Green Healthy Housing for
Older Adults
Jill Breysse, CIH
National Center for Healthy Housing
Sherry Ahrentzen, PhD
University of Florida
By 2030, more than 70 million Americans –
and 960 million
people worldwide – will be 65 years or older
Seniors Susceptible to Housing Conditions
• Many older
adults spend 80% to 90% time indoors at home
• Bronchial hyper-responsiveness, respiratory, diabetes
• More likely to live in older homes
• Arthritis, osteoporosis, muscular atrophy, visual impairments
• With older heating/cooling systems
• Thermal stress, lower activity and metabolic rate, visual impairments
• Older homes can be damp, noisy, stuffy, dark
• Anxiety, depression, 11.2 million seniors living alone in 2008
• Homes built prior to ADA, Fair Housing, or visitability legislation
• Physical, sensory and cognitive disabilities
• Majority live in auto-dependent suburbs
• Limited mobility, diverse population with diverse housing needs
• More likely to engage in pro-environmental behaviors, purchases
• Depression-era frugality, practices, familiarity, consumption values
Is Green Housing Healthy Housing for Seniors?
Two Retrofit Case Studies
GREAT Study: Mankato MN
GAP Study: Phoenix AZ
• Cold Climate (Zone 6)
• 7-story, circa 1970s
• Public housing, primarily seniors
and disabled
• Retrofit to Enterprise Green
Communities & LEED
• Lengthy construction (~2 yrs)
• Environ. monitoring,
health interviews, VA,
bldg performance
• HOS-based interview
• Panel study, pre- and post-
• Hot, Arid Climate (Zone 2)
• 3-story, circa 1970s
• Project-based Section 8,
seniors only
• Retrofit to ARRA Green
Retrofit Program
• Short construction (~6 mos)
• Environ. monitoring, health
interviews, bldg performance,
environ. perceptions
• NHIS-, BRFSS-based interview
• Panel study, pre- and post-
Health Outcomes Among Primarily Elderly
Residents Associated with
Green-Renovated Public Housing
Study Team
Orness photo: Blumentals Architects
Research Goals
Baseline to 1-year post:
• Resident physical and mental health change
• If health declined, resident health declined less than that
of general MN population
• Improvements in temperature, RH, CO2, allergens, total
volatile organic chemicals (TVOC), & formaldehyde levels
• Decrease in # of housing condition deficiencies
PRE-RENOVATION
Source: Blumental Architects
GREEN
POST-RENOVATION
RENOVATION
Source: Blumental Architects
Methodology
• Health Interview:
– Physical &Mental Health: Medicare Health Outcomes Survey (HOS)
• VR-12 Health Survey Physical Component Score (PCS) &
Mental Component Score (MCS)
• Limitations in Activities of Daily Living (ADL)
– Housing condition
• Visual Assessment
• Environmental Monitoring and Sampling
• Building Performance Testing
11
Study and Comparison Groups
Study Group:
• Baseline: 53+19=72 residents in two stages
• 1-Yr Post: 40 of 49 baseline participants
• 2 study groups: All Ages (33-86 yrs; n=40) &
Elder (65-86 yrs; n=22)
Comparison Group: Medicare HOS: HOS All Ages
group (n=40); HOS Elder group (n=572)
Study Group Baseline
Demographics (n=40)
• Median age 66 years
• 70% female
• 95% non-Hispanic White
• 92% had incomes <$20,000
• 82% high school or college
13
All Ages: Mental Health Outcomes
Study Group
Change
HOS Group
Change
Study vs
HOS
Mean # of good
days
1.6
(p=0.066)*
-1.5
(p=0.167)
p=0.026**
Mean VR-12 MCS
1.9
(p=0.159)
-2.8
(p=0.071)*
p=.023**
Outcome
14
*marginally significant and **significant at p<0.05
All Ages: Physical Health Outcomes
Outcome
% who fell in past year
% in fair or poor health
% with ≥1 ADL limitation
Mean VR-12 PCS
Mean # of good days
Study Group HOS Group Study vs.
Change
Change
HOS
-16%
(p=0.134)
-8%
(p=0.317)
28%
(p=0.002)**
-1.1
(p=0.578)
1.4
(p=0.366)
8%
(p=0.257)
2%
(p=0.705)
13%
(p=0.096)*
-0.3
(p=0.797)
0.7
(p=0.546)
p=0.055*
p=0.314
p=0.196
p=0.737
p=0.704
*marginally significant and **significant at p<0.05
ELDER: Physical Health Outcomes
Outcome
% who fell in past year
% in fair or poor health
% with ≥1 ADL limitation
Mean VR-12 PCS
Mean # of good days
Study Group HOS Group
Change
Change
-5%
(p=0.739)
-9%
(p=0.317)
32%
(p=0.008)**
-2.1
(p=0.503)
0.9
(p=0.729)
0%
(p=1.000)
6%
(p<0.001)**
4%
(p=0.024)**
-0.7
(p=0.064)*
-0.7
(p=0.099)*
Study vs
HOS
p=0.742
p=0.094*
p=0.021**
p=0.669
p=0.526
*marginally significant and **significant at p<0.05
Housing
Condition
Tobacco Smoke: -20%**
Water/Dampness: -30%**
Insecticide Use: -38%**
Kitchen Fan Use: 0.6**
Bathroom Fan Use: 2.9**
**significant at p<0.05
Environmental
Monitoring and Sampling
• Dewpoint: Connection between indoor and
outdoor
• CO2 levels significantly improved
• No significant change in TVOC, formaldehyde,
most allergens
18
Building Performance
• Fresh Air Ventilation: 1-BR: 53 cfm
(ASHRAE 20 cfm)
• Bathroom Exhaust Testing: 29 cfm
(ASHRAE 25 cfm)
• Pressure Balance: minimal
deviations from design
• Energy Use: 44% reduction
19
Conclusions
•
•
•
•
•
Greatly improved building, esp. HVAC system
Improved mental health
Improved general physical health
Fewer falls
Substantially less indoor smoking
20
Green Apple Project [GAP]
Phoenix, AZ
Green Apple Project Research Team
Sunnyslope Manor — Phoenix
After a green retrofit of assisted housing
development for low-income older adults…
• IEQ will show sustained
improvement although it may
be worse immediately
• If IEQ improves, residents will
perceive this change
• Environmental and IEQ
improvements will correlate
with corresponding changes
in resident health, behavior
and attitudes
• Retrofit changes may result in
healthcare cost savings, for
falls prevention
Research Methodology
• Panel Study: O X O O
• Data Collection Periods
P1: June-July 2010
X: Feb – July 2011
P2: April – Sep 2011
P3: June – Aug 2012
• Sample Size
— P1: 77 residents in 73 units
— P1 + P2: 59 residents in 55 units
— P1 + P3: 57 residents in 53 units
• Proxy + Threshold Measures
Major Renovations
• PTAC system updated
• Energy Star exhaust fans, appliances
• New bedroom ceiling fan
• Double-pane, low-E sliding balcony
door and window
• Low-flow plumbing fixtures
• New roof primer, insulation
• Complete kitchen remodel and
bathroom remodel with low-VOC
materials
• Low-VOC flooring, paint, adhesives
Resident Characteristics
• 74% women, 26% men
• Average age: 73 (range 62 to 92)
• Race/ethnicity: 83% White,
5% Native American, 4% African American,
2% Asian American, 14% Latino
• 21% smoke
• 88% live alone
• 65% report at least 1 respiratory problem
• # days in last 30 that physical health
not good (at P1): 3 (median)
• Emotional distress significantly higher
than national sample (NHIS) of low-income
older adults
IEQ Data Collection
•
•
•
•
•
•
•
Temperature
RH
CFM50
Particulate Matter
Formaldehyde
Acetone
Acetaldehyde
Health Data Collection
(NHIS, BFRSS/Arizona)
•
•
•
•
•
•
Quality of Health/Life
Respiratory-related
Emotional distress
Sleep
Functional activities
Falls
also
• Comfort/satisfaction of
lighting, thermal, air
quality, humidity
• Household cleaning
frequency, products
Panel (Fixed-Effects) Regression Analyses “Scorecard”
Immediate Outcomes
Sustaining Outcomes
•
•
•
•
•
•
•
Temperature
RH
Air Infiltration
Particulate Matter
Formaldehyde
Acetone
Acetaldehyde
•
•
•
•
•
•
•
Temperature (min, max, extremes, var)
RH (variability)
Air Infiltration
Particulate Matter (for smokers)
Formaldehyde
Acetone (i/o only)
Acetaldehyde
•
•
•
•
•
•
•
Overall Quality of Health/Life
Respiratory
Emotional Distress
Sleep
Functional Limitations, Falls
IEQ Perceptions
Cleaning Behaviors19
•
•
•
•
•
•
•
•
Overall Quality of Health/Life
Respiratory
Emotional Distress (improve)
Sleep
Functional Limitations, Falls
IEQ Perceptions
Cleaning Behaviors + Booklet Use
Falls Risk Cost Threshold Exceeded
1. Major Finding:
Extreme Temperature Reductions
Overall across panels,
a noticeable reduction
in extreme
indoor temperatures
Count = # of times of
448 data points that
Indoor temperature
exceeded 81º
in Units
Extreme Temperature Reductions in Units (cont.)
Within a resident’s
apartment,
significant reductions
in number of
instances of extreme
indoor temperatures
from baseline to
post-retrofit panels
Extreme Temperature Reductions in Units (cont.)
Significant
Regression of Exceed 81 Changes on
correspondence
Reported Health Changes, for P1P3
between a unit’s
sustained (P1P3)
Quality of
Emotional
Health/Life
Distress
reduction in extreme
temperature AND
t
m
t
p value
improvements in
resident’s reported
Exceed 81 3.179
.002
-2.085
.039
quality of health/life,
emotional distress
and sleep
# Hours Sleep
t
p value
2.150
.034
2. Major Finding:
Formaldehyde Reduction
Material choices
(i.e. low VOC
sealants and paint)
had greatest
impact on
decreased
formaldehyde.
Astoundingly high
levels of FA found
in Panels 1 and 2;
decreased in every
unit in the long
term.
Initial elevation
can be expected
for installation of
new carpeting or
cabinetry.
3. Major Finding:
Reduced Emotional Distress Associated with Changes in
Environmental Perceptions Following Retrofit
•
Physiological Changes
– Quality of life/health
– Functional activities
• Environmental Changes
– Long-term reductions in
extreme temperature in unit
– Short-term (and marginally
long term) reductions in
formaldehyde concentrations
– Long-term reduction after
construction
• Environmental Contribution
(+P2, -P3)
• Resident Perceptions of
Environmental Quality (P3)
– Satisfaction kitchen lighting
– Satisfaction kitchen temperature
– Satisfaction kitchen air quality
– Lighting enhances comfort
– Satisfaction with visual comfort
Quality of Functional Kitchen
Life
Activities
Light
Kitchen Kitchen
Light
Visual
Temp Air Quality Enhances comfort
0
-0.1
-0.2
-0.3
-0.4
-0.5
-0.6
Panel 1
Panel 3
Level of significance
4. Major Finding:
Expected Reductions in Health Care Costs of Falls
Approximate Target Renovation Costs
Falls Post Renovation:
Baseline rate of injuries over 15 years:
330 falls, of which
105 would require medical care
After 3 months: 52% reduction
After one year: 6% reduction
$$$
At 6% reduction, savings in health care
costs ($266,000) approximate cost of
selected renovations ($286,000) for:
•
•
•
Improved lighting
Improvements in floor treatments
Improvements in stairway hand rails
Take-Home Lessons
• Both studies: Green renovation can have positive
impact on mental health and fall prevention
• GAP: Green renovation may reduce exposure to
contaminants, and some health improvements
may be tied to changes in environmental quality
• GREAT: No-smoking policies may be feasible part
of green renovation
Where to Go From Here
Studies of and Programs for Older Adults need to:
— Capture impact on healthcare costs
— Ask appropriate questions to better assess health- and activityrelated changes of older people
— Oversample those with more serious chronic health problems,
especially respiratory illness
— Examine relevancy of conventional IEQ standards for older
people
— Collect biomarker data to objectively measure health changes
— In conjunction with home renovations, collect data on
non-structural interventions impacting health, e.g., smoking
programs, home visits by health professionals
Teams
GREAT Study: Minnesota
GAP Study: Phoenix, Arizona
Jill Breysse:
National Center for Healthy Housing
Sherry Dixon:
National Center for Healthy Housing
David Jacobs:
National Center for Healthy Housing
Jorge Lopez:
Southwest Minnesota Housing
Partnership
Billy Weber:
University of Minnesota, Center for
Sustainable Building Research
Co-PIs:
Ernesto Fonseca, Matt Fraser,
William Johnson, Mookesh Patel:
Arizona State University
Kimberly Shea:
University of Arizona
Hugo Destaillats:
Lawrence Berkeley National Lab
Sherry Ahrentzen:
University of Florida
Lead Research Assistants:
Sarah Frey, John Ball, Sarah Stone,
James Erickson, Angela Larson
Funding
These projects were funded by the U.S. Department of Housing and
Urban Development (HUD), Office of Healthy Homes and Lead Hazard
Control.
The work that provided the data for part of this presentation was
supported by “Recovery Act or American Recovery and Reinvestment Act
(ARRA)” funding under an award with HUD.
The substance and findings of the work are dedicated to the public.
The authors are solely responsible for the accuracy of the statements and
interpretations contained in this publication. Such interpretations do not
necessarily reflect the views of the Government.
Contact Information
Jill Breysse
jbreysse@nchh.org
Sherry Ahrentzen
ahrentzen@dcp.ufl.edu