INTRODUCTION
Advances in healthcare and technology have contributed to increased life expectancy, resulting in a growing population of older adults.1) In line with this trend, there are 10 million people in Korea, accounting for 19.5 % of the total population.2) As the population ages, aging individuals with disabilities account for 45% of the total population of people with disabilities, and their number is expected to increase rapidly. "They" refers to the individuals who have lived with a disability for an extended period and have grown older.3) They have persistent functional problems for years, decades, or even a lifetime, making them a vulnerable group experiencing both disability and aging-related issues simultaneously.4) The necessity of establishing a healthy aging strategy and paying attention to their difficulties has been highlighted.5) When aging into later life, these individuals are likely to be at a disadvantage with respect to their health compared to those aging without disabilities. With societies entering an era of aging populations, preparing for later life has become increasingly important for ensuring the quality of life of aging individuals with disabilities. Preparation for later-life can be categorized into physical, economic, and social domains.6) Among these, economic preparation for later-life is essential for maximizing health potential and is a key determinant in ensuring the quality of life of aging individuals with disabilities.7,8)
This preparation is essential but also complex, as it is influenced by a range of bio-physio-psychosocial factors.9-11) According to the theory of environmental gerontology, aging individuals with disabilities are influenced by a lifelong dynamic interaction between people and their social and physical environment.12) Environmental factors were divided into physical and social categories. The physical environment included residential assessment,13,14) while the social environment encompassed family relationship satisfaction and emotional support. The social environment—including relationships with and support from family or neighbors—is essential as individuals grow up in their community, significantly shaping their later-life experiences.15) The physical environment also plays a critical role, serving as a key determinant of frailty or disabilities,16) and ultimately affecting quality of life in older age.17) To effectively support aging individuals with disabilities, it is essential to understand the multifaceted factor operating at multiple levels, from the individuals to the broader environmental factors.10) Despite this importance, the social and physical contexts of individuals with disabilities are often overlooked, even though they significantly influence the disablement process.18) Previous research has examined the associations between various Sociodemographic characteristics—such as age, gender, educational attainment—and health status, and psychological factors and individuals’ characteristics for later life.19-23) Some studies have included younger participants (in their 30s), focused on individuals aging with visual and auditory disabilities, or applied specific behavioral theoretical models.19,20) While existing studies on aging with disabilities have predominantly concentrated on health condition and psychological attributes, the role of broader environmental factors remains underexplored. Consequently, there is a lack of empirical evidence regarding the association between demographic, psychological and environmental factors, and perceived preparation for later life among aging individuals with disabilities. Therefore, our study aims to comprehensively identify and analyze the factors influencing later-life preparation among aging individuals with disabilities, and to suggest relevant policy recommendations tailored to this population.
MATERIALS AND METHODS
Data Source and Analysis Samples
We used data from the 2021 fourth panel survey on the lives of people with disabilities by the Korea Disabled People’s Development Institute (KDDI), aimed at providing foundational data for future policy and support development.24) The survey explored key areas such as demographics, disability acceptance, psychological status, health, independence, and social participation. KDDI's comprehensive Disability Life Panel Survey tracks life changes through one-on-one interviews conducted by professional interviewers. Following the OECD's definition of older workers as those aged 50 and above, only individuals in this age group were asked about preparations for later life. Our analysis focused on 2,945 participants aged 50 or older from the KDDI data.
This study was approved by the Institutional Ethics Committee of the Wonkwang University 2024 (IRB Approval No. WKIRB-202405-SB-026).
Measures
Independent variables
(1) Health condition: Participants rated their general health condition over the past six months on the following 4-point scale: 1=very poor, 2=generally poor, 3=generally good, or 4=very good.
(2) The types and severity of participants' disabilities were obtained from the written information on their disability welfare cards.
(3) Psychological factors: To evaluate self-esteem, ten items were utilized such as: “I believe I’m a valuable person, just like everyone else,” “I think I have a good characteristics as like other person,” “I feel like I’m failure,” “I can work well with others,” “I have a positive attitude towards myself,” “I don’t have much to boast about,” “I’m generally satisfied with myself,” “I wish I could respect myself more,” “I feel like I’m a worthless person,” “I think of myself as a bad person”. The answers were scored as 1=not at all, 2=almost not, 3=that’s how it is, or 4= absolutely. Cronbach’s α was 0.85 in the present study. Disability acceptance was assessed using nine items, such as “I struggle to make friends due to my disability,” “I feel distressed by things I can’t do,” “I’m not distressed by my disability,” “I’m satisfied with my life despite it,” “How I live matters more than my disability,” “My disability greatly affects my life,” “I enjoy life enough to forget about it,” “My life isn’t lacking,” and “With determination, I can achieve anything.” Responses followed the same scale as self-esteem. Cronbach’s α was 0.63 in the present study.
(4) Degree of activities of daily living: It was measured by assessing whether participants could perform twelve tasks without assistance, including dressing, bathing, brushing teeth, eating, washing face, changing posture, getting in/out of chair, transferring out of bedroom, controlling bowel, and controlling urination. The answers scored as 1=no assistance needed at all, 2=almost not needing help, 3=partially needing help, or 4=totally needing help.
(5) Sociodemographic characteristics included factors such as gender, highest education level, and employment status.
(6) Environmental factors: The physical environment was assessed through a residential environment survey with ten items, including statements like: “The house is sturdy with good insulation and moisture control,” “It has proper soundproofing, ventilation, and heating,” “Surrounding noise, vibration, and odors make it uncomfortable,” “It is safe from natural disasters,” “It's convenient for nearby activities,” “Traffic safety facilities support daily living,” “Hospitals, fire stations, and social welfare facilities are nearby,” “My house is safe,” “The house is fire-safe,” and “It has good natural lighting.” The answer options were 1=not at all, 2=almost not, 3=that’s how it is, or 4=absolutely. Cronbach’s α was 0.86 in the present study. The social environment included satisfaction with family relationships, and emotional help or support. Satisfaction with family relationships was evaluated with five items: “I have a good relationship with my in-law(s),” “I have a good relationship with my spouse,” “I have a good relationship with my children,” “I have a good relationship with my brother/sister/relatives,” and “I have a good relationship with my parents.” Each item was rated on a 5-point ordinal scale (1=completely disagree, 2=disagree, 3=agree, 4=always agree, and 5=not applicable). The emotional help or support was assessed using the three items: “I’m receiving emotional help or support from my family,” “I’m receiving emotional help or support from acquaintances,” and “I’m receiving emotional help or support from social welfare facility personnel,”. Responses followed the same scale as satisfaction with family relationships. Cronbach’s α was 0.78 in the present study.
Data Analysis
We conducted descriptive statistics for participants’ general characteristics and variables. Chi-square and t-tests were used to compare variables between participants who prepared for later life and those who did not. Binary logistic regression analysis identified factors associated with later-life preparation, presenting adjusted odds ratios (ORs), confidence intervals, and p-values. All statistical tests were two-tailed, with a significant level of 0.05. Analysis was performed using SPSS Statistics version 26.0 (IBM Corp., Armonk, NY, USA).
RESULTS
General Characteristics
The participants’ general characteristics are presented in Table 1. Most participants did not prepare for later life (n=2,478, 84.1%) and were men (n=1,308, 44.4%), had a high school graduate or less (n=2,067, 70%), and were unemployed (n=2,023, 68.7%). Additionally, compared with those who prepared for later life, the proportion of unemployed participants was higher, and their health condition over the past 6 months was poorer (n=1,442, 48.9%). They had an inner/facial disability (n=613, 20.8%) and tended to have lower mean scores on the variable scales of psychological factors as well as environmental factors. Regarding sociodemographic characteristics such as gender (χ2=6.74, p=0.01), highest education level (χ2=82.3, p<0.001), and employment status (χ2=232.1, p<0.001), the two groups showed statistical differences. The two groups showed statistical differences in the type of disability (χ2=64.52, p<0.001), severity of disability (χ2=43.28, p<0.001), and health condition (χ2=110.7, p<0.001). Regarding psychological factors, the two groups showed statistical differences in self-esteem (t=10.91, p<0.001) and disability acceptance (t=10.86, p<0.001). In both the degree of activities of daily living (t=-9.49, p<0.001) and environmental factors, all items showed statistical differences between the two groups.
Factors Associated with Later-Life Preparation among Aging Individuals with Disabilities
Table 2 shows factors associated with later-life preparation among aging individuals with disabilities. The full model, including all independent variables, was statistically significant (χ2=459.8, p<0.001) with a Nagelkerke R2 of 0.248 and a Hosmer–Lemeshow test value of 0.493, indicating a good fit. The variance inflation factor values ranged from 1.230 to 4.832, and tolerance values were 0.432–0.821, showing no significant multicollinearity. Logistic regression results revealed that the highest education level, employment status, types of disability, health conditions, self-esteem, disability acceptance, residential environment, and family relationship satisfaction were key factors influencing later-life preparation.
Sociodemographic characteristics
(1) Highest education level: Those who responded with “university” and “graduate school/master” had a 1.67-fold and 7.71-fold, respectively, higher probability of being prepared for later life compared to those with an elementary school level.
(2) Employment status: Those who responded to this question as “unemployed” had a 0.37-fold lower probability of being prepared for later life compared to those who were employed.
(3) Types of disability: Those who responded with “brain lesion disability,” “psychiatric disorder,” and “inner/facial disorder” had a 0.56-fold, 0.25-fold, and 0.69-fold, respectively, lower probability of being prepared for later life compared to those with a physical disability. (4) Health condition: Those who responded with “generally good” and “very good” had a 2.65-fold and 6.05-fold, respectively, higher probability of being prepared for later life compared to those with a very poor health condition.
Psychological factors
(1) Self-esteem: A higher score of self-esteem associated with higher probability of being prepared for later life (OR=1.74, p<0.001).
(2) Disability acceptance: A higher score of disability acceptance associated with higher probability of being prepared for later life (OR=1.82, p<0.001).
Environmental factors
(1) Physical environmental factors: A higher score of residential environment assessment associated with higher probability of being prepared for later life (OR=2.60, p<0.001).
(2) Social environmental factors: A higher level of satisfaction with family relationships associated with a higher probability of being prepared for later life. Emotional support or help scores were not associated with the probability of being prepared for later life.
DISCUSSION
Most participants were unprepared for later life, aligning with previous studies showing low preparedness rates.20,22) Despite policies for people with disabilities in Korea, efforts remain insufficient, particularly for aging individuals with disabilities facing aging and functional challenges. Several factors, including education, employment status, health conditions and type of disability, psychological factors (disability acceptance, self-esteem), and environmental factors (physical and social environments) have been identified as significant influences on later-life preparation. Higher education and stable employment were linked to better preparedness.19,25) Health conditions over the past six months were also significant, aligning with,21) who found that recent health status influences later-life preparation.
Health is a well-known predictor of well-being and early retirement, and aging individuals with disabilities often experience secondary health conditions that limit participation.3) Thus, lifelong access to medical services is crucial to improving health outcomes for this population.26) Individuals with psychiatric disorders, brain lesions, or inner/facial disorders were less likely to prepare due to employment challenges and stigma.24,27) Psychological factors played a crucial role, with disability acceptance and self-esteem enhancing social participation and planning.21,22) High self-esteem, as noted by da Silva et al.,28) can foster a sense of security in old age, emphasizing the need for interventions that boost psychological well-being. Degree of activities of daily living was not significant, consistent with study of Lee,23) suggesting that participation restrictions depend on personal and environmental factors rather than activities of daily living limitations.29) Physical and social environments strongly influenced preparedness. Housing conditions impact disability progression,14) and residential barriers limit participation,30) emphasizing the need for supportive policies. While emotional support was not significant, satisfaction with family relationships played a key role. In Korea, older adults with disabilities often rely on family rather than formal services,31) highlighting the need for strategies that strengthen family support networks.
There are some limitations to the interpretation of this study. First, this study was a cross-sectional design and was unable to establish a causal relationship between these variables. Second, the dependent measure, preparation for later life, is only assessed by one item with binary Yes/No answer choices although second data. Thus, future studies should utilize a longitudinal design to observe participants over several years, identify temporal trends between variables, and consider items that assess various aspects of later-life preparation.
In conclusion, the study showed that later-life preparation among aging individuals with disabilities in Korea was associated with multiple aspects of their surroundings. The findings suggest that government policies or welfare related to later-life preparation should take a comprehensive approach, considering not only sociodemographic characteristics, psychological factors, health condition but also environmental factors.
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