Elsevier

Health & Place

Volume 12, Issue 3, September 2006, Pages 267-278
Health & Place

Housing related difficulties, housing tenure and variations in health status: evidence from older people in Wales

https://doi.org/10.1016/j.healthplace.2004.08.010Get rights and content

Abstract

This study aimed to examine housing-related difficulties, the relationship with housing tenure and the subsequent influences on health status in a population sample of older people in Wales. Comparisons with health status normative data were undertaken to determine any geographical differences. A random sample of respondents were interviewed in their own homes (N=423). Data included demographic information, self-reported health status, housing problems, tenure and factors relating to energy efficiency. Univariate analysis found that owner occupiers reported the least housing difficulties and the best health status. Those in public rented properties experienced the most difficulties and the poorest health. The health status of the sample was generally poorer than the norms. Multivariate analysis found that housing difficulties, being cold with current heating and hours spent at home predicted poorer health status. This suggests that characteristics of the home environment may help to explain the differences between tenure and health. Considerable financial outlay may be required to meet policy initiatives that support older people remaining independent, autonomous and able to ‘age in place’.

Introduction

Housing has been described as the foundation of social care (National Housing Federation, 1999; Harrison and Heywood, 2000) and is highlighted in the Framework for a National Housing Strategy for Wales as being an important factor in the successful delivery of ‘community care’ especially for older people wishing to remain in their own homes (National Consultative Forum on Housing in Wales, 1999). The importance of housing is further reinforced in the United Nation's International Plan of Action on Ageing (2000) which states

‘suitable housing is even more important for the elderly, whose abodes are the centre of virtually all of their activities’.

This paper reports some of the findings from a study entitled Housing for an Ageing Population: Planning Implications (HAPPI). HAPPI was designed to provide evidence on housing needs and preferences to inform policy decisions and address many of the requirements of the National Assembly for Wales. The objectives here were to examine housing difficulties, their relationship with housing tenure and the influences on the health status of a population sample of older people in Wales.

It has been estimated that older people spend between 70% and 90% of their time in their home (Baltes et al., 1990, Czaja, 1988, Gabb et al., 1991), therefore, an appropriate living environment should be considered crucial to maintain and/or enhance independent living (The Royal Commission on Long Term Care, 1999). Retaining independence and autonomy are recognised as being crucial for maintaining quality of life, underpinning policy and practice (UN/Division for Social Policy and Development, 2000, Welsh Assembly Government, 2003).

There is considerable evidence suggesting that poor quality housing can have an adverse effect on the health of its occupants (see Table 1), recently confirmed in a systematic review of the literature (Thompson et al., 2002).

For older people, health is widely acknowledged as one of the key elements of the ageing process (e.g. Siddell, 1995, Wenger et al., 2001). Findings from a longitudinal study show that the most salient life domain for older people is reported to be health and the maintenance of mobility (Wenger et al., 2001). Yet health and mobility difficulties can be exacerbated by an inappropriate home environment, affecting the ability to manage at home, which subsequently can impact on independent living (The Royal Commission on Long Term Care, 1999; The Office for National Statistics, 1999), and well-being (Lawton, 1989). Accidents, in particular falls are among the commonest causes of death and disability in older people (Effective Health Care, 1996). In total, 40% of fatal accidents occur in the home and 85% of these involve people over the age of 65 (Effective Health Care, 1996). The ability to heat the home is imperative, as the older population are far more susceptible to the effects of cold temperatures (Environmental Epidemiology Unit, 1999). A number of UK studies have found that houses occupied by older people are slightly colder than average (Collins, 1993) and the Welsh House Condition Survey (National Assembly for Wales, 2001a) found that older people were less likely to live in a home with central heating. The absence of central heating is considered to be an indicator of housing deprivation (National Assembly for Wales, 2000).

It could be argued that difficulties experienced at home by some older people are related to their functional status, and not necessarily a reflection of the condition of the property. On the other hand, if functional limitations are exacerbated by inappropriate housing conditions, then some occupants could face an increased risk of a poor health outcome. Previous research has identified that Wales has a relatively high level of ill health, and the health of the Welsh population as measured by life-expectancy and long term limiting illness is worse than the UK average (Acute Services Development Group, 2000). It is not being suggested here that these high levels of ill health are purely a consequence of poor housing however there are a number of factors relating to housing in Wales that are indicative of potential health risks. Poor and unfit housing is often associated with the age of the property, with older properties more likely to be classed as unfit (Leather et al., 1994; National Assembly for Wales, 2001a). The Welsh housing stock is older and in worse condition than in England: 8.5% of the housing stock was rated as unfit for habitation in 1999, which is above the level in England (National Consultative Forum on Housing in Wales, 1999). The 1998 Welsh House Condition Survey found that 14.9% of dwellings built before 1919 were unfit for habitation compared to 2.4% built after 1964. In Gwynedd (the study area), 48% of the housing stock was constructed before 1919 of which 17% was class as unfit1 (National Assembly for Wales, 2001a).

Housing quality varies further when examined by tenure. The highest proportions of unfit houses are in the private rented sector (Department of the Environment and Transport and the Regions, 2000). In Wales, research has demonstrated that 11.9% of owner occupied houses; 25.5% of private rented houses; 15.8% of LA rented houses and 6% of housing association rented houses were considered unfit. With the exception of the housing association houses these levels were consistently higher that the proportions of unfit housing in England (5.5% owner occupied; 20.5% private rented; 6.9% of LA rented and 6.7% of housing association) (Leather and Morrison, 1997).

Housing tenure is also associated with the age of occupants. The majority of older people are owner-occupiers (Office for National Statistics, 1999). Analysis of the General Household Survey demonstrated that in the age group 65–74, 66% were owner occupiers and owned their properties outright in comparison with 19% of the 45–54 age group. Wales has the largest proportion of home ownership in the UK (72%) and older home owners are more likely than other households to live in properties built before 1919 and least likely to live in properties built after 1965 (Hancock et al., 1999), potentially increasing the likelihood of their homes being of poorer quality. Poor quality housing in the UK has been found to be disproportionately occupied by single older people (Leather and Morrison, 1997). These properties tended to be older and in the private rented sector (Leather and Morrison, 1997). The Welsh House Condition Survey also found that the highest proportion of unfit properties in the owner occupied sector (12.2%) and in the private rented sector (25.7%) belonged to single people of a pensionable age. Older people in Wales may then have an increased chance of health risks from their properties, which may vary by tenure.

Variations in health status and mortality have been linked with housing tenure (owner occupied, or rented property). Home ownership is often found to be an independent predictor of better general health status (Thompson et al., 2002). Conversely, it has been found that living in rented property is associated with low health-related quality of life and low self-reported health status (Kind et al., 1999). A longitudinal study has found that living in rented property is associated with higher death rates compared to home-ownership. Mortality was 26% higher for male and 21% higher for females renting local authority properties than owners during 1971–1981. In the following period (1981–1989) the excess mortality among those renting was 22% for males and 32% for females (Filakti and Fox, 1995). In Scotland a population sample survey found that living in council rented accommodation, compared to living in private rented accommodation or being an owner-occupier, has been independently associated with ratings of both significant and severe chronic pain that had persisted for at least 3 months (Smith et al., 2001).

The reasons why housing tenure might determine variations in health status have until recently been given little attention (Ellaway and Macintyre, 1998). One suggestion is that the variation in health status for housing tenure reflects the socio-economic status of its occupants. Home-ownership is often regarded as an indicator of financial wealth, and socio-economic status is strongly related to health status (Harding et al., 1997). The notion that housing tenure predicts health status as it represents socio-economic status was examined by Macintyre et al. (1998). Using data from two adult cohorts in Scotland these authors found that home ownership was a predictor of better health even when factors such as income were controlled for. They concluded that health may vary perhaps because there were health promoting or health damaging factors in the properties across different housing tenures, these being the least problematic in owned properties.

Building on this finding Ellaway and Macintyre (1998) hypothesised that aspects of tenure (housing conditions and quality of the surrounding environment) could be associated with health, independent of income or social class. A survey of 318 40 year olds and 373 60 year olds in Scotland provided data on tenure and a number of potential housing stressors, such as damp or condensation, cold properties and noise. Their analysis suggests that poor housing and poor quality local environment contributed to poor health, independent of income. Thus, the quality of the housing stock across tenure groups may expose people to a home environment that can have a detrimental effect on their health.

Considering that house conditions can impact on health outcomes, appropriate housing for older people is clearly important. Within Wales there is more poor quality housing than the rest of the UK and the quality of the housing stock varies across housing tenure. Given the increased likelihood that as proportionally more older people live in poor quality housing they may experience housing-related difficulties, this paper aimed to examine whether health variations across housing tenure were due to housing-related difficulties. In line with the literature, it was hypothesised that:

  • 1.

    Respondents in private rented accommodation would experience the most problems, whilst owner occupiers would experience the least.

  • 2.

    Owner occupiers would report the best health status, those in rented accommodation the poorest.

    As there are differences between Wales and the rest of the UK for health status and housing quality, the third hypothesis was that:

  • 3.

    The study sample would have poorer health than UK population norms when examined across housing tenure.

    Finally a model was constructed to determine the independent influences of the variables on health status. In line with the literature it was hypothesised that:

  • 4.

    Characteristics of the home environment may help to explain differences in health between tenure groups. Housing difficulties would independently predict poorer health, irrespective of tenure.

Section snippets

Sampling

The sample for HAPPI was selected from the county of Gwynedd in North Wales to provide a representative sample from a diverse range of areas. These were a dispersed farming community, a retirement destination, an ex-quarrying community, an urban area, a concentration of difficult to let sheltered housing, and a market town.

In order to identify the appropriate age group and to achieve a random sample, a door-to-door census of occupied households in the chosen communities was conducted. Electoral

Results

Four respondents were excluded from this analysis as their scores on the EQ-VAS were difficult to interpret, and five refused to answer, leaving a final sample of 411 for the analysis. The age of the respondents’ ranged from 70 to 99, with the mean age being 78 (standard deviation=5.55). Fifty nine per cent were female and 41% male. 52% were married, 7% single, 37% widowed and 4% were divorced. 41% lived alone. The mean self-reported health score of the whole sample was 70.40 (standard

Discussion

The aim of this study was to examine housing difficulties, their relationship with housing tenure and the influences on the health status of a population sample of older people in Wales. The first hypothesis was partially supported. Owner occupiers experienced the least problems, which was predicted from the literature. Respondents in private rented accommodation had more difficulties than owner occupiers, but it was respondents in public rented accommodation who had the highest number of

Acknowledgements

The study represents collaborative research that has arisen from Gwynedd Rural Ageing Network (GRAN). GRAN is a wide network involving those with concerns in the area of services to older people in Gwynedd, North Wales. This work was funded by Wales Office for the Research and Development of Health and Social Care (WORD).

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