Factors associated with admission to elderly medical-welfare facilities in South Korea: a cross-sectional machine-learning study

초록

Objectives To identify the key factors associated with admission to elderly medical-welfare facilities in South Korea and to evaluate their relative importance using machine learning techniques, providing an evidence base for policy in a rapidly ageing society.Design A cross-sectional secondary data analysis.Setting The analysis was conducted using the National Health Insurance Service -Senior database, a large-scale public dataset constructed to be statistically representative of the elderly population in South Korea.Participants A total of 48 614 elderly individuals aged 60-80 years, selected through a scientifically rigorous stratified random sampling method.Primary and secondary outcome measures The primary outcome was the binary classification of an individual's long-term care arrangement: admission to a facility-based service versus utilisation of home-based care. The secondary outcome was the relative importance and contribution of a wide range of demographic, health-status and care-related variables in predicting facility admission.Results After addressing severe class imbalance with the synthetic minority over-sampling technique, our final random forest model demonstrated excellent predictive power, achieving a sensitivity of 0.856 and a balanced accuracy of 0.921. An analysis of feature importance using Shapley Additive Explanations (SHAP) revealed that the most dominant predictor was an individual's cohabitation with institutional staff (mean SHAP value approximate to 0.180), indicating pre-existing contact with the formal care system. Other critical factors included the absence of a primary caregiver (approximate to 0.056), being fully dependent due to dementia (approximate to 0.017) and the degree of functional impairment as measured by the activities of daily living (ADL) score (approximate to 0.017).Conclusion Admission to medical-welfare facilities in South Korea is a multifactorial issue, most strongly driven by the erosion of informal care support systems combined with severe health decline, particularly in cognitive and physical function. These evidence-based findings highlight the need for policy interventions that strengthen community-based integrated care and enhance support for family caregivers. Such strategies are essential for promoting ageing-in-place, ensuring the long-term sustainability of the public long-term care system and ultimately improving the quality of life for the nation's growing elderly population.

키워드