Housing Cost Burden and Health Decline Among Older Adults

Background and Purpose: Coinciding with population aging and the growing affordable housing crisis, older Americans are increasingly spending more of their income on housing and often face trade-offs between covering housing costs or paying for food, medications and other health-related expenses. Emerging evidence suggests that unaffordable housing is associated with poor health and that renters are especially vulnerable, but many studies exclude the older population and do not examine changes in health over time. This is the first known study to address this gap by examining the extent to which housing cost burden (HCB) and differences by housing tenure are associated with health decline in old age. We hypothesize that HCB contributes to declines in health and that older renters (versus owners) are most at risk.

Methods: We use a nationally representative sample (n=4,819) of older community-dwelling Medicare beneficiaries from the 2015 National Health and Aging Trends Study to test the association between HCB and health decline two years later (2017). HCB is defined as spending 30% or more of monthly income on rent or mortgage. We use the following typology: owners without HCB (referent), renters without HCB, owners with HCB, and renters with HCB. Our dependent variables are physical capacity (0-12; capacity on activities such as, walking, climbing stairs, lifting, opening jars, etc.), self-rated health (1=poor; 5=excellent), depression (≥3 Patient Health Questionnaire-2), and anxiety (≥3 Generalized Anxiety Disorder-2). Weighted regression models (linear and logistic) adjust for race, age, gender, low-income, education, living alone, and the corresponding baseline (2015) health measure.

Results: 47% of renters with HCB and 38% of owners with HCB experienced physical capacity decline over two years compared to 34% of owners and 37% of renters without HCB. Holding all else constant, owners (β=-0.24, SE=0.10) and renters (β=-0.38, SE=0.15) with HCB were both at risk of physical capacity decline (compared to owners without HCB). HCB was not significantly associated with declines in self-rated health two years later. Compared to owners without HCB, renters with HCB were significantly more likely to develop anxiety (OR=1.78, SE=0.33), whereas owners with HCB were significantly more likely to develop depression by 2017 (OR=1.76, SE=0.44), holding all else constant.

Conclusions and Implications: Living in affordable housing helps older adults age well in the community. Our findings suggest that, even in the short-term, HCB contributes to declines in physical capacity and mental health among older adults. Collaboration across aging, housing and healthcare sectors is necessary to develop affordable housing solutions that meet the needs of the aging population. Social work assessments at the individual and community level should include measures of housing affordability and social workers should continue advocacy efforts to improve access to subsidized affordable housing options for older adults. Future research should investigate potential differences in the mental health effects of HCB among older owners and renters.