In 2025, South Korea entered a super-aged society. What the reporting team focused on was the number '53.9%.' Among registered disabled individuals in South Korea, 53.9% are aged 65 and older. This shows that aging and disability are closely related. The reporting team analyzed health statistics for the elderly population and met with disabled individuals, caregivers, and healthcare professionals to amplify their voices. The lives of elderly disabled individuals signaled a need for a bold transition in our society's healthcare and welfare paradigms. [Editor’s note]
The arduous journey of Kim Kyung-soon (86, female, pseudonym) began in her early 70s. Due to chronic conditions like hypertension and Parkinson's disease, she suffered from uncontrollable muscle tremors. As her knee joints stiffened, even standing became a struggle. Pill bottles piled up around her bed. A* pill 5mg, O* pill 20mg, I* pill 40mg… Kim took more than 15 types of pills daily.
The problem was that Kim's consciousness became increasingly muddled, making it difficult to swallow the pills. There were days when her caregiver had to crush the pills and feed her the powder. Around that time, her dementia symptoms also worsened. Kim frequently stated that 'someone stole her belongings.'
Many people say that living a long life feels more like a fear than a blessing. Cases like Kim's are becoming common among family members, relatives, and acquaintances. In Kim's case, she repeatedly went in and out of nursing homes.
'17 years of frailty.' This term arose from the significant gap between the average life expectancy of Koreans (82.7 years) and their healthy life expectancy (65.8 years). The most vivid indicator of 17 years of frailty is 'the aging of the disabled population.'
Among new registered disabled individuals in 2023, 56.3% were aged 65 and older. The proportion of registered disabled individuals aged 65 and older increased from 37.1% in 2010 to 42.4% in 2015, 49.9% in 2020, 52.8% in 2022, and 53.9% in 2023 (the total number of disabled individuals in 2023 is 2,642,000).
When elderly individuals acquire disabilities due to dementia, stroke, fractures, etc., not only does the individual suffer, but the entire family must also devote themselves to caregiving.
Path to becoming an elderly disabled person
ChosunBiz analyzed data from the Korean Frailty and Aging Cohort Study (KFACS), which has tracked approximately 3,000 elderly individuals aged 70 to 84 since 2016, to understand the pathways leading to frailty, physical dysfunction, and death among Koreans. This is the first time a media outlet has analyzed and reported the complete KFACS data from 2016 to 2023.
KFACS is a study led by the Korea Disease Control and Prevention Agency, with participation from 10 medical institutions nationwide. It is regarded as high-quality medical data that conducts long-term tracking of the elderly population, not only in South Korea but also in Asia.
With the cooperation of Professor Kim Mi-ji's team from Kyunghee University College of Medicine, the study examined changes in health status and factors contributing to health deterioration by gender and age.
View the path to becoming an elderly disabled person in interactive content
① The vulnerable pathways of aging differ significantly between genders
Frailty refers to a state in which overall functional decline is accompanied by a decrease in physiological reserve ability to maintain bodily homeostasis. Frail elderly individuals are at an increased risk of developing dementia, walking disabilities, falls, or potential hospitalizations, leading to significant physical dysfunction impacting their basic living.
Elderly physical dysfunction does not limit itself to specific areas or functions, but often gradually manifests throughout the body. It is important to distinguish between Instrumental Activities of Daily Living (IADL), such as shopping, cooking, and medication management, and Activities of Daily Living (ADL), such as eating, dressing, and controlling bowel and bladder functions, to assess the degree of disability.
ChosunBiz selected and analyzed 1,512 participants who continuously participated in three follow-up surveys conducted at two-year intervals among KFACS participants (including mortality status checks).
The analysis revealed that the vulnerable pathways of aging (frailty, mild frailty, dysfunction, death) diverged sharply starting at age 75. At this point, the mortality rate for males increased significantly, while the rates of frailty and physical dysfunction for females surged sharply.
In the follow-up survey six years later (2016 → 2022 or 2017 → 2023), the male mortality rates were 8.4% in the 70-74 age group, 11.4% in the 75-79 age group, and 21.4% in the 80-84 age group. For females, although the mortality rate was less than half that of males, the incidence of physical dysfunction rose to 18% in the 70-74 age group, 24% in the 75-79 age group, and 29.6% in the 80-84 age group.
In the case of elderly males, many succumb to fatal diseases such as cancer due to drinking and smoking, while elderly females often experience severe muscle weakness and cognitive decline due to limited living space and lack of exercise. Thus, it was confirmed that elderly females survive longer in states of frailty and disability while experiencing a significant decline in quality of life.
② Polypharmacy, a hidden time bomb
What associations do frailty and physical dysfunction have with elderly individuals' characteristics? KFACS data includes demographic, physical, clinical, and social characteristics such as age, gender, education level, residence, and illnesses.
This time, we explored the correlations between the major 32 characteristics recorded in KFACS and frailty and physical dysfunction. Using logistic regression models, we analyzed the relative impact of 32 characteristics among 788 participants who had deteriorated to frailty, dysfunction, or death following the baseline survey conducted in 2016-2017.
The analysis revealed that the characteristic with the most significant impact on health deterioration was, unsurprisingly, age. Following that, surprisingly, was polypharmacy. Polypharmacy refers to a situation in which an individual takes multiple types of medications simultaneously. This suggests that elderly individuals taking multiple medications due to chronic illnesses may accelerate frailty and disabilities. It implies that different medications can interact with each other and produce considerable side effects.
③ Good air in the countryside?… Many experience frailty and disability
The residence of elderly individuals was also found to be related to frailty and disability. Contrary to the common notion that living in the countryside with good air is beneficial for health, the analysis indicated that residing in rural areas negatively impacts health management (ranking 6th in influence). It is assumed that rural residents face difficulties in health management due to a high prevalence of chronic diseases and low access to healthcare services and health information.
④ Muscle strength, the defensive line against frailty
Meanwhile, key characteristics related to muscle strength emerged as critical factors influencing frailty assessments. Longer times to walk or stand up (3rd, TUG test), calf circumference below 32 cm (5th), and weakened grip strength (7th) were all highly correlated with health deterioration.
View the path to becoming an elderly disabled person in interactive content
Health → Disability vs. Frailty → Health
This analysis also confirmed that the health status of elderly individuals is dynamic. Participants who were classified as healthy during the baseline survey also faced mortality six years later, while those who were in a mild frailty state were able to regain their health after six years.
In the first year of the survey, the health distribution of participants classified as healthy six years later was 44% healthy, 28% mildly frail, 2% frail, 20% with disabilities, and 7% deceased. The health distribution of participants in the mild frailty stage six years later was 34% healthy, 33% mildly frail, 5% frail, 19% with disabilities, and 9% deceased. The health distribution of participants in the frail stage six years later was 1% healthy, 32% mildly frail, 18% frail, 21% with disabilities, and 28% deceased.
Professor Kim Mi-ji, the lead researcher of the elderly frailty cohort project, stated, 'The health status of elderly individuals can change depending on their health management efforts and social support,' adding, 'Research into the factors that alleviate or exacerbate frailty among the elderly will be vital references for developing health policies in a super-aged society.'
"We must change the healthcare and welfare system with great determination."
Based on the results of this analysis, looking at various surveys, a significant portion of our elderly population is either already on a vulnerable pathway of aging or has a high likelihood of entering such a path soon.
According to the 2023 senior status survey, 86.1% of elderly individuals aged 65 and older have at least one chronic illness, while 35.9% suffer from three or more chronic illnesses.
The state of polypharmacy among the elderly population is also severe. According to data submitted by Congressman Han Ji-a's office from the National Health Insurance Service, as of the first half of 2023, there are 394,029 individuals aged 65-74, 456,666 aged 75-84, and 185,939 aged 85 and older who are taking 10 or more medications.
Medical expenses for the elderly over 65 are also soaring. As of 2023, elderly medical expenses reached 48.9 trillion won, which accounts for 44.1% of total medical expenses. This amount is equivalent to twice the budget needed for the basic pension received by about 70% of the total elderly population.
The aging trend in our country is accelerating. This is because 16 million individuals from the first baby boom generation (born from 1955 to 1964) and the second baby boom generation (born from 1964 to 1974) are entering the elderly population.
Professor Yun Jong-ryul, an emeritus professor of family medicine at Hallym University (former president of the Korean Geriatrics Society), noted, 'By 2050, around 40% of the Korean population will be 65 and older, and if we don’t change the healthcare and welfare system with great determination now, we won't be able to handle the situation later.'
He added, 'The explosion of elderly medical expenses and severe polypharmacy highlight that our country has not established a healthcare system suited for an aging society,' urging, 'Now is the time to create specialized geriatric departments and a primary care system for the elderly, and to activate home visits (home healthcare).'
Individuals who assisted in analyzing health statistics
Professor Yun Jong-ryul, emeritus professor of family medicine at Hallym University
Professor Kim Mi-ji, Department of Medicine, Kyunghee University
Jeong Hui-eun, PhD student, Department of Converging Science and Technology, Kyunghee University
Kim Sung-min, postdoctoral researcher at the Research Institute of Future Humanities-based Social Innovation Education at Sungkyunkwan University