Aging is often accompanied by increasing difficulties in daily living that may compromise aging in place. In France, three main housing types can be distinguished: ordinary home (OH), intermediate housing (IH) and nursing home (NH). This study aimed to explore the relationship between functional disability, cognition, and residential transitions in older adults.

Participants aged 65 years and older living in OH at baseline were drawn from three French population-based cohorts (PAQUID, Three-City and AMI), followed for up to 30 years. A hierarchical indicator of functional disability was derived from mobility, IADL and ADL disabilities, while cognitive function was assessed using the Mini Mental State Examination (MMSE). A multi-state model was applied to investigate the associations between functional disability and cognition (as time-dependent variables) with housing transitions, adjusting for sex, cohort, marital status and education. We also examined the involvement of IADL disabilities on transitions from OH to IH or NH in sex-stratified models. Sensitivity analyses were performed using lagged measures.

Among 5264 included participants (mean age 74.7 ± 6.0 years; 56.9% women), 832 relocated from OH during a median follow-up of 10.2 years, including 216 to IH and 616 to NH. Mild and moderate disability, as lower MMSE scores, were independently associated with higher risks of transitioning to IH or NH, while severe disability and cognitive impairment were only associated with NH transitions. In sex-stratified analyses, transportation difficulties were associated with IH and NH transitions among women, whereas only with NH admission in men. Difficulties with handling finances in women, with medications management in men, and difficulties with shopping in both sexes were also associated with transition to NH.

Intermediate housing was more frequently associated with mild or moderate disability, whereas transitions to long-term care were more often observed in participants with severe cognitive decline.