The impact of indoor air quality and contaminants on respiratory health of older people living in long-term care residences in Porto

A study about the impact of indoor air pollution on cognitive function among middle-aged and older adult people in India

BACKGROUND

In the 21st century, people still use solid fuel for cooking at home, resulting in poor indoor air quality. Prolonged exposure to such conditions may negatively affect one's cognitive function. So, the present study examines the possible association between IAP and the cognitive function of individuals aged 45 years or above in India.

METHODS

The study utilizes secondary data, procured from the longitudinal ageing study in India (2017-18). Treatment effects through regression-adjusted models were applied to represent the association between IAP and cognitive health and the results are represented by beta coefficient (β). Three separate models with a 95% confidence interval adjusting with the other factors like housing environment, individual and behavioural were framed.

RESULTS

The study revealed that households without a separate kitchen (β = -0.64; 95%CI: -0.90 to -0.39) and electricity (β = -0.97; 95%CI: -1.34 to -0.61) significantly affect cognitive strength. Cognitive decline is likely more pronounced among older adults (β = -1.19; 95%CI: -1.42 to -0.96) than the middle-aged population. Moreover, the cognitive ability of rural residents (β = -1.11; 95%CI: -1.49 to -0.73) and women (β = -2.05; 95%CI: -2.29 to -1.81) is negatively associated with IAP exposure. Older adults with no reading habits (β = -6.28; 95%CI: -6.72; to -5.85) and physical inactivity (β = -0.96; 95%CI: -1.22 to -0.70) had a sign of notable decline in cognitive ability.

CONCLUSIONS

Findings revealed that cognitive function is negatively associated with IAP, demanding a deep intervention plan to minimize the detrimental effect.

Issue 2 - "Update on adverse respiratory effects of indoor air pollution" Part 1): Indoor air pollution and respiratory diseases: A general update and a Portuguese perspective

OBJECTIVE

To quantify the impact of different air pollutants on respiratory health based on robust estimates based on international data and to summarise the evidence of associations between indoor exposure to those pollutants and respiratory morbidity in the Portuguese population.

RESULTS

Several systematic reviews and meta-analyses (MA) at the world level demonstrate the impact of indoor air quality on respiratory health, with indoor particulate matter and gasses exerting a significant effect on the airways. Volatile organic compounds (VOC) have been related to asthma and lung cancer. However, only meta-analyses on biomass use allowed documentation of long-term respiratory effects. While early publications concerning Portuguese-based populations mainly focused on indoor exposure to environmental tobacco smoke, later studies relocated the attention to relevant exposure environments, such as day care buildings, schools, residences and nursing homes. Looking at the pooled effects from the reviewed studies, high levels of carbon dioxide and particulate matter in Portuguese buildings were significantly associated with asthma and wheezing, with VOC and fungi showing a similar effect in some instances.

CONCLUSIONS

Despite the significant reduction of indoor air pollution effects after the 2008 indoor smoking prohibition in public buildings, studies show that several indoor air parameters are still significantly associated with respiratory health in Portugal. The country shares the worldwide necessity of standardisation of methods and contextual data to increase the reach of epidemiological studies on household air pollution, allowing a weighted evaluation of interventions and policies focused on reducing the associated respiratory morbidity.

Low-dose blood BTEX are associated with pulmonary function through changes in inflammatory markers among US adults: NHANES 2007-2012

The effects of blood benzene, toluene, ethylbenzene, and xylenes (BTEX) on lung function among general adults remain unknown. We enrolled 5519 adults with measured blood BTEX concentrations and lung function from the US National Health and Nutrition Examination Survey 2007-2012. Weighted linear models were fitted to assess the associations of BTEX with lung function and inflammation parameters (white blood cell five-part differential count and C-reactive protein). The mediating effect of inflammation between BTEX and lung function was also examined. Blood BTEX concentrations decreased yearly from 1999 and were extremely low from 2007 to 2012. Benzene and toluene exerted the greatest influence on lung function in terms of forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), calculated FEV1:FVC ratio, peak expiratory flow rate (PEFR), and forced mid expiratory flow (FEF_25-75%). Both ethylbenzene and all xylene isomers had no effects on FVC but reduced FEV1, FEV1:FVC ratio, PEFR, and FEF_25-75%. Weighted quantile analyses demonstrated that BTEX mixture was associated with decreases in FVC, FEV1, FEV1:FVC ratio, PEFR, and FEF_25-75%, with benzene weighted most heavily for all lung function parameters. BTEX also increased the levels of inflammation indicated by white blood cell five-part differential count and C-reactive protein, and increased levels of inflammation also reduced lung function. From multiple mediation analysis, inflammation mediated the effects of benzene on FEV1 and PEFR, the effects of toluene on FEV1, and the effects of ethylbenzene on FEV1 and PEFR. Low-dose exposure to BTEX was associated with reduced pulmonary function both in large and small airways. Inflammation could be involved in this pathogenesis.

A Scoping Review of Adverse Incidents Research in Aged Care Homes: Learnings, Gaps, and Challenges

Background: Adverse incidents are well studied within acute care settings, less so within aged care homes. The aim of this scoping review was to define the types of adverse incidents studied in aged care homes and highlight strengths, gaps, and challenges of this research. Methods: An expanded definition of adverse incidents including physical, social, and environmental impacts was used in a scoping review based on the PRISMA Extension for Scoping Reviews Checklist. MEDLINE, CINAHL, and EBSCOhost were searched for English language, peer-reviewed studies conducted in aged care home settings between 2000 and 2020. Forty six articles across 12 countries were identified, charted, and analyzed using descriptive statistics and narrative summary methods. Results: Quantitative studies (n = 42, 91%) dominated adverse incidents literature. The majority of studies focused on physical injuries (n = 29, 63%), with fewer examining personal/interpersonal (15%) and environmental factors (22%). Many studies did not describe the country's aged care system (n = 26, 56%). Only five studies (11%) included residents' voices. Discussion: This review highlights a need for greater focus on resident voices, qualitative research, and interpersonal/environmental perspectives in adverse event research in aged care homes. Addressing these gaps, future research may contribute to better understanding of adverse incidents within this setting.

Indoor Air Quality in Elderly Centers: Pollutants Emission and Health Effects

The world population is ageing, in particular in the developed world, with a significant increase in the percentage of people above 60 years old. They represent a segment of the population that is more vulnerable to adverse environmental conditions. Among them, indoor air quality is one of the most relevant, as elders spend comparatively more time indoors than younger generations. Furthermore, the recent COVID-19 pandemic contributed immensely to raising awareness of the importance of breathing air quality for human health and of the fact that indoor air is a vector for airborne infections and poisoning. Hence, this work reviews the state of the art regarding indoor air quality in elderly centers, considering the type of pollutants involved, their emission sources, and their health effects. Moreover, the influence of ventilation on air quality is also addressed. Notwithstanding the potential health problems with the corresponding costs and morbidity effects, only a few studies have considered explicitly indoor air quality and its impacts on elderly health. More studies are, therefore, necessary to objectively identify what are the impacts on the health of elderly people due to the quality of indoor air and how it can be improved, either by reducing the pollutants emission sources or by more adequate ventilation and thermal comfort strategies.

Association between exposure to air pollution and risk of allergic rhinitis: A systematic review and meta-analysis

BACKGROUND

Allergic rhinitis (AR) is one of the most common allergic diseases in the world, and usually persists throughout the activity. Epidemiological studies have shown a positive association between air pollution and allergic rhinitis. However, we could not find any meta-analysis of the risk of air pollutants (PM_2.5, PM₁₀, NO₂, SO₂, O₃ and CO) on the prevalence of AR in people of all ages.

OBJECTIVES

Carry out a meta-analysis on the results of recent studies (up to 2020) to present valid information about exposure to air pollution and risk of prevalence of AR.

METHODS

We systematically searched three databases for studies up to December 17, 2020, including air pollution and AR. Random effect models were conducted to estimate the pooled odds ratios (ORs) and 95% confidence intervals (95% CIs). Subgroup analysis, funnel plot, Egger's test, and the trim-and-fill method were also conducted.

RESULTS

Thirty-five studies across 12 countries, including a total of 453,470 participants, were included. The OR per 10 μg/m³ increase of pollutants was 1.13 (1.04-1.22) for PM₁₀ and 1.12 (1.05-1.20) for PM_2.5. The OR per 10 μg/m³ increment of gaseous pollutants were 1.13 (1.07-1.20) for NO₂, 1.13 (1.04-1.22) for SO₂ and 1.07 (1.01-1.12) for O₃. No significant association was observed between CO and AR. Children or adolescents are more sensitive to air pollution than adults. The effects of PM₁₀ and SO₂ were significantly stronger in Europe than Asia. The effects of air pollutants were more significant and higher in developing countries than in developed countries, except for PM₁₀. A significant difference of subgroup test was found between developed and developing countries of NO₂.

CONCLUSION

This meta-analysis showed a positive association between air pollution and the prevalence of allergic rhinitis, and identified geographic area and economic level as the potential modifiers for the association.

The contribution of cooking appliances and residential traffic proximity to aerosol personal exposure

PURPOSE

Indoor and outdoor factors affect personal exposure to air pollutants. Type of cooking appliance (i.e. gas, electricity), and residential location related to traffic are such factors. This research aims to investigate the effect of cooking with gas and electric appliances, as an indoor source of aerosols, and residential traffic as outdoor sources, on personal exposures to particulate matter with an aerodynamic diameter lower than 2.5 μm (PM_2.5), black carbon (BC), and ultrafine particles (UFP).

METHODS

Forty subjects were sampled for four consecutive days measuring personal exposures to three aerosol pollutants, namely PM_2.5, BC, and UFP, which were measured using personal sensors. Subjects were equally distributed into four categories according to the use of gas or electric stoves for cooking, and to residential traffic (i.e. houses located near or away from busy roads).

RESULTS/CONCLUSION

Cooking was identified as an indoor activity affecting exposure to aerosols, with mean concentrations during cooking ranging 24.7-50.0 μg/m³ (PM_2.5), 1.8-4.9 μg/m³ (BC), and 1.4 × 10⁴-4.1 × 10⁴ particles/cm³ (UFP). This study also suggest that traffic is a dominant source of exposure to BC, since people living near busy roads are exposed to higher BC concentrations than those living further away from traffic. In contrast, the contribution of indoor sources to personal exposure to PM_2.5 and UFP seems to be greater than from outdoor traffic sources. This is probably related to a combination of the type of building construction and a varying range of activities conducted indoors. It is recommended to ensure a good ventilation during cooking to minimize exposure to cooking aerosols.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40201-020-00604-7.

Reducing Morbidity and Mortality Rates from COVID-19, Influenza and Pneumococcal Illness in Nursing Homes and Long-Term Care Facilities by Vaccination and Comprehensive Infection Control Interventions

The COVID-19 pandemic identifies the problems of preventing respiratory illnesses in seniors, especially frail multimorbidity seniors in nursing homes and Long-Term Care Facilities (LCTFs). Medline and Embase were searched for nursing homes, long-term care facilities, respiratory tract infections, disease transmission, infection control, mortality, systematic reviews and meta-analyses. For seniors, there is strong evidence to vaccinate against influenza, SARS-CoV-2 and pneumococcal disease, and evidence is awaited for effectiveness against COVID-19 variants and when to revaccinate. There is strong evidence to promptly introduce comprehensive infection control interventions in LCFTs: no admissions from inpatient wards with COVID-19 patients; quarantine and monitor new admissions in single-patient rooms; screen residents, staff and visitors daily for temperature and symptoms; and staff work in only one home. Depending on the vaccination situation and the current risk situation, visiting restrictions and meals in the residents' own rooms may be necessary, and reduce crowding with individual patient rooms. Regional LTCF administrators should closely monitor and provide staff and PPE resources. The CDC COVID-19 tool measures 33 infection control indicators. Hand washing, social distancing, PPE (gowns, gloves, masks, eye protection), enhanced cleaning of rooms and high-touch surfaces need comprehensive implementation while awaiting more studies at low risk of bias. Individual ventilation with HEPA filters for all patient and common rooms and hallways is needed.

Systemic inequalities in indoor air pollution exposure in London, UK

Deprived communities in many cities are exposed to higher levels of outdoor air pollution, and there is increasing evidence of similar disparities for indoor air pollution exposure. There is a need to understand the drivers for this exposure disparity in order to develop effective interventions aimed at improving population health and reducing health inequities. With a focus on London, UK, this paper assembles evidence to examine why indoor exposure to PM2.5, NOx and CO may disproportionately impact low-income groups. In particular, five factors are explored, namely: housing location and ambient outdoor levels of pollution; housing characteristics, including ventilation properties and internal sources of pollution; occupant behaviours; time spent indoors; and underlying health conditions. Evidence is drawn from various sources, including building physics models, modelled outdoor air pollution levels, time-activity surveys, housing stock surveys, geographical data, and peer-reviewed research. A systems framework is then proposed to integrate these factors, highlighting how exposure to high levels of indoor air pollution in low-income homes is in large part due to factors beyond the control of occupants, and is therefore an area of systemic inequality.

POLICY RELEVANCE

There is increasing public and political awareness of the impact of air pollution on public health. Strong scientific evidence links exposure to air pollution with morbidity and mortality. Deprived communities may be more affected, however, with limited evidence on how deprivation may influence their personal exposure to air pollution, both outdoors and indoors. This paper describes different factors that may lead to low-income households being exposed to higher levels of indoor air pollution than the general population, using available data and models for London (i.e. living in areas of higher outdoor air pollution, in poor-quality housing, undertaking more pollution-generating activities indoors and spending more time indoors). A systems approach is used to show how these factors lead to systemic exposure inequalities, with low-income households having limited opportunities to improve their indoor air quality. This paper can inform actions and public policies to reduce environmental health inequalities, considering both indoor and outdoor air.

Pulmonary Health Effects of Indoor Volatile Organic Compounds-A Meta-Analysis

Volatile organic compounds (VOCs) are commonly found in consumer products, including furniture, sealants and paints. Thus, indoor VOCs have become a public health concern, especially in high-income countries (HICs), where people spend most of their time indoors, and indoor and outdoor air exchange is minimal due to a lack of ventilation. VOCs produce high levels of reaction with the airway epithelium and mucosa membrane and is linked with pulmonary diseases. This paper takes a stock of the literature to assess the strength of association (measured by effect size) between VOCs and pulmonary diseases with the focus on asthma and its related symptoms by conducting a meta-analysis. The literature was searched using the PubMed database. A total of 49 studies that measured VOCs or VOC types and pulmonary health outcomes were included in the analysis. The results of these studies were tabulated, and standard effect size of each study was computed. Most studies were conducted in high-income countries, including France (n = 7), Japan (n = 7) and the United States (n = 6). Our analysis suggests that VOCs have a medium-sized effect on pulmonary diseases, including the onset of asthma (effect size (or Cohen's d) ~0.37; 95% confidence interval (CI) = 0.25-0.49; n = 23) and wheezing (effective size ~0.26; 95% CI = 0.10-0.42; n = 10). The effect size also varied by country, age and disease type. Multiple stakeholders must be engaged in strategies to mitigate and manage VOC exposure and its associated pulmonary disease burden.

Household solid fuel use and peak expiratory flow in middle-aged and older adults in China: A large cohort study (2011-2015)

Indoor air pollution caused by solid fuel use in cooking and heating in China is common. The relationship between household solid fuel use and peak expiratory flow (PEF) in middle-aged and older adults in China has not been clarified. The aim of this study was to assess the relationship between long-term household solid fuel use (clean for both cooking and heating, solid for either cooking or heating, and solid for both cooking and heating) and PEF changes in middle-aged and older adults using a nationally representative prospective cohort. Covariance analysis was used to compare PEF changes in different indoor air pollution exposure groups. Separate analysis of cooking and heating as well as sub-group analyses by age, sex and smoking status were conducted, linear mixed growth model analysis was used to evaluate the association between cooking fuel type and PEF. A total of 6818 participants were enrolled in the cohort analysis. Results revealed that solid fuel use in cooking and heating separately or conjointly were associated with reduced PEF (solid fuel use in cooking: least square mean [LSM] = 19.9, 95% confidence interval [CI]: 11.5-28.2, P = 0.03; solid fuel use in heating: LSM = 19.4, 95% CI:11.2-27.5, P = 0.04; both solid fuel use: LSM = 17.6, 95% CI: 9.3-25.9, P for trend <0.0001), especially in participants aged >65 years (LSM = -9.22, 95% CI: 27.9-69.52, P for trend <0.0001), females (LSM = -6.41, 95% CI: 19.12-6.30, P for trend <0.0001) and current or former smokers (LSM = -21.55, 95% CI: 36.14 to -6.97, P < 0.02). Compared to that of participants using clean fuels for cooking, PEF of participants using solid fuels were decreased by 3.5 l/min per 2 years over a 4-year follow-up. This cohort study highlights the adverse effects of indoor air pollution on lung function in middle aged and older adults in China.

Quality of the Indoor Environment in Elderly Care Centers in Two Cities in Central Portugal: Viseu and Covilhã

Assessments of Indoor Environment Quality (IEQ) present a very significant challenge when analyses are undertaken mainly in buildings that include a particularly sensitive and vulnerable population, such as elderly people. In order to maintain an indoor environment that is adequate for occupants, it is necessary to comply with a set of requirements (for TVOC, the Portuguese threshold values) regarding concentrations of airborne pollutants and hygrothermal comfort conditions. This paper studies IEQ in compartments in 3 buildings in two cities in central Portugal, Viseu and Covilhã, which hold elderly care centers. The following environmental parameters were continuously recorded: air temperature, relative humidity, concentration of carbon dioxide, formaldehyde, and total volatile organic compounds and ventilation rates. An analysis of the obtained results was performed, taking recommended guidelines and threshold values into account, thus making it possible to evaluate the IEQ conditions and hygrothermal comfort in the selected indoor spaces. On the basis of the conclusions reached and the observed problems of hygrothermal comfort and indoor pollutants in the indoor spaces, a number of recommendations are proposed, specifically in terms of climate control, ventilation, and maintenance, in order to obtain an overall improvement of IEQ.

The impact of indoor air quality on respiratory health of older people living in nursing homes: spirometric and exhaled breath condensate assessments

In the Portuguese Geriatric Study of the Health Effects of Indoor Air Quality in Senior Nursing Homes, we aimed to evaluate the impact of indoor air contaminants on the respiratory symptoms and biomarkers in a sample of elderly living in nursing homes. A total of 269 elderly answered a health questionnaire, performed a spirometry and 150 out of these collected an exhaled breath condensate sample for pH and nitrites analysis. The study included the evaluation of indoor chemical and microbiological contaminants. The median age of the participants was 84 (78-87) years and 70.6% were women. The spirometric data indicated the presence of airway obstruction in 14.5% of the sample. Median concentrations of air pollutants did not exceed the existing standards, although increased peak values were observed. In the multivariable analysis, each increment of 100 µg/m³ of total volatile organic compounds was associated with the odds of respiratory infection in the previous three months ( OR̂ =1.05; 95% CI: 1.00-1.09). PM_2.5 concentrations were inversely associated with pH values ( β̂ = -0.04, 95%: -0.06 to -0.01, for each increment of 10 µg/m³). Additionally, a direct and an inverse association were found between total bacteria and FEV₁/FVC and FVC, respectively.

Assessing the seasonality of occupancy number-associated CO2 level in a Taiwan hospital

This study enabled the assessment of indoor CO₂ levels and evaluated the relationship between occupancy numbers with CO₂ levels in a Taiwan hospital. The measurements were conducted over four seasons for five working days (Monday to Friday), with sampling conducted simultaneously from 09:00 am to 5:00 pm and across six locations (for spatial variability): hall (H), registration and cashier (RC), waiting area (WA), occupational therapy room (OT), physical therapy room (PT), and outdoors (O). Based on the analysis, three of the five indoor sampling sites showed significant differences in seasonal CO₂ concentrations (p < 0.0001). Based on our result, the physical therapy room had the highest level of CO₂ concentration that exceeded the IAQ standard in Taiwan Environmental Protection Agency (EPA) in all seasons, in that the number of occupants contributing to nearly 40% of the variation in CO₂ measured. Our results also showed that the indoor/outdoor (I/O) ratios of CO₂ concentration for all locations and seasons exceeded 1 in ~ 100% of those locations. The median I/O ratio at sites WA and OT was 2.37 and 2.08 during four seasons, respectively. The highest median I/O ratio was found at site PT, with a calculated range of 2.69 in spring to 3.90 in fall. The highest correlation of occupancy number and CO₂ concentration also occurred in PT which correlation coefficients were estimated at 0.47, 0.65, 0.63, and 0.40 in spring, summer, fall, and winter. The findings of the present study can be used to understand occupancy number and its effect on CO₂ levels in a hospital environment, as well as the effect of time of day (Monday to Friday) on the number of patients admitted.

A pilot study on semivolatile organic compounds in senior care facilities: Implications for older adult exposures

The occurrence of five groups of semivolatile organic compounds (SVOCs) (total of ∼120 distinct chemicals) was investigated in senior care facilities in the United States and in Portugal. Indoor settled dust samples were collected from fourteen facilities, and the concentrations of organophosphate esters (OPEs), brominated flame retardants (BFRs), polycyclic aromatic hydrocarbons (PAHs), organochlorine pesticides (OCPs), and polychlorinated biphenyls (PCBs) were measured in these samples. Overall, OPEs, PAHs, and BFRs were the most abundant, and OCPs and PCBs were the least abundant SVOC groups in dust collected from both U.S. and Portuguese facilities. ∑OPE, ∑PAH, and ∑BFR concentrations were significantly higher in U.S. facilities than those in Portuguese facilities (P < 0.001), while ∑OCP and ∑PCB concentrations were not different between the two countries (P < 0.05). The samples were collected from three different microenvironments, including bedrooms, living rooms, and corridors. ∑OPE, ∑PAH, and ∑BFR concentrations were up to five times higher in corridors compared to bedrooms and living rooms. ∑OCP and ∑PCB concentrations were overall higher in bedrooms and in living rooms and lower in corridors.

Mold and Human Health: a Reality Check

There are possibly millions of mold species on earth. The vast majority of these mold spores live in harmony with humans, rarely causing disease. The rare species that does cause disease does so by triggering allergies or asthma, or may be involved in hypersensitivity diseases such as allergic bronchopulmonary aspergillosis or allergic fungal sinusitis. Other hypersensitivity diseases include those related to occupational or domiciliary exposures to certain mold species, as in the case of Pigeon Breeder's disease, Farmer's lung, or humidifier fever. The final proven category of fungal diseases is through infection, as in the case of onchomycosis or coccidiomycosis. These diseases can be treated using anti-fungal agents. Molds and fungi can also be particularly important in infections that occur in immunocompromised patients. Systemic candidiasis does not occur unless the individual is immunodeficient. Previous reports of "toxic mold syndrome" or "toxic black mold" have been shown to be no more than media hype and mass hysteria, partly stemming from the misinterpreted concept of the "sick building syndrome." There is no scientific evidence that exposure to visible black mold in apartments and buildings can lead to the vague and subjective symptoms of memory loss, inability to focus, fatigue, and headaches that were reported by people who erroneously believed that they were suffering from "mycotoxicosis." Similarly, a causal relationship between cases of infant pulmonary hemorrhage and exposure to "black mold" has never been proven. Finally, there is no evidence of a link between autoimmune disease and mold exposure.

Solid fuel use for cooking and its health effects on the elderly in rural China

Indoor air pollution is mainly caused by solid fuel use for cooking in developing countries. Many previous studies focused on its health risks on the children and in specific local area. This paper investigates household energy usage and transition for cooking in rural China and the health effects on the elderly. A national large-scale dataset CHARLS (China Health and Retirement Longitudinal Study) covering 450 villages and communities is employed. Logit regressions were used to quantitatively estimate the effects, after controlling for some factors such as income, demographic, and geographical variables. The results robustly show that compared to non-solid fuels, solid fuel use significantly increases the possibility of chronic lung diseases (30%), exacerbation of chronic lung diseases (95%), seizure of heart disease (1.80 times), and decreases self-evaluated health status of the elderly (1.38 times). Thus, it is urgent to improve clean energy access for cooking in rural China.

The Influence of Thermal Comfort on the Quality of Life of Nursing Home Residents

Thermal comfort (TC) parameters were measured in 130 rooms from nursing homes (NH), following ISO 7730:2005 in order to evaluate the influence of winter season TC indices on quality of life (QoL) in older individuals. Mean radiant temperature (mrT), predicted mean vote (PMV) and predicted percent of dissatisfied people (PPD) indices, and the respective measurement uncertainties were calculated using Monte Carlo Method. The WHOQOL-BREF questionnaire was conducted from September 2012 to April 2013, during the winter season TC sampling campaign. Winter PMV and PPD indices showed significant differences between seasons in median values for comfort. There were also significant differences between seasons for air temperature, air velocity, mrT, and relative humidity. The winter PMV index displayed a "slightly cool" [≤-1] to "cool" [≤-2] in thermal sensation scale [-3 to 3]. PPD index reflected this discomfort as evidenced by a high rate of predicted dissatisfied occupants (64%). The influence of winter season TC on older individual QoL results demonstrated that values of PMV above -0.7 had higher mean score of QoL (coefficient estimate: 11.13 units) compared with values of PMV below -0.7. These findings are of relevance to public health and may be useful for understanding NH indoor environment variables thus implementing preventive policies in terms of standards and guidelines for these susceptible populations.