How is housing insecurity measured among older adults? A systematic review

Housing insecurity is an established social determinant of health, with older adults being disproportionately vulnerable. Despite growing research attention, no studies have reviewed the measurement tools existing specifically for this population. This systematic review synthesizes quantitative measures of housing insecurity used among older adults, examines their dimensional structures, and evaluates their psychometric properties.

Following PRISMA 2020 guidelines, a systematic search was conducted across 5 electronic databases with no date restrictions. Eligible studies were required to include samples of older adults or mixed-age adults without an upper age limit, employ quantitative housing insecurity measures, and report psychometric evaluation.

A total of 1,310 articles were retrieved initially, and 13 studies were included in the final review. Most studies constructed composite indices from secondary survey data rather than purpose-built instruments. Six core dimensions were identified: housing unaffordability, instability, poor physical quality, inadequacy, lack or disrepair of housing durables, and poor neighborhood quality. Age-friendly housing characteristics were incorporated in only one study. Internal consistency was reported in two studies and test-retest reliability in none, with validity evidence largely confined to informal content justifications.

The reviewed tools showed considerable fragmentation in measurement approaches, uneven dimensional coverage, and insufficient psychometric reporting. The near-universal absence of age-friendly indicators across reviewed tools presents a notable gap. Future research may benefit from developing purpose-built, comprehensively validated instruments that integrate aging-specific dimensions across diverse policy and cultural contexts.