Living arrangements shape the determinants of life-sustaining treatment preferences among Korean older adults

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.