Geriatric conditions and healthcare utilization among older adults living in subsidized housing

Abstract Background Nearly 2.9 million older Americans with lower incomes live in subsidized housing. While regional and single‐site studies show that this group has higher rates of healthcare utilization compared to older adults in the general community, little is known about healthcare utilization nationally nor associated risk factors. Methods We conducted a retrospective cohort study of Medicare beneficiaries aged ≥65 enrolled in the National Health and Aging Trends Study in 2011, linked to Medicare claims data, including individuals living in subsidized housing and the general community. Participants were followed annually through 2020. Outcomes were hospitalization, short‐term skilled nursing facility (SNF) utilization, long‐term care utilization, and death. Fine–Gray competing risks regression analysis was used to assess the association of subsidized housing residence with hospitalization and nursing facility utilization, and Cox proportional hazards regression analysis was used to assess the association with death. Results Among 6294 participants (3600 women, 2694 men; mean age, 75.5 years SD, 7.0), 295 lived in subsidized housing at baseline and 5999 in the general community. Compared to older adults in the general community, those in subsidized housing had a higher adjusted subdistribution hazard ratio sHR of hospitalization (sHR 1.21; 95% CI, 1.03–1.43), short‐term SNF utilization (sHR 1.49; 95% CI, 1.15–1.92), and long‐term care utilization (sHR 2.72; 95% CI, 1.67–4.43), but similar hazard of death (HR, 0.86; 95% CI, 0.69–1.08). Individuals with functional impairment had a higher adjusted subdistribution hazard of hospitalization and short‐term SNF utilization and individuals with dementia and functional impairment had a higher hazard of long‐term care utilization. Conclusions Older adults living in subsidized housing have higher hazards of hospitalization and nursing facility utilization compared to those in the general community. Housing‐based interventions to optimize aging in place and mitigate risk of nursing facility utilization should consider risk factors including functional impairment and dementia.