When home is a dangerous place: the cost of falls among older people living in the community.

Falls among older people are common, and they may have consequences such as fractures and injuries. Falls may also reduce older people's independence and wellbeing and increase demand for both healthcare and social care services. This research aims to investigate whether older people living in the community who experience poor housing conditions face a greater risk of falls than those living in better-quality housing after controlling for other risk factors. In particular, we aimed to (i) identify housing-related drivers of falls, and (ii) estimate associated costs. Using data from the English Longitudinal Study of Ageing (ELSA), covering the period from 2002/03-2021/23, we performed a combination of cross-lag and Heckman selection models to address endogeneity and selection bias. We also developed a decision tree model to estimate associated healthcare and social care costs. We found that those living in homes with electrical or plumbing problems, as well as those lacking space, are more likely to experience a fall. Similarly, we found that older people living in homes that are 'too dark' are more likely to experience a fall and to visit a healthcare service as a consequence. We estimated that the annual cost of falls attributable to poor housing conditions is £1.2 billion. 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, neighbourhood-level falls prevention strategy could yield significant benefits for individuals and for the sustainability of health and care systems.