Falls are often described as accidents, but new research suggests that for many older people, the danger may be built into the place they call home. An analysis of approximately 5,500 adults aged 65 and over in England has found that electrical or plumbing faults, inadequate space and poor lighting are associated with a greater likelihood of falling. The researchers estimate that falls linked to substandard housing could cost England around £1.2 billion each year, including hundreds of millions of pounds in healthcare and formal care expenses.
The study, published in PLOS One, examined data collected between 2002 and 2023 through waves 1–10 of the English Longitudinal Study of Ageing, a large research programme that tracks the health, finances and living conditions of people in England as they grow older. Participants reported whether they had experienced falls and whether their homes had problems such as defective plumbing or electrical systems, insufficient space and inadequate lighting. The researchers then assessed how these housing conditions were related to falls and to falls that resulted in healthcare use.
Falls are among the most consequential health events affecting older adults who live independently. In England, about one in three people aged 65 and over experiences at least one fall each year. Although some falls cause little physical harm, others result in fractures, head injuries, hospital admissions and long-term disability. A fall can also trigger a loss of confidence, leading people to reduce their activity, become socially isolated or require additional assistance with daily tasks. For health systems, the consequences can extend far beyond the initial injury.
The strongest association in the study involved electrical or plumbing problems. Older adults living in homes with these defects had a 10.8 percent higher probability of reporting a fall than those without such problems. These conditions were also associated with falls requiring healthcare. The mechanisms may be both direct and indirect: leaking pipes can create slippery surfaces, damaged electrical systems may limit safe lighting or heating, and temporary repairs, clutter or exposed fixtures can create obstacles. Housing disrepair may also signal broader environmental risks that were not fully captured by the survey.
A lack of space was associated with a 3.3 percent increase in the probability of falling. In cramped homes, furniture and personal belongings can narrow walking routes, making it harder for residents to turn, use mobility aids or move safely between rooms. Limited space may also increase the need to step around obstacles or climb over items placed on the floor. These risks can be especially important for people with reduced balance, weakened muscles, impaired vision or conditions such as arthritis and Parkinson’s disease.
Poor lighting was particularly linked to falls that resulted in healthcare use, with a reported 9.3 percent increase in fall probability. Vision naturally changes with age, often reducing the ability to detect contrasts, judge distances and identify hazards in dim conditions. Shadows, glare and abrupt changes between bright and dark areas can make steps, loose rugs and uneven flooring difficult to see. Adequate illumination is therefore not simply a matter of comfort. It is an environmental factor that can influence how the nervous system detects obstacles and how quickly a person can adjust their movement.
Using the observed relationships and estimates from earlier research, the investigators modelled the financial consequences of housing-related falls. They calculated that poor housing could be responsible for approximately £440 million in healthcare costs and £778 million in formal care costs annually, producing a combined estimate of £1.2 billion. Healthcare costs may include emergency treatment, hospital care and follow-up services, while formal care costs can arise when people need professional assistance after an injury reduces their independence. The estimate does not mean that every fall in a defective home was caused solely by the housing condition, but it indicates the potential scale of preventable expenditure.
The findings support a shift in the way falls prevention is designed. Current strategies often focus on clinical interventions such as exercise programmes, medication reviews, vision checks and assessments of bone health. Those measures remain important, but they may be less effective if a person returns to a hazardous home environment. Repairs to plumbing and electrical systems, improvements in lighting, removal of unnecessary obstacles and modifications that create more usable space could complement medical and rehabilitation services. Treating housing improvement as part of integrated public health policy could help reduce injuries while allowing older people to remain independent for longer.
The researchers caution that the study cannot prove that housing problems directly caused the reported falls. Both falls and housing conditions were self-reported, which means that participants may have forgotten events, interpreted questions differently or underreported problems. The cost estimates also depend on assumptions drawn from previous literature, and the analysis may not capture every relevant factor, such as the design of staircases, flooring surfaces, footwear, medication use, muscle strength or the availability of informal family support. Even with these limitations, the results point to a modifiable source of risk. If poor housing contributes to falls on the scale suggested, improving homes could protect older residents while reducing pressure on already stretched health and care systems.
Subject of Research: People
Article Title: When home is a dangerous place: the cost of falls among older people living in the community
News Publication Date: 5 August 2026
Web References: https://doi.org/10.1371/journal.pone.0353755
References: Cartagena-Farías J, Fernández J-L, 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.
Image Credits: Anthony Lewis (www.anthony-lewis.com), PLOS, CC BY 4.0
Keywords: older adults, falls, housing conditions, poor lighting, home safety, healthcare costs, formal care, public health, England, PLOS One
