Affiliation:
1. VA Connecticut Healthcare System US Department of Veterans Affairs West Haven Connecticut USA
2. National Clinician Scholars Program Yale School of Medicine New Haven Connecticut USA
3. Department of Surgery Maine Medical Center Portland Maine USA
4. Department of Internal Medicine Yale School of Medicine New Haven Connecticut USA
5. Department of Social and Behavioral Health Yale School of Public Health New Haven Connecticut USA
6. Department of Surgery Yale School of Medicine New Haven Connecticut USA
Abstract
AbstractObjectivesThe number of older adults struggling to maintain adequate housing is growing. Prior studies have used various criteria to measure housing insecurity; however, no standardized definition exists to date. Using a multidimensional approach, our study sought to calculate population‐based estimates of various forms of housing insecurity among community‐living older Americans and determine how these estimates differ across key characteristics.MethodsThis study utilized data from the 2011 round of the National Health and Aging Trends Study (NHATS), a prospective longitudinal study of Medicare beneficiaries aged 65 years or older. Three key forms of housing insecurity were operationalized: poor housing affordability (PHA), poor housing quality (PHQ), and poor neighborhood quality (PNQ). Population‐based estimates of these forms of housing insecurity were calculated using analytic sampling weights and stratified by age, gender, race and ethnicity, frailty status, and dementia status.ResultsTotally 6466 participants were included in the analysis, representing 29,848,119 community‐living older Americans. The mean (standard deviation) age was 77.3 (7.7) years; by weighted percentages, 56.0% identified as female, 81.3% as White, 8.2% Black, and 7.1% Hispanic. At least one form of housing insecurity was identified in 38.5% of older Americans. Individually, the prevalence of PHA was 14.8%, PHQ 24%, and PNQ 12.5%. The prevalence of at least one form of housing insecurity was higher among persons of color (62.9% Black and 66% Hispanic vs White; p < 0.001), those with frailty (40.9% pre‐frail and 49.4% frail vs robust; p < 0.001), and those with cognitive impairment (48.1% possible and 51% probable dementia vs no dementia; p < 0.001).DiscussionNearly one in three community‐living older Americans experience at least one form of housing insecurity. This was most common among vulnerable subgroups. Our multidimensional approach to defining various forms of housing insecurity can be used for future studies focused on improving social determinants of health among high‐risk older adults.
Funder
National Institute on Minority Health and Health Disparities
National Center for Advancing Translational Sciences
National Institute on Aging
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