Association between exposure to green and blue spaces and respiratory health in the elderly: a scoping review

Given the ageing global population, chronic respiratory diseases like COPD and emphysema are increasingly contributing to health and economic burdens. Green and blue spaces offer potential respiratory health benefits through improved air quality, increased physical activity, and reduced stress. However, evidence regarding their impact on older adults is limited, with few studies addressing this population's long-term respiratory health outcomes. This scoping review aims to assess the effects of exposure to green and blue spaces on the respiratory health of older adults. Studies evaluating the impact of green and blue spaces on respiratory health in adults aged > 65 years were identified from Medline, Scopus, and Web of Science, with publications from August 2013 to August 2023 included. Both observational and experimental studies were considered. Inclusion criteria were defined based on the PCC framework (Population, Concept, Context). Data extraction and synthesis were conducted independently by multiple researchers. According to inclusion criteria, 27 studies were identified, including three intervention studies and 24 observational studies. Green spaces were linked to lower risks of mortality from lung cancer, pneumonia, and chronic obstructive pulmonary disease (COPD). However, the evidence for short-term effects was mixed, with some studies showing improvements in lung function and reduced respiratory symptoms after brief exposure to green spaces, while others found no significant changes. Only one study on blue spaces was retrieved, suggesting that coastal living may lessen the impact of air pollution on COPD hospitalizations. This review suggests that exposure to green spaces can offer significant respiratory health benefits, particularly in reducing mortality from respiratory diseases. The evidence for blue spaces remains limited, and the mixed results for short-term effects highlight the need for further research.