Age-Friendly Environments for Healthy Ageing in Place: Refinement of a Multidimensional Index and Regional...

South Korea faces one of the world's most rapid demographic transitions. As population ageing accelerates, creating environments that support healthy ageing-in-place has become a critical public health priority. Grounded in environmental gerontology and the WHO Age-Friendly Cities framework, Ko and colleagues developed the Age-Friendly City Index to assess physical, social, and service environments influencing older adults' health and well-being; however, the index had only undergone face validity testing. This study empirically evaluated and refined the Index at the district level and examined regional disparities in age-friendliness across South Korean municipalities.

Data from 89 randomly selected municipal (si-gun-gu) districts across 7 metropolitan and 8 provincial cities were drawn from 2020 national public administrative sources. Confirmatory factor analysis was conducted using Mplus 7.0. The retained indicators were standardized and aggregated into dimension and total scores. Exploratory comparisons between metropolitan and non-metropolitan municipalities were conducted using Welch's t-tests.

The refined Index retained ten indicators across the three dimensions, including four for the physical environment, three for the social environment, and three for the service environment. The physical environment showed the strongest empirical coherence, whereas the social and service environments were weakly defined. Non-metropolitan municipalities had higher observed scores across all three dimensions and in the total score. Effect sizes ranged from moderate to large, with the largest difference observed in the physical environment.

The refined Index offers a preliminary diagnostic framework for benchmarking age-friendliness, with the physical environment score providing the most dependable basis for comparison. Findings reveal pronounced regional disparities in per-older-resident environmental provision and underscore the need for region-specific public health and urban planning strategies to foster inclusive, supportive, and health-promoting communities for older adults.