JAMA Netw Open
Housing affordability is a risk factor in geriatric decline
Clinical Takeaway: Housing insecurity may warrant the same clinical attention as other modifiable risk factors in older adults. Asking about housing affordability and condition could help identify patients at elevated risk.
Housing has long been recognized as a social determinant of health, but its specific impact on aging-related outcomes has been understudied. This analysis tested whether three distinct dimensions of housing insecurity, affordability, quality, and neighborhood quality, independently predicted the development of geriatric conditions and mortality in older adults.
Two of these dimensions emerged as clinically meaningful. Older adults who spent at least 30% of their income on housing had a 23% higher risk of frailty, 24% higher risk of disability, 37% higher risk of dementia, and 51% higher risk of death over five years compared with those whose housing was affordable. This was after adjustment for age, sex, race and ethnicity, education, Medicaid eligibility, household income, smoking status, and comorbidities.
Poor housing quality, defined by interviewer-observed problems such as peeling paint, pests, broken steps, or roof damage, was associated with a 30% higher risk of frailty, 33% higher risk of disability, and 15% higher risk of mortality, but not dementia. Poor neighborhood quality showed no independent association with any outcome after adjusting for socioeconomic status.
Researchers analyzed data from 7,499 community-living adults age 65 or older in the National Health and Aging Trends Study, followed from 2015 to 2020 with mortality confirmed through linked Medicare records. The study did not capture housing instability indicators such as eviction or forced moves, which the authors flag as an important gap for future research.
Unaffordable housing may force trade-offs against medical care, medications, and nutrition, while poor housing quality exposes older adults to fall hazards, allergens, mold, and conditions that limit physical activity. Both pathways could plausibly accelerate the geriatric syndromes the study tracked.
The findings strengthen the case for incorporating housing into routine clinical assessment of older adults. The Centers for Medicare & Medicaid Services has begun including social determinants of health indicators in its Age-Friendly Hospital metrics, and the authors suggest housing affordability could be a candidate for similar integration into geriatric care models.
Source: Wang Y, et al. JAMA Netw Open. 2026 May 1. Housing Insecurity, Incident Geriatric Conditions, and Mortality in Community-Living Older Persons