Geographic Proximity to Support Services and Psychological Distress of Older Adults in South Korea

Background and Purpose: Older adults are closely connected with their neighborhoods and spend more time there than younger adults. The two leading types of mobility for older adults in neighborhood settings are walking and driving. Because both are often impeded by the growing number of chronic health conditions, it is important that neighborhoods offer access to health and social services. Findings on the relationship of geographic proximity to these services and later-life psychological distress are mixed. This study examines whether the accessibility of support services is associated with psychological distress among older adults in South Korea.      

Methods: We used data from A Profile of Older Adults: 2015, collected by the Busan Social Welfare Development Institute. Using a proportionate quota sampling method (i.e., age, gender, location), the survey sampled 1,507 community-dwelling older adults ages 60 and older in South Korea. The average age was 69 years (SD=7.1) and 55% were women. One third of participants lived alone and 30% held a high school diploma.

The Patient Health Questionnaire-9 (PHQ-9) (M=5.4; SD=4.8; range: 0-23) was used to assess psychological distress, the outcome. Independent variables included six measures of geographic proximity (i.e., time it takes to go to grocery store, hospital, government office, senior center, social service center, bus station) (1= less than 5 minutes, 2=5 to 10 minutes, 3=10-30 minutes, 4= over 30 minutes). Adjusting for individual characteristics (i.e., age, gender, education, income, living alone, self-rated health, social participation, family network, and social friend network), we used latent profile analysis (LPA) with a distal outcome to examine whether proximity to services is associated with psychological distress.      

Results: We identified subgroups of proximity to support services. All model selection criteria for LPA solutions (i.e., Akaike Information Criteria, Bayesian Information Criteria, Vuong-Lo-Mendell-Rubin adjusted likelihood ratio test) and substantive interpretability supported a three-class model. Average posterior probability values met the criterion of >.70 (range: .92 to .96). We labeled Class 1 Moderate Access (41%), wherein respondents could access public spaces within 10 minutes. The second group, High Access (10%), could access services within 5 minutes. The third and largest class, Low Access (49%), included all locations within 30 minutes or so. After identifying the unconditional class, we ran an LPA with a distal outcome using the BCH method. Older adults in the Low Access (b = 4.90, p < .001) and the Moderate Access (b =3.89, p < .001) groups had higher levels of psychological distress compared to those in the High Access group. Further, older adults with a high school diploma, higher income, higher levels of self-rated health, greater levels of social friend network and social participation had lower levels of psychological distress.    

Conclusions and Implications: Greater geographic proximity to support services was associated with lower levels of psychological distress among older adults in South Korea. Since access can improve health and social service use, and thereby promote well-being, social work practitioners and policymakers should work to increase access to support services, including transportation.