The Aging World

The number of people worldwide aged 60 years and older (United Nations 2022)

Age-Friendly Communities Framework

Launched by the World Health Organization in 2007.

Recognized the impact of the built and social environment on healthy aging.

Community Features and Older Adult Health

• Housing, outdoor spaces, and social participation were associated with a decreased likelihood of any functional limitation (Choi 2020)

• Outdoor spaces and transportation were positively associated with high self-rated health (Choi 2020)

• Outdoor spaces, health/community services, and social participation were positively associated with self-rated health (Kim, Buckley, Burnette, Kim, et al. 2022)

• AARP Livability Index was positively associated with self-rated health(Kim, Buckley, Burnette, Huang, et al. 2022)

• Healthcare service proximity, fewer neighborhood problems, social support, and community engagement were positively associated with self-rated health (Lehning, Smith, and Dunkle 2014)

Housing and Older Adult Health

• Housing problems associated with poorer health (Kantz, Enah, and Abdallah 2023)

• Housing insecurity associated with poorer health and development of new chronic conditions (Bhat et al. 2022)

• Renters have lower self-rated health than homeowners (Mehdipanah et al. 2022)

• Among low-income renters, rental cost burden was associated with declining health and the development of functional limitations (Jenkins Morales and Robert 2022)

Conceptual Models

Housing functions as an intermediary between community-level factors and individual health.

• Social Determinants of Health
• Social Ecology

Conceptual Models

Housing as a Social Determinant of Health (Swope and Hernández 2019)

Conceptual Models

Housing as a Social Determinant of Health (Swope and Hernández 2019)

The Four C’s

• Cost: the financial burden of acquiring and maintaining housing including rent, utilities, mortgage, maintenance, and modification.

• Conditions: the structural soundness, environmental hazards, and safety features of a home.

• Consistency: the resident’s ability to remain in their home while avoiding harassment and dispossession.

• Context: the qualities of the build and social environments and the availability of resources.

Conceptual Models

Ecological Model (Mehdipanah et al. 2017)

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Conceptual Models

Mehdipanah et al. (2017) tested their model using census tract data.

Home ownership partially mediated the relationship between neighborhood racial composition and mortality, but not neighborhood racial composition and disability.

Home value did not moderate relationship between neighborhood racial composition and either health outcome.

Ecological Model of Community Age-Friendliness, Housing, and Health Among Older Adults

Structural forces shape the age-friendliness and housing system within a community.

Policies, programs, and features that support aging may not provide equitable benefit across the range of housing circumstances.

• Why?

  • The centrality of home ownership in the U.S. retirement model (Haurin and Moulton 2017)

  • Unaffordable housing limits the amount of money available to engage in health-promoting behaviors (Meltzer and Schwartz 2016)

  • Strategies used to cope with unaffordability (overcrowding, neglecting needs) compromise health (Swope and Hernández 2019)

Ecological Model

• Hypotheses

  • H1: Rating of community as a place to age is positively associated with self-rated health.

  • H2: Housing tenure modifies the association between community rating and health.

  • H3: Being concerned about housing affordability modifies the association between community rating and health.

Data Source

2021 Central Ohio Regional Assessment on Aging.

• Eligible households were identified using household data managed by Data Axle.

• Random sample stratified by county.

• 15% response rate resulted in 1417 surveys.

• Removed 37 participants who reported their housing tenure as “other”.

• Final analytic sample of 1380.

Missing Data

• 5% of all data was missing.

• 37% of respondents had incomplete data.

• MCAR Test (χ2 = 601.35, df = 427, p < 0.001) indicated non-random missingness.

• Imputed 37 data sets using multiple imputation by chained equations (Azur et al. 2011).

Analytic Approach

Moderation Effect Size

\(\Delta R^2_{mo}\) procedure to measure the proportion of variance of self-rated health jointly explained by community rating and the interaction term that is uniquely attributed to the interaction term (Liu and Yuan 2021).

where:

\(\Delta R^2_{mo} = \frac{R^2_2 - R^2_1}{R^2_2- R^2_0}\)

\(R^2_0\) corresponds to the moderator only model

\(R^2_1\) corresponds to the main effects model

\(R^2_2\) corresponds to the interaction model

Housing Tenure Interaction Plot

Affordability Concern Interaction Plot

Moderation Effect Size

Conclusion

Hypothesis 1 Subjective rating of one’s community as a place to age was positively associated with self-rated health.

Hypothesis 2 Housing tenure did not modify the relationship between community rating and health.

Hypothesis 3 There is weak evidence that housing affordability concerns modified the relationship between community rating and health.

Conclusion

• The positive connection between community rating and older adult health is strong, but unaffordable housing may the by undermine this relationship.

• Older adults living in unaffordable housing are perceiving the desirable aspects of their community but not experiencing the health benefits of them.

• Increasing access to affordable housing may allow the health benefits of age-friendly initiatives to be distributed more equitably.

Limitations

• Coarse measurements of health (1-5), community as a place to age (1-5), and affordability concerns (Y/N).

• Subjective rating is not well established in the literature of age-friendly communities and health.

• Regional sample excludes other types of housing markets (i.e. high density or shrinking city).