Inntroduction

Life satisfaction is defined as a subjective well-being at the psychological level, based on an individual's happiness and quality of life. It reflects an overall evaluation of one's life [1,2]. In older adults, life satisfaction is associated with successful aging [3], and those with higher life satisfaction often experience better outcomes in various areas. These include physical health (e.g., improved subjective health status, fewer physical disabilities, and lower mortality rates), health behaviors (e.g., reduced sleep disturbances and increased physical activity), and psychosocial status (e.g., fewer negative emotions such as depression and loneliness, alongside higher positive emotions) [2,4,5]. A systematic review focusing on older adults in Asia identified multiple factors that influenced life satisfaction, including activities of daily living, cognitive function, depression, educational level, economic status, health status, housing satisfaction, sleep state, and social support [6].

Various factors affect life satisfaction in older adults, and numerous studies have shown that mobility improves life satisfaction, acting as a facilitator of well-being [1,7,8]. Webber et al. [9] defined mobility as the ability to move independently, whether by walking, using assistive devices, or utilizing transportation. Physical mobility specifically involves human activities that include moving from one place to another by walking or using a wheelchair [10]. Studies indicate that more active older adults tend to have higher life satisfaction than their less active counterparts [11], and sedentary behavior has been linked to lower life satisfaction in this demographic [12]. Given the global spread of COVID-19 since 2019, it is crucial to explore how reduced physical mobility, resulting from factors such as stay-at-home orders, decreased social activities, and fewer in-person social interactions, impacts the life satisfaction of older adults [13,14].

Social participation is also known to be an important factor influencing life satisfaction and is essential for successful aging [8,15]. As older adults undergo various life changes, their social networks, along with the quality and quantity of their social participation, evolve [16]. Particularly in later life—a period often marked by retirement and the loss of family members or acquaintances—maintaining social participation becomes vital for managing emotions such as depression, loneliness, and social isolation [17]. Social participation enables older adults to engage in meaningful activities, utilizing their experiences, knowledge, skills, wisdom, and abilities to contribute to society, which in turn enhances their life satisfaction [18]. However, compared to other regions like the EU and China, the level of social participation among older adults in South Korea remains relatively low [19]. During the COVID-19 pandemic, strict social distancing measures severely restricted social participation, and physical mobility to access venues or infrastructure for social engagement further impacted this participation, potentially affecting life satisfaction [20].

Depression is a significant determinant of life satisfaction in older adults. Data from the Health Insurance Review and Assessment Service of Korea indicate that the prevalence of depression among individuals aged 60 and older is on the rise, with a notable 26.8% increase in those aged 80 and older from 2017 to 2021 [21]. Severe depression can drastically reduce life satisfaction and, in extreme cases, may lead to suicidal thoughts or attempts [22,23]. Considering that South Korea has the highest suicide rate among older adults among Organization for Economic Co-operation and Development countries [24,25], addressing depression in older adults is a pressing public health concern. Therefore, this study explored the relationships among physical mobility, depression, social participation, and life satisfaction in older adults, particularly in the context of decreased mobility and social engagement due to the COVID-19 pandemic, alongside heightened negative psychological states caused by the prolonged crisis.

Methods

Study design

This descriptive correlational study aimed to examine the effects of physical mobility on life satisfaction in older adults and identify the serial multiple mediating effects of social participation and depression in these relationships.

Participants

The participants were individuals aged 65 and older from Daejeon, a city in South Korea, who did not have severe cognitive impairments. The sample size was determined using the G*power program version 3.1.9.7, based on the assumptions of a multiple regression analysis with a significance level of .05, an effect size of .15, a power of .95, and 11 predictor variables. Anticipating high non-response rates among older adults during the COVID-19 pandemic, we applied a 40% dropout rate, supported by a previous study conducted under similar conditions [26]. After accounting for this 40% dropout rate, the total sample size required was calculated to be 245. Data analysis was subsequently performed on the final sample of 245 participants.

Measures

1. General Characteristics

Based on previous studies [6,27,28], eight general characteristic variables were measured: sex, age, living with spouse, monthly income, current economic activity, religion, comorbidity, and cognitive status (MMSE-DS).

2. Physical mobility

To measure the physical mobility of older adults, we utilized the Physical Functioning Scale for Community-Dwelling Older Persons, developed by Lee et al. [29]. This instrument includes 10 items, divided equally between mobility and self-care tasks. It evaluates the difficulty of performing specific actions independently, without assistance or aids, using a 4-point Likert scale, thereby facilitating an easy assessment of physical function. The reliability of the tool was shown by Cronbach’s ⍺ values of .92 in the initial study [30] and .94 in the current study.

3. Social Participation

Social participation among older adults is defined as their engagement in activities that allow them to interact with others within society or their community [30]. This study utilized a measurement tool originally developed by Lee [31] and later revised by Yim et al. [32] to assess social participation. The tool comprises 8 items that evaluate satisfaction with participation in social activities. These items are rated on a 4-point Likert scale, ranging from 1 (not at all) to 4 (very much), with total scores varying from 8 to 32. The reliability of the tool was shown by Cronbach's ⍺ values of .90 in the study by Yim et al. [32] and .99 in the current study.

4. Depression

To evaluate the mental health of older adults, this study employed the Korean version of the short form of the Geriatric Depression Scale (SGDS-K). This version was translated, revised, and validated by Kee in 1996 [33], adapting the abbreviated scale originally developed by Sheikh and Yesavage [34]. The SGDS-K comprises 15 items, each scored with a "yes" (1 point) or "no" (0 points). Items 1, 5, 7, 11, and 13, which are phrased positively, have their scores reversed. A total score ranging from 0 to 4 is considered normal, scores between 5 and 9 suggest probable depression, and scores from 10 to 15 indicate depression [35,36]. The reliability of the tool was initially demonstrated by a Cronbach’s ⍺ value of .88 in the study by Kee [33], and later by Cronbach's ⍺ values of .86 in the study by Bae and Cho [35] and .81 in the current study.

5. Life Satisfaction

Life satisfaction, the dependent variable in this study, is defined as the subjective satisfaction an individual experience in their daily life. It was assessed using a 10-point Likert scale, which ranged from 1 (very dissatisfied) to 10 (very satisfied). Participants responded to the question, "Considering all things, how satisfied have you been with your life recently?"

Data collection

This study recruited participants aged 65 and older residing in the urban area of Daejeon, South Korea, through collaboration with senior welfare centers and senior citizen centers. Recruitment occurred from December 29, 2020, to January 19, 2021. Data collection involved a combination of self-administered questionnaires and structured interviews conducted by trained researchers. The entire data collection process, including both the completion of questionnaires and the interviews, lasted approximately 20 to 30 minutes.

Ethical considerations

This study received approval from the Institutional Review Board of the university affiliated with the corresponding author (IRB No. KYU-2020-106-02). Before commencement, participants were informed that the data collected would be exclusively used for research purposes. Research assistants provided a detailed explanation of the study's objectives and procedures during individual sessions with the participants. The study involved participants who voluntarily agreed to take part and provided written consent. Participants were also informed that they could withdraw from the study at any time without facing any penalties or disadvantages, a point that was reiterated in the consent form. Upon completion of the study, participants received a thank-you gift. No personal data, such as names or contact information, were collected; instead, each participant was assigned a unique ID. Furthermore, all data, including details on sex, age, and monthly income, were encrypted to maintain anonymity and were accessible only to the research team.

Data analysis

Data were analyzed using SPSS/WIN 26.0 and PROCESS Macro V4.1, with a significance level set at p < .05. Frequency and descriptive analyses were conducted to understand the general characteristics of the participants. The normality of the data was assessed using the Shapiro-Wilk test. The differences in life satisfaction based on these characteristics were examined using the independent t-test and one-way ANOVA for normally distributed data, followed by Scheffé’s test for post-hoc analysis. For data that were not normally distributed, the Mann-Whitney U test and Kruskal-Wallis test were employed. Partial correlation analysis was used to explore the relationships between physical mobility, social participation, depression, and life satisfaction, while controlling for confounding variables. Prior to testing for mediation effects, the assumption of independent errors was verified using the Durbin-Watson statistic, and multicollinearity among the independent variables was checked using the Variance Inflation Factor (VIF). The serial multiple mediation model (Model 6) with two mediators was tested using Hayes’ [37] PROCESS Macro V4.1. The significance of the mediation effect was assessed using 5,000 bootstrap samples. A mediation (indirect) effect was considered statistically significant if the confidence interval generated by bootstrapping did not include zero.

Results

Characteristics of participants

The general characteristics of the participants are shown in Table 1. The majority were women, accounting for 58.0%, compared to 42.0% men. Participants aged 75 and older were more common, representing 51.4%, as opposed to those aged 65-74, who made up 48.6%. Most participants, 62.9%, lived with their spouse, and a significant portion, 74.7%, reported a monthly income of KRW 1 million or less. A large majority, 70.6%, were not engaged in economic activities, and 59.6% identified with a religion. Over half of the participants, 55.1%, had two or more chronic diseases, with an average of 1.83±1.22 chronic conditions each. The average scores for cognitive function (MMSE-DS) were 24.80±3.91, for physical mobility 86.34±16.40, and for social participation 25.30±6.83. In terms of depression among older adults, 63.3% scored 0-4 (normal), 26.5% scored 5-9 (probable depression), and 10.2% scored 10-15 (depression). The average life satisfaction score for the participants was 6.36±2.10.

Life satisfaction varied significantly according to monthly income, the number of chronic diseases, and depression scores. Specifically, participants earning between KRW 1 million and approximately KRW 3 million per month reported higher life satisfaction compared to those earning KRW 1 million or less. Participants with one chronic disease reported higher life satisfaction than those with two or more chronic diseases. Furthermore, higher life satisfaction was associated with lower depression scores.

Correlations of physical mobility, social participation, depression, and life satisfaction

Referring to the suggestion of Hayes [37] for including intermediary variables, there must be a significant correlation between the predictors and the outcome variables. To determine whether physical mobility, social participation, depression, and life satisfaction could be included in the model, we conducted a partial correlation analysis, controlling for age, monthly income, comorbidity, and cognitive status (Table 2). The analysis revealed that physical mobility (r=.25, p<.001) and social participation (r=.18, p<.001) were positively correlated with life satisfaction, while depression (r=-.61, p<.001) was negatively correlated. Based on these findings, we concluded that these four variables were appropriate for inclusion in the intermediary model analysis.

Multiple mediation analysis in the relationship between physical mobility and life satisfaction

To determine if social participation and depression act as multiple mediators in the relationship between physical mobility and life satisfaction, we employed a bootstrapping analysis using Model 6 of the Process macro in SPSS 26.0. This analysis involved 5,000 resamples and was conducted at a 95% confidence interval. Prior to conducting the mediation analysis, regression assumptions were examined. The Durbin-Watson value was below 2, indicating that the assumption of independence of residuals was satisfied. The VIF ranged from 1.00 to 1.70, which are well below the commonly accepted threshold of 10, and tolerance values ranged from 0.57 to 1.00, exceeding the recommended minimum of 0.10. Therefore, multicollinearity was not considered a concern in the regression model.

First, we examined the significance of each pathway, with the results presented in Table 3. Physical mobility was positively associated with social participation (B=0.27, p=.005) and negatively associated with depression (B=-0.32, p<.001). Social participation was also related to depression (B=-0.12, p<.001). In terms of life satisfaction, neither physical mobility (B=-0.01, p=.738) nor social participation (B = -0.00, p=.911) showed a significant association. However, depression was significantly associated with life satisfaction (B=-0.36, p<.001) (Table 3).

Next, the indirect effects of social participation and depression on the relationship between physical mobility and life satisfaction were tested, controlling for age, monthly income, number of chronic diseases, and cognitive status as covariates. The results are shown in Table 4. The results are presented in Table 4. The indirect association through social participation on the relationship between physical mobility and life satisfaction was shown by a B coefficient of 0.00, with a bootstrap 95% CI -0.01 to 0.01. This included zero, indicating that the effect was statistically insignificant. Conversely, the mediation effect of depression on this relationship was shown by a B coefficient of 0.11 (bootstrap 95% CI: 0.07-0.16), demonstrating statistical significance. Furthermore, when considering the sequential mediation of both social participation and depression, the effect of physical mobility on life satisfaction was demonstrated by a B coefficient of 0.01 (bootstrap 95% CI: 0.00-0.02), which was also statistically significant. This suggests that physical mobility was not directly associated with life satisfaction, but showed an indirect relationship through the combined mediating roles of social participation and depression, as shown in Table 4 and Figure 1.

Discussion

This study aimed to identify the serial multiple mediating effects of social participation and depression in the relationship between physical mobility and life satisfaction among older adults during the COVID-19 pandemic. The findings provide foundational data and policy implications to improve life satisfaction in older adults. Physical mobility did not have a significant direct effect on life satisfaction. Depression significantly mediated the relationship between physical mobility and life satisfaction. In contrast, social participation did not demonstrate an independent mediating effect. However, a significant sequential mediation pathway was identified, whereby physical mobility influenced life satisfaction through social participation and subsequent depression.

The study found that the physical mobility of older adults scored an average of 86.34 out of 100, surpassing the average score of 83.9 reported in a previous domestic study using the same assessment tool [29]. The decline in physical mobility, a common issue among older adults as they age, can significantly affect their daily range of activities, leading to decreased social participation and adversely impacting their health and function. In this study, social participation averaged 25.30 out of 32, which is higher than the 23.2 points recorded for rural older adults in a prior Korean study using the same tool [32]. Despite the challenges posed by the COVID-19 pandemic, urban older adults who participated in this study appeared to derive greater satisfaction from social activities compared to their rural counterparts. This observation aligns with previous research, which suggests that social participation programs and policies are often more concentrated in urban areas, leaving rural older adults, who represent a larger segment of the aging population, with insufficient human, material, and cultural infrastructure for social participation [32]. The depression score was 4.08 out of 15, which is higher than the 3.54 points recorded for rural older adults in Korea [38] and the 3.62 points for older adults in Japan during the COVID-19 pandemic [39]. However, this score is relatively low compared to the 6.61 points observed among older adults residing in nursing homes or retirees’ associations in Serbia during the same period [16]. Various studies have indicated that protective measures during the COVID-19 pandemic, such as movement restrictions and reduced social contacts, have led to decreased social participation, increased loneliness, and higher depression levels among older adults [16,40]. However, the impact of these measures on depression in older adults varied depending on the extent of COVID-19 spread and the response policies implemented, limiting the ability to make direct comparisons. Life satisfaction had a score of 6.36 out of 10, higher than the 5.7 points measured in a survey of individuals aged 60 and older in 2020 [41]. The higher life satisfaction observed in this study may reflect the perception among older adults in Korea that measures such as stay-at-home policies, social distancing, and reduced in-person social interactions were safe practices that protected them from the virus [42,43].

The study results showed that physical mobility did not directly affect life satisfaction among older adults during the COVID-19 pandemic. Previous research has demonstrated a positive correlation between activities of daily living and quality of life in community-dwelling older adults [5], as well as between mobility and life satisfaction in studies involving Korean older adults [8]. However, studies that utilized objective measures of older adults’ activity, rather than self-reports, found no significant relationship with life satisfaction [12]. Furthermore, meta-analyses of community-dwelling older adults have shown insufficient evidence to support the impact of physical activity on quality of life [44]. The relatively high physical mobility score of 86.34 among the healthier participants in this study, indicating fewer difficulties with physical function, may account for the lack of significant impact on life satisfaction. Due to social distancing guidelines during the COVID-19 pandemic, data collection was limited to urban welfare centers and senior centers. Consequently, the sample may have disproportionately included older adults who were relatively physically healthy and actively engaged in social activities, leading to a potential “healthy user bias.” This bias may partly explain the non-significant direct effect of physical mobility and suggests that caution is warranted when generalizing the research findings.

Moreover, prior research that compared older adults living in different regions has yielded varied results regarding the impact of mobility on life satisfaction. Physical mobility significantly affects life satisfaction among rural older adults, while other types of mobility, such as the ability to independently use transportation and drive, have a greater influence on urban older adults [8]. This difference likely stems from rural older adults; proximity to workplaces and their ability to live more self-sufficiently without the need for frequent travel, whereas urban older adults may place a higher value on the ability to use public transportation or to drive [8,45]. The focus of this study on relatively healthy urban older adults might have aligned its findings with previous research. Future studies should include rural older adults to provide a more comprehensive analysis.

In this study, we found a positive correlation between social participation and life satisfaction, although no direct effect was confirmed. Additionally, the influence of physical mobility on life satisfaction, mediated by social participation, was not statistically significant. Previous research has indicated that social participation among older adults generally improves life satisfaction by fostering greater involvement in community activities and interpersonal relationships [8,15,46, 47]. This enhancement is linked to the maintenance of physical mobility in old age [48]. Elderly individuals who preserve their physical mobility gain access to a variety of social opportunities and activities, which lead to increased social interactions and participation opportunities [46]. This, in turn, boosts their autonomy and independence, allowing them to engage in meaningful social roles and maintain a sense of agency [49]. However, not all studies consistently report the same findings regarding the relationship between social participation and life satisfaction, which may stem from variations in how these terms are defined [47,50,51]. This study defined social participation as activities that enable older adults to interact with others in their society or community [30], focusing the measurement tool on qualitative aspects such as personal intentions, fulfillment of desires, and the formation of new friendships [32]. In contrast, other studies have explored the impact of different types of social participation (e.g., friendship activities, volunteer activities, religious activities) on life satisfaction [52], suggesting that the specific type of social participation should be considered when analyzing its relationship with life satisfaction. As this study was conducted during a period when the impact of the COVID-19 pandemic was ongoing, it is difficult to rule out the possibility that contextual factors related to the pandemic influenced the findings. During the pandemic, social distancing measures, restrictions on gatherings, and the closure of senior centers and community welfare facilities substantially reduced opportunities for face-to-face social participation among older adults [14]. This may have altered both the quantitative and qualitative characteristics of social participation. In particular, even when physical mobility was maintained, concerns about infection and restrictions on outdoor activities may have prevented physical mobility from leading to actual social engagement. As a result, the pathway through which physical mobility affects life satisfaction via social participation may not have reached statistical significance in this study. Therefore, future research should provide a more refined explanation by conducting comparative analyses that distinguish between pre- and post-pandemic periods, or by differentiating between face-to-face and non-face-to-face types of social participation.

The present study found a negative correlation between depression and life satisfaction, with depression having a direct impact on it. As depression decreased among older adults, their life satisfaction increased, aligning with the findings of numerous previous studies [6,43,52,53]. Typically, older adults face challenges such as social isolation, functional disabilities, chronic diseases, cognitive decline, and other physical and psychological changes associated with aging, all of which can contribute to depression [54-56]. Depression compromises the emotional and psychological well-being of older adults, adversely affecting their life satisfaction [57] and intensifying social isolation, which further diminishes life satisfaction [56]. Furthermore, in 2021 during the COVID-19 pandemic, the number of patients diagnosed with depressive disorders and anxiety disorders increased by 35.1% and 32.3%, respectively, compared with 2017, prior to the pandemic [21]. This suggests that overall mental health deteriorated during the pandemic period. Accordingly, the direct effect of depression on life satisfaction identified in this study may have been more pronounced within the unique social context of the pandemic, in which emotional vulnerability was exacerbated by the spread of infectious disease and prolonged social distancing measures. Ultimately, it is crucial to address and manage depression effectively in older adults, not only to alleviate psychological distress but also to improve overall life satisfaction in their later years.

Additionally, this study showed that physical mobility significantly influences life satisfaction by affecting depression levels. Although no existing research directly corresponds with this finding, it is known that limited physical mobility can reduce community involvement, independence, and daily activities, which may lead to depressive symptoms [58,59]. This partially supports previous findings that depression subsequently impacts life satisfaction [6,43,53,57]. Earlier studies have documented a frequent co-occurrence of reduced physical mobility and heightened depressive symptoms [60, 61], and research indicates that diminished physical mobility can predict the onset of depression [62]. To mitigate depression among older adults, interventions that promote physical mobility are needed.

According to the results of this study, physical mobility in older adults affects life satisfaction through the sequential mediation of social participation and depression. This implies that physical mobility boosts social participation, which subsequently reduces depression and ultimately improves life satisfaction. While there are no prior studies that directly compare these findings, they are somewhat consistent with existing research. Social participation has been shown to affect depression in older adults [63], and it can also decrease the risk of depression by stimulating physical activity and bolstering other psychosocial resources [53,64]. Furthermore, reduced mobility directly impacts an individual’s ability to engage in social activities and maintain independence [46,49], and is associated with depressive symptoms [65], which in turn indirectly affects life satisfaction [5,8].

This study possesses a notable strength in its contribution to the literature by identifying both direct and indirect pathways through which physical mobility influences life satisfaction, particularly highlighting the critical mediating roles of social participation and depression. However, several limitations should be noted. The generalizability of the findings is limited due to the relatively small sample size. Owing to the limited data collection sites during the pandemic, the sample may have consisted primarily of relatively healthy and socially active older adults, necessitating consideration of potential sample bias. Future research should broaden the scope to include older adults in rural areas and those with limited physical mobility to address this issue. Additionally, this study was conducted during the COVID-19 pandemic, a time characterized by reduced social interaction due to social distancing measures. Therefore, the results should be interpreted with caution, as physical mobility and social participation among older adults can be influenced by the cultural, regional, and economic contexts of their society. Furthermore, because this study utilized a cross-sectional design, the relationships among the variables should be interpreted with caution. Causal inferences cannot be drawn, and the possibility of bidirectional relationships exists (e.g., lower life satisfaction or higher depression might also lead to decreased physical mobility). Future longitudinal studies are needed to clarify the causal directions of these pathways. Finally, as life satisfaction was assessed using a single-item measure, this study may be methodologically limited in capturing the multidimensional facets of the construct; therefore, caution is warranted in the interpretation of the results.

Conclusions

The findings of this study offer insights into strategies to improve life satisfaction among older adults during the COVID-19 pandemic. The research confirmed that physical mobility boosts life satisfaction by sequentially mediating social participation and reducing depressive symptoms. Unlike prior studies that focused on the importance of individual variables, this study elucidates the pathways through which physical mobility enhances life satisfaction. These results underscore the necessity for a multidimensional approach that encompasses physical, mental, and social aspects to improve life satisfaction in community-dwelling older adults. Future studies should include comparative analyses with rural older adults to investigate the variations in the mediating effects of social participation and depression on the relationship between mobility and life satisfaction across different regional contexts.

Figure 1.

Serial mediating effects of social participation and depression in the relationship between physical mobility and life satisfaction

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