Air pollution and self-care ability among middle-aged and older adults: evidence from China

Amid rapid population ageing, designing an effective elderly care system requires understanding the health risks faced by older adults. Ambient air pollution presents a widespread environmental threat, particularly to the self-care ability of middle-aged and older adults. This study investigates the impact of PM2.5 exposure on activities of daily living in China, using longitudinal data from CHARLS and fixed-effects models. We find that each 1 µg/m3 increase in PM2.5 leads to the ADL, BADL, and IADL impairment increases by 0.0886, 0.0397, and 0.0493 units, equivalent to 4.36%, 3.64%, and 4.40% of their respective standard deviations. The effects are most severe in specific domains such as bathing, getting in and out of bed, toilet use, shopping, taking medicine, and handling finances. Vulnerability is higher among those aged 60 or older, women, rural residents, the less educated. Importantly, family support – economic, emotional, and daily care – can mitigate these negative effects. Mechanism analysis reveals that air pollution can indirectly impair the self-care ability by increasing the incidence of cardiovascular diseases and undermining cognitive level. These results reveal the role of familial buffers in environmental health and offer policy insights for supporting ageing populations in polluted environments.