{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T14:30:55Z","timestamp":1786113055656,"version":"build-2736575974"},"reference-count":47,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["NIHR206116"],"award-info":[{"award-number":["NIHR206116"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Falls among older people are common, and they may have consequences such as fractures and injuries. Falls may also reduce older people\u2019s independence and wellbeing and increase demand for both healthcare and social care services. This research aims to investigate whether older people living in the community who experience poor housing conditions face a greater risk of falls than those living in better-quality housing after controlling for other risk factors. In particular, we aimed to (i) identify housing-related drivers of falls, and (ii) estimate associated costs. Using data from the English Longitudinal Study of Ageing (ELSA), covering the period from 2002\/03\u20132021\/23, we performed a combination of cross-lag and Heckman selection models to address endogeneity and selection bias. We also developed a decision tree model to estimate associated healthcare and social care costs. We found that those living in homes with electrical or plumbing problems, as well as those lacking space, are more likely to experience a fall. Similarly, we found that older people living in homes that are \u2018too dark\u2019 are more likely to experience a fall and to visit a healthcare service as a consequence. We estimated that the annual cost of falls attributable to poor housing conditions is \u00a31.2 billion. Poor housing conditions significantly increase the risk of falls among older people. Associated costs could be avoided. Viewing housing improvements as part of an integrated, neighbourhood-level falls prevention strategy could yield significant benefits for individuals and for the sustainability of health and care systems.<\/jats:p>","DOI":"10.1371\/journal.pone.0353755","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T17:22:23Z","timestamp":1785950543000},"page":"e0353755","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["When home is a dangerous place: the cost of falls among older people living in the community"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5984-0317","authenticated-orcid":true,"given":"Javiera","family":"Cartagena-Far\u00edas","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4190-7341","authenticated-orcid":true,"given":"Jos\u00e9-Luis","family":"Fern\u00e1ndez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wagner","family":"Silva-Ribeiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Brimblecombe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"pone.0353755.ref001","author":"Office for Health Improvement & Disparities","year":"2022"},{"key":"pone.0353755.ref002","volume-title":"WHO global report on falls prevention in older age","author":"World Health Organization","year":"2007"},{"key":"pone.0353755.ref003","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1071\/NB10065","article-title":"Prevalence, circumstances and consequences of falls among community-dwelling older people: results of the 2009 NSW Falls Prevention Baseline Survey","volume":"22","author":"AJ Milat","year":"2011","journal-title":"N S W Public Health Bull"},{"key":"pone.0353755.ref004","article-title":"Prevention of falls in older people living in the community","volume":"353","author":"ER Vieira","year":"2016","journal-title":"BMJ"},{"issue":"9","key":"pone.0353755.ref005","doi-asserted-by":"crossref","DOI":"10.1093\/ageing\/afac205","article-title":"World guidelines for falls prevention and management for older adults: a global initiative","volume":"51","author":"M Montero-Odasso","year":"2022","journal-title":"Age Ageing"},{"key":"pone.0353755.ref006","author":"NHS England","year":"2022"},{"key":"pone.0353755.ref007","author":"D Skelton","year":"2004"},{"issue":"6","key":"pone.0353755.ref008","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1093\/ageing\/afw129","article-title":"Prevalence and risk factors for falls in older men and women: The English Longitudinal Study of Ageing","volume":"45","author":"CR Gale","year":"2016","journal-title":"Age Ageing"},{"issue":"6","key":"pone.0353755.ref009","doi-asserted-by":"crossref","first-page":"2427","DOI":"10.1007\/s40615-021-01179-1","article-title":"Racial and Ethnic Differences in Falls Among Older Adults: a Systematic Review and Meta-analysis","volume":"9","author":"N Wehner-Hewson","year":"2022","journal-title":"J Racial Ethn Health Disparities"},{"key":"pone.0353755.ref010","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.b3692","article-title":"Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials","volume":"339","author":"HA Bischoff-Ferrari","year":"2009","journal-title":"BMJ"},{"issue":"24","key":"pone.0353755.ref011","doi-asserted-by":"crossref","first-page":"1750","DOI":"10.1136\/bjsports-2016-096547","article-title":"Exercise to prevent falls in older adults: an updated systematic review and meta-analysis","volume":"51","author":"C Sherrington","year":"2017","journal-title":"Br J Sports Med"},{"key":"pone.0353755.ref012","doi-asserted-by":"crossref","first-page":"100300","DOI":"10.1016\/j.metop.2024.100300","article-title":"Effect of vitamin D on risk of falls and fractures - The contribution of recent mega-trials","volume":"23","author":"B Dawson-Hughes","year":"2024","journal-title":"Metabol Open"},{"issue":"1","key":"pone.0353755.ref013","article-title":"Population-based interventions for preventing falls and fall-related injuries in older people","volume":"1","author":"SR Lewis","year":"2024","journal-title":"Cochrane Database Syst Rev"},{"key":"pone.0353755.ref014","doi-asserted-by":"crossref","first-page":"100397","DOI":"10.1016\/j.lanepe.2022.100397","article-title":"Home modifications and disability outcomes: A longitudinal study of older adults living in England","volume":"18","author":"T Chandola","year":"2022","journal-title":"Lancet Reg Health Eur"},{"issue":"1","key":"pone.0353755.ref015","doi-asserted-by":"crossref","first-page":"105347","DOI":"10.1016\/j.jamda.2024.105347","article-title":"Effectiveness Evaluation of Smart Home Technology in Preventing and Detecting Falls in Community and Residential Care Settings for Older Adults: A Systematic Review and Meta-Analysis","volume":"26","author":"CX Yeoh Lui","year":"2025","journal-title":"J Am Med Dir Assoc"},{"issue":"46","key":"pone.0353755.ref016","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hta25460","article-title":"Home environmental assessments and modification delivered by occupational therapists to reduce falls in people aged 65 years and over: the OTIS RCT","volume":"25","author":"S Cockayne","year":"2021","journal-title":"Health Technol Assess"},{"issue":"8","key":"pone.0353755.ref017","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1177\/0898264308324672","article-title":"Environmental interventions to prevent falls in community-dwelling older people: a meta-analysis of randomized trials","volume":"20","author":"L Clemson","year":"2008","journal-title":"J Aging Health"},{"issue":"9","key":"pone.0353755.ref018","article-title":"Interventions for preventing falls in older people living in the community","volume":"2012","author":"LD Gillespie","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"issue":"7","key":"pone.0353755.ref019","article-title":"Multifactorial and multiple component interventions for preventing falls in older people living in the community","volume":"7","author":"S Hopewell","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"pone.0353755.ref020","doi-asserted-by":"crossref","DOI":"10.1093\/med\/9780198701590.003.0050","article-title":"Falls.","volume-title":"Jean-Pierre Michel, and others (eds), Oxford Textbook of Geriatric Medicine, 3 edn (Oxford, 2017; online edn, Oxford Academic","author":"C Becker","year":"2017"},{"key":"pone.0353755.ref021","author":"Health and Safety Executive","year":"2024"},{"key":"pone.0353755.ref022","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.puhe.2023.09.006","article-title":"Cold indoor temperatures and their association with health and well-being: a systematic literature review","volume":"224","author":"H Janssen","year":"2023","journal-title":"Public Health"},{"key":"pone.0353755.ref023","author":"P Burns","year":"2016"},{"issue":"4","key":"pone.0353755.ref024","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1177\/0036933013507848","article-title":"The high cost to health and social care of managing falls in older adults living in the community in Scotland","volume":"58","author":"J Craig","year":"2013","journal-title":"Scott Med J"},{"key":"pone.0353755.ref025","volume-title":"English Longitudinal Study of Ageing: Waves 0-10, 1998-2023. SN: 5050","author":"J Banks","year":"2024","edition":"43"},{"key":"pone.0353755.ref026","article-title":"Unit Costs of Health and Social Care 2023 Manual","author":"K Jones","year":"2024"},{"key":"pone.0353755.ref027","author":"NHS England","year":"2024"},{"issue":"21","key":"pone.0353755.ref028","article-title":"Impact of NHS 111 Online on the NHS 111 telephone service and urgent care system: a mixed-methods study. Health Services and Delivery Research","volume":"9","author":"J Turner","year":"2021","journal-title":"Natl Instit Health Care Res"},{"key":"pone.0353755.ref029","volume-title":"Census 2021","author":"Office for National Statistics","year":"2021"},{"issue":"2","key":"pone.0353755.ref030","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1177\/0049124119882473","article-title":"How to deal with reverse causality using panel data? Recommendations for researchers based on a simulation study","volume":"51","author":"L Leszczensky","year":"2019","journal-title":"Sociol Methods Res"},{"issue":"1","key":"pone.0353755.ref031","doi-asserted-by":"crossref","first-page":"153","DOI":"10.2307\/1912352","article-title":"Sample selection bias as a specification error","volume":"47","author":"JJ Heckman","year":"1979","journal-title":"Econometrica"},{"key":"pone.0353755.ref032","author":"StataCorp","year":"2023"},{"key":"pone.0353755.ref033","author":"J Forder","year":"2011"},{"issue":"8","key":"pone.0353755.ref034","doi-asserted-by":"crossref","DOI":"10.1093\/ageing\/afac131","article-title":"Predictors of returning home after hip fracture: a prospective cohort study using the UK National Hip Fracture Database (NHFD)","volume":"51","author":"S Hawley","year":"2022","journal-title":"Age Ageing"},{"issue":"5","key":"pone.0353755.ref035","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1302\/2046-3758.95.BJR-2019-0221.R1","article-title":"Utilization and costs of formal and informal care, home adaptations, and physiotherapy among older patients with hip fracture","volume":"9","author":"ME Png","year":"2020","journal-title":"Bone Joint Res"},{"issue":"8","key":"pone.0353755.ref036","doi-asserted-by":"crossref","DOI":"10.1093\/ageing\/afac183","article-title":"Multiple hospital organisational factors are associated with adverse patient outcomes post-hip fracture in England and Wales: the REDUCE record-linkage cohort study","volume":"51","author":"R Patel","year":"2022","journal-title":"Age Ageing"},{"issue":"1","key":"pone.0353755.ref037","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1111\/j.1532-5415.2010.03221.x","article-title":"Environmental assessment and modification to prevent falls in older people","volume":"59","author":"AC Pighills","year":"2011","journal-title":"J Am Geriatr Soc"},{"issue":"7626","key":"pone.0353755.ref038","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1136\/bmj.39343.649097.55","article-title":"Effectiveness of paramedic practitioners in attending 999 calls from elderly people in the community: cluster randomised controlled trial","volume":"335","author":"S Mason","year":"2007","journal-title":"BMJ"},{"key":"pone.0353755.ref039","doi-asserted-by":"crossref","first-page":"32","DOI":"10.3389\/fpubh.2019.00032","article-title":"How Do General Practitioners (GPs) Engage in Falls Prevention With Older People? A Pilot Survey of GPs in NHS England Suggests a Gap in Routine Practice to Address Falls Prevention","volume":"7","author":"L Mackenzie","year":"2019","journal-title":"Front Public Health"},{"issue":"5","key":"pone.0353755.ref040","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0197792","article-title":"Correction: Fear of falling in community-dwelling older adults: A cause of falls, a consequence, or both?","volume":"13","author":"A Laved\u00e1n","year":"2018","journal-title":"PLoS One"},{"key":"pone.0353755.ref041","author":"Age UK","year":"2025"},{"issue":"6","key":"pone.0353755.ref042","doi-asserted-by":"crossref","first-page":"1438","DOI":"10.1111\/hsc.12814","article-title":"Outcomes of reablement and their measurement: findings from an evaluation of English reablement services","volume":"27","author":"B Beresford","year":"2019","journal-title":"Health Soc Care Community"},{"key":"pone.0353755.ref043","author":"NHS","year":"2025"},{"key":"pone.0353755.ref044","author":"Age UK","year":"2024"},{"key":"pone.0353755.ref045","author":"Age UK","year":"2010"},{"key":"pone.0353755.ref046","doi-asserted-by":"crossref","first-page":"105246","DOI":"10.1016\/j.healthpol.2025.105246","article-title":"Projected costs of long-term care for older people in England: The impacts of housing quality improvements","volume":"152","author":"B Hu","year":"2025","journal-title":"Health Policy"},{"key":"pone.0353755.ref047","author":"Department of Health and Social Care","year":"2025"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0353755","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T17:22:30Z","timestamp":1785950550000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0353755"}},"subtitle":[],"editor":[{"given":"Mahmut Zeki","family":"Akarsu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,8,5]]},"references-count":47,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,5]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0353755","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,5]]}}}