT.0000000000000099

26. Loureiro V, Gomes M, Loureiro N, Aibar-Almazán A, Hita-Contreras F. Multifactorial programs for healthy older adults to reduce falls and improve physical performance: Systematic review. Int J Environ Res Public Health. 2021;18(20):10842. doi: 10.3390/ijerph182010842

27. Lage I, Braga F, Almendra M, Meneses F, Teixeira L, Araujo O. Falls in older persons living alone: The role of individual, social and environmental factors. Enferm Clín (Engl Ed). 2022;32(6):396-404. doi: 10.1016/j.enfcle.2022.04.003

28. Wetherell JL, Bower ES, Johnson K, Chang DG, Ward SR, Petkus AJ. Integrated exposure therapy and exercise reduces fear of falling and avoidance in older adults: A randomized pilot study. Am J Geriatr Psychiatry. 2018;26(8):849-859. doi: 10.1016/j.jagp.2018.04.001

29. Kumar A, Carpenter H, Morris R, Iliffe S, Kendrick D. Which factors are associated with fear of falling in community-dwelling older people? Age Ageing. 2014;43(1):76-84. doi: 10.1093/ageing/aft154

30. Wang R, Liu Y, Xue D, Yao Y, Liu P, Helbich M. Cross-sectional associations between long-term exposure to particulate matter and depression in China: The mediating effects of sunlight, physical activity, and neighborly reciprocity. J Affect Disord. 2019;249:8-14. doi: 10.1016/j.jad.2019.02.007

31. Araya AX, Iriarte E. Fear of falling among community-dwelling sedentary and active older people. Invest Educ Enferm. 2021;39(1):e13. doi: 10.17533/udea.iee.v39n1e13

32. Guo Y, Lin H, Shi Y, et al. Long-term exposure to ambient PM2.5 associated with fall-related injury in six low- and middle-income countries. Environ Pollut. 2018;237:961-967. doi: 10.1016/j.envpol.2017.10.134

33. Torkashvand J, Jonidi Jafari A, Pasalari H, et al. The potential osteoporosis due to exposure to particulate matter in ambient air: Mechanisms and preventive methods. J Air Waste Manag Assoc. 2022;72(9):925-934. doi: 10.1080/10962247.2022.2085820

34. Yang Y, Li R, Cai M, et al. Ambient air pollution, bone mineral density and osteoporosis: Results from a national population-based cohort study. Chemosphere. 2023;310:136871. doi: 10.1016/j.chemosphere.2022.136871

35. Zhang X, Yu S, Zhang F, et al. Association between traffic-related air pollution and osteoporotic fracture hospitalizations in inland and coastal areas: Evidences from the central areas of two cities in Shandong Province, China. Arch Osteoporos. 2023;18(1):96. doi: 10.1007/s11657-023-01308-9

36. Prada D, Crandall CJ, Kupsco A, et al. Air pollution and decreased bone mineral density among Women’s Health Initiative participants. EClinicalMedicine. 2023;57:101864. doi: 10.1016/j.eclinm.2023.101864