Health and Functioning of Community Dwelling Older Adults In China and Korea

Objectives. Population aging is occurring at an unprecedented pace in China and Korea. Living standards in East Asia have accompanied by an increase in the prevalence of chronic disease and disability among older people due to increased exposure to major risk factors such as smoking, drinking, and more leisure time without physical activity. Meanwhile, care for the elderly, traditionally provided at home by adult children, will become increasingly less feasible. Meeting the health and care needs of this growing elderly population will have potential implications for maintaining skyrocketing health care cost and informal and formal care demands. The purpose of this study is to describe the state of health and functional limitations of community dwelling older persons in China and Korea and to identify the contextual factors that explain the country difference.

Methods. Community dwelling adults aged 65 and older (n=11,449) were drawn from Chinese Longitudinal Healthy Longevity Survey (CLHLS) conducted in 2005 (Gu & Xu, 2007). The comparable Korean sample (n=4,152) was drawn from Wave I of the Korean Longitudinal Study on Aging conducted in 2006 (Chang et al., 2008). Using internationally comparable questionnaires these national surveys collected information on demographics, health outcomes, family, and social activities via face-to-face interviews. The functional limitation outcome measure is defined as difficulty or dependence in self-care tasks as evidence in Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). Hierarchical multiple regression analysis assessed the unique explanatory contribution of socio-demographics, chronic health conditions, cognition, lifestyle factors (e. g., smoking, drinking, and exercise), and social engagement on functional limitations.

Results. Korean elders have a higher level of ADL, but lower level of IADL, compared to Chinese counterparts. Common predictors of ADL and IADL limitations in both Chinese and Koreans were being older, being women, having more years of schooling, being currently unmarried, reporting more number of chronic diseases, and maintaining lower cognition. Income and employment status is significant for Koreans only. Lifestyle factors of drinking and absence of exercise were significant predictors of poor ADL and IADL for Koreans, while prevalence of smoking and social/leisure activities were more significant for Chinese. The final model explained 31% of ADL and 38% of IADL in Korean sample. The final model for Chinese explained only 24% of ADL (R2=.24, F=208.3, p<.001) but explained twice that amount (55%) of IADL (R2=.55, F=805.4, p<.001).

Given the long history of cultural exchanges between China and Korea, these Asian elders also share certain factors that are unique in these two countries. Our comparative approach explained how the potential demand for care and support varies between two countries regarding the prevalence of functional limitations among older adults. Common approaches could include implementation of various chronic disease prevention and community-based health promotion programs at the national level, as well as evidence-based practice intervention to improve cognition and exercise. Community-based care services—both informal and local government-supported—should activate a variety of services for the elderly and their family caregivers, including daily care, home maintenance, and referral services.