Determinants of Health-Related Quality of Life in Older Adults in Korea: Evidence from the Korea National Health and Nutrition Examination Survey

Abstract

The rapid demographic transition toward a super-aged society has made health-related quality of life (HRQOL) a critical issue for older adults. This study examined determinants of HRQOL among Korean adults aged 65 years and older, focusing on lifestyle behaviors, preventive health practices, healthcare utilization, mental health, and digital health literacy. Data were drawn from the 2023 Korea National Health and Nutrition Examination Survey (KNHANES), a nationally representative cross-sectional survey. A total of 2,052 participants were included after applying weights. HRQOL outcomes were assessed using the EQ-5D index, the HINT-8 scale, and self-rated health. Descriptive, bivariate, and multivariate analyses identified significant predictors. Results showed that physical activity and vaccination uptake were positively associated with HRQOL, whereas smoking, high-risk drinking, and depressive symptoms were linked to lower scores. Depressive symptoms exerted the strongest negative effect. Preventive behaviors, including routine health checkups and cancer screening, were also related to improved subjective health. Conversely, rural residence and unmet medical needs emerged as barriers, reflecting healthcare disparities. Digital health literacy moderates positive associations of physical activity and preventive care, suggesting that technology readiness can amplify benefits. These findings underscore the need for integrated approaches combining lifestyle promotion, preventive and mental health services, equitable healthcare access, and digital health strategies to enhance HRQOL in super-aged societies.