This study aims to examine determinants of health in older adults aged 65 or older with a particular attention to community environment (physical, social, and policy environment). The study also investigates whether the associations between community environment and health vary by individual socioeconomic status. Data are drawn from multiple sources including the 2019 Community Health Survey, Korean Statistical Information Service Regional Indicators, and Land Survey to analyze the association between community-level environment indicators and individual-level health outcomes. We use multilevel modeling to take into account the interdependence between individuals within each region(si-gun-gu). The analytic sample includes 66,949 adults aged 65 or older living in 250 si-gun-gu regions.
The results show that the average walking distances to parks, health care facilities, senior centers, and public gyms are significantly different across regions. Levels of social capital (trust toward and support from other community residents) and satisfaction with community environment also significantly differ across regions. Findings from the multilevel models suggest the positive effects of social capital and satisfaction with community environment on older individuals’ self-rated health, depressive symptoms, and cognitive disability. Also, the higher rates of basic pension recipients in the regions are associated with poorer self-rated health of individuals, and those who are residing in rural area report lower levels of depressive symptoms but show higher likelihoods of cognitive disabilities. Finally, the positive effects of the better access to health care and recreational facilities of the communities are more evident among older adults in 70s and those with lower levels of socioeconomic status compared to their respective counterparts.
Our findings suggest that community environment and social capital such as trust and support between community residents are important for the physical, mental, and cognitive health of community-residing older adults. Thus, it is important to make the communities more aging-, health-friendly and develop community programs and places to encourage interactions and support between the residents. Given the greater effects of the access to the community resources among those with lower levels of socioeconomic status, special attention and policies are needed for such vulnerable groups of older adults.