Aging & Mental Health

ISSN: 1360-7863 (Print) 1364-6915 (Online) Journal homepage: http://www.tandfonline.com/loi/camh20

Age-friendly environments and life satisfaction

among South Korean elders: person–environment
fit perspective

Sojung Park & Sangchul Lee

To cite this article: Sojung Park & Sangchul Lee (2016): Age-friendly environments and life
satisfaction among South Korean elders: person–environment fit perspective, Aging & Mental
Health, DOI: 10.1080/13607863.2016.1154011

To link to this article: http://dx.doi.org/10.1080/13607863.2016.1154011

Published online: 03 Mar 2016.

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 AGING & MENTAL HEALTH, 2016
http://dx.doi.org/10.1080/13607863.2016.1154011

Age-friendly environments and life satisfaction among South Korean elders:

person
environment fit perspective
Sojung Parka and Sangchul Leeb
a
George Warren Brown School of Social Work, Washington University in Saint Louis, St. Louis, MO, USA; bSchool of Social Work, Dong Seoul
College, Seoul, South Korea

ABSTRACT ARTICLE HISTORY

Objectives: Drawing on the person
environment (P
E) fit perspective, this study examined the role Received 8 July 2015
of environment on the well-being of vulnerable older adults in a non-western context. Using the Accepted 5 February 2016
indicators from the World Health Organization’s (WHO) framework for age friendly cities (ACF), we KEYWORDS
examined life satisfaction among South Korean older adults, exploring the extent to which Age-friendly environment;
multidimensional environmental characteristics are associated with low socioeconomic status (SES).
Downloaded by [University of California, San Diego] at 21:37 08 March 2016

vulnerable older adults;

Method: Using the regionally representative data from the Seoul City-wide needs assessment of living alone; poverty
middle- and old-aged adults, an analytic sample (N D 1657) focused on community-living individuals
aged 65 and older. Multilevel regression models examined interaction between SES subgroups and
varying aspects of the environment (i.e. physical, social, and service environment) as related to life
satisfaction.
Results: Consistent with the environmental docility hypothesis, members of the most vulnerable
subgroup in the Korean context
older adults who are living alone and poor
are more likely to
have higher life satisfaction when they have higher levels of support in physical and social
environments. Interestingly, a higher level of support in the service environment was related to lower
life satisfaction for this subgroup.
Conclusion: This study provides an empirical foundation for efforts to identify age-friendly
environmental characteristics as modifiable environmental resources that can improve older adults’
psychological well-being. As the first attempt to use WHO ACF indicators within the P
E fit
perspective in a non-Western context, our study provides a foundation for designing support services
or programs that effectively meet the needs of vulnerable older adults.

Introduction instruments for large-scale assessment of the age-friendliness

of a community (Dellamora et al., 2015). Using regionally rep-
Developing age-friendly environments that meet the needs of
resentative data developed by the Seoul City government
older people is a recent social policy focus in many countries
based on the WHO framework, we empirically examined to
(Buffel & Phillpson, 2012) because adaptive, responsive envi-
what extent various environmentally supportive features are
ronments may help older adults successfully age in place. An
associated with the enhanced well-being of older individuals.
age-friendly environment generally refers to a community in
Second, guided by Lawton’s P
E fit perspective (Lawton &
which older adults are valued, involved, and supported (Alley,
Nahemow, 1973), we attempt a theory-based examination of
Liebig, Pynoos, Banerjee, & Choi, 2007) in both basic daily
the links between person
environment (P
E) and well-being
activities such as driving and shopping and further participa-
in later years. With a dual focus on the aging individual and
tion in the community such as involvement in political and
on the environmental characteristics, the perspective sug-
related organizations which involves a role of public and ser-
gests some subgroups are more at risk of reduced health and
vice organizations in the community (Fitzgerald & Caro, 2014).
well-being due to disparity among personal resources, oppor-
Core features of the supportive environment include condi-
tunities, and living environment constraints. For person char-
tions in housing, mobility through transportation system,
acteristics, we focus on socioeconomically vulnerable
neighborhood safety, access to social support, and participa-
subgroups of older adults
a viable, but understudied, con-
tions of older adults (Fitzgerald, & Caro, 2014; Hanson & Emlet,
struct of the P
E fit perspective (Lehning, Smith, & Dunkle,
2006). Several age-friendly frameworks such as the WHO ini-
2012). For the environment, we examined multidimensional
tiatives for age-friendly communities suggest a number of
environmental characteristics: the physical, social, and service
supportive environmental features. The interest in age-
environments.
friendly environments is still relatively new, and few empirical
Finally, most research on the role of age-friendly environ-
studies have examined whether and to what extent the sug-
ments and older adults has been done in western contexts
gested environmental characteristics affect aging in place for
(Phillips, Cheng, Yeh, & Siu, 2010). A cross-national study on
older adults in the real world (Scharlach, 2012).
age-friendly environments, and/or research in a non-western
We aim to add to the age-friendly environment literature
context using concepts from an age-friendly environment
in three respects. First, despite numerous existing surveys and
framework could contribute to the literature. Focusing on the
questionnaires, there is a paucity of published research using

CONTACT Sojung Park spark30@wustl.edu

© 2016 Taylor & Francis

 2 S. PARK AND S. LEE
vulnerable subgroups of older adults in Korean society, we
examine two factors of socioeconomic vulnerability in the
society: income and living arrangement (i.e. living alone).
Age-friendly environments for vulnerable elders:
person
environment fit perspective
Within the P
E fit perspective, the person dimension refers
mainly to a person’s various attributes, including biological
health, sensory capacity, and motor skills (Lawton, 1982) and
attends particularly to those attributes specific to aging individ-
uals. Most existing P
E fit research has examined health-
related aspects; however, other aspects of aging individuals’
resources and constraints
such as low socioeconomic status
or other social stratification factors
are also viable theoretical
constructs in P
E fit research (Lehning et al., 2012; Scharlach,
2012). Although age-friendly environmental characteristics may
benefit older adults in general, there may be subgroups at risk
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because they lack the resources to use even available support
in their living environment and may remain at risk (Scharlach,
2012). Despite the theoretical importance of vulnerable older
adult subgroups in the person dimension, there is little empiri-
cal understanding of the varied ways age-friendly environ-
ments may influence their well-being (Golant, 2003).
Age-friendly environment is a multidimensional concept. It
includes the physical and social infrastructure that support
daily activities through transportation; local amenities; safe
and accessible housing, neighborhoods, and communities;
access to social support; and opportunities to engage in
meaningful activities (Plouffe & Kalache, 2010; Scharlach &
Lehning, 2013). Such various characteristics may well be con-
sidered in the P
E fit perspective which encompasses the
physical, social, societal, and cultural environments (Lawton,
1999). To empirically examine this multidimensional environ-
ment, we use the P
E fit perspective as a theoretical frame-
work (Lawton, 1999) for examining the physical and social
environment. In addition, we use an empirical construct of
the P
E fit perspective to examine the service environment.
Thus, we group available environmental indicators from the
data into three domains: physical, social, and service environ-
ments. Physical environment refers to structural characteristics
of the environment comprising housing, neighborhood, and
community subdomains (Golant, 1984). Social environment
comprises social participation and social inclusion (WHO,
2007), and service environment comprises community agen-
cies and health and social services (Grabowski, 2006; WHO,
2007).
In the P
E fit perspective, ‘Fit’ is specifically conceptual-
ized in the environmental docility hypothesis (Lawton, 1989),
which suggests that individuals with lower competence or
fewer resources are more affected by environmental opportu-
nities or constraints. Based on this hypothesis, socioeconomi-
cally vulnerable older adults may be positively affected by
age-friendly environments. Moreover, the concept of multidi-
mensional environment suggests the influence of age-friendly
environments on older adults’ experiences may vary by the
aspect of environment. To date, much existing environmental
gerontological research has focused on the indoor home
environment and has overlooked broader contexts such as
neighborhoods and communities (Scheidt & Windley, 2003).
Only a few studies have comprehensively examined multidi-
mensional aspects of environment (Wahl, Fange, Oswald,
Gitlin, & Iwarsson, 2009).
Limited empirical research focuses on vulnerable sub-
groups of older adults when examining environmental influ-
ence on older adults’ health and well-being. Lehning and
colleagues (2012) studied the self-rated health of a subgroup
of vulnerable older adults in urban Detroit, where most resi-
dents are African Americans with few socioeconomic resour-
ces. To gauge age-friendly environmental measures, they
derived six factors including neighborhood condition, social
support environment, and community engagement. When
analyzing the environmental measures, they found no inde-
pendent effect of disadvantaged socioeconomic status (i.e.
income and education status) in participants’ health. How-
ever, Lehning and colleagues’ (2012) study is a rare empirical
examination of a subgroup of vulnerable older adults. Contin-
ued research on the experience of such subgroups is needed.
Inquiry using P
E fit perspective, for example, can guide
researchers to more clearly examine how socioeconomic dis-
advantage (Person) interacts with age-friendly environment
(Environment) and affects various outcomes and adaptations
in older adults’ health and well-being. The challenge of socio-
economic disadvantage is an important concern for P
E fit
perspective, because impoverished individuals in impover-
ished communities amplify the environmental demands and
challenges older adults experience. Drawing explicitly from
the P
E fit perspective, another study examined the residen-
tial satisfaction of African American older adults in Detroit, a
subgroup of vulnerable older adults (Byrnes, Lichtenberg, &
Lysack, 2006). Findings indicated that hazards in the home
and neighborhood (e.g. garbage, noise, crimes) affected
neighborhood satisfaction among participants who have
higher levels of mental and physical health problems.
The Korean context
Some aspects of the P
E fit perspective may manifest differ-
ently among subgroups of socioeconomically vulnerable
older adults and in different cultures and societies. The experi-
ence of older adults in South Korea (hereafter Korea) offers a
unique portrait of the association between subgroups of vul-
nerable older adults and their environments in an Asian coun-
try. Korea is home to one of the world’s fastest-aging
populations (Ministry of Health and Welfare [MOHW], 2012).
By 2018, 14% of the population will be of age 65 or older; by
2050, that figure will rise to 38.2%. Korea has experienced a
rapid decline in the traditional family system and a rise in
nuclear families, leading to an increase in older adults living
alone (Kim & Baik, 2010). It is estimated that more than 20%
of Koreans older than 65 live alone, a percentage which is
expected to continue growing (MOHW, 2012).
In this present study, we focus specifically on living-alone
older adults in Korea, where this status often indicates mem-
bership in a vulnerable subgroup. This is particularly true since
the pace of Korea’s socioeconomic and demographic change
has outstripped the ability of its public policies and programs
to address social problems emerging for older adults. For
example, Korea has the highest elderly poverty rate among
Organization for Economic Cooperation and Development
(OECD) countries, with more than 45% of its older adults and
71% of its living-alone older adults living below the poverty
line (OECD, 2011; Yoon & Kwon, 2013).
Previous studies (see Lee & Kim, 2013) found that living-
alone individuals tend to be women who are older, have low
incomes and education levels, and live in rental housing.

Extant research has also shown that those who live alone and/
or are poor older adults suffering from serious physical and
mental health problems, as well as of low subjective well-
being (Kim, 2009; Kim & Baik, 2010; Lee & Kim, 2013). To
examine socioeconomic vulnerability among older adults in
Korea, it is important to understand the connection between
living-alone and low-income status.
In Korea, research and policy interest in age-friendly envi-
ronments is at an early developmental stage. Many existing
sociorelational studies demonstrate that a supportive social
environment (many friends, contact with relatives) is associ-
ated with better health outcomes (Ann, 2005; Chang, 2010;
Kim & Lee, 2009). However, only a few studies examine such
physical aspects of environment as housing and neighbor-
hood. Those studies focus on the relationship between hous-
ing characteristics and housing satisfaction among older
adults. Kang and Jeoung (2015), for example, examine how
social and physical environmental characteristics are associ-
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ated with housing satisfaction. They find
in addition to a
supportive social environment
access to neighborhood
amenities, facilities, and transportation is related to higher
levels of housing satisfaction.
To our knowledge, researchers have devoted little atten-
tion to a systematic examination of environmental character-
istics and their relationship to the experience of older adults
in Korea. More importantly, no study has yet investigated the
extent to which characteristics of a multidimensional environ-
ment are associated with well-being of subgroups of vulnera-
ble older adults.
The present study
This study addresses two primary questions. First, in order to
examine socioeconomic vulnerability in Korea, we examine
subgroups of older individuals by living-alone status and low-
income status in relation to various environmental character-
istics. Based on the existing evidence, we expected elders
who were of low income and lived alone would comprise the
most vulnerable subgroup and that being in a vulnerable
socioeconomic subgroup would be associated with living in a
less supportive environment.
Second, we examine the extent to which socioeconomic
subgroups and age-friendly environment are associated with
life satisfaction, both independently and together (i.e. the
P
E fit), after controlling for all relevant covariates. Based on
the socioeconomic inequality literature (Braubach & Fairburn,
2010; Feinstein, 1993; House et al., 1994) as well as previous
Korean studies, we expect lower socioeconomic status to pre-
dict low life satisfaction. Regarding environment, we do not
posit a specific hypothesis, since no known study has empiri-
cally considered the multidimensional environment among
Korean older adults. Still, it is expected that older adults in
supportive environments are likely to have higher life satisfac-
tion. To empirically examine P
E fit, we ask to what degree
varying characteristics of environment moderate the effect of
socioeconomic vulnerability on life satisfaction. Guided by the
environmental docility hypothesis (Lawton, 1989), we hypoth-
esize that socioeconomically vulnerable older adults are likely
to have higher life satisfaction when living in supportive envi-
ronments. Drawing on the multidimensional perspective of
environment, we further expect that the pattern of P
E fit
will vary depending on the aspect of the environment
measured.
AGING AND MENTAL HEALTH 3
Methods
Design and sample
This study is a secondary data analysis of the Seoul City-wide
needs assessment of middle- and old-aged adults (Seoul
Welfare Foundation [SWF], 2011). Seoul is one of 250 cities
that have joined the WHO Global Network of Age-Friendly
Cities and Communities. The SWF developed indicators of an
age-friendly environment using WHO Global Age-Friendly
Cities Guidelines (WHO, 2007), a checklist of age-friendly fea-
tures for cities to assess their progress toward age-friendliness.
Data were collected via face-to-face interviews during
November and December 2012 from a representative sample
of 4000 non-institutionalized individuals aged 50 and older
who resided in Seoul. The protocols for data collection were
reviewed and approved by the internal review board of the
Seoul Welfare Foundation. A proportional stratified random
sampling was employed to identify respondents for the sur-
vey in 25 neighborhood (Kun) area clusters. In the Korean
Population Census, information about the objective neighbor-
hood characteristics is provided at the ‘Shi (city), Kun, or Ku’
level. These geographic identifiers are comparable to a census
county (parish or state) in the United States
smaller than a
state, but larger than a census tract. Based on the 25 neigh-
borhood areas, we selected a final geographic identifier of
five regions. The regional divisions reflected compositional
characteristics of the physical environment such as affordable
housing, transportation system, and size of green areas. In the
present study, we use this regional identifier as a neighbor-
hood-level indicator.
The present study focuses on adults aged 65 and older
with a final sample of 1657 participants. Average participant
age was 73 (SD D 5.76: range 65 to 94 years). Of participants,
53% were women. For age-cohort comparisons, we formed
two groups: the young
old group, aged 65 to 74 (56%; n D
936) and the old
old, aged 75 and older (44%; n D 721).
Within the sample, 22% completed a high school education
(12 years); 8% had a disability; and 66% were homeowners.
Compared to our sample of older adults, the middle group,
aged 50 to 64 (N D 2343) had higher levels of education (59%
completed high school), a lower proportion of home owner-
ship (76%), and a lower proportion of disability (3%).
Independent variables
Person dimension: living arrangements and poverty status
Reflecting the parallel phenomena of Korea’s high older-adult
poverty rate and high older-adult-living-alone poverty rate, a
composite socioeconomic (SES) vulnerability indicator was
created using living arrangement and income variables. For
living arrangement, a binary indicator was created to measure
living alone (0 D co-residing, 1 D living alone). For income,
total net value of household income was used. Following the
criteria used in the Housing Survey of Elderly Households
(Ministry of Land, Transport and Maritime, 2008), we used a
decile indicator measuring total household net income and
defining the lower four tiles, or bottom 40%, as low-income
groups. The final income variable was created using three cat-
egories: (1) first and second tiles, or bottom 20% D poor, (2)
third and fourth tiles, or between the lower 30% and 40% D
near poor, (3) all other higher tiles D non-poor. A final SES vari-
able was created to better examine and identify vulnerable
elderly subgroups in the Korean context. This variable had six
 4 S. PARK AND S. LEE

categories ranging from 0 (co-residing, non poor), 1 (co-resid- Cronbach’s alpha in most environmental aspects across the
ing, near poor), 2 (co-residing, poor), 3 (living alone, non-poor), two samples.
4 (living alone, near poor), to 5 (living alone, poor).

Environment dimension Physical environment indicators. Three aspects of the physi-

The data contain environmental indicators adopted from the
WHO framework including housing, transportation, neighbor-
hood, social participation, social inclusion, and community
and health services (SWF, 2011). In this study, we grouped the
original indicators into three theoretical constructs of P
E fit
perspective, the physical, social, and service environment.
These are presented in Table 1.
We examined and compared item reliability for the indica-
tors in physical, social, and service environment domains in
the entire original sample (n D 4000) and the subsample of
this study (n D 1657). The result showed little difference in
cal environment were examined: housing, transportation, and
neighborhood. All questions were measured on a 5-point
scale ranging from 1 (not at all) to 5 (very much). Housing
environment was originally measured with three items
(Table 1). Due to the low internal consistency reliability, we
did not use an average score from the three indicators.
Instead, we selected the item that best reflected housing
needs for socioeconomically vulnerable older adults. Housing
environment was measured with the question, ‘To what
extent is your housing equipped with physical features of
housing such as water, heating, and others?’

Table 1. Age-friendly environmental indicators.

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Physical environment
Housing
Transportation
Neighborhood
Social environment
Social participation
Social inclusion
Service environment
Community and health services.
Indicators
1. I feel burdened with housing-related cost Not at all (1)
very much (5)
2. My current home is well equipped with physical features of housing such as water,
heating, and others
3. I want to modify my house to prevent accidents and alleviate physical
inconvenience (i.e. grab bar, anti-slippery device, barrier free device, etc.)
1. Public transportation is reliable and frequent Not at all (1)
very much (5);
2. Vehicles are accessible, not overcrowded, and offer priority seating for the elderly a D 0:76.
3. Where it is hard to get an access to local buses or subways, there are free shuttle or
community buses that I can use
4. In the buses and subways there is enough seating area for the elderly and the infirm
5. Bus drivers are careful and considerate when loading and unloading passengers to
make sure safety
6. It is easy for me to use buses or subways to get to where I want to go
7. Bus stops have shaded benches to provide comfort
1. The public spaces (walking trails, parks, roads, sidewalks) in my neighborhood are Not at all (1)
very much (5);
clean and well maintained (a D 0:75Þ.
2. Walking trails and parks are easy to access from my home
3. The sidewalks in my area have smooth surface and are free of obstructions, making
it safe for me to walk on
4. The traffic signals allow enough time for me to cross the roads safely
5. At crosswalks and narrow roads, drivers give way to pedestrians so that the latter
can safely cross the road
6. Cyclists are considerate and give way to pedestrians
1. The venues for most of the events and activities that I can participate are easy to Not at all (1)
very much (5);
reach (a D 0:76Þ.
2. Entertainment, leisure, and sports activities take place at times convenient to me
3. The information about the community events (e.g. how to participate, how to use
facilities, transport routes) are easy to obtain
4. There are many opportunities to participate in various social activities (religious,
cultural gatherings, leisure activities, hobbies, etc.)
5. There are many opportunities to join volunteer services
6. The Seoul Metropolitan Government and my community provide sustained
assistance and support to those in need
1. The people in my neighborhood are courteous and respectful to senior citizens Not at all (0)
very much (5);
2. The staff at Seoul Metropolitan City, the district office, the community center, and (a D 0:78Þ.
the public health service are kind and helpful
3. Activities and events attract all generations by accommodating age-specific needs
and preferences
4. I feel respected in social interactions
5. Older people are regularly consulted by public, voluntary, and commercial services
on how to serve them better
6. The elderly are positively described in public media (TV, news paper, and radio
programs) …
1. The health center and the welfare center are built in ways that make it easy and safe Not at all (0)
very much (5);
for me to use (a D 0.76)
2. The staff at public facilities such as the hospital and the welfare agency are helpful
and responsive when I make inquiries
3. In my area, I have easy access to programs and information on health education,
nutrition class, physical therapy, etc.
4. At public facilities (Seoul Metropolitan City, the district office, the community center,
etc.) and the welfare center, I can use computers and the Internet for free or at a low
fee

Transportation environment was measured with seven
items that gauge various aspects of Seoul’s public transporta-
tion systems. Participants were asked to what extent public
transportation is reliable, frequent, and offers priority seating
for the elderly. Responses to the seven variables were aver-
aged to create an indicator of transportation
environment
friendliness (a D 0:76). Neighborhood environment was
measured with six items that gauge various aspects of partici-
pants’ neighborhoods. Participants were asked to what extent
the public spaces (walking trails, parks, roads, sidewalks) in
their neighborhoods are clean and well maintained and
whether pedestrian crossings are sufficient in number and
safe for people with different levels and types of physical abil-
ity. Responses to the six variables were averaged to create an
indicator of neighborhood environment friendliness
(a D 0.75).
Social environment indicators. Social environment was mea-
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sured with two indicators: social participation and social inclu-
sion. Social participation consisted of six items, all measured
on a 5-point scale ranging from 1 (not at all) to 5 (very much).
Survey participants were asked to what extent venues for
events and activities are conveniently located and accessible
by public transportation and whether events are held at times
convenient for older people. Responses to the six variables
were averaged to create a social participation indicator (a D
0.76). Social inclusion was measured with six questions includ-
ing to what extent older people are regularly consulted by
public, voluntary, and commercial services on how to serve
them better, and to what extent activities and events attract
all generations by accommodating age-specific needs and
preferences. A social inclusion indicator was created by aver-
aging the six variables (a D 0.78).
Service environment indicators. Service environment was
measured with four items that examined the degree to which
community services are age-friendly. Participants responded
to such questions as: ‘To what extent are the health center
and the welfare center built in ways that make it easy and
safe for me to use?’ and ‘At public facilities (Seoul Metropoli-
tan City, the district office, the community center) and
the welfare center, I can use computers and the Internet for
free or a low fee.’ All questions were measured on a 5-point
scale ranging from 1 (not at all) to 5 (very much). Responses to
the four variables were averaged to create a service environ-
ment indicator (a D 0.76).
Dependent Variables
Life Satisfaction
Life satisfaction was measured using eight items that
explored multidimensional aspects of older-adult life experi-
ences. Questions ask to what extent a respondent is satisfied
with the public transportation system, housing conditions,
family relationships, relationships with friends and relatives,
cultural activities, social participation, economic status, per-
sonal health, and information and services provided by public
agencies in the community. All questions were measured on
a 5-point scale ranging from 1 (not at all) to 5 (very much).
Responses to the eight variables were averaged to create a
life-satisfaction indicator (a D 0.78).
AGING AND MENTAL HEALTH 5
Covariates
Age cohort groups were coded 0 (age 65
74) or 1 (age 75 and
older). Gender was coded 1 (men) and 2 (women). Education
was measured as categorical variables from 0 (no education),
1 (middle-school graduated or 9 years), 2 (high-school gradu-
ated or 12 years), and 3 (some college and higher).
A binary indicator for disability status (0/1) was used. For
disability, respondents were asked if they had been diag-
nosed with a disability in any of the following health condi-
tions: developmental disorder, brain disorder, visual
impairment, hearing impairment, speech impairment, intellec-
tual disorder, autism, psychiatric disorder, a heart disease, a
respiratory disease, liver disease, facial disorder, urinary disor-
der, epileptic disorder, and others.
Analysis
First, chi-square and one-way ANOVA tests were undertaken to
determine differences among demographic covariates and
age-friendly environmental characteristics. Next, the subjective
well-being outcome, life satisfaction, was regressed for SES and
environmental contexts to examine their main and interaction
effects after the effects of covariates were controlled. The data
had a natural hierarchical structure, consisting of respondents
nested within five regional areas of Seoul City. To address the
non-independence of observations engendered by the nesting
of respondents within regional areas, we used multilevel
modeling. Preliminary analyses examined multilevel models
that included Level-1 information on individual older adults
and Level-2 variables at the regional level that were created by
averaging individual responses. Likelihood-ratio tests of the
multilevel models with Level-2 information suggested that
regional-level factors do not have a significant relationship
with environments. As a result, we conducted analyses using
multilevel models that allowed the intercepts of the models to
vary by region without Level-2 variables.
Cross-sectional multilevel models are employed in the rela-
tionships between socioeconomic vulnerability (low-income
and living-alone status) and various dimensions of environ-
ment and older adults’ life satisfaction, while effectively
accounting for the hierarchical nature of the data in which
individuals are nested in regional areas. Multilevel modeling
separately estimated the variance in life satisfaction both
across older individuals and across communities. That is, Level
1 included information that is unique to individual older
adults while Level 2 included region-level variables. Random
intercept models for this study can be expressed as follows:
Life satisfaction D b0 C b1 ðSocioeconomic vulnerabilty Þij
C b2 ðEnvironment Þij C b3 ðCovariatesÞij C u0j C eij
b0 is the intercept for regional area j
b1 , b2 , b3 are the coefficients of predictors
u0j is the cluster-specific random intercept term for regional area
jeij is the error term for older individual i in regional area j
Variables were entered sequentially in a model-building pro-
cess. The first model examined random effect (effect of
regional areas). The second model examined the effect of SES
on life satisfaction. Model 3 added SES and covariates. Model
4 included environmental characteristics. The final model
included the interaction terms between SES and environmen-
tal contexts. Analyses were performed in Stata Version 13.
 6 S. PARK AND S. LEE

Results Socioeconomic Subgroups, Environment, and Life

Satisfaction
Socioeconomic Vulnerability, Environment, and
Background Characteristics Table 3 shows the hierarchical models. In Model 1, we first
assessed the intraclass correlation (ICC), the proportion of the
Socioeconomic vulnerability varied on all correlates exam-
total variance in life satisfaction accounted for by the clustering
ined (Table 2). Across demographic covariates, a common
in the regional areas. ICC was calculated as the ratio of the
pattern emerged. For both co-residing and living-alone
between-cluster variance (0.007) to the total variance (0.007 C
elders, low-income groups were significantly older, had
0.221). The result indicated that although small proportion,
lower levels of education, higher incidence of disability,
around 3% of the overall variance in life satisfaction was
and lower likelihood of home ownership. Gender was also
explained by the fact that respondents were clustered in same
unequally distributed across SES groups. The proportion of
regional areas. Within group variance, however, was much
women in living-alone groups was higher than the propor-
larger, indicating most of the variation in life satisfaction was
tion of women in co-residing groups. The living-
due to individual differences within regional areas. In Model 2,
alone
poor elder group stood out as having the highest
SES was entered first to examine the extent to which SES sub-
proportion of the oldest old (58%), women (67%), no edu-
groups were differentially associated with life satisfaction. As
cation (27%), having a disability (11%), and renter (72%).
expected, compared to co-residing, non-poor older adults,
Regarding environmental characteristics, for both co-resid-
other SES groups reported significantly lower life satisfaction.
ing and living-alone elders, the lower-income groups lived
The effects of SES groups on life satisfaction are attenuated by
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in worse housing conditions than the higher-income

each additional set of variables. The living-alone poor group
groups.
demonstrated a strong relationship with lower life satisfaction
In terms of transportation and neighborhood environ-
(b D ¡0.398, p < 0.01 in Model 2). The negative relation
ment, no clear pattern of relationships emerged. Poor older
between this group and life satisfaction persisted across all
adults in both the living-alone and co-residing groups
models and was strongest in Model 5 (b D ¡0.468, p < 0.05)
assessed age-friendliness in transportation at high, positive
when all other key variables were taken into account.
levels (M D 3.67 among co-residing poor, M D 3.58 among
All environmental characteristics were strongly related to life
living-alone poor). Regarding neighborhood, respondents
satisfaction. After controlling for SES and other covariates,
in the living-alone poor group had the lowest level of posi-
higher levels of age-friendliness in physical, social, and service
tive assessment (M D 3.64). In terms of social environment,
aspects of living environment were associated with higher life
respondents in the co-residing poor group assessed the
satisfaction in Models 4 and 5.
social participation environment at a high positive level,
In Model 5 (Table 3), the interaction terms between SES
while those in the living-alone poor group reported the
groups and environmental characteristics were included to
lowest level (M D 2.97). On social inclusion, respondents in
examine the extent to which age-friendliness of the environ-
both co-residing poor and living-alone poor groups were
ment moderates the main effect of vulnerability on life satis-
less likely to perceive themselves as socially included.
faction. Nonsignificant interactions were trimmed in the final
Regarding social service environment, respondents in the
model. Several key findings emerged. First, the environment’s
living-alone poor group had the highest level of positive
moderating effects varied by environmental subdomains
assessment (M D 3.4).
(physical, social, service). Among physical environment

Table 2. SES, environment, and background characteristics of the sample (N D 1657).

SES

Co-residing Living alone

Co-residing
Co-residing
Co-residing
Living alone
Living alone
Living alone

non-poor (Ref) near-poor poor non poor near-poor poor
Entire (N D 734, 44%) (N D 326, 20%) (N D 158, 10%) (N D 60, 4%) (N D 122, 7%) (N D 257, 15%) Statistics
M (SD), %
Life satisfaction (M) 3.31 3.43 3.26 3.24 3.43 3.29 3.05 F D (51,651) D 29.46
Covariates
Age group (%)
Young old (<75)(Ref) 56.4 64 55 51 58 51 42 x 2 (5) D 45.86a
Old old ( D >75) 43.5 36 45 49 42 49 58
Women (%) 52.6 51 47 42 58 61 67 x 2 (5) D 39.46
Education
No education (ref) 13.8 11 10 15 10 17 27 x 2 (15) D 133.50
Middle school (9 yrs) 56.9 50 65 69 57 52 61
High school (12 yrs) 22.1 28 21 13 30 28 8
Some college or higher 7 11 4 3 3 3 4
Disability (%) 7.8 7 8 10 3 7 11 x 2 (5) D 8.46
Home ownership (%) 66.5 80 77 56 77 46 28 x 2 (15) D 333.95
Age-friendly environment characteristics
Physical environment (M)
Housing condition 3.61 3.79 3.63 3.62 3.66 3.58 3.21 F D (5,1651) D 16.73 
Transportation 3.64 3.69j 3.60 3.67 3.57 3.59 3.58 F D (5,1651) D 2.62 
Neighborhood 3.70 3.76 3.60 3.72 3.74 3.72 3.64 F D (5, 1651) D 4.31a
Social environment (M)
Social participation 3.16 3.25 3.09 3.21 3.24 3.20 2.97 F D (5, 1651) D 8.93 
Social inclusion 3.11 3.17 3.08 3.06 3.23 3.08 3.02 F D (5, 1651) D 3.18
Service environment (M) 3.42 3.45 3.38 3.24 3.39 3.36 3.4 F D (5, 1651) D 1.19

Note: aThe significance level of p-value: p <.05; p < 0.01.

 AGING AND MENTAL HEALTH 7

Table 3. SES, environment, and life satisfaction: P
E fit perspective.

Model 1 Model 2 Model 3 Model 4 Model 5

Life satisfaction
Fixed effect
SES
0.Co-residing C non-poor (ref)
1. Co-residing C near-poor ¡0.171(0.03) ¡0.145(0.02) ¡0.080(0.02) 0.298(0.18)
2. Co-residing C poor ¡0.189(0.03) ¡0.109(0.03) ¡0.086(0.02) ¡0.369(0.23)
3. Living alone C non poor ¡0.026(0.06) ¡0.008(0.025) 0.008(0.04) ¡0.247(0.38)
4. Living alone C near-poor ¡0.154(0.04) ¡0.067(0.04) ¡0.042(0.03) 0.184(0.28)
5. Living alone C poor ¡0.398(0.03) ¡0.25(0.03) ¡0.158(0.02) ¡0.468(0.20)
Covariates
Age group (%)
Young old (<75)(Ref)
Old old ( D >75) ¡0.05(0.02) ¡0.008(0.01) ¡0.001(0.01)
Women (%) 0.012(0.02) 0.000(0.01) ¡0.013(0.01)
Education
No education (ref)
Middle school (6 yrs) 0.051(0.05) 0.066(0.02) 0.066(0.02)
High school (9 yrs) 0.105(0.03) 0.106(0.02) 0.108(0.02)
Some college or higher 0.181(0.05) 0.128(0.03) 0.128(0.03)
Disability (%) ¡0.894(0.04) ¡0.115(0.02) ¡0.109(0.03)
Home ownership (%) 0.191(0.02) 0.102(0.01) 0.093(0.01)
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Age-friendly environment characteristics

Physical environment (M)
Housing condition 0.107(0.01) 0.097(0.01)
Transportation 0.095(0.01) 0.070(0.02)
Neighborhood 0.065(0.01) 0.083(0.02)
Service environment (M) 0.174(0.01) 0.273(0.03)
Social environment (M)
Social participation 0.161(0.01) 0.107(0.02)
Social inclusion 0.133(0.01) 0.093(0.02)
SES  physical environment
5. Living alone C poor  transportation 0.124(0.05)a
SES  social environment
5. Living alone C poor  social participation 0.150(0.04)
5. Living alone C poor  social inclusion 0.116(0.04)
SES  service environment
4. Living alone C near-poor  Service environment ¡0.196(0.06)
5. Living alone C poor  service environment ¡0.235(0.04)
Constant 3.336(0.04) 3.462(0.01) 3.251(0.09) 0.739(0.10) 0.776(0.13)
Random effect Estimate Estimate Estimate Estimate Estimate
Variance (intercept) 0.007(0.00) 0.010(0.00) 0.008(0.00) 0.003(0.00) 0.003(0.00)
Variance (residual) 0.221(0.00) 0.202(0.00) 0.191(0.00) 0.103(0.00) 0.098(0.00)
Number of groups 5 5 5 5 5
Log likelihood ¡1109.86 ¡1034.66 ¡988.99 ¡477.76 ¡436.14
LR x2 (df) ¡ 150.41(5) 91.34(5) 1022(6) 79.90(30)
N 1657 1657 1657 1657 1657

Note: aThe significance level of p-value: p <.05; p < 0.01.

In model 5, only significant interaction terms are presented.

characteristics, only transportation age-friendliness signifi-
cantly moderates the effect of SES on life satisfaction, while
social and service environments moderate the effect of vul-
nerability on life satisfaction for some SES groups. Second,
within each environmental subdomain, moderating effects
were found primarily for the most vulnerable older adults,
those in the living-alone poor group (b D 0.124, p < 0.05 in
transportation; b D 0.150, p < 0.01 in social participation; b D
0.116, p < 0.01 in social inclusion; b D ¡0.196, p < 0.05 for liv-
ing-alone near-poor; and b D ¡0.235, p < 0.01 for living-alone
poor in service environment). Third, a higher level of age-
friendliness in the service environment is negatively associ-
ated with life satisfaction among the living-alone near-poor
and the living-alone poor.
Discussion
Socioeconomic Vulnerability and Age-friendly
Environment
As previously established (see Lee & Kim, 2013), individuals in
the living-alone group are generally older and women, have
lower education levels, and live in rental housing. In this
study, both co-residing and living-alone older adults who
were poor or near-poor were more often women, were signifi-
cantly older, had lower education levels, and were less likely
to be homeowners. These findings confirmed that, in Korea,
living-alone is clearly a social stratification factor.
Closer examination, however, revealed an interesting varia-
tion among living-alone Korean older adults. The proportion
of co-residing older adults with a disability was significantly
higher (8.4%) than living-alone older adults (7%), suggesting
that co-residence with family members reflects a decision to
care for parents with severe health limitations. Respondents
in the living-alone group, particularly those with lower
incomes, were substantially more vulnerable in the absence
of proximal family support.
Identifying older adults’ perceived environmental chal-
lenges and resources is an important component of under-
standing their needs. As expected from previous studies,
among both co-residing and living-alone older adults, those
in poor groups have worse housing conditions than those in
non-poor groups. Poor older adults frequently experience
problems like leaky roofs, broken equipment (toilets and
 8 S. PARK AND S. LEE
heaters), and structural issues (slippery floors) that can result
in both unsanitary and uncomfortable living situations, and
serious health and safety problems. In terms of transportation,
lower SES is not necessarily related to lower levels of age-
friendliness. Rather, poor elders in both co-residing and
living-alone groups assessed transportation positively. Con-
ceptualized as personal competency in the P
E fit perspec-
tive, SES helps a person to overcome the shortcomings and
press of environment. Therefore, SES potentially ameliorates
effects of environmental demand or resource. For example, it
is possible that those in a higher SES group who have cars,
may not be as sensitive to public transportation systems as
those in lower SES groups without cars. Considering Seoul
City, the public transportation system is well developed and
connected, serving as a resource for those in lower SES
groups. Regarding social environment, the co-residing poor
group assesses the social participation environment posi-
tively, but the living-alone poor group reported the lowest
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level of friendliness (M D 2.97). Regarding social inclusion,
findings again confirm the vulnerability of living-alone older
adults in Korea. They felt less likely to be respected and
included by others. Interestingly, this group assessed the ser-
vice environment most positively. The service environment
may be more relevant to, and more directly affect the daily
experiences of, marginalized older adults.
Person
Environment Fit and Life Satisfaction
After controlling for demographic covariates, we find charac-
teristics of the environment in different subdomains are sig-
nificantly related to life satisfaction among older adults in
Korea. The importance of physically supportive environments
(Hoenig, Landermann, Shipp, & George, 2003; Murphy,
Nyquist, Straburg, & Alexander, 2006; Rochette, Desrosiers, &
Noreau, 2001; Yen, Michael, & Perdue, 2009), as well as social
integration for older adults’ subjective well-being and suc-
cessful aging are well established (Choi, 2008; Cornwell, Lau-
mann, & Schumm, 2008; Cutchin, 2003; Davidson, Daly, &
Arber, 2003; Gaugler, Duval, Anderson, & Kane, 2007; Lawler,
2001; Tang & Lee, 2011). The findings that emerge from our
multidimensional examination of the environment demon-
strate the different components of living environment that
contribute to older adults’ life satisfaction and transcend the
effects of SES disadvantage and demographic characteristics.
This finding is an empirical foundation for efforts to identify
aspects of the living environment that can serve as modifiable
resources and improve psychological well-being for vulnera-
ble older adults.
Our findings develop a lens through which to view com-
plex interactions among vulnerable SES subgroups and their
environments. Results of the interaction between environ-
ment and SES were not consistent across environmental sub-
domains (physical, social, and service). Guided by the
environmental docility hypothesis (Lawton, 1989), we
expected that individuals in vulnerable SES groups living in
age-friendly environments would have higher life satisfaction,
a hypothesis supported in the physical and social environ-
ments, but not the service environment. Our findings suggest
vulnerable subgroups of older adults in the Korean context
may successfully age-in-place if they benefit from supportive
physical and social environmental resources. Further, they are
more likely to have higher life satisfaction when transporta-
tion and social environments are age-friendly, since these
areas strengthen opportunities for social engagement. These
insights provide valuable evidence for developing and imple-
menting policies and programs that benefit vulnerable sub-
groups of older adults in Korea. At the policy level, the Korean
government has implemented a range of community-based
programs for older adults, in an effort to address the increas-
ing societal problem of predominantly poor, socially isolated
elders living alone. These programs have been designed to
locate such at-risk elders and link them with various available
community-based services such as free meal delivery, health
services, and others. Moreover, in 2012 the Korean govern-
ment established laws that protect the elderly and the dis-
abled. One feature of this legislation has established
minimum standards for aging-friendly housing features and
safety criteria. These initial policy efforts seem to be bifur-
cated, focusing on service environment on one hand and
physical environment on the other. According to the empiri-
cal evidence in our findings, a comprehensive policy and pro-
gram approach should consider the role that complex
environmental contexts play in the well-being of vulnerable
subgroups of older adults.
One unexpected finding emerged: members of the most
vulnerable subgroup, the living-alone poor, are less likely to
be satisfied with life when their service environment is more
age-friendly. This is intriguing, given this group’s need for
affordable, community-based welfare services. The P
E fit
perspective proposes a mismatch between one’s needs and
environmental support may frustrate autonomy, which may
manifest as a reduced sense of personal control (Lawton,
1990; Scheidt & Norris-Baker, 2003). Although personal control
has been conceptualized as a construct independent of per-
son and environment, little empirical research examines how
personal and environmental contexts and the fit between the
two translates into well-being. Future P
E fit research should
expand this concept to better understand differential pro-
cesses of aging-in-place.
As an explanation for this finding, we speculate personal
control may be another factor that influences aging-in-place.
The P
E fit perspective proposes that a mismatch between a
person’s needs and environmental support may frustrate
autonomy, which may manifest in a reduced sense of per-
sonal or self-efficacy (Lawton, 1990; Scheidt & Norris-Baker,
2003). Although personal control has been conceptualized as
a construct independent of person and environment, little
empirical research illuminates how the personal and environ-
mental context and the fit between the two may translate
into well-being.
Specifically, there might be a mechanism underlying
depletion of psychological resources (i.e. self-control) and
subjective well-being (i.e. life satisfaction). It may be that what
the most vulnerable elders perceive as personal control might
be compromised by their interactions with service professio-
nals at community welfare agencies and public offices. That
is, by interacting with the service environment as recipients of
entitlement benefits due to their disadvantaged status, their
sense of control may be reduced, which may negatively relate
to their level of life satisfaction.
Another plausible explanation may be rooted in cultural
factors. Despite rapid demographic and family structure
changes, filial piety is a key intergenerational support sche-
mata, and it is a deeply entrenched cultural norm in Korea.
Despite the increasing prevalence of older adults living
alone, those who do may be stigmatized as being aban-
doned by their children. Coupled with their lower SES, the

living-alone
poor elders are, of all groups, the most vulnera-
ble in both material and nonmaterial aspects of life. Their
experiences and perceptions, shaped by everyday transac-
tions in public welfare agencies, may not necessarily benefit
their subjective well-being, even though the transactions
themselves are intended to help. Empirical testing of this
mechanism is beyond the scope of this study. However,
future efforts in this line of inquiry should expand P
E fit
research to better understand differential processes of
aging-in-place.
Our findings provide direction for future research. Low SES
is a manifestation of inequality accumulated through demo-
graphic and developmental processes during the life course
(Elder & Shanahan, 2006; Willson, Shuey, & Elder, 2007).
According to the cumulative-inequality perspective, disadvan-
tage may increase rates of illness, disability, and death, and
worsen well-being (DiPrete & Eirich, 2006; Ferraro & Kelley-
Moore, 2003). Living in an age-friendly environment might
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compensate for, or partially counter, earlier processes that led
to the current disadvantage (Ferraro, Shippee, & Schafer,
2009). Living in an age-friendly environment may also posi-
tively moderate the long-term effects of disadvantage on
health and well-being (Pearlin, Schieman, Fazio, & Meersman,
2005). Incorporating the life-course perspective into the P
E
fit perspective to examine why and how each dimension
helps vulnerable older adults age-in-place is a promising area
for future research.
Limitations and Conclusion
We acknowledge the study’s limitations. First, a longitudinal
investigation would enhance key aspects of research on age-
friendly environments. Underlying the P
E fit perspective is a
dynamic association between personal competence and the
environment. Generalizations about age-friendly environmen-
tal contexts for vulnerable elders in different cultures
and
environmental contexts’ influence on subjective well-being

would be stronger had we examined the development of
individuals’ P
E fit over time and observed whether changes
in person and environment lead to or result from changes in
subjective well-being. For example, it is well known that older
adults experience well-being paradox, maintaining a high level
of subjective well-being despite disadvantaged social loca-
tion, low SES, and/or health decline (Diener, Suh, Lucas, &
Smith, 1999). However, longitudinal research on subjective
well-being is limited (Smith, Borchelt, Maier, & Jopp, 2001),
and longitudinal P
E fit studies of vulnerable older adults do
not yet exist. A longitudinal examination of the extent to
which health, environment, and changes in the fit between
the two affect well-being would contribute substantively to
well-being research.
Another limitation stems from indicators of the person and
environment dimensions. We used a small set of indicators
due to the limited availability of more refined measures in the
data. For example, we did not find any significant role for
housing in the final P
E fit analysis, an unexpected finding
given that environmental gerontological researchers have
examined many aspects of the physical environment. We
speculate several factors may have contributed to this. First,
our housing indicator was fairly limited compared to the
housing indicators used in other research. For example,
researchers have examined multiitem housing indicators that
tapped into objective and subjective indicators of housing
AGING AND MENTAL HEALTH 9
quality (Oswald, Hieber, Wahl, & Mollenkopf, 2005); distin-
guished basic versus higher order housing needs (Carp &
Carp, 1984); and used multidimensional indicators such as
adequacy, quality, and use (Christensen, Carp, Cranz, & Wiley,
1992). Future research efforts should use a more refined set of
indicators when examining the physical environment.
Despite these limitations, our findings demonstrate age-
friendly environmental contexts may have both benefits and
detriments for vulnerable older adults’ well-being, depending
on P
E fit. Our study is the first attempt to use WHO AFC indi-
cators within the P
E fit perspective, but it is hoped that
future research will contribute to this area of knowledge to
provide a foundation for designing support services and pro-
grams that will effectively meet the priorities of vulnerable
older adults.
Acknowledgment
No financial or material support and assistance was provided to the
authors for conducting the study.
Disclosure statement
The authors of the manuscripts have no competing interests.
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