Housing adaptations and older adults’ health trajectories by level of initial health: evidence from the English Longitudinal Study of Ageing

In many ageing societies, the housing stock is poorly designed to meet the needs of older people with health limitations. Housing adaptations may enable older people to retain functional ability in the home, improve well-being and reduce the risks of falls. There is mixed evidence on whether adaptations are most beneficial for those who have limitations or whether they have a greater impact if implemented before people experience substantial disability. This study aimed to identify socio-demographic factors associated with obtaining housing adaptations and whether and how the impact of adaptations on changes in mental and physical health varied by initial level of health measured using objective indicators. We used data from the English Longitudinal Study of Ageing to analyse socio-demographic factors associated with acquiring housing adaptations using logistic regression. We then estimated mixed-effects models to assess how a measure of baseline physical health, derived from observer-measured indicators of physical function, modified the association between acquiring housing adaptations and health and disability outcomes for two cohorts each followed up for three waves. Having more activities of daily living (ADL) limitations was positively associated with acquiring housing adaptations, but we found no evidence for socio-demographic variations. Acquiring housing adaptations was associated with slower development of instrumental ADL/ADL disability among older people with initially good latent physical health. Sensitivity analysis suggested that housing adaptations mitigated the predicted probability of falls for those with severe mobility impairments. Housing adaptations may slow down development of disability in older people with initially good health.