Housing quality and related housing environmental factors associated with falls in older adults: results from the longitudinal ageing study in India

BACKGROUND: Falls are a significant cause of morbidity, disability, and mortality amongst older adults worldwide, with approximately one-third of Indian older adults experiencing falls annually. Despite extensive research on individual-level risk factors, the relationship between housing quality and fall risk remains understudied. This study examined the relationship between housing quality and falls. METHODS: We analysed data from 30 632 adults aged ≥60 years from the longitudinal ageing study in India (2017-2018). Housing quality was assessed using five indicators (housing materials, sanitation, water access, cooking fuel, electricity) categorised as good (scores 0-1), moderate (scores 2-3), or poor (scores 4-5). Related environmental factors included lack of separate bedrooms/kitchens, indoor air pollutants, and household dampness. Self-reported falls >2 years were analysed using generalised linear mixed models with adjustment for sociodemographic, health, and lifestyle factors. RESULTS: Participants had a median age of 67 years (interquartile range: 63, 73) with 52.0% female. After full adjustment, the housing quality index showed significant association with falls [odds ratio (OR) = 1.17, 95% confidence interval (CI): 1.13-1.21 per unit increase, P < .001]. Compared to good housing quality, moderate (OR = 1.32, 95% CI: 1.20-1.45) and poor (OR = 1.76, 95% CI: 1.56-1.98) housing quality were associated with a higher fall risk. Four housing quality indicators (poor sanitation, inadequate water access, solid fuel use, lack of electricity) and related housing environment factors (lack of separate bedrooms/kitchen, indoor air pollutants, household dampness) were all independently associated with increased fall risk. CONCLUSIONS: Poor housing quality significantly increases fall risk in older Indians, suggesting housing interventions may be effective fall prevention strategies.