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Address for correspondence: Carrie Henning-Smith, Division of Health Policy and Management, School of Public Health, University of Minnesota, 420 Delaware St. S.E., Mail Code MMC 729, Minneapolis, MN 55455, USA E-mail: [email protected]
Introduction
The past several decades have seen an ageing population and a shift in the United States of America (USA) and elsewhere from institutional to home and community-based settings for individuals with long-term care needs. As a result, there has been an increase in the number of individuals with disabilities, especially older adults, living in the community, despite a decline in the overall incidence of disability in the US population (Martin, Schoeni and Andreski 2010). Yet, research on the living arrangements of older adults with disabilities is scarce. In particular, there is a dearth of research that combines information on household composition (who one lives with) and housing characteristics (e.g. structure type, ownership, crowding), despite the fact that such information is of key importance to demographers, policy makers and service providers. This paper seeks to address that gap by describing the frequency of disability by type of living arrangement for older adults and by identifying some of the characteristics of living arrangements most strongly associated with having a disability.
The relationship between disability and living arrangements is bidirectional. While disability may predict living arrangements, such as in the case of individuals leaving their homes to rent smaller or more accessible living spaces, these same arrangements, including one's household composition and housing type, can influence the disablement process (Mor et al. 1989). Living arrangements may reflect one's current disability status, e.g. living in a nursing home because of an inability to live independently (Latham 2011). Living arrangements may also shape future disability through the resources that they provide (or not). For instance, an older adult with mobility impairments may successfully live independently in a single-storey home with an accessible entrance and bathroom, but may find those same impairments to be disabling in a less-accommodating setting. Similarly, household composition can have significant effects on older adults' health and wellbeing, e.g. older adults living alone or with family members other than their spouse exhibit more depressive symptoms and worse psychological wellbeing than older adults living with their spouses (Henning-Smith 2014). The majority of older...