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Living arrangements shape the determinants of life-sustaining treatment preferences among Korean older adults
Hwang IC, Kim SH, Lee YJ, Choi YS, Ahn HY.. Research Square, 2026-08-31
Topic: Health services, long-term care and technology
Background Preferences regarding life-sustaining treatment (LST) are an important component of advance care planning. This study examined whether determinants of LST preferences differ according to living arrangement among Korean older adults. Methods Data from 6,682 adults aged ≥ 65 years participating in the 2023 National Survey of Older Koreans were analyzed. Participants with dementia, depression, or cognitive impairment were excluded. The sample was stratified into couples only (n = 3,787), with offspring (n = 756), and alone (n = 2,139). Multivariable logistic regression analyses were performed to identify factors associated with LST acceptance. Results More than 92% of participants in all groups declined LST. However, factors associated with LST acceptance differed according to living arrangement. Among couples, younger age, urban residence, limited activities of daily living, smartphone non-use, and the absence of heart disease were associated with greater acceptance. Among those living with offspring, current smoking and infrequent alcohol consumption were associated with greater acceptance. Among those living alone, stroke was associated with increased acceptance of LST, whereas religious affiliation, heart disease, and pain-related disease were associated with lower acceptance. Conclusions Although most Korean older adults declined LST regardless of living arrangement, determinants of LST preferences differed according to household structure. These findings suggest that advance care planning may benefit from approaches tailored to the social and health contexts associated with different living arrangements. Trial registration: Not applicable. This study is a secondary analysis of data from the Korean Longitudinal Study of Aging (KLoSA) and did not involve a clinical trial or healthcare intervention.
Key findings
- Multivariable logistic regression analyses were performed to identify factors associated with LST acceptance.
- Results More than 92% of participants in all groups declined LST.
- However, factors associated with LST acceptance differed according to living arrangement.
- Among couples, younger age, urban residence, limited activities of daily living, smartphone non-use, and the absence of heart disease were associated with greater acceptance.
- Among those living with offspring, current smoking and infrequent alcohol consumption were associated with greater acceptance.
Study details
- Study designlongitudinal study
- Participants3,787
- Evidence strengthModerate
How this study scored 16/100
Preprint — not yet peer-reviewed. It scored 45 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. Scored zero for effect reported and randomised / blinded because the record does not state it. We have no data on times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 28 of the 62 points we could judge it on, which is 45 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (Research Square) |
| Journal's citation record | 0 / 4 | Not a journal article, so the journal's record does not count |
| Study design | 7 / 12 | A longitudinal study following the same people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 4 / 10 | Preprint — not yet peer-reviewed. Hosted on a preprint server. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 3 / 4 | 3,787 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 28 / 62 | Scored on 12 of 20 parts. We have no data for the rest, so they are left out: 28 of the 62 points we could judge it on is 45 out of 100. |
| Total | 45 / 100 | Capped to 16 because this is not a peer-reviewed article. |
What each of these 20 components measures, and what this score is not →
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Hwang, I. C., Kim, S. H., Lee, Y. J., Choi, Y. S., & Ahn, H. Y. (2026). Living arrangements shape the determinants of life-sustaining treatment preferences among Korean older adults. Research Square. https://doi.org/10.21203/rs.3.rs-10441296/v1
Vancouver
Hwang IC, Kim SH, Lee YJ, Choi YS, Ahn HY. Living arrangements shape the determinants of life-sustaining treatment preferences among Korean older adults. Research Square. 2026. doi:10.21203/rs.3.rs-10441296/v1.
BibTeX
@article{hwang2026-bc771d3f,
author = {Hwang, I. C. and Kim, S. H. and Lee, Y. J. and Choi, Y. S. and Ahn, H. Y.},
title = {{Living arrangements shape the determinants of life-sustaining treatment preferences among Korean older adults}},
journal = {Research Square},
year = {2026},
doi = {10.21203/rs.3.rs-10441296/v1},
url = {https://doi.org/10.21203/rs.3.rs-10441296/v1}
}
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