Using data from the English Longitudinal Study of Ageing (ELSA), our recent research explored whether poor housing conditions increase the risk of falls among older people living in the community, and what this means for health and care associated costs. The findings suggest that housing quality is not just a background issue, but a key and avoidable driver of falls. Some of the issues identified, such as lack of space or inadequate lighting, are not necessarily expensive to address, but may require coordinated action from local government, the voluntary sector, and families.

Falls are common and costly

Each year, around one in three people aged 65 or over experiences at least one fall. For many, this leads to injuries, fractures, or a loss of confidence that reduces independence and quality of life. Around one in ten older people who fall require healthcare, adding pressure to already stretched health and care services .

While most research focuses on individual risk factors (such as age, long-term conditions, or mobility) much less attention has been given to housing conditions, even though older people spend much of their time at home.

Which housing problems matter most?

Our analysis found that certain housing issues significantly increase the likelihood of falling, even after accounting for age, health, disability, previous falls, and other key factors. Older people living in homes with electrical or plumbing problems were 11% more likely to fall. Lack of space, often linked to clutter or difficulty moving around safely, increased fall risk by 3%.

Some housing problems were also linked to more serious falls. Living in a home that is too dark or poorly lit, or one with electrical or plumbing issues, increased the risk of falling and needing healthcare as a result. In other words, housing conditions not only affect whether falls occur, but also how severe their consequences can be.

Interestingly, issues such as cold temperatures, noise, condensation, or general disrepair were not found to be statistically significant once other factors were taken into account, highlighting that targeted improvements may be especially effective.

The hidden cost of poor housing

Falls linked to poor housing are harmful and expensive. We estimate that around £1.2 billion per year in healthcare and formal care costs can be attributed to falls among older people living in poor-quality housing. Notably, care costs account for nearly two-thirds of this total. Costs to individuals and families (e.g. unpaid care or lost income) also exist but could not be included due to data limitations.

Our modelling indicates that home adaptations and repairs could reduce total costs by around 23%, while supporting older people to remain independent for longer.

Why housing must be part of falls prevention

Improving housing quality should be a core component of falls prevention. Many helpful changes, better lighting, minor repairs, decluttering, or rearranging furniture, are relatively inexpensive. However, addressing housing problems often requires coordinated effort.

By working across housing, health, and care sectors, we can reduce avoidable falls, ease pressure on services, and support older people to live safely and well at home.

*Javiera Cartagena-Farías is an Assistant Professorial Research Fellow at the Care Policy and Evaluation Centre (CPEC) at the London School of Economics and Political Science (LSE).

**Debs Smith is a Public Advisory at the NIHR Policy Research Unit: Economics of Health and Social Care Systems (ESHCRU).

When home is a dangerous place: the cost of falls among older people living in the community Cartagena-Farías J, Fernández JL, Silva-Ribeiro W, Brimblecombe N (2026) When home is a dangerous place: the cost of falls among older people living in the community. PLOS ONE 21(8): e0353755. https://doi.org/10.1371/journal.pone.0353755

This research is funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme (reference NIHR206116). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.