Poor housing rivals prior falls in predicting falls

Clinical takeaway: The home environment may add important context to fall risk in older adults beyond what is captured in the clinical history, particularly when everyday surroundings may affect safety and mobility.

A fall is rarely just a fall for an older adult. It can mean injury, loss of independence, and a lasting need for care. New longitudinal data suggest that the condition of the home may play a larger role in that risk than previously recognized.

Researchers looked at housing conditions reported before subsequent falls in adults aged 65 and older. Electrical or plumbing problems were associated with roughly an 11-percentage-point higher probability of falling. That came close to the 15-point increase associated with a previous fall, and was more than twice the increase seen with poor health, long-term illness or disability, or each additional limitation in basic daily activities.

Other parts of the home also stood out. Lack of space was associated with about a 3-point higher probability of falling. Poor lighting was associated with about a 9-point higher probability of a fall that required medical care. In contrast, general disrepair, cold, noise, condensation, leaks, pest infestations, and damp did not show clear associations.

Researchers followed older adults in the UK for roughly two decades, from 2002 to 2023, to examine whether housing problems reported earlier were associated with falls reported later. The analysis accounted for previous falls, health, functional needs, and other factors, helping separate the housing findings from changes that might follow a fall. Participants reported both their housing conditions and whether they had fallen.

The financial consequences could be substantial. A separate model estimated that falls attributed to poor housing account for about £1.2 billion, or approximately $1.6 billion, each year in health and paid social care costs, with formal care representing the larger share. Because the model drew on assumptions and data from previous studies, the researchers tested how much the estimate changed under different assumptions. The total ranged from roughly £1 billion to £2 billion, or about $1.3 billion to $2.7 billion.

The authors placed the findings within a broader approach to fall prevention. “Poor housing conditions significantly increase the risk of falls among older people. Associated costs could be avoided. Viewing housing improvements as part of an integrated falls-prevention strategy could yield significant benefits for individuals and for the sustainability of health and care systems,” they wrote.

For everyday practice, the findings widen what may be relevant when trying to understand an older adult’s fall risk. Medical history and function remain central, but limited space, poor lighting, and unresolved electrical or plumbing problems, may reveal risks that are easy to miss when assessing why an older adult is vulnerable to falls.

Source: Cartagena-Farías J, et al. (2026 Aug 5) PLoS One. When home is a dangerous place: the cost of falls among older people living in the community