Housing and Health in Older People: Ageing in Place
Howden-Chapman, Philippa, Signal, Louise, Crane, Julian, Social Policy Journal of New Zealand
Housing has a clear impact on the health of occupants (National Health Committee 1998, Howden-Chapman et al. 1996). Affordable and appropriate housing protects people from hazards and promotes good health and well-being (WHO 1989). The older population is as diverse as any other in our society and older people in New Zealand live in all kinds of dwellings: detached and semi-detached houses, apartments, units, boarding houses, institutions, papakainga housing clustered around marae and "granny flats" on the grounds of a family member's home. But regardless of the diversity, there are a number of common housing hazards older people face, which could be minimised by creative public policies. Older people deserve special consideration in government policy, community support and industry response, but they are often a low priority for resource allocation or policy innovation because of their relative lack of economic and political power.
In this paper we briefly review the demography and housing patterns of older people in New Zealand. We describe the impact of New Zealand's climate and housing construction on health, before reviewing some significant health problems exacerbated by the indoor environment: respiratory conditions, coronary disease and hypothermia. We then analyse a variety of policy measures that could be used to improve the housing conditions of older people, paying particular attention to the assistance older people can be given to age in the communities where they have lived during their adult lives.
THE OLDER POPULATION
While many older people do not require special consideration, as a group they do -- clearly -- have some distinct population characteristics, such as a higher incidence of disability. Demographically, the impact of the baby boom means that the proportion of the population 65 years and older will rise for the next few decades. Disability associated with ageing increases the possibility of housing and health problems, which can lead to stress and costs to older people, their families, the community and the government. Older people with dementia, whose numbers are growing, will need particular housing assistance.
During the next 30 years, the proportion of people aged 60 or over will increase from 15.4% in 1996 to 25.3% in 2030. Some of the key trends associated with population ageing are an increase in lone-person households (associated with longevity and widowhood) and an increasing proportion of people over the age of 80 (Zodgekar 1993).
As people age, their income is increasingly made up of self-employment and investment income, rather than wages and salaries (Statistics New Zealand 1998b). One-person-superannuitant households have among the lowest incomes of any household type in New Zealand. Further, the household types most concentrated in the bottom quintile of income in New Zealand, in addition to sole-parent households, are older people living alone and, to a lesser extent, older couples. There are also gender differences: women between 60 and 74 years have lower incomes than men in the same age group (Davey 1998).
The existing housing stock in New Zealand presents some significant issues for an ageing society. More than 35% of New Zealand houses were constructed before the Second World War (Isaacs et al. 1995). These houses, being older, often lack modern conveniences and therefore are potentially in need of significant repair and refurbishment. Housing built before April 1978 was not required to have insulation.
HOUSING TENURE AND THE HEALTH OF OLDER PEOPLE
The housing circumstances of older people are directly linked to the social and economic processes that govern the disposition of life chances. Ownership of a house is one of the results of life chances that favour the better educated, and those with more skilled jobs who have earned higher incomes for longer periods, but it also reflects the impact of the larger economic, policy and social cycles that generations live through. …