A Pollution Season Plan for Older Adults

Why older adults are at greater risk

Ageing airways and hearts have less reserve, so a day of heavy pollution can tip a person from coping to struggling. Fine particles inflame the airways, trigger asthma and COPD flare-ups, increase the risk of chest infection, and can raise blood pressure and strain the heart. People with diabetes, kidney disease, a previous stroke or heart attack, and those who are frail or live in poorly ventilated or crowded homes are also affected. Pollution is not only an outdoor matter: the air indoors follows the air outdoors, plus the home's own sources. See indoor air quality for older lungs: dust, smoke and damp.

Reading air quality

India's pollution control authorities publish an Air Quality Index (AQI), grouped into categories commonly named Good, Satisfactory, Moderate, Poor, Very Poor and Severe. Many city bulletins, news sites and apps show it, with figures that differ slightly between sources and between stations. As a rough guide for older adults and those with lung or heart disease:

• Good or Satisfactory: normal activity, with ventilation of the home.
• Moderate: sensitive people should reduce long or heavy outdoor activity.
• Poor and above: limit outdoor time to what is needed, avoid exertion outdoors, keep windows closed during peak hours and run a purifier if you have one.
• Very Poor and Severe: stay indoors as much as possible, avoid all but essential trips and be ready for symptoms.

Air is often worst in early morning and late evening in winter, when cold air traps smoke near the ground, and often better in the early afternoon. Local readings vary by neighbourhood, so a low-cost monitor at home can help; see air quality monitors for homes with older adults. Check the AQI before planning walks, hospital visits or temple trips.

Before the season starts: a checklist

1. See the doctor in September or early October for a review. Ask: - Is my parent's treatment right for the pollution season? - What should we do on bad days? Can we have a written action plan? See building a COPD action plan with your doctor. - Are vaccines due? See vaccines that protect older lungs. - Do we need a peak flow meter, an oximeter or changes to inhaler use? See peak flow meters: tracking asthma and breathing at home and inhaler technique and spacers for older adults. 2. Stock up on prescribed medicines, with at least a few weeks in hand, plus spacers, spare inhalers (checking expiry and dose counters), a thermometer, and, if advised, an oximeter with fresh batteries. 3. Service equipment: nebuliser, concentrator, purifier and air conditioner filters. See air purifier filters: replacement, costs and maintenance and a cleaning schedule for breathing equipment. 4. Seal gaps: doors, windows and vents, using weather strips where you can, so less outdoor air leaks in. 5. Choose a refuge room, usually the bedroom, where the cleanest air can be kept. 6. Prepare an emergency list: doctor, hospital, ambulance, pharmacy and supplier numbers, and 112. 7. Plan food and fluids so that trips outside are fewer. 8. Talk to the family about festival habits that add smoke; see below.

On a bad air day: the daily routine

At home

• Keep windows and doors shut during peak pollution, usually early morning and evening, and air the home briefly when outdoor air is better, if the AQI allows. Opening a window for a few minutes at the cleanest time of day reduces the build-up of carbon dioxide and indoor pollutants without letting in too much outdoor smoke.
• Run a purifier with a true HEPA filter in the main room or bedroom, with the door closed; see air purifiers: choosing one for an older adult's room.
• Do not add indoor smoke: no smoking, no burning of incense, camphor, mosquito coils or wood, and minimal frying and strong cooking without ventilation. Use a chimney or exhaust fan.
• Clean damp, not dry: damp-mop and damp-dust, and avoid sweeping or leaf-burning near the house.
• Keep humidity moderate and fix damp; see pest, damp and mould at home.
• Stay hydrated with water or other fluids, unless restricted by the doctor; warm drinks may soothe the throat.
• Eat regularly, with fruit and vegetables.
• Rest, and keep exercise indoors, gentle and within breathlessness limits; see pulmonary rehabilitation exercises at home.
• Take medicines as prescribed, including preventer inhalers, even if your parent feels well. Do not change doses on your own.

If going out is unavoidable

• Choose the least polluted time, usually mid-day to afternoon.
• Keep it short and slow, avoiding busy roads, construction, garbage fires and crowded places.
• Use a well-fitting mask that filters fine particles; see below.
• Carry the reliever inhaler and phone.
• Travel in a closed car with the vents on recirculate, where possible.
• Avoid temples and gatherings with heavy incense or fireworks smoke, or choose a quieter time.
• On return, wash face and hands and rinse the mouth, and change clothes if they smell of smoke.

Masks: what helps and what does not

• Cloth and surgical masks do little against fine particles.
• Respirator-type masks that meet recognised filtration standards (for example those marked N95, FFP2 or equivalent) can reduce exposure to fine particles if they fit snugly with no gaps; a beard or poor fit lets air leak.
• Valved masks vent exhaled air, which is fine for pollution but not for infection control.
• Breathing effort: a respirator adds resistance, and some older adults with COPD or heart failure find it hard or feel breathless. Ask the doctor before using one, start with short periods and stop if breathlessness increases or dizziness occurs.
• Do not use masks as a licence to exercise hard in polluted air.
• Replace disposable masks when damp, dirty or damaged, and follow the maker's guidance on re-use.

Festivals and fireworks

Diwali and other celebrations add a spike of smoke and noise. Plan with sensitivity:

• Choose quiet, low-smoke ways to celebrate, such as lamps with minimal smoke, flowers, rangoli and sweets, rather than fireworks.
• Keep your parent indoors with windows closed and a purifier running during fireworks, and arrange for them to stay in a less exposed room.
• Ask neighbours to be mindful of the older residents.
• Keep reliever medicines and the action plan ready.
• Avoid loud blasts that can cause anxiety or alarm in people with dementia or heart disease.

See how to celebrate a risk-free Diwali with elders.

Watching for symptoms

Keep a simple record of cough, wheeze, breathlessness, sleep, reliever use and, if advised, peak flow or oxygen readings. See pulse oximeters: how they work and how to use one for its limits.

Call the doctor the same day if:

• Cough, wheeze or breathlessness is worse than usual.
• The reliever is needed more often or relief is short.
• Sputum increases or changes colour.
• There is fever, chest pain on coughing, or more tiredness.
• Eyes, nose and throat are very irritated.
• Blood pressure or blood sugar readings are unusual.
• Ankle swelling or rapid weight gain appears in someone with heart failure.

Call 112 if:

• Your parent is struggling to breathe or cannot complete sentences.
• Lips or fingertips are blue or grey.
• There is chest pain or pressure, fainting, or a very fast, irregular heartbeat.
• Confusion, drowsiness or sudden weakness occurs.
• The reliever does not help as the plan expects.

See when breathlessness is an emergency.

Special groups

• Heart disease: pollution can trigger angina or arrhythmias. Know the emergency plan; see after a heart attack: recovery at home.
• Diabetes: infections and stress raise blood sugar; follow the testing plan.
• People on oxygen: keep to the prescribed flow, and take extra care with fire safety if windows are closed and heaters are used; see using an oxygen concentrator safely at home.
• Dementia: maintain routine, and gentle indoor activities.
• Frail or bedbound: keep the room clean, use the purifier and watch for chest infection and bedsores.

Looking after mood and routine

Staying indoors for weeks can lower mood and strength. Plan indoor walking, chair exercises, calls and visits, light, music or games. See chair exercises for seniors and loneliness and isolation in older adults.

Think beyond the home

Pollution is a community problem. Families can push for cleaner cooking fuel, fewer open fires, dust control on construction sites and better public information. In the meantime, protect those at greatest risk.

When to ask a professional

Ask the doctor for a pre-season review, written action plan, vaccine advice and guidance on masks. Ask a pharmacist about inhaler technique and supplies. Ask a physiotherapist for indoor exercises. Seek help promptly for increasing breathlessness, fever or chest symptoms. Call 112 for severe breathlessness, blue lips, chest pain or confusion.