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Housing conditions and limitations in physical function among older adults
  1. Esther García-Esquinas1,
  2. Bibiana Pérez-Hernández1,
  3. Pilar Guallar-Castillón1,
  4. José R Banegas1,
  5. José Luis Ayuso-Mateos2,
  6. Fernando Rodríguez-Artalejo1
  1. 1Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Idipaz and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
  2. 2Department of Psychiatry, Universidad Autónoma de Madrid/Instituto de Investigación del Hospital de la Princesa and CIBER of Mental Health (CIBERSAM), Madrid, Spain
  1. Correspondence to Dr Esther García-Esquinas, Department of Preventive Medicine and Public Health, School of Medicine Universidad Autónoma de Madrid Calle del Arzobispo Morcillo 4, Madrid 28029, Spain; esthergge{at}


Introduction Housing conditions are an important social determinant of health. However, to the best of our knowledge, no previous study has systematically assessed the association between housing conditions and physical function limitations in older adults; moreover, whether this association is independent of the socioeconomic status achieved earlier in life is still uncertain.

Methods Cross-sectional analysis conducted among 2012 non-institutionalised individuals aged ≥60 years, who participated in the Seniors-ENRICA cohort. Participants reported the following poor housing conditions: living in a walk-up building, lacking heating, or feeling cold frequently. We assessed lower extremity performance with the Short Physical Performance Battery (SPPB), mobility or agility limitations with standardised questions, frailty according to the Fried criteria, and disability in instrumental activities of daily living (IADL) with the Lawton and Brody questionnaire.

Results In analyses adjusting for demographic, behavioural and comorbidity variables, when compared with those living in homes without poor housing conditions, those with ≥2 poor conditions showed worse scores in the SPPB (β −1.06; 95% CI −1.46 to −0.65) and a higher frequency of agility limitation (OR 1.62; 95% CI 1.00 to 2.61) and frailty (OR 8.78; 95% CI 3.00 to 25.60). These associations held after adjustment for educational and occupational levels. Living in a walk-up building was associated with a higher frequency of frailty, while lacking heating was linked to lower scores in the 3 SPPB tests, as well as with an increased frequency of frailty and 4 of its components (exhaustion, slow walking speed, low physical activity and weakness). Feeling cold was linked to increased exhaustion. No association was found between housing conditions and IADL disability.

Conclusions Poor housing conditions, particularly living in a walk-up building and lacking heating, are independently associated with limitations in physical function in older adults. This entails serious inequalities in functional status, which should be firmly addressed.


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