What makes growing older at home hard.
Most people want to grow old in their own home. What decides whether they can is rarely one big illness. It is a handful of everyday problems, and the evidence on each of them is clearer than most people think.
In 2022 there were 57.8 million Americans aged 65 and older, more than one in every six people in the country, and 6.5 million of them were 85 or older.3 Most of them are not ill in the way the word suggests. A third report some form of disability, and one in five has serious difficulty walking or climbing stairs.3 That second number matters more than it sounds. Almost everything in a home, from the bed to the bathroom to the front door, assumes you can do both.
Falls
More than one in four older adults falls every year. Less than half tell their doctor, and falling once doubles the chance of falling again.1 Most falls do not end in hospital. Enough do to fill emergency departments every day.
What falls cost, every year
Older adults in the United States
Source: CDC, Older Adult Falls Data. 88 percent of hip fracture hospital stays are caused by falls.
Worldwide, falls kill an estimated 684,000 people a year, and adults over 60 account for the largest share.2
Getting back up is its own problem. In a study that followed people over 90 for a year, 82 percent of falls happened when they were alone, 80 percent of those who fell could not get up on their own at least once, and 30 percent lay on the floor for an hour or more.8 Lying there that long was strongly linked to serious injury, hospital admission and moving into long-term care. (Why so few of them used the alarm they had is a story of its own, told in The pendant in the drawer.)
The quieter cost is what happens after. People who have fallen often start to move less because they are afraid of falling again, and moving less makes the legs weaker, which makes the next fall more likely. The cycle usually starts in the most ordinary places: getting up from a chair, turning in a hallway, bending to pick something up.
Living alone
About 28 percent of older Americans living in the community live alone, 16.2 million people. For women the share is one in three, partly because women tend to outlive their partners.3
About one in four Americans aged 65 and older is socially isolated, a risk to health the National Academies compare to high blood pressure, smoking or obesity.5
Living alone is not the same as being lonely, but the two overlap, and isolation and loneliness are linked to heart disease, stroke, depression, dementia and earlier death.4 The practical side is simpler and harder at the same time. When you live alone, nobody notices that you have stopped going upstairs, or that the walk to the shop has become a walk to the corner. Those changes are slow, and by the time they are visible they are usually hard to reverse.
Staying home
Three in four Americans aged 50 and older want to stay in their current home as long as possible, and nearly as many want to stay in the same community.6 Very few homes were built for that. Stairs, low chairs, high shelves and slippery bathroom floors all become harder at the same time as the help to manage them becomes more expensive.
What a year of care costs
National medians in the United States, 2025
Source: CareScout, Cost of Care Survey (2025).
A paid caregiver at home costs a median of $35 an hour. Help for a few hours a day, five days a week, already adds up to more than $27,000 a year, and full-time help at home is around $80,000.7 That is why, in practice, most care is not bought. It is given.
After the hospital
A hospital stay is meant to fix one problem. For older people it often creates another. About one in three patients over 70 leaves hospital less able to manage daily life than when they arrived, needing help with things like walking, bathing or getting dressed that they could do on their own before.9 Clinicians call it hospitalization-associated disability.
For someone who was only just managing at home, that loss can be the difference. The person who comes home is not quite the person who left, and the home that worked last month may not work now.
What the evidence says helps
The good news in the research is that falls and lost independence are not fixed outcomes. Some interventions have been tested in large trials, and a few clearly work.
Exercise. In a large Cochrane review of trials, regular exercise cut the rate of falls by 23 percent and reduced the number of people who fell at all by 15 percent. Balance and functional exercises on their own cut falls by 24 percent.10
Fixing the home. Home hazard reduction, such as removing trip hazards and adding rails, reduced the rate of falls by 38 percent for people already at high risk. For people who were not at high risk, the same changes made no clear difference.11 What helps depends on who it is for.
The pattern under all of these is the same. Strength, balance and confidence in the legs decide more about growing older at home than almost anything else, and the trials show that what happens to them is not fixed. That pattern is the reason we started Veema with mobility.
These figures describe the need. They are not results or claims about Veema.
Sources
- CDC, Older Adult Falls Data: more than 1 in 4 older adults fall each year and less than half tell their doctor; falling once doubles the chance of falling again; about 4.5 million emergency department visits and 1.4 million hospitalizations a year; nearly 319,000 hip fracture hospitalizations a year; 88% of hip fracture emergency visits and hospitalizations are caused by falls.
- World Health Organization, Falls fact sheet (2021): an estimated 684,000 deaths from falls a year worldwide; adults over 60 suffer the greatest number of fatal falls.
- Administration for Community Living, 2023 Profile of Older Americans: 57.8 million Americans 65+ and 6.5 million 85+ in 2022; 28% of community-dwelling older adults (16.2 million) live alone, 33% of older women; 33% report a disability; 21% report serious difficulty walking or climbing stairs.
- CDC, Health effects of social isolation and loneliness: linked to heart disease, stroke, type 2 diabetes, depression, dementia and earlier death; older adults are at higher risk of isolation.
- National Academies of Sciences, Engineering, and Medicine, Social Isolation and Loneliness in Older Adults (2020): about one-quarter of community-dwelling Americans 65+ are socially isolated; a major risk for premature death comparable to high blood pressure, smoking or obesity.
- AARP, 2024 Home and Community Preferences Survey: 75% of adults 50+ want to live in their current home as long as possible; 73% want to stay in their community.
- CareScout, Cost of Care Survey (2025): national medians of $35 an hour for a home care aide ($80,080 a year at 44 hours a week), $6,200 a month for assisted living, $355 a day ($129,575 a year) for a private nursing home room.
- Fleming J, Brayne C. Inability to get up after falling, subsequent time on floor, and summoning help: prospective cohort study in people over 90. BMJ (2008): 82% of falls happened when alone; 80% of fallers were unable to get up after at least one fall; 30% lay on the floor for an hour or more; lying long was strongly associated with serious injury, hospital admission and moves into long-term care; call alarms were not used in most long lies.
- Covinsky KE, Pierluissi E, Johnston CB. Hospitalization-associated disability. JAMA (2011): occurs in approximately one third of patients older than 70.
- Sherrington C, et al. Exercise for preventing falls in older people living in the community. Cochrane Review (2019): exercise reduces the rate of falls by 23% (RaR 0.77) and the number of people falling by 15% (RR 0.85); balance and functional exercises reduce the rate of falls by 24%.
- Clemson L, et al. Environmental interventions for preventing falls in older people living in the community. Cochrane Review (2023): home hazard reduction reduces the rate of falls by 26% overall (RaR 0.74) and by 38% in people at high risk (RaR 0.62); no clear effect when people were not selected for fall risk.
