Long-term Care Needs and Fuel Poverty among Older People: Beyond Energy Consumption and Affordability.

Both financial disadvantage and poor housing conditions are recognised as social determinants of poorer health and health inequalities across and within countries. In the UK and some other nations, low income and housing problems in interaction manifest as 'fuel poverty'-a measure of a household's ability to keep their homes warm. In these countries, tackling fuel poverty has become a priority, not least because of the known negative effects on health. Nevertheless, there is no gold standard measurement of fuel poverty, and there is also, more importantly, scant evidence on the relationship between fuel poverty and the development of long-term care needs among older people, which is important as understanding this relationship could inform preventative policy interventions aimed at reducing care needs and associated costs. Older people spend a larger proportion of their time indoors and the role of fuel poverty has wider health and social care impacts that go beyond immediate household hardship. This paper i) develops a data-driven measure of fuel poverty that goes beyond household income and energy consumption, ii) explores whether fuel poverty is associated with the development of care needs, an increase in care needs, and/or a decline in mental health among older people, and iii) whether there are any inequalities in the role played by fuel poverty across more potentially vulnerable groups. We use the English Longitudinal Study of Ageing, a large representative sample of people aged 50 or over. Structural Equation Modelling was used to provide a latent and comprehensive definition of fuel poverty. We found that fuel poverty is associated with a greater risk of developing long-term care needs and worse mental health. We also found that fuel poverty is multidimensional and as such, influences the development of care needs from many fronts. We provide evidence on the importance of reducing fuel poverty as a potential prevention mechanism of higher (or development of) care needs, and is particularly relevant in the current energy and cost-of-living crisis context in many countries.