Urban environments and depression among older adults: policy implications from the WHO age-friendly cities framework

Abstract

Background

Depression is a significant mental health concern among older adults and is often exacerbated by environmental and social factors. Despite rapid global urbanisation and ageing populations, few empirical studies have explored the associations between age-friendly urban environments and depression in older populations. This study investigated the relationship between the World Health Organization (WHO) Age-Friendly Cities Framework and depression among older adults in South Korea, aiming to derive urban planning and policy implications for healthy ageing.

Methods

We analysed data from the 2020 National Survey of Older Koreans, which included 9,920 individuals aged 65 and older. Depression was measured using the Korean version of the Short-Form Geriatric Depression Scale (SGDS-K). Eight domains of the WHO Age-Friendly Cities Framework—such as park accessibility, housing convenience, social participation, and access to information—were used as independent variables. Sociodemographic characteristics were included as covariates. Associations between environmental factors and depression were examined using multiple logistic regression.

Results

Several urban environmental factors were significantly associated with a reduced likelihood of depression. These included better accessibility to parks (OR = 0.815), living in elderly-friendly housing or adequate housing (no elderly-friendly features) (OR = 0.482 and OR = 0.419), participation in leisure activities (OR = 0.763), perceived social respect (OR = 0.690), and engaging in volunteer activities (OR = 0.396). In contrast, difficulty in accessing life information services was associated with an increased risk of depression, particularly among those experiencing the greatest difficulty. Access to healthcare institutions was also linked to a higher risk of depression, especially for those living within a 10-minute walking distance. No significant associations were found for public transportation or participation in elderly employment programs.

Conclusions

This study highlights the critical role of age-friendly urban environments in supporting the mental health of older adults. Urban planning should prioritise accessible green spaces, elderly-friendly housing, inclusive leisure opportunities, and improved access to life information. Promoting social respect and volunteer engagement can further enhance emotional well-being. These findings provide empirical support for implementing the WHO Age-Friendly Cities Framework as a strategic approach to reducing depression and promoting healthy ageing in urban contexts.

Background

The global population aged 65 years and older was estimated at 810 million in 2024, accounting for 10% of the total population, and is projected to reach 2.2 billion by the late 2070s [1, 2]. This demographic shift presents significant challenges, including the rising burden of age-related diseases, increasing healthcare expenditures, and growing demand for long-term care services [3]. Depression is a major public health concern among older adults and is often exacerbated by social isolation and declining physical health [4]. In South Korea, 13.5% of older adults reported experiencing depression in 2020, and the suicide rate among this population was 41.7 per 100,000—more than double the OECD average of 16.3 [5, 6]. Late-life depression is frequently associated with medical comorbidities, anxiety, and somatic symptoms, making it more difficult to diagnose and manage, and substantially increasing the risk of suicide [7]. Ageing often leads to declines in physical functioning, mobility, and social participation, thereby increasing reliance on one’s surrounding environment [8, 9].

The World Health Organization’s (WHO) Global Age-Friendly Cities: A Guide (2007) and the World Report on Ageing and Health (2015) both emphasise the importance of environments that promote health, participation, and security in later life [10, 11]. Conversely, environments that are not adapted to the needs of older adults can contribute to physical and mental health problems, including depression [12].

Recent studies have highlighted associations between age-friendly urban features and improved mental health outcomes among older adults. A study using an age-friendly city index that included safety, service accessibility, and walkability found that older adults living in cities with higher age-friendly scores reported better quality of life, lower depressive mood scores, and reduced loneliness [13]. In China, age-friendly neighbourhoods significantly buffered the negative impact of functional decline on future depressive symptoms, and their cumulative effects slowed the rate of increase in depressive symptoms over time [14]. Among older adults with multimorbidity, housing quality and neighbourhood cohesion were associated with higher life satisfaction and lower depressive symptoms, with partial mediation by social support and social participation [15]. Furthermore, accessible green spaces, safe and suitable housing, and opportunities for meaningful social participation have been shown to play protective roles in supporting mental health in later life [16–18].

However, most prior studies have focused on individual domains of age-friendliness or specific population subgroups, and comprehensive evaluations that simultaneously consider all eight WHO Age-Friendly Cities domains in a nationally representative sample remain limited. This study aims to address this gap by investigating the relationship between depression and age-friendly urban environmental factors as defined by the WHO Age-Friendly Cities Framework in South Korea. By analysing nationally representative data, this study seeks to provide evidence-based insights to guide urban planning and age-friendly policies that support mental health and quality of life in ageing populations.

Methods

Study population and data source

This study used raw data from the 2020 National Survey of Older Koreans, conducted by the Korea Institute for Health and Social Affairs (KIHASA). KIHASA is a government-funded research institute established under the Act on the Establishment, Operation and Fostering of Government-Funded Research Institutions, conducting evidence-based policy research on health, social security, and social welfare [5, 19]. The survey is a national statutory survey mandated under Article 5 of the Welfare of the Aged Act, conducted every three years since 2007; the 2020 survey was the fifth wave.

The sampling frame was based on the 2018 Population and Housing Census. A stratified sampling method proportional to the population of older adults was applied to select community-dwelling adults aged 65 and over residing in general housing across Korea’s 17 administrative districts (7 metropolitan cities and 10 provinces). Residents of dormitories, institutions, and island regions were excluded due to small and unrepresentative subsamples in the 2017 survey (64 out of 10,299 participants). Moreover, these institutionalized older adults were excluded because their living environments differ substantially from those of community-dwelling older adults and may introduce confounding factors. This exclusion is consistent with the aim of the present study, which focuses on how age-friendly urban environments—such as access to parks, housing convenience, and public transportation—affect depression among older adults aging in place.

The survey was conducted between 14 September and 20 November 2020 by 169 trained interviewers through face-to-face interviews using tablet-assisted personal interviewing (TAPI). A total of 10,097 older adults participated. After excluding proxy respondents and cases with missing data on key variables through listwise deletion, 9,920 participants were included in the final analysis.

Dependent variable

Depression was measured using the Korean version of the Short-Form Geriatric Depression Scale (SGDS-K), a validated 15-item instrument adapted from the original Geriatric Depression Scale developed by Yesavage and Sheikh [20]. Each item was scored dichotomously (0 = non-depressive, 1 = depressive), with a total possible score ranging from 0 to 15. A score of ≥ 8 indicates clinically significant depression [21]. In this study, the SGDS-K demonstrated high internal consistency (Cronbach’s α = 0.850).

Independent variables: WHO age friendly cities framework domains

Outdoor spaces: park accessibility

Access to urban green spaces, such as parks, has been associated with reduced psychological distress and improved self-rated health among older adults [16, 22]. In this study, park accessibility was assessed based on respondents’ reported walking time to the nearest park where they could take a walk or exercise, with coding and response details provided in Table 1. According to Shon (2018), the average walking speed of older adults in South Korea is approximately 47.9 m per minute [23]. Therefore, an accessible park was defined as one within about 500 m of the residence, in line with the concept of an age-friendly environment. Urban areas can be considered more age-friendly when essential facilities for daily living are located within walking distance, as walking is the most common mode of transport for older adults [24]. A typical 65-year-old can walk 500 m in 10 min at a normal pace, and this distance represents an optimal daily exercise goal for older adults [25].

Table 1.

Measures of variables

WHO AFC Domain	Survey Question	Response Options	Coding for Analysis
Park accessibility	How long does it take to walk from your home to the nearest park where you can take a walk or exercise?	< 5 min, 5-<10 min, 10-<20 min, 20-<30 min, ≥ 30 min	< 10 min = 1 ≥ 10 min = 0
Public transportation accessibility	How long does it take to walk from your home to the nearest bus stop or subway station?	< 5 min, 5-<10 min, 10-<20 min, 20-<30 min, ≥ 30 min	< 10 min = 1 ≥ 10 min = 0
Housing convenience	Do you think this residence is convenient for the older adult to live in? (Interviewers responded to the question)	(1) the residence has inconvenient features (2) the residence has no inconvenient features but lacks facilities designed for older adults (3) the residence includes facilities designed for older adults (e.g., removal of door thresholds, adjustment of slopes, installation of handrails)	3 = 1 (elderly-friendly) 2 = 2 (adequate) 1 = 3 (inconvenient housing)
Participation in leisure and cultural activities	In the past year, have you participated in any leisure or cultural activities (excluding television viewing, radio listening, and travel)?	(1) Yes, (2) No	As is
Perceived social respect	Do you feel respected by society?	(1) Strongly agree, (2) Agree, (3) Neutral, (4) Disagree, (5) Strongly disagree	1–3 = 1 (respected) 4–5 = 0 (not respected)
Participation in elderly employment programmes	Have you ever participated in elderly employment or social activity support programmes?	(1) Currently, (2) Previously, (3) Applied no opportunity, (4) Never applied	1–2 = 1 3–4 = 0
Participation in volunteer activities	In the past year, have you participated in any volunteer activities?	(1) Yes, (2) No	As is
Difficulty accessing life information services	Do you experience difficulties in accessing the following types of practical life information?	1) Difficulty understanding terms or contents of government or public institution mail/notices 2) Difficulty reading notices from public institutions, neighbourhoods (apartments), marts due to small font 3) Difficulty accessing various information or services that are mainly online/internet-based No difficulty (0 points), Difficulty (1 point)	Sum score: 0, 1, 2, 3
Access to healthcare institutions	How long does it take to walk from your home to the nearest medical facility, such as a clinic or public health?	< 5 min, 5-<10 min, 10-<20 min, 20-<30 min, ≥ 30 min	< 10 min = 1 ≥ 10 min = 0

Transportation: public transportation accessibility

Accessible and affordable public transportation is crucial for active ageing, as it enables older adults to maintain social participation, civic engagement, and access to health and community services [10]. In this study, accessibility was measured by walking time to the nearest bus stop or subway station.

Housing: housing convenience

Safe and functional housing supports independence and reduces accident risks among older adults [26]. Prior research indicates that older adults’ subjective perceptions of their housing environment significantly influence mental health, potentially more so than objective housing conditions [17]. In this study, housing convenience was assessed based on interviewer judgement of whether the residence was generally convenient or included elderly-friendly features, as reflected in their response to a standardised survey item (see Table 1).

Social participation: participation in leisure and cultural activities

Participation in leisure and cultural activities positively influences older adults’ physical health, subjective well-being, and overall ageing experience [27]. In this study, social participation was assessed by asking whether respondents had engaged in any leisure or cultural activities (excluding television, radio, and travel) within the past year.

Respect and social inclusion: perceived social respect

Respect and social inclusion were assessed through a measure of perceived social respect, as older adults’ perceptions of societal attitudes toward ageing have been significantly associated with life satisfaction and health-related quality of life [28]. For the analysis, only affirmative responses (“strongly agree” or “agree”) were classified as perceived respect. In contrast, “Neutral”, “disagree”, and “strongly disagree” responses were grouped as not respected, based on a conservative coding designed to distinguish clear positive perceptions from all other responses.

Civic participation and employment: Participation in elderly employment programmes, Participation in volunteer activities

Opportunities for older adults to engage in paid work or volunteering are advocated by the World Health Organization [10], as participation in such activities has been associated with improved financial security, stronger social connections, greater sense of purpose, and enhanced overall well-being [28–30]. In this study, civic participation and employment were assessed through questions about involvement in elderly employment programmes and volunteer activities.

In South Korea, elderly employment programmes are government-supported initiatives established under the Welfare of the Aged Act and the Framework Act on Low Birth Rate in an Aging Society. These programmes are classified into public sector (e.g., community service, talent sharing), social service sector (e.g., community care, school meal assistance), and private sector (e.g., job placement services, senior internships) categories [31]. The primary aim of these programmes is to promote social participation and economic activity among older adults while contributing to the local community.

Communication and information: difficulty accessing life information services

Access to practical life information is essential for maintaining autonomy and daily functioning in later life. Previous research has identified limited access to such information as a key barrier to older adults’ utilisation of necessary health and community services [32]. In this study, communication and information accessibility was measured by assessing respondents’ difficulties in using various life information services.

Community support and health services: access to healthcare institutions

Older adults often have complex healthcare needs due to age-related functional decline, chronic conditions, and psychosocial vulnerability. Unmet healthcare needs may exacerbate disease severity, increase complications, and elevate mortality risk [33]. Equitable access to healthcare services is therefore essential; however, geographical disparities in the distribution of medical facilities can lead to inefficiencies in service delivery and contribute to health inequalities among older populations [34]. In this study, accessibility was measured by walking time to the nearest medical institution. Detailed coding and response options for all variables are summarized in Table 1.

Control variables: sociodemographic characteristics

Sociodemographic characteristics known to be associated with depression were included as control variables: sex; age (65–69, 70–74, 75–79, ≥ 80); educational attainment (no formal education, elementary, middle school, high school or above); income level (quartiles); household composition (living alone/other households, living with spouse, living with adult children); number of chronic diseases (0, 1, ≥ 2); functional status(dependence in ADL and IADL); employment status (employed or unemployed); and frequency of social contact (almost daily (≥ 4 times/week), 1–3 times/week, 1–2 times/month, 1–2 times/quarter or less). The conceptual framework of this study is presented in Fig. 1.

Fig. 1.

Conceptual framework of urban environments and depression among older adults

Analysis methods

Descriptive statistics were used to examine the distribution of key variables. Chi-square tests were conducted to compare the prevalence of depression across subgroups. Multiple logistic regression analyses were performed to assess the independent associations between the eight domains of the WHO Age-Friendly Cities Framework and depression, while adjusting for sociodemographic covariates. All eight domains were entered simultaneously into the model as independent variables, enabling estimation of each domain’s unique association with depression, accounting for the influence of the others. Results are presented as odds ratios (ORs) with 95% confidence intervals (CIs). To assess multicollinearity among independent variables, variance inflation factors (VIFs) were calculated; all VIFs were below 10, with the highest being 1.670, indicating no serious multicollinearity. All analyses were conducted using SPSS version 27.0.

Results

General characteristics of the study participants

Among the 9,920 older adult participants, 13.0% were identified as having depression based on the SGDS-K. Regarding environmental characteristics, 60.4% of respondents lived within a 10-minute walking distance to a park, while 39.6% reported longer travel times. For public transportation, 68.8% had access within 10 min, and 31.2% did not. In terms of housing, 18.8% lived in elderly-friendly housing, 71.4% in adequate housing (no elderly-friendly features), and 9.8% in inconvenient housing. With respect to social participation, 79.1% had engaged in leisure or cultural activities during the past year, whereas 20.9% had not. In terms of perceived social respect, 62.8% of respondents reported feeling that older adults were not respected in society. For civic participation, 13.5% had participated in elderly employment programmes, and only 2.5% had engaged in volunteer activities. Regarding access to life information, 53.2% of participants reported the highest level of difficulty in using life information services, while only 21.2% reported no difficulty. As for access to healthcare institutions, 42.1% could reach a healthcare institution within 10 min on foot, whereas 57.9% required more time (Table 2).

Table 2.

Descriptive statistics of urban environment of the participants

Domain	Variables	Categories	Frequency (%)
Outdoor spaces	Park accessibility	Less than 10 min on foot	5,994(60.4)
		10 min or more on foot	3,926(39.6)
Transportation	Public transportation accessibility	Less than 10 min on foot	6,823(68.8)
		10 min or more on foot	3,097(31.2)
Housing	Housing convenience	Elderly-friendly housing	1,867(18.8)
		Adequate housing (no elderly-friendly features)	7,078(71.4)
		Inconvenient housing	975(9.8)
Social participation	Participation in leisure and cultural activities	Participated in the past year	7,848(79.1)
		Not participated in the past year	2,072(20.9)
Respect and social inclusion	Perceived social respect	Respected	3,688(37.2)
		Not respected	6,232(62.8)
Civic participation and employment	Participation in elderly employment programmes	Participated	1,340(13.5)
		Not participated	8,580(86.5)
	Participation in volunteer activities	Participated in the past year	246(2.5)
		Not participated in the past year	9,674(97.5)
Communication and information	Difficulty accessing life information services	0 points	2,096(21.2)
		1 point	1,413(14.2)
		2 points	1,131(11.4)
		3 points	5,280(53.2)
Community support and health services	Access to healthcare institutions	Less than 10 min on foot	4,177(42.1)
		10 min or more on foot	5,743(57.9)
Total			9,920(100.0)

Depression prevalence by sociodemographic characteristics

The prevalence of depression was higher among women (14.6%) than among men (10.6%). Prevalence increased with age, ranging from 8.5% among those aged 65–69 to 19.2% among those aged 80 or older. An inverse relationship was observed between educational attainment and depression: 21.5% among individuals with no formal education compared to 8.2% among those with a high school education or higher. Depression prevalence declined with increasing income level, from 18.4% in the lowest quartile to 8.9% in the highest. Living arrangement was also associated with depression: 18.0% among those living alone/other households, 14.8% among those living with adult children, and 9.3% among those living with spouse. The number of chronic diseases showed a positive association with depression: 3.6% among those with no chronic conditions, 9.1% with one, and 18.2% with two or more. Depression prevalence was 11.5% among those who were independent in activities of daily living (ADL), compared to 48.7% among those who required assistance. For instrumental activities of daily living (IADL), the prevalence was 10.0% among independent individuals and 39.6% among those who needed help. Employment status was also relevant, with 16.0% of unemployed participants experiencing depression compared to 8.1% of those employed. Finally, frequency of social contact was inversely associated with depression: 9.4% among those with almost daily (≥ 4 times/week) contact, compared to 20.3% among those with infrequent contact (1–2 times/quarter or less) (Table 3).

Table 3.

Depression status by sociodemographic factors

Variables	Category	Depression Status		n=9,920	χ2
		No depression (%)	Depression (%)	Total (%)
Sex	Men	3,549(89.4)	422(10.6)	3,971(40.0)	33.851***
	Women	5,078(85.4)	871(14.6)	5,949(60.0)
Age	65– 69	3,211(91.5)	300(8.5)	3,511(35.4)	139.647***
	70–74	2,156(87.4)	310(12.6)	2,466(24.9)
	75–79	1,655(84.6)	301(15.4)	1,956(19.7)
	80 and older	1,605(80.8)	382(19.2)	1,987(20.0)
Education level	No formal education	725(78.5)	198(21.5)	923(9.3)	170.903***
	Elementary school	2,438(83.3)	488(16.7)	2,926(29.5)
	Middle school	1,991(87.0)	298(13.0)	2,289(23.1)
	High school or above	3,473(91.8)	493(8.2)	3,782(38.1)
Income level	1st quartile	2,049(81.6)	461(18.4)	2,510(25.3)	127.047***
	2nd quartile	2,090(85.2)	363(14.8)	2,453(24.7)
	3rd quartile	2,247(90.0)	251(10.0)	2,498(25.2)
	4th quartile	2,241(91.1)	218(8.9)	2,459(24.8)
Household type	Living alone/Other households	2,664(82.0)	583(18.0)	3,247(32.8)	135.204***
	Living with spouse	4,598(90.7)	473(9.3)	5,071(51.2)
	Living with adult children	1,365(85.2)	237(14.8)	1,602(16.0)
Number of chronic diseases	0	1,630(96.4)	60(3.6)	1,690(17.0)	299.902***
	1	2,663(90.9)	267(9.1)	2,930(29.5)
	2 or more	4,334(81.8)	966(18.2)	5,300(53.4)
ADL	Independent	8411(88.5)	1088(11.5)	9499(95.8)	493.204***
	Needs assistance	216(51.3)	205(48.7)	421(4.2)
IADL	Independent	8022(90.0)	896(10.0)	8918(89.9)	695.022***
	Needs assistance	605(60.4)	397(39.6)	1002(10.1)
Employment status	Employed	3,466(91.9)	307(8.1)	3,773(38.0)	128.840***
	Unemployed	5,161(84.0)	986(16.0)	6,147(62.0)
Frequency of social contact	Almost daily (≥ 4 times/week)	2,373(90.6)	246(9.4)	2,619(26.4)	96.724***
	1–3 times/week	3,870(86.7)	593(13.3)	4,463(45.0)
	1–2 times/month	1,290(88.1)	175(11.9)	1,465(14.8)
	1–2 times/quarter or less	1,094(79.7)	279(20.3)	1,373(13.8)
total				9,920(100.0)

*p<.05, **p<.01, ***p<.001

Depression prevalence by WHO age-friendly environment domains

Depression was more prevalent among older adults with limited access to age-friendly environmental features. The prevalence of depression was 15.4% among those who required more than 10 min to access a park, compared to 11.5% among those with access within 10 min. A similar pattern was observed for public transportation accessibility, with depression rates of 15.3% among those requiring more than 10 min and 12.0% among those with closer access, although the difference was smaller.

Housing convenience showed a strong association with depression: 27.3% among those in inconvenient housing, compared to 11.5% among those in elderly-friendly housing and those in adequate housing (no elderly-friendly features).

Regarding social participation, non-participants in leisure and cultural activities had a depression rate of 18.3%, compared to 11.6% among participants. Perceived social respect was similarly associated with depression: 15.0% among those who did not feel respected by society versus 9.7% among those who did.

Participation in elderly employment programmes was not significantly associated with depression (13.0% vs. 13.5%). Volunteer activity appeared to be strongly protective: only 3.7% of participants who had volunteered in the past year were depressed, compared to 13.3% of non-volunteers. Depression prevalence increased with greater difficulty in accessing life information services, from 6.4% among those with moderate difficulty to 17.0% among those with the highest level of difficulty. In contrast, access to healthcare institutions was not significantly associated with depression (12.6% vs. 13.3%) (Table 4).

Table 4.

Depression by urban environment based on the WHO age-friendly cities framework

Variables	Categories	Depression Status		n = 9,920	χ2
		No depression (%)	Depression (%)	Total (%)
Park accessibility	Less than 10 min on foot	5,305(88.5)	689(11.5)	5,994(60.4)	31.664***
	10 min or more on foot	3,322(84.6)	604(15.4)	3,926(39.6)
Public transportation accessibility	Less than 10 min on foot	6,004(88.0)	819(12.0)	6,823(68.8)	20.484***
	10 min or more on foot	2,623(84.7)	474(15.3)	3,097(31.2)
Housing convenience	Elderly-friendly housing	1,653(88.5)	214(11.5)	1,867(18.8)	193.641***
	Adequate housing (no elderly-friendly features)	6,265(88.5)	813(11.5)	7,078(71.4)
	Inconvenient housing	709(72.7)	266(27.3)	975(9.8)
Participation in leisure and cultural activities	Participated in the past year	6,935(88.4)	913(11.6)	7,848(79.1)	65.037***
	Not participated in the past year	1,692(81.7)	380(18.3)	2,072(20.9)
Perceived social respect	Respected	3,330(90.3)	358(9.7)	3,688(37.2)	57.329***
	Not respected	5,297(85.0)	935(15.0)	6,232(62.8)
Participation in elderly employment programmes	Participated	1,159(86.5)	181(13.5)	1,340(13.5)	0.306
	Not participated	7,468(87.0)	1,112(13.0)	8,580(86.5)
Participation in volunteer activities	Participated in the past year	237(96.3)	9(3.7)	246(2.5)	19.562***
	Not participated in the past year	8,390(86.7)	1,284(13.3)	9,674(97.5)
Difficulty accessing life information services	0 points	1,865(89.0)	231(11.0)	2,096(21.2)	172.930***
	1 point	1,322(93.6)	91(6.4)	1,413(14.2)
	2 points	1,055(93.3)	76(6.7)	1,131(11.4)
	3 points	4,385(83.0)	895(17.0)	5,280(53.2)
Access to healthcare institutions	Less than 10 min on foot	3,649(87.4)	528(12.6)	4,177(42.1)	0.986
	10 min or more on foot	4,978(86.7)	765(13.3)	5,743(57.9)

*p<.05, **p<.01, ***p<.001

Association between age-friendly urban environment and depression

A multiple logistic regression analysis was conducted to examine the associations between age-friendly environmental factors and depression, adjusting for sociodemographic characteristics.

Park accessibility within a 10-minute walking distance was significantly associated with lower odds of depression, with a 18.5% reduction compared to those requiring more than 10 min (p < .01). Public transportation accessibility was not significantly associated with depression.

Housing convenience was a significant predictor: living in elderly-friendly housing or in adequate housing (no elderly-friendly features) was associated with 51.8% and 58.1% lower odds of depression, respectively, compared to living in inconvenient housing (p < .001).

Participation in leisure and cultural activities was associated with 23.7% lower odds of depression than non-participation (p < .001). Older adults who perceived themselves as respected by society had 31% lower odds of depression compared to those who did not feel respected (p < .001).

Participation in elderly employment programmes was not significantly associated with depression. However, participation in volunteer activities was associated with a 60.4% reduction in the likelihood of depression compared to non-participation (p < .01).

Regarding difficulty in accessing life information services, participants with low difficulty (score 1) had 37.8% lower odds of depression, and those with moderate difficulty (score 2) had 48.2% lower odds, compared to those reporting the highest level of difficulty (score 3) (both p < .001).

Access to healthcare institutions was significantly associated with depression, with individuals living within a 10-minute walking distance having 1.176 times higher risk of depression compared to those living more than 10 min away (p < .05) (Table 5).

Table 5.

Associations between age-friendly urban environment factors and depression among older adults

Category		OR	SE	95% CI
				LLCI	ULCI
Sex(ref=Women)	Men	0.994	0.075	0.858	1.150
Age (ref = 80 and older)	65 ~ 69	1.270*	0.108	1.028	1.568
	70 ~ 74	1.285*	0.099	1.059	1.560
	75 ~ 79	1.208*	0.095	1.002	1.456
Education level (ref=High school or above)	No formal education	1.320*	0.127	1.029	1.693
	Elementary school	1.413***	0.094	1.175	1.701
	Middle school	1.420***	0.095	1.178	1.712
Income level (ref=4th quartile)	1st quartile	1.456**	0.120	1.151	1.842
	2nd quartile	1.444**	0.114	1.155	1.805
	3rd quartile	1.288*	0.111	1.037	1.600
Household type (ref= Living alone/Other households)	Living with spouse	0.645***	0.083	0.548	0.759
	Living with adult children	1.143	0.110	0.921	1.419
Number of chronic diseases (ref = 2 or more)	0	0.283***	0.142	0.214	0.373
	1	0.602***	0.079	0.515	0.702
ADL (ref=Needs assistance)	Independent	0.607***	0.139	0.463	0.797
IADL (ref=Needs assistance)	Independent	0.332***	0.102	0.272	0.406
Employment status (ref=Unemployed)	Employed	0.662***	0.083	0.563	0.778
Frequency of social contact (ref = 1 ~ 2 times/quarter or less)	Almost daily (≥ 4 times/week)	0.474***	0.105	0.386	0.582
	1 ~ 2times/week	0.731***	0.090	0.613	0.871
	1 ~ 2times/month	0.725**	0.115	0.579	0.908
Park accessibility (ref = 10 min or more on foot)	Less than 10 min on foot	0.815**	0.074	0.706	0.942
Public transportation accessibility (ref = 10 min or more on foot)	Less than 10 min on foot	0.932	0.078	0.800	1.086
Housing convenience (ref=Inconvenient housing)	Elderly-friendly housing	0.482***	0.114	0.385	0.604
	Adequate housing (no elderly-friendly features)	0.419***	0.091	0.350	0.501
Participation in leisure and cultural activities (ref = Not participated in the past year)	Participated in the past year	0.763***	0.075	0.659	0.883
Perceived social respect (ref = Not respected)	Respected	0.690***	0.071	0.601	0.794
Participation in elderly employment programmes (ref = Not participated)	Participated	1.188	0.098	0.981	1.439
Participation in volunteer activities (ref = Not participated in the past year)	Participated in the past year	0.396**	0.354	0.198	0.793
Difficulty accessing life information services (ref = 3 points)	0 points	1.068	0.091	0.894	1.277
	1 point	0.622***	0.123	0.488	0.792
	2 points	0.518***	0.132	0.400	0.671
Access to healthcare institutions (ref = 10 min or more on foot)	Less than 10 min on foot	1.176*	0.071	1.024	1.351
Constant		2.684	0.208
χ 2		1198.137***(df = 32)
-2LL		6480.691
Nagelkerke R²		0.211
Hosmer & Lemeshow test		8.730(p=.366) (df = 8)
AIC		6546.691
BIC		6784.423

*p<.05, **p<.01, ***p<.001

Discussion

This study examined the association between urban environmental factors, as defined by the WHO Age-Friendly Cities Framework, and depression among older adults in South Korea. The findings demonstrate that specific environmental features—including park accessibility, housing convenience, participation in leisure and cultural activities, perceived social respect, engagement in volunteer activities, and ease of accessing life information—are significantly associated with lower odds of depression. In contrast, access to healthcare institutions was significantly associated with an increased risk of depression.

The association between park accessibility and reduced likelihood of depression is consistent with prior evidence suggesting that proximity to green spaces promotes mental well-being through increased physical activity, stress reduction, and opportunities for social interaction [35, 36]. However, the strength of this relationship may be moderated by park quality, safety, and usability, which influence actual utilisation by older residents [37]. These findings support WHO recommendations emphasising the role of accessible and inclusive outdoor environments in fostering active and healthy ageing [10].

While earlier studies have shown that accessible public transportation can facilitate social participation and improve mental health [38, 39], no statistically significant association was found in the present study. This discrepancy may be partially explained by the context of the COVID-19 pandemic. During this period, many older adults significantly reduced their use of public transportation due to infection concerns and social distancing measures, which may have attenuated the observed effects [40]. Such behavioural changes may have varied by urbanicity. In densely populated areas with greater dependence on public transit, the perceived risk of infection may have led to greater avoidance. In contrast, park use may have been less affected, as parks are open-air environments where older adults could continue to engage in physical activity while maintaining physical distance.

Housing conditions were strongly associated with depression. Both elderly-friendly housing and adequate housing (no elderly-friendly features) were linked to lower depression risk compared to inconvenient housing. This finding aligns with existing research that underscores the importance of safe, functional, and supportive housing in later life [41, 42].

Participation in leisure and cultural activities was also associated with reduced depression risk, echoing earlier evidence that such engagement enhances psychological well-being by strengthening social connections, promoting life satisfaction, and supporting cognitive stimulation [43, 44]. Likewise, older adults who perceived themselves as being respected by society had lower odds of depression. This highlights the adverse mental health impact of ageism and the protective role of social inclusion and perceived societal value [45–47].

Volunteer activity showed a particularly strong relationship with lower depression levels, suggesting that meaningful civic participation may reinforce self-worth and social integration [48, 49]. In contrast, we found no significant association between participation in elderly employment programmes and depression, which diverges from prior studies demonstrating mental health benefits of productive roles among older adults [50, 51]. This discrepancy may reflect the relatively low participation rates observed in our sample and the limited ability to distinguish among different types of employment programmes. Future research should examine how structural and qualitative aspects of these programmes—such as task complexity, social interaction, and autonomy—may differentially influence mental health outcomes.

Difficulty accessing life information services was strongly associated with higher odds of depression. This suggests that digital exclusion may constitute a significant barrier to mental well-being. As society becomes increasingly digitised, older adults with limited digital literacy may face reduced autonomy, heightened frustration, and greater social isolation [52, 53].

Contrary to some previous studies suggesting that better access to healthcare may reduce the risk of depression [54], this study found that access to healthcare institutions was significantly associated with higher odds of depression. While causality cannot be inferred, several interpretations are possible. Environmental stressors such as ambulance noise, traffic, and the visible presence of illness around healthcare facilities may contribute to psychological distress [14, 55, 56]. Recent studies have similarly reported increased depressive symptoms among those living near high-use medical centers, suggesting that proximity alone may not yield mental health benefits. These findings highlight the need to consider the broader psychosocial and environmental context of healthcare infrastructure. Given the cross-sectional nature of this study, unmeasured confounding factors may exist, and longitudinal research is needed to better understand this relationship.

Overall, the findings suggest that age-friendly urban environments function as important non-clinical determinants of mental health in later life. Policymakers should consider environmental interventions that prioritise accessible green spaces, safe and adaptable housing, inclusive cultural programming, social engagement opportunities, and digital inclusion strategies.

These findings underscore the importance of integrating environmental determinants into urban health policy. To effectively reduce depression among older adults, urban planners and policymakers must go beyond isolated interventions and pursue comprehensive, multi-sectoral approaches that align with the WHO Age-Friendly Cities Framework.

First, municipalities should adopt spatial planning strategies that ensure access to age-appropriate green spaces within a 10-minute walking distance. These parks should be designed with safety, rest facilities, and social engagement features tailored to older populations.

Second, investments in safe and adaptable housing must be prioritized, including retrofitting existing housing stock to meet universal design standards. Supportive housing policies can contribute to sustained independence and psychological stability in ageing communities.

Third, enhancing opportunities for meaningful social participation—including volunteer programs, neighbourhood clubs, and community arts—can foster a sense of purpose and mitigate loneliness. Digital inclusion efforts, such as personalized digital literacy programs and age-friendly information systems, are equally critical to overcoming informational isolation.

Lastly, findings from the COVID-19 context suggest a need for hybrid models that combine physical infrastructure with remote or mobile services, ensuring resilience in future crises. Incorporating these environmental considerations into national and local ageing policies will be essential for building sustainable, mentally healthy cities for all generations.

Strengths and limitations

This study contributes to the growing literature on environmental determinants of mental health in ageing populations by applying the WHO Age-Friendly Cities Framework to a nationally representative dataset. The use of eight operationalized environmental domains, combined with adjustment for key sociodemographic factors, allows for a comprehensive and nuanced analysis. Furthermore, the use of the validated Korean version of the Short-Form Geriatric Depression Scale (SGDS-K) enhanced the reliability of the findings.

Nevertheless, this study has several limitations. First, the cross-sectional design restricts our ability to infer causal relationships. Second, there is a possibility of measurement error and sampling bias. For example, reliance on self-reported measures may introduce recall bias or social desirability bias. In addition, older adults who were hospitalized or residing in long-term care facilities may have been excluded during the survey process, which could limit the generalizability of our findings to all older populations. Third, the secondary dataset limited our ability to assess qualitative aspects of the environment, such as park safety, housing quality, or the nature of social activities. Fourth, the study was based on data collected during the COVID-19 pandemic period. Therefore, there is a possibility that the unique circumstances during this period might have influenced elderly depression, potentially imposing restrictions on elderly individuals utilizing urban environments. Future research employing longitudinal designs and mixed-method approaches could help address these gaps.

Conclusions

This study provides empirical evidence that age-friendly urban environments are significantly associated with lower odds of depression among older adults. Specifically, features such as access to green spaces, elderly-friendly housing, participation in leisure and volunteer activities, perceived social respect, and ease of accessing life-related information emerged as key protective factors.

These findings underscore the importance of integrating age-friendly design principles into urban policy to support mental health and well-being in ageing societies. Targeted interventions—such as expanding walkable green spaces, investing in adaptable housing, promoting inclusive social programs, and improving digital inclusion—can contribute to more supportive environments for older adults.

To enhance the effectiveness of future policies, longitudinal research and qualitative investigations are needed to better understand the mechanisms through which environmental factors influence mental health. By prioritizing age-friendly urban development, societies can take a crucial step toward ensuring healthier and more equitable ageing for all.

Authors' contributions

This study was conceptualised and designed by Ye-seul Sung (YS) under the supervision of Changwoo Shon (CS). YS conducted the data analysis and drafted the manuscript. CS critically reviewed and revised the manuscript for important intellectual content. Both authors have read and approved the final manuscript.

Funding

This study received no external funding.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

This study was approved by the Institutional Review Board of the Korea Institute for Health and Social Affairs (IRB No. 2020-36). All methods were performed in accordance with the relevant guidelines and regulations for research involving human participants. Informed consent was obtained from all participants.

Consent for publication

Consent for publication: The dataset analysed in this study does not disclose any personally identifiable information. Therefore, consent for publication was not required.

Competing interests

The authors declare no competing interests.