Emerging Resident Concerns as Signals of a Paradigm Shift in the Spatial Infrastructure for Integrated Community Care: Focusing on Yeonpyeong Island, a Medically Isolated Declining Region of Korea

Abstract

Across East Asia, rapid population aging and regional decline threaten the sustainability of rural and island communities. Yeonpyeong Island provides a critical context for examining how spatial infrastructure shapes older residents’ daily challenges. The aim of this study is to identify how older adults evaluate their housing and community environments and to determine whether these perceptions signal a transition toward more integrated and community-based care settings. Using a primary quantitative survey of 102 older residents, supplemented by contextual input from a local representative, the study analyzes how health decline, mobility constraints, and housing obsolescence interact with aspirations for service-integrated and socially connected living. Composite scores for perceived home modification needs remained consistently in the mid-to-upper range (approximately 3.5–4.0 on a 5-point scale). Acceptance of alternative, cohousing-type community housing also remained above the midpoint (approximately 3.5–4.1), reflecting an unusually high level of openness in a setting traditionally characterized by low receptivity to residential change and limited local housing alternatives. Safety risks, poor accessibility, and inadequate facilities function as push factors, while preferences for shared programs, proximity-based reassurance, and integrated hubs operate as pull factors, together signaling readiness for more supportive communal living. By integrating Push–Pull Theory with Environmental Press and Life-Space perspectives, the study contributes theoretically by extending these frameworks to the community scale and empirically by providing resident-level evidence from an under-researched island context. The findings highlight how older adults act as evaluators of their environments, articulating practical signals for spatial restructuring and integrated care planning.

1. Introduction

1.1. Background and Rationale

Population aging has become an irreversible global phenomenon, although its pace and intensity vary across regions. East Asia—particularly Japan and South Korea—stands at the forefront of this demographic transformation, with both countries already classified as super-aged societies. According to the United Nations [1] and Statistics Korea [2], by 2060 more than 60% of the world’s older population will reside in Asia, positioning the region’s response to aging as a matter of global significance. In South Korea, the proportion of citizens aged 65 and above surpassed 19% in 2024 and continues to increase rapidly, intensifying the spatial and social consequences of depopulation and regional decline.

These challenges are most acute in medically isolated island communities, where geographic separation constrains access to healthcare, mobility, and everyday services. In such settings, aging is experienced not only as a biological process but also as a spatial condition shaped by deteriorating housing, limited infrastructure, and fragmented support systems. The interaction of these factors places older residents at heightened risk of functional decline and reduced autonomy. Within environmental gerontology, this condition has been conceptualized as environmental press—the cumulative physical and psychological strain arising from a mismatch between individual competence and environmental demand [3]. Older adults with chronic conditions often experience unmet needs across social, psychological, and functional domains, particularly in contexts where service information and support systems are fragmented [4]. As functional capacity declines, even minor environmental barriers can significantly constrain daily life and independent living.

While prior research has extensively examined environmental press at the micro scale of individual dwellings, relatively limited attention has been given to how this framework operates at the community scale in medically isolated island contexts. Studies of rural aging have highlighted service accessibility constraints, workforce shortages, and long travel distances [5,6], yet empirical research rarely examines how structural limitations and residents’ adaptive aspirations interact within isolated island communities. In particular, the literature has not sufficiently explained how environmental constraints operate simultaneously as push factors that intensify residential pressure and as catalysts for emerging pull factors oriented toward integrated and supportive living environments.

This study addresses this gap by focusing on Yeonpyeong Island, a rapidly aging and medically underserved island region. Rather than treating older residents as passive recipients of environmental decline, the study examines how they actively evaluate their living conditions and articulate emerging needs for change. By interpreting residents’ perceptions as early signals of environmental transformation, this research conceptualizes aging as a process of anticipatory judgment regarding future living arrangements under conditions of accumulated spatial constraint.

1.2. Significance of the Study

This study seeks to determine whether environmental dynamics operating within medically isolated island communities possess the intrinsic momentum required to support a transition toward more integrated and preventive care environments. Through a push–pull perspective, the research examines whether tensions between environmental pressure (push) and aspirations for supportive communal living (pull) can function as structural drivers of sustainable transformation.

Beyond identifying these dynamics, the study reconceptualizes the role of the built and social environment from a passive backdrop of care to an active, preventive agent of intervention. In service-limited regions, sustainable aging cannot rely solely on the expansion of medical facilities; rather, it requires spatial and social infrastructures capable of supporting daily prevention, mobility, and social connection. Within this context, the study positions environmental conditions as critical determinants shaping aging trajectories in medically underserved territories and highlights the importance of proactive spatial planning for community-based care sustainability.

1.3. Originality and Contribution

This study differentiates itself from prior research on aging and community development through three key dimensions: theoretical expansion, methodological positioning, and policy relevance. By integrating environmental gerontology and residential decision frameworks within an island-based empirical setting, it offers a structured account of how older residents cognitively evaluate environmental constraints and articulate emerging needs for future-oriented spatial transformation.

1.3.1. Theoretical Expansion: From Individual Adaptation to Community-Level Dynamics

Traditional frameworks such as Environmental Press Theory [3] and Push–Pull Theory [7] have primarily focused on individual adaptation and mobility decisions. This study extends these perspectives to the community scale by conceptualizing environmental press as a collective spatial condition shaped by housing deterioration, service fragmentation, and geographic isolation. Push factors (e.g., declining health, safety risks, housing obsolescence) and pull factors (e.g., aspirations for shared housing and integrated care environments) are interpreted as interactive forces influencing community-level adaptation rather than isolated personal choices. This shift reframes aging as an active process of environmental evaluation and prospective transformation within spatially constrained settings.

In this context, a spatial spectrum framework integrating docility and life-space has recently been introduced as a conceptual basis for understanding age-friendly environments and multi-scalar adaptation needs in later life [8]. This study extends that perspective by applying it to Yeonpyeong Island—an aging and medically isolated community—where housing deterioration, mobility constraints, and limited care infrastructure intensify person–environment mismatch. By examining older residents’ perceived needs as early signals of spatial transformation, the study empirically expands the framework toward understanding readiness for preventive, community-integrated care environments in isolated aging regions.

1.3.2. Methodological Positioning: A Primary Quantitative Study with Contextual Qualitative Validation

While much of the existing literature on rural and island aging relies on secondary data or macro-level demographic indicators, this study adopts a resident-centered quantitative approach grounded in structured survey data. The primary data consist of surveys administered to 102 older residents of Yeonpyeong Island, capturing perceived difficulties, environmental evaluations, and future-oriented housing preferences.

To enhance contextual accuracy and reduce misinterpretation in a medically isolated island setting, qualitative input was incorporated through repeated consultation with a local community representative. This contextual qualitative validation served to confirm place-specific conditions and clarify ambiguous responses, supporting interpretation rather than functioning as an independent qualitative analysis. Through this methodological structure, the study provides grounded empirical evidence while preserving interpretive sensitivity to the unique cultural and spatial conditions of the island setting.

1.3.3. Policy and Practical Contribution: Environmental Intervention as Preventive Infrastructure

From a policy perspective, the study advances an environmental intervention-based understanding of integrative care. Rather than emphasizing centralized facility expansion, the findings highlight the importance of distributed environmental supports that enhance safety, accessibility, and social interaction within existing communities. This approach reframes aging in place not merely as remaining at home, but as sustaining a viable and supportive relationship between people and their environments.

The insights derived from Yeonpyeong Island offer a transferable foundation for other aging island and rural regions in East Asia seeking sustainable, community-based care strategies. By demonstrating how residents’ perceived needs signal readiness for preventive and integrated support environments, the study contributes practical evidence for shaping future spatial policies and community care infrastructures in medically underserved territories.

1.3.4. Aim of This Study

Bringing these elements together, the aim of this study is to examine how older residents in a medically isolated island community evaluate their current housing and community environments, and whether such perceptions signal an emerging transition toward more integrated and preventive care settings. By consolidating resident-reported difficulties, housing-related needs, and community-level aspirations through the combined framework of Environmental Press, Push–Pull Theory, and Life-Space perspectives, the study offers an integrated account of how environmental strain and future-oriented preferences jointly shape residential adaptation pathways in service-limited island regions.

1.4. Key Concept Definitions

As summarized in

Table 1. Key Concept Definitions and Theoretical Grounding.

Concept	Scholarly Definition & Theoretical Basis	Key Citation	Relevance to This Study
Emerging Concern	Early-stage perceptual signals showing that residents recognize instability, insufficiency, or mismatch in their living environments. Conceptually represents the cognitive–affective precursor to environmental or behavioral adaptation.	Kahana et al. [9]; Lawton & Nahemow [3]	Interprets Yeonpyeong residents’ subtle worries (mobility decline, lack of services, safety risks) as the earliest signals of environmental transformation needs.
Signal of a Paradigm Shift	Detectable turning point in expectations, values, and behavioral orientation; indicates collective movement from individual-based aging patterns toward community-integrated and preventive care models.	Kuhn [10]; Greenfield et al. [11]	Frames residents’ expressed needs as societal cues suggesting the island is transitioning toward integrated community care.
Infrastructure for Integrated Community Care	A multidimensional system combining physical environments (housing, community hubs, mobility paths), service networks (healthcare, welfare, nutrition, safety), and ICT platforms (telehealth, monitoring, coordination) to support autonomy, participation, and preventive care.	WHO [12]; Wiles et al. [13]; Greenfield et al. [11]	Provides conceptual grounding for the proposed spatial restructuring and service-integration model for aging-friendly island communities.

, four core concepts—environmental press, push–pull dynamics, anticipatory transformation signals, and integrated care infrastructure—form the analytical framework through which the lived experiences and perceptions of Yeonpyeong Island’s older residents are examined.

Together, these concepts provide an interpretive lens for understanding how vulnerability can evolve into transformation potential within medically isolated aging communities.

2. Theoretical Background

2.1. Aging Society and Regional Environmental Imbalance

Contemporary population aging has unfolded unevenly across regions, with East Asia experiencing particularly rapid demographic restructuring. Consequently, aging operates not merely as a demographic trend but as a spatially differentiated process that highlights underlying regional inequalities. South Korea exemplifies this dynamic, where rapid aging intersects with persistent regional depopulation and uneven infrastructure provision.

These demographic pressures are most acute in rural and island communities, where geographic isolation, population decline, and infrastructure erosion intersect. In such contexts, limited healthcare access, mobility constraints, and weakened service networks generate conditions of medical isolation, in which environmental context itself becomes a determinant of vulnerability [14]. Aging under these circumstances cannot be understood solely as an individual or biological process, but rather as a systemic condition embedded within regional spatial structures.

Lawton and Nahemow’s Environmental Press Theory [3] provides a useful lens for interpreting this imbalance, emphasizing the relationship between individual competence and environmental demand. When environmental demands exceed adaptive capacity—as is often the case in geographically isolated regions—cumulative environmental press undermines both physical functioning and psychosocial well-being [15]. Addressing aging in such regions therefore requires extending environmental analysis beyond the household to the broader community scale, where spatial organization, service accessibility, and daily mobility collectively shape adaptive capacity.

2.2. Expansion of Environmental Press and Environmental Intervention

The Environmental Press Theory originally emphasized person–environment fit at the micro level, focusing on the home as the key unit of adaptation [3]. Most practical applications have centered on housing modification—such as handrails, ramps, and barrier-free design—to maintain functionality and autonomy [16]. Yet, as Wahl and Oswald [17] observed, these interventions often fail to address the structural absence of community infrastructure, transport systems, and social networks.

Recent research has extended the theory to a broader spatial scale. Sixsmith and Sixsmith [18] introduced the concept of micro and macro press to capture layered environmental influences, while Phillipson [19] reframed environmental press as an ecological continuum that includes regional infrastructure and social systems. This interpretation emphasizes that environmental demand is not confined to domestic settings but extends across spatial hierarchies—from individual dwellings to neighborhoods, towns, and entire regions.

Building on this theoretical evolution, this study situates environmental press as a multi-scalar framework. In medically isolated island communities, the press manifests through transportation barriers, healthcare inaccessibility, and declining public interaction—macro-level forces that compound personal functional decline. Addressing these cumulative pressures calls for environmental intervention not merely as physical renovation, but as a preventive ecological strategy that integrates spatial design, care delivery, and community participation [20]. When aligned with integrated-care models, such interventions can operate as spatial prescriptions—environmental infrastructures that sustain mobility, accessibility, and social engagement [21]. Hence, the extended environmental-press framework provides a theoretical lens for analyzing how physical and social environments collectively influence sustainable aging.

2.3. Push–Pull Dynamics in Community Transformation

The Push–Pull Theory [7] originally conceptualized migration as the result of forces that repel individuals from a place (push) or attract them toward alternative locations (pull). Subsequent interpretations expanded this framework beyond physical relocation to encompass psychological, social, and environmental transitions [22]. In aging island communities, where actual migration is limited, transformation often occurs as psychological mobility—a re-evaluation of local living conditions and the imagination of improved community forms [23].

Within this adapted framework, push factors emerge from accumulated environmental and infrastructural stress, including declining health, limited services, housing deterioration, and spatial isolation. Pull factors, by contrast, represent anticipatory aspirations for safer, more accessible, and socially supportive living environments, such as integrated housing or community-based care facilities [24]. When these forces interact, they generate transformative momentum, enabling dissatisfaction to evolve into collective demand for environmental change [25].

This process can be understood through three interrelated stages: (1) accumulation of environmental pressure through chronic unmet needs; (2) recognition of maladaptation, expressed through dissatisfaction and concern; and (3) transformation, in which emerging aspirations are translated into spatial and social innovation. From this perspective, aging in place does not imply stasis but rather adaptive reorientation within existing environments.

In the present study, push factors are conceptualized primarily at the dwelling level, reflecting pressures that undermine continued residence under existing housing conditions. Pull factors, while potentially extending to broader community infrastructures, are examined here in relation to residents’ anticipatory preferences for alternative housing arrangements that support future living. This analytical focus allows for closer examination of domains in which older adults’ residential decision-making and perceived mobility are most directly involved.

2.4. Decayed Island as a Living Lab for Theoretical Exploration and Application

2.4.1. Global Justification

By 2050, nearly 60% of the global older population will reside in Asia, positioning the region as central to the global aging agenda [26]. Japan and South Korea represent contrasting yet complementary cases within this trajectory: Japan entered the super-aged stage earlier, while South Korea is experiencing one of the fastest aging rates worldwide. Together, these contexts offer valuable insights into how societies can sustain livable environments and integrated care systems amid rapid demographic change.

2.4.2. Islands as Isolated Yet Strategic Regions

Island regions embody a paradox of vulnerability and strategic importance. While characterized by limited accessibility, fragile infrastructure, and constrained emergency response capacity, many islands—particularly those near national borders—hold geopolitical and cultural significance that precludes abandonment. Japan’s Remote Islands Development Act (Ritō Shinkōhō), enacted in 1953, exemplifies long-term policy efforts to sustain island communities through welfare improvement and integrated care expansion [27,28].

South Korea has similarly begun institutionalizing a Community Integrated Care System, signaling growing recognition of the need to extend care infrastructure to remote coastal and island settlements. These comparative experiences underscore the importance of interpreting islands not merely as spaces of decline but as strategic testing grounds for sustainable community care models.

2.4.3. Theoretical Expansion and Implications

Decayed island regions offer unique conditions for theoretical expansion. Environmental Press Theory, traditionally applied to domestic environments, can be extended to interpret how mismatches between aging infrastructure and declining functional capacity generate cumulative strain at the regional level. Life-Space Theory complements this perspective by illustrating how older adults’ mobility contracts across nested spatial zones—from home to neighborhood to village—particularly in geographically constrained settlements.

The Push–Pull Framework further enables identification of dynamic forces shaping community transformation: push forces arising from dissatisfaction with deteriorating environments and pull forces reflecting aspirations for renewed accessibility, safety, and inclusion. Together, these perspectives justify conceptualizing decayed island regions as living laboratories—empirical and theoretical spaces in which environmental, social, and infrastructural systems can be reimagined to support sustainable aging in isolated contexts.

Figure 1 illustrates the geographical location and residential environment of Daeyeonpyeong Island, part of Yeonpyeong-myeon in Ongjin County, Incheon. Although geographically close to the Seoul metropolitan area, the island is separated by sea and remains physically and functionally isolated from the regional development network.

2.5. Life-Space and Walk Appeal: Integrating Mobility, Experience, and Control

Mobility has long been recognized as a fundamental determinant of independence and quality of life in gerontology and environmental psychology [30]. The Life-Space Theory proposed by May, Nayak, and Isaacs [31] defined mobility as the spatial extent of an individual’s activities, emphasizing measurable performance—how far and how frequently one moves across nested environmental zones. This quantitative orientation inspired assessment tools such as the Life-Space Assessment [32], which operationalized mobility into indices of functional autonomy. However, this focus on spatial reach and frequency provides limited understanding of how older adults experience movement—how safety, comfort, and meaning shape their willingness and ability to move.

Recent research emphasizes that the quality of life-space mobility is mediated by perceived control and environmental appeal [33]. Thus, life-space should not be conceptualized merely as physical reach, but as a multidimensional construct encompassing affective, cognitive, and sensory experiences of movement. The sense of agency, trust, and pleasure associated with mobility often determines whether older adults remain engaged or withdraw from their surroundings.

The concept of Walk Appeal extends this understanding by addressing the experiential and aesthetic aspects of movement. While Walkability evaluates the functional feasibility of walking—such as safety, distance, or slope—Walk Appeal concerns the emotional and visual motivation that invites people to move through space [24,34]. When the built environment provides not only safety and accessibility but also sensory richness, walking becomes a restorative, social, and psychologically engaging act [35].

Integrating Life-Space Theory with Walk Appeal reframes the environment from a passive backdrop into an active agent that shapes well-being and autonomy. This synthesis offers a conceptual basis for preventive environmental design—one that enhances both the extent and experience of movement. It redefines mobility not as “how far one travels” but as “how meaningfully and confidently one moves within life-space,” emphasizing the interplay of physical structure, sensory perception, and psychological control in sustaining healthy aging.

2.6. Proposed Integrative Model: Environmental Intervention-Based Care Infrastructure (EIICI)

Building upon the preceding frameworks, this study proposes the Environmental Intervention-Based Integrative Care Infrastructure (EIICI) as a theoretical model for sustaining life and care in aging island communities. Traditional housing theories derived from Lawton and Nahemow’s [3] Environmental Press Model have primarily addressed micro-level fit between personal competence and environmental demand. Yet, they often overlook macro-level pressures—such as limited healthcare access, transport isolation, and social disconnection—that erode regional resilience and accelerate functional decline [36,37].

The EIICI extends the environmental-press paradigm into a multiscalar, preventive framework. It conceptualizes the environment itself as an active agent of care, capable of reducing vulnerability through anticipatory design and systemic integration of housing, mobility, and welfare infrastructure [38,39]. Rather than responding to crises after they occur, this model embeds care-by-design principles into the spatial and social fabric of everyday environments.

The proposed model comprises three interrelated dimensions:

• Environmental Press and Coping Response—Environmental strain functions as a push factor that, when institutionally recognized, can be transformed into adaptive community responses [17].
• Spatial–Psychological Dynamics—Through push–pull interactions, residents engage in psychological mobility, imagining new spatial and social possibilities such as community-based housing, accessible facilities, or shared care systems [23].
• Preventive Environmental Intervention—Care shifts from reactive treatment to proactive prevention, echoing Antonovsky’s [40] Salutogenic Model of Health, wherein environmental structure itself becomes a source of resilience, safety, and inclusion.

These three mechanisms operate cyclically: environmental press triggers awareness → awareness mobilizes adaptive alternatives → preventive interventions reinforce community resilience. Thus, the EIICI redefines community care not as a static service provision but as a dynamic process of spatial restructuring—where architecture, mobility, and social participation coalesce into a sustainable, inclusive care ecosystem.

The EIICI thus reconceptualizes community care as a process of spatial restructuring rather than mere adaptation, positioning the environment itself as an active medium for preventive health and social well-being. By integrating environmental press, life-space mobility, and push–pull dynamics, the framework enables the simultaneous recognition of both environmental strain and residents’ adaptive potential. In medically isolated communities such as Yeonpyeong Island, the model functions as a theoretical and operational foundation for transforming passive spatial decline into proactive, community-driven resilience.

This theoretical framework forms the basis for the subsequent research design, which empirically examines how environmental pressures, spatial mobility, and residents’ perceptions interact to shape the pathways toward sustainable aging communities. The following chapter elaborates on the research structure, data collection, and analytical procedures developed to operationalize the EIICI framework within the island’s real-world context.

2.7. Empirical Foundations in Yeonpyeong Island

Building on the theoretical synthesis established in Section 2.5 and Section 2.6, this section introduces empirical investigations conducted in Yeonpyeong Island that are directly relevant to understanding housing–health–community adaptation in medically isolated aging environments. Collectively, prior research in this field setting provides an empirical foundation for the proposed EIICI model by illustrating how housing conditions, health status, and everyday adaptation intersect across micro–meso–macro scales in an aging island context. Rather than treating Yeonpyeong Island as a singular case, these studies demonstrate how environmental press accumulates through residential deterioration and limited infrastructure, and how older adults respond through both functional adaptation and emerging expectations for community-based support systems.

2.7.1. Bridging the Theoretical Framework to the Yeonpyeong Context

Recent research on housing environments for aging societies emphasizes that technological and physical improvements alone are insufficient to ensure sustainable aging-in-place. Grounded in Environmental Press Theory [3] and the Person–Environment Fit Model [5,41], the literature has increasingly integrated physical, physiological, and psychosocial dimensions of aging. Wahl and Oswald [17] further advanced this discussion through the concept of Life-Space, highlighting that older adults’ activity environments extend beyond the home into community settings. Home modification and hazard reduction have also been widely recognized as essential components of aging-in-place strategies, as they can mitigate safety risks and support continued community dwelling among older adults [42]. Schulz et al. [43] further advanced a Preventive Environmental Intervention approach, framing housing adaptation as a form of preventive medicine—particularly relevant in regions with limited medical services.

Within this conceptual trajectory, empirical studies conducted in Yeonpyeong Island provide an applied context in which these frameworks can be interpreted across housing, health, and community-level adaptation under conditions of medical isolation and accelerated aging.

2.7.2. Residential Suitability and Health Implications

Among the empirical studies conducted in Yeonpyeong Island, the present review highlights two representative investigations that most clearly capture the island’s housing and aging conditions in a holistic and policy-relevant manner. Although the Yeonpyeong research series comprises multiple studies addressing diverse aspects of aging and environmental vulnerability, the following two studies are emphasized here because they provide foundational evidence on (i) the structural and spatial risk conditions embedded in deteriorated housing environments and (ii) the health-related functional constraints that intensify housing improvement needs in medically underserved island communities.

The first study, Assessing the Residential Suitability of Elderly Housing in Coastal Island Communities from the Fall Prevention Perspective [14], identified structural vulnerabilities in elderly housing—such as uneven floor levels, bathroom configurations, and circulation routes—and operationalized residential suitability as the integration of safety, accessibility, and usability. Falls were interpreted as outcomes of cumulative environmental press, indicating priority targets for physical intervention and preventive modification.

A subsequent study, Health Conditions and Their Implications for Housing Improvement [44], examined 30 elderly households in Yeonpyeong-do and reported strong associations between chronic disease, limited mobility, and substandard housing conditions. The findings underscored that housing modification can function as preventive medicine, particularly where medical access is structurally constrained and residents’ daily functioning is highly contingent on environmental usability. Together, these studies demonstrate that physical deterioration and health vulnerability reinforce each other in aging island contexts, amplifying the need for both dwelling-level intervention and supportive community infrastructure.

2.7.3. Integrative Implications and Position of the Current Study

Together, these studies establish Yeonpyeong Island as an empirical foundation for understanding environmental, physical, and psychosocial adaptation in medically isolated aging communities. Importantly, they demonstrate that aging-in-place in such contexts cannot be sustained through individual dwelling improvements alone; rather, it requires a broader transition toward preventive and community-oriented environmental support that can stabilize daily life, reduce safety risks, and maintain functional independence.

The current study builds upon this continuum by expanding the analytical scale—from micro-level housing and safety concerns and meso-level health-related usability constraints to macro-level community perceptions and environmental infrastructure needs. It examines how residents perceive and respond to environmental press across their broader living spectrum and explores readiness for community-integrated care systems. Through a comprehensive survey of 102 households with contextual verification, this research identifies emerging push–pull dynamics that signal a paradigm shift from reactive housing repair toward preventive, community-based environmental transformation—offering theoretical and practical grounding for designing sustainable symbiotic care infrastructures in aging island regions.

3. Research Methods

3.1. Conceptual and Theoretical Framework for Research Design

Building on the Environmental Intervention-Based Integrative Care Infrastructure (EIICI) framework presented in Section 2, this study operationalizes the theoretical model into an empirical research design. The research examines how environmental press, life-space mobility, and push–pull dynamics interact to shape older residents’ evaluations of their living environment and their anticipatory orientation toward spatial transformation. By applying the EIICI framework to Yeonpyeong Island—a medically isolated and demographically declining region—the study aims to identify mechanisms through which environmental intervention may trigger adaptive awareness and resident-driven participation.

Methodologically, this study is designed as a primary quantitative study based on structured survey data, supplemented by contextual qualitative validation. Quantitative components assess perceived residential conditions, mobility constraints, and housing- and service-related needs, while contextual validation is achieved through repeated consultation with a local community representative to confirm place-specific conditions and clarify ambiguous responses. This approach strengthens interpretive accuracy in an isolated island setting without constituting an independent qualitative dataset or standalone qualitative analysis.

To structure the analytical logic, the research integrates three theoretical perspectives—Environmental Press Theory, Life-Space Theory, and the Push–Pull mechanism. Environmental Press Theory explains how mismatches between environmental demand and individual competence generate cumulative adaptive pressure. Life-Space Theory extends this perspective by addressing the spatial and behavioral consequences of aging, including contraction of activity ranges across daily environments. The Push–Pull mechanism complements these frameworks by interpreting dissatisfaction with current conditions as push forces and preferences for more supportive environments as pull forces that together shape residents’ prospective judgments and transformation signals.

Figure 2 and Figure 3 visualize this conceptual synthesis. Figure 2 presents the multi-scalar extension of environmental press and life-space, illustrating how cumulative pressure emerges across nested spatial zones—from dwellings to community environments. Figure 3 depicts the dynamic mechanism through which push–pull interactions can generate participatory momentum toward resident-driven environmental transformation. Together, these figures provide a structural bridge between the EIICI framework and the empirical procedures described in the following sections.

3.2. Nature of the Research Design

This study adopts a creative, theory-driven integrative research design that links theoretical reconstruction with empirical grounding. Rather than merely testing existing theories, the study aims to generate conceptual insights through an iterative dialogue between abstract frameworks and contextual realities [45,46]. This approach is particularly appropriate for isolated and rapidly aging communities such as Yeonpyeong Island, where social, spatial, and environmental conditions interact in ways that are not fully captured through linear or purely quantitative explanation [17,36].

The research follows an integrative cycle progressing from Theoretical Framing to Empirical Grounding and finally to Conceptual Integration. Through this cycle, the researcher assumes a dual role as an empirical investigator and a designer–theorist who interprets place-based realities through theoretical imagination and re-synthesis. This structure enables the study to function as both an interpretive inquiry and a concept-generating effort oriented toward practical innovation.

3.2.1. Philosophical Foundation

The study is grounded in a constructivist paradigm and design epistemology, which conceptualize knowledge as co-constructed through interaction among the researcher, participants, and contextual conditions rather than as an external and fixed truth [47]. Accordingly, the study does not aim to describe Yeonpyeong Island solely “as it is,” but to reinterpret its meanings through a structured theoretical lens. Knowledge is generated through re-contextualization, in which lived experiences are translated into conceptual understanding. This orientation aligns with the premise that theory development and design innovation are mutually constitutive processes of meaning-making and future-oriented possibility formation.

3.2.2. Characteristics of the Research Approach

The study integrates two complementary methodological traditions—Grounded Theory and Design-Based Research (DBR)—to support conceptual generation and model development. Grounded Theory [46] informs inductive conceptual extraction from empirical materials (e.g., survey responses, contextual confirmations, and field observations), while DBR [48] provides a structured logic for iterative refinement through cycles of design articulation, reflection, and validation. Together, these approaches support a creative methodology in which empirical grounding and theoretical abstraction inform one another throughout the study. The structural features of this integrative methodology are summarized in

Table 2. Structural Features of the Creative Methodology.

No.	Structural Feature	Description
1	Theoretical Induction	Expands or modifies existing theories based on field-grounded data.
2	Conceptual Integration	Synthesizes Environmental Press, Push–Pull, and Life-Space frameworks into one integrative system.
3	Generative Outcome	Produces the conceptual model of Environmental Intervention-Based Integrative Care Infrastructure (EIICI) as a theoretical innovation.

.

3.2.3. Logical Structure of the Research Design

The overall research logic is cyclical and self-reinforcing, progressing from theoretical inquiry to empirical exploration and returning to conceptual synthesis. Each stage interacts dynamically with the next, creating a feedback loop among observation, interpretation, and model refinement. The logical flow of this design is summarized in

Table 3. Logical Flow of the Research Design.

Stage	Research Focus	Key Content
1	Theoretical Framing	Establishes core frameworks—Environmental Press, Push–Pull Dynamics, and Life-Space.
2	Empirical Grounding	Conducts field surveys, interviews, and contextual observations in aging island settings.
3	Conceptual Integration	Reinterprets the push–pull relationship as the structural mechanism of the EIICI model.
4	Visual Modeling	Presents the conceptual framework for sustainable spatial transformation in island communities.

.

This design departs from conventional positivist approaches in that it does not treat theory as a fixed structure applied to reality; rather, it conceptualizes theory as co-developed through engagement with reality. Building on this integrative logic, the following section presents the study context and site characteristics, followed by the empirical procedures, sampling strategy, and analytical sequence used to operationalize the theoretical frameworks within Yeonpyeong Island.

3.3. Situated Characteristis of Study Area

3.3.1. Study Area and Characteristics

Yeonpyeong Island, located in Ongjin County, Incheon Metropolitan City, is a frontier island situated near the northwestern maritime boundary of the Korean Peninsula. It comprises two inhabited areas—Daeyeonpyeong and Soyeonpyeong Islands—and lies more than 80 km from the Incheon mainland, accessible primarily via a two-hour ferry. Despite its geographic remoteness, Yeonpyeong holds strategic importance for national security and maritime governance; its continued habitation is therefore closely linked not only to local sustainability but also to national resilience.

Figure 4 presents the island’s projected population density in 2040 and the proportion of residents living within a 10-min walking distance of a health facility. As of 2024, the island’s population is approximately 1800, and more than 55% are aged 65 or older [2]. Combined with youth outmigration and low fertility, Yeonpyeong has become a super-aged community characterized by limited economic vitality, restricted healthcare access, and fragile welfare infrastructure. A single public health clinic serves the entire population, and emergency transfers depend on helicopters or sea routes to mainland hospitals in Incheon [49]. For older residents, this condition represents a persistent state of medical inaccessibility rather than occasional inconvenience.

Topographically, the island consists of small plains and gentle hills with a residential landscape dominated by detached housing. Steep road gradients, outdoor restrooms, and irregular entry steps create mobility barriers for older adults. During winter, adverse weather frequently disrupts sea transportation, further intensifying physical and social isolation. These conditions align with Lawton’s [3] Environmental Press Theory, which conceptualizes stress as arising when environmental demands exceed individual functional capacity. In this sense, Yeonpyeong operates as a living laboratory of extreme aging and infrastructural constraint, offering a prototype scenario for future rural depopulation and spatial decline in Republic of Korea.

According to Ministry of Health and Welfare [50], as of 2020, a total of 11,083 health-related facilities nationwide—including hospitals, clinics, pharmacies, and convenience stores—were identified, with an average of 32.6 facilities per administrative unit. Figure 4 (right) contextualizes Yeonpyeong’s health accessibility within this broader national distribution pattern [51]. Against this backdrop, Yeonpyeong provides a distinct empirical setting for exploring environmentally integrated care systems under severe spatial constraints. Rather than functioning as a disappearing island, it can be interpreted as a testbed for designing sustainable community-based aging models in medically isolated regions.

Furthermore, the present study builds on prior empirical research conducted in Yeonpyeong Island [14,44], which identified compound environmental vulnerabilities, including structural level differences, inadequate thermal and lighting conditions, and limited accessibility to shared facilities. Building upon these findings, the current research reinterprets Yeonpyeong as a site for examining environmental intervention-based integrative care infrastructures, highlighting both accumulated risks and latent adaptive potential.

3.3.2. Wartime Damage, Governmental Reconstruction, and Residential Deterioration

The 2010 North Korean artillery attack on Yeonpyeong Island disrupted the community’s spatial and social fabric and prompted government-led reconstruction through the West Sea Five Islands Comprehensive Development Plan. According to a Ministry of the Interior and Safety survey [52], more than 51% of dwellings were built before the 1980s and an additional 35.2% during the 1990s, indicating that most housing stock was structurally outdated and poorly insulated. At that time, 47% of residents expressed a desire for housing renovation and 33% hoped for complete reconstruction, suggesting that nearly 80% perceived a need for substantial residential improvement. However, post-attack interventions largely prioritized immediate structural safety—reinforcing pillars, walls, and roofs—without systematically addressing long-term livability, accessibility, or age-friendly functionality. As a result, reconstruction efforts tended to emphasize short-term restoration rather than preventive, sustainable adaptation.

Over the following decade, Yeonpyeong’s housing environment continued to deteriorate due to cumulative neglect, environmental wear, and limited maintenance resources. Field observations indicate that many homes still feature steep exterior stairs, detached restrooms, narrow corridors, and uneven floor levels, which increase fall risk and constrain everyday mobility among older adults [53]. Inadequate thermal insulation and outdated heating systems intensify winter hardship, while persistent limitations in grocery supply and healthcare access are compounded by irregular maritime transportation. These conditions illustrate how reactive reconstruction, in the absence of continuous maintenance and preventive design, can perpetuate a cycle of structural decline and environmental deprivation, reinforcing the environmental press that constrains aging in place.

As of 2024, the officially registered older population is recorded at 39%, yet the Yeonpyeong Residents’ Committee chairperson noted that the visible proportion of older residents approaches nearly 70% when stationed military personnel are excluded. The chairperson remarked that “most people you actually see around the village are seniors—roughly seven out of ten.” This observation suggests a demographic distortion in which younger residents maintain formal registration while residing on the mainland for employment, thereby obscuring the effective aging concentration in everyday community life. In practice, Yeonpyeong’s social landscape is overwhelmingly dominated by older adults, intensifying environmental press as human capacity and the built environment decline concurrently.

Table 4. Population Composition of Yeonpyeong Region.

Age (Year)	Total	Man	Female
0–19	132	71	61
20–50	937	697	240
51–64	479	288	191
Over 65	445	214	231
Total	1993	1270	723

presents the current population composition of the Yeonpyeong region.

3.4. Data Collection Process

3.4.1. Primary Quantitative Study with Contextual Qualitative Validation

This study employed a primary quantitative design supplemented by contextual qualitative validation. The survey, administered to 102 older residents selected through stratified proportional sampling, measured living discomfort, health conditions, mobility constraints, and service needs using close-ended scaled items. No standalone interviews or thematic qualitative coding were conducted; instead, contextual clarification was obtained through repeated consultations with the local residents’ committee chairperson regarding place-specific norms, mobility patterns, and island-specific constraints. During fieldwork, surveyors also used brief follow-up probing to confirm ambiguous responses, which served as supplementary validation rather than independent qualitative data. This approach strengthened interpretive accuracy while maintaining the study’s primarily quantitative structure.

To ensure response reliability among participants with limited literacy, hearing difficulties, or sensory decline, the study adopted a five-point graphic (smile-face) response scale paired with simple verbal anchors. Graphic scales of this type have been widely validated in gerontological and clinical contexts—such as the Wong–Baker FACES Pain Rating Scale [53] and Visual Analogue Scales [54,55]—as effective tools for improving comprehension, supporting cognitively vulnerable respondents, and reducing response burden. All surveys were conducted orally, and respondents indicated their chosen level by pointing to the face icon that best matched their perception. This visual-verbal format minimized misunderstanding of scale gradations, reduced fatigue during longer sessions, and helped sustain engagement among older adults unfamiliar with formal surveys.

3.4.2. Ensuring Response Reliability

Because Yeonpyeong Island has had little prior exposure to formal research, many older residents exhibited low survey familiarity, variable literacy, and reduced cognitive/sensory capacity. Ensuring response reliability was therefore treated as a core methodological requirement. To address this, the research team implemented five systematic strategies to enhance reliability, participant comfort, and contextual accuracy (

Table 5. Response Reliability Strategies.

No.	Strategy	Description	Expected Effect
1	Local Surveyor Recruitment	Recruited a long-term resident and community leader with administrative experience as field surveyor; leveraged social trust and contextual insight to elicit candid, accurate responses.	Enhanced participant trust and contextual accuracy.
2	Surveyor Training and Workshop	Conducted iterative workshops on research aims, question intent, ethics, and interview practice, including hands-on tablet/Google Form use.	Improved interviewer consistency and ethical awareness.
3	Visual Scale for Accuracy	Applied a smile-face graphic scale so elderly respondents with limited literacy or hearing could indicate answers visually rather than verbally.	Increased precision and self-directed participation.
4	Flexible Time Scheduling	Arranged interviews around daily work routines, avoiding early-morning and late-evening fatigue periods.	Reduced inattentive or rushed replies; stronger focus.
5	Contextual Verification	Used local surveyor follow-up questions to clarify ambiguous answers and confirm field context.	Greater reliability through on-site triangulation.

). These strategies drew upon established frameworks—including Dillman et al.’s Tailored Design Method [56], Rubin & Rubin’s Responsive Interviewing Model [57], and Cutchin et al.’s Elderly Survey Adaptation Theory [58]—to incorporate visual cues, rapport-building, and adaptive pacing. This multi-layered approach mitigated cognitive burden, reduced misunderstanding and social-desirability tendencies, and ensured methodological rigor appropriate for an aging, medically isolated community.

3.4.3. Fieldwork Procedure

Fieldwork was conducted between March and July 2025 (

Table 6. Fieldwork Stages and Key Activities.

Stage	Period	Description	Main Purpose and Activities
1	Preliminary Field Visit	January 2025	Initial site visit and environmental assessment
2	1st Exploratory Field Survey	March 2025	Pilot testing of questionnaire and graphic scale of face icon
3	2nd Preparatory Interview	May 2025	Consultation with community representative
4	Pre-Survey Preparation & Training	June 2025	Recruitment and training of local surveyor
5	Main On-Site Interview Survey	July 2025	Final face-to-face survey (n = 102, approx. 23% of elderly residents)

Note. The table outlines the timeline and procedural steps of field data collection conducted between March and July 2025.

). Interview times and locations were adjusted according to each participant’s daily routine and physical condition to minimize fatigue and improve response quality. All participants received a clear explanation of study procedures, provided written informed consent, and were assured anonymity and confidentiality. Ethical approval was granted by Y University’s Research Ethics Committee.

Local collaborators supported communication and community entry, improving trust and logistical feasibility. To reduce fatigue, the core-before-supplementary questioning principle was applied. Although the island lacks a formal emergency response system, the research team and local surveyors remained prepared to contact the local health clinic if needed to ensure participant safety.

3.4.4. Representativeness and Sampling Validity

Stratified proportional sampling was conducted across Yeonpyeong Island’s five village clusters to ensure geographic balance and avoid spatial concentration of responses. Each village cluster was assigned a target number of participants proportional to its older-adult population (see

Table 7. Distribution of Participants by Village Cluster.

Cluster	Participants	Key Characteristics
Daeyeonpyeong 1–ri	21	Fishing- and farming-oriented, high proportion of detached housing
Daeyeonpyeong 2–ri	19	High rate of single-person households
Daeyeonpyeong 3–ri	18	Located near the village center and senior hall
Soyeonpyeong 1–ri	24	Limited transportation, low medical accessibility
Soyeonpyeong 2–ri	20	Higher proportion of shared or collective living
Total	102	Approx. 50% of the island’s senior population

). Within each stratum, trained surveyors conducted sequential household visits during extended time windows (early morning to evening) to accommodate variable schedules. When a household was unavailable or declined participation, the surveyor proceeded to the next household following a predefined visitation order. This structured, stratum-based procedure minimized convenience bias while remaining feasible in an island setting with limited transportation and highly variable daily routines.

As of 2024, Yeonpyeong Island had a total population of 1999, including 445 residents aged 65 or older (38%). This study surveyed 102 older adults—approximately 23% of the older population—meeting the criterion for practical representativeness in small, heterogeneous, aging island contexts. Because registry-based counts often overestimate day-to-day residency due to temporary absence (e.g., hospital stays, mainland employment, or seasonal mobility), the achieved sample constitutes a substantial share of the actual surveyable population. Given that all respondents were cognitively and physically capable of participating, the sample effectively represents the functionally active older population and captures lived concerns related to mobility, safety, and care needs.

3.4.5. Data Processing and Analytical Framework

Survey responses were automatically compiled using Google Forms (Google LLC, Mountain View, CA, USA) and organized into a structured database. Quantitative analysis included descriptive statistics and cross-tabulation to examine distributions and associations among variables. Interpretation followed the integrated theoretical sequence of Environmental Press → Push–Pull Dynamics → Environmental Intervention, and the survey instrument was structured to reflect this staged process (

Table 8. Structure of the Survey Instrument for Integrated Care Infrastructure.

Stage	Title	Core Content	Question Type	Analytical Focus & Linkage
1	Background Information	(1) Basic demographics, health status, mobility, and dwelling type	Objective/ Descriptive	Establish sample profile and control variables
2	Current Residential Conditions	(1) Residential adequacy and housing conditions (detached houses) (2) Use and perceived importance of community facilities and spatial mobility patterns	Fact-oriented	Mainly Push Factors— identification of physical and social constraints
3	Perceived Needs for Future Living & Community Infrastructure	(1) Perceived adequacy and improvement needs of current housing (2) Necessity and acceptability of alternative housing (3) Perceived need for community facilities and social connection	Perception- oriented	Push–Pull Interaction—awareness of discomfort (push) and aspiration for improvement (pull)

Note: Table 8 presents a three-phase structure that traces the transition from present conditions (push) to future-oriented perceptions (pull), including housing, alternative living, and community support components as integrated care infrastructure elements.

).

3.5. Analytical Method Based on the Creative Research Process

This study’s analysis was guided by creative inquiry, emphasizing iterative interaction between theoretical reasoning and contextual reality [45,59]. Rather than treating knowledge as fixed and external, creative inquiry views it as emerging through reflection, contextual interpretation, and conceptual synthesis. In this orientation, the researcher functions as a designer–theorist who reconstructs relationships between theory and empirical phenomena. This stance aligns with grounded theorizing [46] and constructivist assumptions that knowledge is co-constructed among researcher, participants, and context [47].

Analytically, the study followed a three-phase iterative cycle: (1) theoretical grounding, (2) empirical dialogue, and (3) conceptual reconstruction. First, theoretical frameworks (Environmental Press, Push–Pull, Life-Space, and Walk Appeal) were examined for contextual applicability. Second, emergent patterns from the survey data were compared with theoretical constructs to refine relationships among key variables. Third, findings were synthesized into the conceptualization of an Environmental Intervention-Based Integrative Care Infrastructure model, linking housing, care, and community functions into an integrated interpretive structure.

Methodologically, this creative analytical logic was supported by a hybrid combination of design-oriented reasoning and theoretical coding [60]. Quantitative analyses (frequencies, ratios, means, and standard deviations) were conducted to describe overall response patterns and identify focal variables for interpretation. Qualitative validation was performed through contextual confirmation and interpretive categorization of residents’ statements into push and pull domains, strengthening plausibility and interpretive coherence within the island context.

Although community-level improvements may operate as broader pull factors, the present analysis prioritizes housing-related domains in which older residents’ needs are most directly tied to dwelling conditions and residential decision-making. Community redevelopment requires multi-layered governance and policy coordination and thus was treated as contextual background rather than a domain for detailed subgroup-pattern analysis. Moreover, because Yeonpyeong has had limited exposure to large-scale community renewal initiatives beyond minimal facility provision, responses regarding community improvement needs were interpreted at a general level to avoid over-interpretation beyond measurement scope and contextual feasibility.

3.6. Statistical Analysis of Housing-Related Needs

To examine age-stage differences in housing-related needs, the analysis focused on two residential decision domains directly associated with older adults’ living-environment choices: home improvement need and need for alternative (community-based) housing. Composite scores for each domain were calculated by averaging responses across the relevant five-point Likert-scale items, ensuring consistent metric ranges across items.

Group differences across the three age stages (young-old, middle-old, and old-old) were examined using one-way analysis of variance (ANOVA). When the omnibus F-test indicated a significant main effect (p < 0.05), Tukey’s Honestly Significant Difference (HSD) procedure was applied to identify specific pairwise differences while controlling for familywise Type I error.

Preliminary independent-samples t-tests revealed gender-based differences in overall response patterns. Therefore, all subsequent analyses were conducted separately for female and male participants, allowing identification of subgroup-specific age trajectories rather than relying on pooled estimates that may mask divergent patterns. This gender-stratified approach aligns with the study’s objective of capturing practical, subgroup-relevant variations in housing needs while maintaining a consistent inferential procedure across domains.

All statistical analyses were performed using Python (Python Software Foundation, Wilmington, DE, USA) with open-source statistical libraries (NumPy, pandas, and SciPy), and results are reported using means, standard deviations, and associated significance levels.

4. Results and Analysis

4.1. Residential Environment Characteristics of Elderly Households

This study surveyed 102 older residents (≥65 years) across five village clusters on Yeonpyeong Island. Participants were selected through stratified random sampling proportional to each village population, and the sample characteristics are summarized in Table 8. All participants provided written informed consent prior to the survey.

4.1.1. Characteristics of Elderly Residents

Most respondents were in advanced old age: 42.2% were in their seventies and 40.2% were aged 80 or older, indicating that over four-fifths of the sample were ≥70 years. The gender distribution was skewed toward women (77 women, 25 men). Household composition was predominantly small: single-person households accounted for 42.2% and couple-only households for 41.2%, together exceeding 80%.

Regarding sensory function, 49.6% reported no impairment, while 19.0% indicated hearing decline, 14.9% balance deterioration, and 8.3% each reported visual or tactile decline. Multiple sensory impairments (two or more types) were observed in 13.7% of respondents. Basic Activities of Daily Living (ADL) were largely independent (e.g., eating: 92.2%; standing up/mobility: 94.1%), although a minority required limited assistance in specific activities. For Instrumental Activities of Daily Living (IADL), approximately 8–13% required support in managing finances, using transportation, or performing household chores.

In the care context, 66.7% reported having no caregiver; among those with caregivers, support was primarily provided by family members or relatives. Awareness of aging was moderate (53.9% agreed with “I increasingly feel changes due to aging”). Emotional and behavioral indicators included fear of falling (43.1% responded “agree” or “strongly agree”) and reduced space use when feeling unwell (83.4%). Overall, the respondent profile reflects late-old-age households with limited caregiving resources in an isolated island context.

4.1.2. Physical Characteristics of Residential Dwellings

Most respondents lived in detached single-story houses (≈94%), with 91.2% residing on the ground floor and 89.2% owning their homes. Although many dwellings were constructed between 2011 and 2019, remodeling was highly concentrated in 2011 (63.7%), with few subsequent upgrades, suggesting a one-time renovation pattern followed by prolonged stagnation. Medium-to-small dwellings (50–80 m²) predominated (≈61.8%). None of the houses had bathtubs; 92.2% were equipped with standing washbasins, and a small number of households reported using outdoor toilets. Layouts were generally compact, most commonly two rooms (48.0%) with one living room and one bathroom.

Finishes were primarily practical and easy to maintain (synthetic flooring: 99.0%; wooden ceilings: 99.0%); however, deficits were identified in slip resistance, impact absorption, fire safety, and moisture control. Accessibility hazards were widespread: thresholds and level differences at entrances, bathrooms, and interior transitions were observed in 95.1% of homes. In addition, 88.2% reported steps or elevation gaps in storage/utility areas, and 92.2% lacked supportive fixtures to assist rising from seated positions.

These conditions were reflected in residents’ reported priorities for improvement, particularly installing safety grab bars (bathrooms: 39.7%; entrances: 28.5%; main doors: 19.0%) and removing level differences (entrances: 38.9%; bathrooms: 30.6%). Collectively, the dwelling environment indicates high fall-risk exposure amid aging-related functional decline.

4.1.3. Community Facility Utilization Patterns

This subsection summarizes residents’ awareness, utilization frequency, and perceived importance of community facilities, drawing on

Table 9. Awareness and Utilization of Local Community Facilities (n = 102).

Category	Facility	n (%)	Facility Use Frequency (%)
			Daily	1–2 Times/Week	Once/Month	Once/Season	Once/Year	Never Use
Basic Health-Maintenance Activities	Convenience Store/Mart	102 (100.00)	4 (3.92)	59 (57.84)	15 (14.71)	1 (0.98)	1 (1.00)	22 (21.57)
	Public Health center	102 (100.00)	0 (0.00)	5 (4.90)	62 (60.78)	24 (23.53)	2 (1.96)	9 (8.82)
	Public Bathhouse	102 (100.00)	0 (0.00)	33 (32.35)	40 (39.22)	3 (2.94)	2 (1.96)	24 (23.5)
Administrative Task– Related Activities	Senior Center	102 (100.00)	54 (52.94)	2 (1.96)	1 (0.98)	1 (0.98)	1 (0.98)	43 (42.16)
	Resident Service Center	101 (99.02)	3 (2.94)	0 (0.00)	6 (5.88)	30 (29.41)	33 (32.35)	30 (29.41)
	Post Office	102 (100.00)	0 (0.00)	8 (7.84)	7 (6.86)	6 (5.88)	3 (2.94)	78 (76.47)
	Bank	101 (99.02)	0 (0.00)	11 (10.78)	52 (50.98)	11 (10.78)	2 (1.96)	26 (25.49)
Outdoor Health- Promotion Activities	Outdoor Sports Facility	102 (100.00)	27 (26.47)	10 (9.80)	1 (0.98)	4 (3.92)	6 (5.88)	54 (52.94)
	Walking Trail	102 (100.00)	4 (3.92)	2 (1.96)	2 (1.96)	7 (6.86)	41 (40.20)	46 (45.10)
	Park	102 (100.00)	11 (10.78)	17 (16.67)	1 (0.98)	25 (24.51)	12 (11.8)	36 (35.29)
Indoor Leisure Activities	Indoor Sports Facility	102 (100.00)	4 (3.92)	0 (0.00)	0 (0.00)	2 (1.96)	1 (0.98)	95 (93.14)
	Cafés	101 (99.02)	0 (0.00)	0 (0.00)	1 (0.98)	0 (0.0)	1 (0.98)	100 (98.04)
	Cinema	1 (0.98)	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)	102 (100.00)
Others	Religious* & Transportation** Facilities	1 (0.98)	2 (1.96)*	0 (0.00)	0 (0.00)	1 (0.98)**	0 (0.00)	99 (97.06)

Note. Percentages in parentheses represent the proportion of respondent’s awareness and usage of each facility. Bold values highlight the high frequency within each row. Results show that while basic health related services such as food mart, public health center, Public bathhouse, senior center and bank remain relatively active in monthly range, leisure and cultural facilities (e.g., cafés, cinemas, indoor gym) exhibit minimal utilization, reflecting the limited diversity of community infrastructure in the region.

and

Table 10. Perceived Importance of Community Facilities (n = 102).

No.	Facility	Rank 1	Rank 2	Rank 3	Overall Rank
1	Public Health Center	2 (1.96)	21 (20.59)	35 (34.31)	58 (56.86)
2	Senior Center	36 (35.29)	12 (11.76)	7 (6.86)	55 (53.92)
3	Resident Service Center	33 (32.35)	4 (3.92)	2 (1.96)	39 (38.24)
4	Religions Facility	10 (9.80)	14 (13.73)	5 (4.90)	29 (28.43)
5	Convenience Store/Mart	2 (1.96)	8 (7.84)	12 (11.76)	22 (21.57)
6	Hospital	5 (4.90)	10 (9.80)	5 (4.90)	20 (19.61)
7	Community Welfare Center	1 (0.98)	9 (8.82)	8 (7.84)	18 (17.65)
8	Outdoor Sports Facility	7 (6.86)	5 (4.90)	3 (2.94)	15 (14.71)
9	Park	2 (1.96)	1 (0.98)	8 (7.84)	11 (10.78)
10	Bank	0 (0.00)	4 (3.92)	7 (6.86)	11 (10.78)
11	Post office	0 (0.00)	2 (1.96)	3 (2.94)	5 (4.90)
12	Indoor Sports Facility	1 (0.98)	1 (0.98)	2 (1.96)	4 (3.92)
13	Public Bathhouse	0 (0.00)	2 (1.96)	2 (1.96)	4 (3.92)

, and Figure 5, Figure 6 and Figure 7.

(1)

Awareness and frequency of use.

Awareness was generally high for facilities supporting daily living and essential services (e.g., convenience stores/marts, public health center, senior center, bank, post office, and administrative service center). In contrast, cultural and leisure-related facilities (e.g., traditional markets, cafés, indoor sports facilities, karaoke rooms, and cinemas) showed comparatively lower awareness, reflecting the island’s basic-living-oriented service environment. Frequency patterns in Table 9 suggest temporally structured activity zones. This table summarizes older residents’ awareness and frequency of use of major community facilities on Yeonpyeong Island, illustrating routine activity patterns across different temporal scales.

The senior center exhibited polarized patterns, including both frequent use and complete non-use. Convenience stores/marts represented the most stable weekly routine facility (≈58–60%), while the public bathhouse aligned with weekly or biweekly routines. Monthly routines were commonly anchored by the public health center and banks. In contrast, several facilities showed persistently low utilization, indicating constraints related to accessibility, limited purpose, or seasonal vulnerability.

(2)

Perceived importance.

Table 10 indicates that residents prioritized facilities supporting health management, daily stability, and social–emotional well-being. The highest priority items included the public health center (56.9%) and senior center (53.9%), followed by administrative service centers (38.2%), religious facilities (28.4%), and convenience stores/marts (21.6%). Leisure and culture facilities were generally rated as low priority, suggesting function-driven preferences rather than leisure-oriented demands. This table presents residents’ perceived importance rankings of community facilities, highlighting priorities related to health, daily living, and social–emotional support.

(3)

Required facilities for an extended old-age period.

When asked about future needs for prolonged old age, respondents expressed strongest demand for facilities that are absent or insufficient on the island. The most frequently requested was a community welfare center (51%) envisioned as an integrated hub for counseling, health programs, leisure activities, and daily living support, followed by hospital/clinic functions (22%) and co-living housing (19%). Notably, these future-oriented needs diverged from current routine-use patterns, indicating a shift from minimal daily infrastructure toward welfare–medical–housing integration.

Figure 5 visualizes the proportional distribution of perceived importance assigned to community facilities by older residents, indicating relative priority levels across facility types.

Figure 6 illustrates residents’ expressed demand for age-friendly community facilities needed to support extended old-age living in the residential area.

(4)

Integrated interpretation.

Figure 7 integrates awareness, frequency, and perceived importance. Existing facilities used in everyday life are contrasted with facilities that are currently absent yet perceived as highly important, highlighting gaps between routine behavior and anticipated long-term aging needs.

4.1.4. Integrated Assessment of the Residential Environment of Older Households

Older residents on Yeonpyeong Island are predominantly in late old age and largely live alone or as older couples, with limited caregiving resources. Gradual declines in mobility and sensory function coexist with chronic health vulnerabilities under conditions of geographic isolation and constrained medical access. Housing environments are primarily small, detached dwellings with accumulated deterioration and widespread fall hazards, including level differences, narrow bathrooms, and inadequate supportive features. These conditions suggest a pronounced person–environment mismatch as functional capacities decline.

At the community level, facility awareness is high, but service functions are dispersed and fragmented. Utilization patterns indicate compressed daily activity space centered on basic living, minimal health routines, and administrative tasks, while leisure and cultural engagement remains limited. At the same time, residents expressed future-oriented needs for integrated welfare–medical–housing infrastructure, including community welfare functions, enhanced clinical access, and co-living options. Together, these findings provide an empirical basis for subsequent discussion on integrated care infrastructure and multi-scalar environmental intervention in isolated aging communities.

4.2. Emerging Resident Concerns as Signals for Spatial Transformation

Section 4.2 interprets older residents’ concerns as early indicators of spatial transformation required for integrated community care. Moving from limitations in individual dwellings (Section 4.2.1) to openness toward alternative co-housing (Section 4.2.2) and then to community-supportive environments (Section 4.2.3), this section illustrates how older adults cognitively register person–environment imbalance and articulate future-oriented needs. These empirical findings provide the foundation for the conceptual and policy discussion in Section 5.

4.2.1. Emerging Concerns: Early Signals of Residential Adaptation Needs

Table 11. Perceived Need for Home Modification and Improvement of Residential Spaces.

Category	Item	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree	M (SD)
Perceptions of Aging-Related Health Decline	1. I feel that gradual aging is causing noticeable changes.	1 (0.98)	54 (52.94)	45 (44.12)	1 (0.98)	1 (0.98)	3.52 (0.59)
	2. My health condition has worsened over the past year and a half.	0 (0.00)	18 (17.65)	82 (80.39)	1 (0.98)	1 (0.98)	3.15 (0.45)
	3. I am afraid that I may fall when moving around alone.	3 (2.94)	41 (40.20)	55 (53.92)	2 (1.96)	1 (0.98)	3.42 (0.64)
Awareness of Safety Risks and Grab Bar Necessity	4. I feel that installing grab bars is useful.	17 (16.67)	45 (44.12)	36 (35.29)	4 (3.92)	0 (0.00)	3.74 (0.78)
	5. As I grow older, daily mobility within the home is becoming more difficult.	12 (11.76)	73 (71.57)	17 (16.67)	0 (0.00)	0 (0.00)	3.95 (0.53)
	6. I think grab bars are needed in other areas of the home as well.	8 (7.84)	41 (40.20)	46 (45.10)	7 (6.86)	0 (0.00)	3.49 (0.74)
Perceived Necessity and Expected Benefits of Home Modification	7. I believe that improving residential features will greatly enhance convenience.	22 (21.57)	50 (49.02)	30 (29.41)	0 (0.00)	0 (0.00)	3.92 (0.71)
	8. Certain parts of my home need improvement to ensure safety and usability.	6 (5.88)	45 (44.12)	49 (48.04)	2 (1.96)	0 (0.00)	3.54 (0.64)
	9. If properly repaired, I could live in my home for a longer period.	18 (17.65)	46 (45.10)	34 (33.33)	4 (3.92)	0 (0.00)	3.76 (0.79)
	10. If my home is modified, I will be able to live more independently for longer.	16 (15.69)	45 (44.12)	36 (35.29)	5 (4.90)	0 (0.00)	3.71 (0.79)

summarizes perceived residential adaptation needs across three domains:

• perceived changes in health and daily function,
• perceived safety risks and usefulness of assistive features, and
• perceived necessity and benefits of home modification.

Together, these domains represent early-stage awareness of person–environment mismatch and openness to environmental intervention in a medically isolated island setting.

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Recognition of age-related change and vulnerability

Items 1–3 yielded moderate agreement (M ≈ 3.15–3.52), indicating that many respondents recognize an increasing difficulty in daily living and vulnerability to fall-related risks. Because the sample consists of older adults who were still able to participate, these values likely underestimate community-wide vulnerability.

(2)

Experiential understanding of environmental interventions

Items 4–6 showed higher agreement (M ≈ 3.50–3.95). Respondents recognized the usefulness of assistive features—particularly grab bars previously installed in 19 pilot homes. Notably, perceived usefulness extended beyond direct beneficiaries, suggesting that observed interventions may shape broader community perceptions of feasibility and value.

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Attitudinal openness to housing improvement

Items 7–10 also demonstrated high endorsement (M ≈ 3.7–3.9), indicating strong openness to home repair and remodeling as a means to sustain independence. Given widespread housing deterioration on the island, these responses reflect both repair needs and broader aspirations for improved residential conditions.

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Age- and Gender-Related Differences in Home Improvement Needs

To examine demographic variation in decision-related housing improvement needs,

Table 12. Home Modification Needs: Mean Scores by Age Group and Gender (One-Way ANOVA Results).

Gender	Mean (SD)			F (df)	p	Post Hoc Summary
	Age 65–74	Age 75–84	Age 85+
Female	3.69 (0.64)	3.75 (0.65)	3.83 (0.51)	F (2.74) = 0.25	0.778	ns
Male	3.50 (0.57)	3.89 (0.71)	3.63 (0.47)	F (2.22) = 0.97	0.397	ns

Note. One-way ANOVA was conducted separately by gender to compare age-group differences in decision-related home improvement needs. Post hoc multiple comparisons were performed using [Tukey HSD/Bonferroni]. Significance level was set at p < 0.05. Composite scores represent the mean of the item-level mean scores derived from the four items comprising the third cluster in Table 11 (“Perceived Necessity and Expected Benefits of Home Modification”), which functions as a focused signal subset capturing residents’ decision-related readiness for home modification. “ns” indicates no statistically significant difference (p≥0.05).

presents composite mean scores derived from the four items constituting the “Perceived Necessity and Expected Benefits of Home Modification” cluster (Table 11), compared across three age groups separately for female and male participants.

As shown in Table 12, age-stage differences did not reach statistical significance within either gender group (female: p = 0.778; male: p = 0.397). Nevertheless, the descriptive pattern suggests that female participants reported a gradual increase in perceived home improvement needs with advancing age, whereas male participants showed a peak in the middle-old stage followed by a slight decline in the late-old stage.

Overall, these findings indicate that perceived home improvement needs are consistently high across age stages, and that gender-based differences may be more salient than age-stage differentiation in this domain.

Figure 8 visualizes these patterns and highlights that, although not statistically significant, women show a steady upward trajectory across age stages, whereas men display a more variable pattern characterized by an increase into the middle-old stage and a slight decline thereafter. This suggests that perceived housing-related strain may accumulate more continuously among women, while men’s perceived needs may fluctuate across later-life stages.

Summary: Taken together, the findings indicate that older residents show a consistent and measurable awareness of housing-related adaptation needs. While perceived necessity and expected benefits of home modification were generally high across all age groups, age-stage differences within gender did not reach statistical significance in the decision-related home improvement signal subset (Table 12 and Figure 8). Nevertheless, the descriptive patterns suggest that women show a steadier accumulation of perceived needs with advancing age, whereas men display more fluctuation across stages. Overall, the results suggest that gender-based differentiation may be more salient than age-stage differentiation in this domain, supporting the interpretation of home improvement needs as an early but broadly shared signal of residential adaptation readiness in a service-limited island context.

4.2.2. Perceived Acceptability of Alternative Co-Housing Models

Table 13. Perceived Acceptability of Alternative Cohousing Models Across Three Domains.

Category	Item	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree	M (SD)
Functional Strain and Residential Fit	1. Daily living is becoming increasingly difficult.	2 (1.96)	52 (50.98)	48 (47.06)	0 (0.00)	0 (0.00)	3.55 (0.54)
	2. I am worried about depression and loneliness.	1 (0.98)	15 (14.71)	76 (74.51)	10 (9.80)	0 (0.01)	3.07 (0.53)
	3. I need meal service support.	1 (0.98)	26 (25.49)	62 (60.78)	12 (11.76)	1 (0.98)	3.14 (0.66)
Emotional Needs and Relational Dependency	4. I miss having people come and go.	6 (5.88)	76 (74.51)	19 (18.63)	0 (0.01)	1 (0.98)	3.84 (0.56)
	5. I wish there were more opportunities to interact with neighbors.	25 (24.51)	70 (68.63)	7 (6.86)	0 (0.00)	0 (0.00)	4.18 (0.53)
	6. It would be reassuring to have someone nearby in case of an emergency.	43 (42.16)	56 (54.90)	3 (2.94)	0 (0.00)	0 (0.00)	4.39 (0.55)
Cognitive Openness toward Community-Based Living	7. Outdoor mobility is becoming increasingly difficult.	2 (1.96)	32 (31.37)	59 (57.84)	9 (8.82)	0 (0.00)	3.26 (0.64)
	8. I am concerned about whether I can continue living in my current home.	5 (4.90)	37 (36.27)	52 (50.98)	8 (7.84)	0 (0.00)	3.38 (0.70)
	9. I would like to live together with others while maintaining personal privacy.	37 (36.27)	57 (55.88)	8 (7.84)	0 (0.00)	0 (0.00)	4.28 (0.60)
	10. Well-designed community housing supports autonomous living.	67 (65.69)	27 (26.47)	8 (7.84)	0 (0.00)	0 (0.00)	4.58 (0.64)

summarizes perceived acceptability of alternative co-housing across three domains—functional strain, emotional–relational needs, and openness toward shared/autonomous living.

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Functional strain and declining residential fit

Respondents widely acknowledged increasing difficulty in daily life. A smaller but meaningful share expressed concerns about psychological vulnerability (e.g., depression, solitary death), reflecting latent risks associated with medical isolation and limited emergency services.

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Emotional–relational needs and desire for social reassurance

Items related to relational reassurance and emergency support showed very high endorsement. Proximity to others and daily interaction were perceived as increasingly essential for late-life security.

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Openness to co-housing models that preserve autonomy

Strong agreement was expressed for accepting co-housing if privacy is protected. Respondents viewed community-supported living not as dependency but as a viable alternative under autonomy-supportive conditions.

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Age- and Gender-Related Differences in Alternative Housing Needs

To examine demographic variation in perceived need for alternative/community-based housing,

Table 14. Gender-Stratified Age Differences in Mean Scores for Alternative (Cohousing-Type) Housing Needs.

Gender	Mean (SD)			F (df)	p	Post Hoc Summary
	Age 65–74	Age 75–84	Age 85+
Female	3.74 (0.40)	3.94 (0.46)	4.09 (0.45)	F (2.74) = 3.79	0.027	65–74 < 75–84 < 85+
Male	3.53 (0.31)	3.95 (0.43)	4.00 (0.47)	F (2.22) = 3.18	0.061	ns

Note. One-way ANOVA was applied separately by gender to compare age-group differences in perceived need for alternative (cohousing-type) housing. Post hoc multiple comparisons were performed using [Tukey HSD/Bonferroni]. Significance level was set at p < 0.05. Composite scores represent the mean of the item-level mean scores derived from the four items constituting the alternative (cohousing-type) housing cluster in Table 13, which functions as a focused signal subset reflecting residents’ decision-related openness to community-based living arrangements. “ns” indicates no statistically significant difference (p≥0.05).

presents composite scores derived from the four items constituting the alternative (cohousing-type) housing cluster (Table 13), compared across three age groups and analyzed separately by gender.

As shown in Table 14, female participants exhibited a statistically significant age-stage effect (F(2,74) = 3.79, p = 0.027), showing a stepwise increase across the three age groups (65–74 < 75–84 < 85+). This indicates that older women increasingly recognize cohousing-type housing as an acceptable and needed option as age advances, suggesting a progressively intensifying signal of readiness for community-supported living arrangements.

In contrast, male participants showed an increase from the young-old to the middle-old stage but a more limited rise into the late-old stage, and the overall age-stage effect did not reach statistical significance (p = 0.061). This implies that among men, the perceived relevance of cohousing-type options may emerge earlier but does not intensify as strongly in advanced old age, at least within this sample.

Figure 9 reinforces these trends by visualizing a pronounced and continuous upward trajectory among women, while depicting a more moderate increase among men with relative stabilization in later old age. Taken together, the results suggest that cohousing-type needs may function as a clearer age-related signal among women, whereas men demonstrate a weaker and statistically non-significant age-stage differentiation.

Summary: Findings across Table 13 and Table 14 and Figure 9 demonstrate that perceived alternative (cohousing-type) housing needs emerge as a meaningful decision-related signal of residential adaptation. Among women, perceived needs increased progressively across the three age stages and showed statistically significant age-stage differentiation, suggesting that cohousing-type options become increasingly relevant as women advance into later old age. In contrast, men showed a more moderate increase with limited escalation into the late-old stage, and the age-stage effect did not reach statistical significance. Taken together, the results indicate that cohousing-type housing needs function as a clearer age-related signal among women, whereas men’s needs appear to emerge earlier but remain less differentiated across later stages. These patterns reinforce the coexistence of push-side functional strain, pull-side relational reassurance, and autonomy-supportive preferences as interrelated drivers of readiness for community-supported living options in isolated aging regions.

4.2.3. Perceived Needs for Community Support Spaces

Table 15. Perceived Needs for Community Support Spaces (n = 102).

Category	Item	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree	M (SD)
Adequacy and Accessibility of Leisure Spaces	1. Appropriate places where I can spend my leisure time together with others are well provided.	3 (2.94)	0 (0.01)	4 (3.92)	74 (72.55)	21 (20.59)	1.92 (0.71)
	2. The routes to meeting places are well connected and easy to use.	1 (0.98)	0 (0.00)	5 (4.90)	80 (78.43)	16 (15.69)	1.92 (0.54)
	3. There are places I can continue to visit even as I grow older.	1 (0.98)	0 (0.00)	5 (4.90)	86 (84.31)	10 (9.80)	1.98 (0.49)
Demand for Programmatic and Service Integration	4. It would be good if a variety of services were provided in a single place.	58 (56.86)	43 (42.16)	0 (0.00)	1 (0.98)	0 (0.00)	4.55 (0.56)
	5. We need places that can be used together by people of different age groups.	76 (74.51)	25 (24.51)	1 (0.98)	0 (0.00)	0 (0.00)	4.74 (0.47)
	6. It would be good to have places where programs are well provided.	95 (93.14)	5 (4.90)	2 (1.96)	0 (0.00)	0 (0.00)	4.83 (0.40)
Environmental and Climatic Requirements for New Community Facilities	7. Places that I can go to even when my mobility is limited are necessary.	86 (84.31)	15 (14.71)	1 (0.98)	0 (0.00)	0 (0.00)	4.91 (0.35)
	8. We need places that can be used during very hot or very cold weather.	95 (93.14)	6 (5.88)	1 (0.98)	0 (0.00)	0 (0.00)	4.92 (0.31)
	9. When working together with others, I would like the work environment and conditions to be good.	94 (92.16)	7 (6.86)	1 (0.98)	0 (0.00)	0 (0.00)	4.91 (0.32)
	10. Good community spaces support an autonomous, self-reliant life.	96 (94.12)	6 (5.88)	0 (0.00)	0 (0.00)	0 (0.00)	4.94 (0.24)

This table summarizes perceived deficits in current community spaces and future-oriented preferences for integrated, mobility-safe, and climate-resilient facilities. The three categories in Table 15 correspond to the three domains described in Section 4.2.3: (A) adequacy and accessibility, (B) program/service integration, and (C) environmental and climatic requirements.

summarizes perceived needs for community support spaces across three domains: (A) adequacy and accessibility of leisure/everyday spaces, (B) demand for program and service integration, and (C) environmental and climatic requirements for future community facilities.

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Environmental adequacy and accessibility deficits

Items 1–3 showed strong dissatisfaction with the adequacy and accessibility of leisure spaces and routes to meeting places, with negative responses dominating and mean levels remaining low (e.g., M = 1.92 for leisure-space adequacy). These results indicate structural constraints in proximity, accessible circulation, and continuity of use as mobility declines.

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Programmatic and service integration needs

Items 4–6 showed near-universal endorsement of consolidated, multi-functional hubs providing diverse services and programs, including spaces usable across age groups. This pattern reflects strong preference for integrated community environments that support everyday stability and participation.

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Environmental and climatic requirements for new facilities

Items 7–10 also received overwhelmingly positive responses, emphasizing mobility-safe access, usability during extreme weather, and expectations that well-designed community spaces support autonomous living. These responses indicate explicit criteria for future facilities in an aging and climate-vulnerable island context.

Summary: Overall, community-level responses show a clear contrast between strong dissatisfaction with current accessibility (push-side conditions) and exceptionally high endorsement of integrated, mobility- and climate-resilient facilities (pull-side preferences), indicating readiness for community-scale spatial and service restructuring.

4.2.4. Integrated Interpretation of Emerging Concerns Across Housing, Co-Housing, and Community Spaces

Across the three domains—housing adaptation needs (Section 4.2.1), acceptability of alternative co-housing (Section 4.2.2), and community support spaces (Section 4.2.3)—a coherent multi-scalar signal of transition emerges. At the dwelling level, respondents recognize accumulating difficulty and safety risk, yet simultaneously endorse concrete interventions and express strong openness to housing improvement. At the residential-preference level, they reveal pronounced relational needs and high acceptability of privacy- and autonomy-preserving co-housing, suggesting that shared living is increasingly imagined as a viable late-life option rather than a last resort. At the community level, dissatisfaction with current accessibility and activity infrastructure coexists with near-universal support for integrated hubs and mobility- and climate-resilient facilities. Taken together, these patterns indicate a shift from passive endurance toward articulated readiness for preventive, care-supportive environments, providing an empirical basis for the theoretical and policy discussion developed in Section 5.

5. Discussion

Building on the findings in Section 4, this chapter interprets residents’ responses as socio-spatial signals of change in an aging, medically isolated island context. The results indicate (i) an emerging press–competence imbalance expressed as housing-related push signals, (ii) a latent pull toward autonomy-supportive communal living (alternative/co-housing), and (iii) near-universal expectations for integrated community support spaces. To translate these empirical patterns into conceptual and actionable implications, the Discussion is organized into three parts. Section 5.1 proposes a directional framework for functional integration of community facilities, aligning facility roles with residents’ life-space hierarchy and mobility constraints. Section 5.2 develops theoretical implications by connecting Environmental Press, push–pull dynamics, and life-space as an integrated interpretive lens for anticipatory adaptation. Section 5.3 synthesizes policy implications, outlining how local governments and community actors can operationalize integrated-care infrastructure under conditions of geographic and service isolation.

5.1. A Directional Framework for Functional Integration of Community Facilities

This section translates the empirical patterns in Section 4, into a forward-looking framework for reorganizing community facilities in Yeonpyeong Island. While the findings documented compressed daily life-space, polarized facility use, and near-universal demand for integrated hubs, the present framework specifies how existing facilities can be repositioned as a staged, mobility-efficient service ecosystem rather than isolated, single-purpose points.

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Framework logic and visualization

Figure 10 maps existing community facilities along residents’ life-space hierarchy (daily, weekly, monthly, and seasonal zones) and visualizes their potential evolution toward functional integration. Nodes positioned closer to the center represent high-frequency destinations that structure routine living, whereas peripheral nodes indicate activities requiring longer travel, seasonal movement, or higher physical effort.

Connections between nodes represent potential service linkages (program sharing, on-site service dispatch, and mobility support) that can reduce the cumulative burden of fragmented access. The framework is intentionally staged to accommodate local constraints in budget, staffing, and governance capacity while preserving a clear direction of change: consolidation of essential functions into a small number of accessible hubs and reinforcement of linkages among them.

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Direction of integration: from dispersed points to multi-functional hubs

Conventional facility planning in small islands often produces dispersed, single-function facilities that require repeated travel across challenging terrain, thereby accelerating life-space contraction in later life. In contrast, the present framework proposes a transition toward flexible, multi-functional hubs that allow residents to access essential services—basic goods, health-related support, administrative assistance, social participation, and daily programs—within a reduced and safer mobility range. Rather than prescribing a single architectural form, the framework emphasizes incremental activation: strengthening existing facilities’ core functions first, then adding complementary services, and finally enabling remote or mobile service integration where permanent staffing is not feasible. Universal Design principles underpin this direction by prioritizing safe circulation, reduced level differences, resting points, sheltered pathways, and mobility assistance (e.g., small shuttles or senior-friendly on-demand services) that stabilize routine access under weather and seasonal vulnerability.

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Senior centers (Gyeongrodang) as a practical testbed for staged activation

Yeonpyeong’s senior centers function as the most visible daily anchor for older residents, yet their roles remain limited when programming, health linkage, and coordination functions are weak. The framework therefore uses the senior center as an illustrative testbed for staged activation: (i) reinforcing the facility’s basic daily function (safe gathering, warming/cooling, meals or meal linkage); (ii) adding routine programs (light exercise, health education, social participation activities) coordinated with existing administrative or welfare actors; (iii) enabling periodic on-site service delivery (screening, counseling, welfare navigation, visiting programs); and (iv) integrating remote services (teleconsultation support, digital health monitoring assistance) where appropriate. This staged pathway addresses island-specific constraints by emphasizing feasibility: building capacity around an existing, familiar place rather than creating a new facility-dependent system from scratch.

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Integration pathways for other core facilities

Based on residents’ reported routines and priorities, four facility types constitute the backbone of functional integration:

• Local mart (Facility #1) as a daily-life support node: As a stable weekly routine destination, the mart can incorporate light health-linked functions (nutrition guidance, simple wellness information, coordination of meal-related support) without requiring major institutional restructuring.
• Resident/administrative support center (Facility #5) as a multi-service civic node: Beyond administrative tasks, the center can serve as a coordination point for welfare navigation, program scheduling, information access, and linkage to visiting or remote services, reducing informational isolation.
• Outdoor sports facility (Facility #8) as an active-aging and rehabilitation node: With modest upgrades (weather protection, seating, safer walking loops, senior-friendly equipment), this node can support routine mobility maintenance and psychosocial restoration.
• Community welfare center (Facility #14) as a future integrated-care hub: Although currently absent, the welfare center represents the most strongly articulated future hub that can coordinate island-wide program delivery, dispatch services to smaller nodes (including senior centers) and integrate welfare–health–leisure functions in one place.

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Synthesis: toward a web-shaped service ecosystem.

In sum, the framework proposes a “web-shaped service ecosystem” organized around a limited number of activated hubs linked through program coordination and mobility support. The objective is not facility expansion per se, but the reduction in cumulative access burdens and the stabilization of routine life-space under conditions of aging, isolation, and climate vulnerability. By shifting from fragmented facility use to an integrated network, the island can operationalize sustainable aging-in-place as a mobility-efficient and resilient system rather than an abstract policy aspiration.

The observed mid-to-high endorsement levels should therefore be interpreted not simply as moderate demand, but as meaningful early signals of readiness for transformation in a low-openness, medically isolated setting. In contexts where residential change has historically been limited, even midpoint-level acceptance of alternative housing suggests a notable cognitive and attitudinal shift. Together, these signals indicate that residents are actively evaluating their environments and envisioning adaptation pathways beyond incremental repairs, reinforcing the rationale for a hub-based, integrated service ecosystem.

5.2. Theoretical Discussion

5.2.1. Diagnosing Yeonpyeong’s Residential Environment Through Lawton’s Environmental Press Theory

Lawton and Nahemow’s Environmental Press Theory [3] provides a robust framework for interpreting the adaptive patterns observed among Yeonpyeong’s older residents. The findings of this study reveal a typical press–competence imbalance, where age-related functional decline, hazardous housing conditions, and spatially fragmented services generate environmental demands that exceed residents’ capacities. These pressures did not merely result in discomfort; rather, they operated as adaptive triggers, prompting residents to anticipate future risks and express a proactive desire for housing improvement, service consolidation, and community transformation.

This behavior aligns with Lawton’s proposition that older adults, when faced with high environmental press, seek new settings that restore the competence–environment balance [3]. In Yeonpyeong’s insular context—characterized by limited service infrastructure and high mobility dependency—the emergence of such adaptive signaling is particularly noteworthy. Instead of passively enduring deficiencies, residents actively judged their environments as inadequate and articulated concrete alternatives (e.g., grab-bar installations, desire for communal living, requests for integrated services). This points to a form of environmental self-awareness that functions not simply as dissatisfaction but as a developmental step toward anticipatory adaptation.

In this sense, Yeonpyeong Island represents a distinctive case through which Environmental Press Theory can be extended to explain pre-adaptive community transitions, not only individual behavioral responses.

5.2.2. Push–Pull Dynamics in Elderly Residential Mobility

The revised subgroup patterns indicate that housing-related signals accumulate more strongly and progressively among women than among men. Across both domains, women consistently reported higher perceived needs, and their trajectories showed a clearer upward orientation with advancing age. In particular, the alternative (cohousing-type) housing cluster revealed a statistically meaningful age-stage gradient among women, suggesting that openness to community-based living becomes increasingly reinforced in later life. By contrast, men exhibited a comparatively flatter pattern, with weaker age-stage differentiation and a tendency toward stabilization.

This gendered divergence is theoretically meaningful within a push–pull interpretation. For women in medically isolated, service-limited island contexts, aging appears to intensify the convergence of functional strain, safety concerns, and unmet daily support needs, thereby amplifying both push-side pressures (perceived limits of remaining in deteriorated housing) and pull-side orientations (valuing supportive, autonomy-preserving communal living). In other words, women’s responses signal not merely heightened demand, but an increasingly structured readiness for alternative living arrangements as age-related vulnerabilities accumulate.

Accordingly, these results suggest that older women may function as particularly sensitive evaluators of environmental mismatch and future adaptation needs. Rather than reflecting immediate relocation intentions, the observed gender- and age-patterned trajectories should be interpreted as socio-spatial early signals that inform preventive, staged intervention planning—especially for late-old residents whose needs become increasingly differentiated and pronounced.

5.2.3. Life-Space Theory and Directions for Aging-Friendly Housing Development

Life-Space Theory [31,32] emphasizes how the spatial extent of daily movement and social participation reflects autonomy, identity, and well-being. In Yeonpyeong, residents’ life-spaces were significantly constrained due to poor accessibility, dispersed facilities, and limited transportation options. This contraction not only restricted physical activity but also produced psychological withdrawal and social disengagement.

Thus, an age-friendly housing model for Yeonpyeong must prioritize life-space expansion rather than simply removing architectural barriers. Community-based living zones—clustered hubs that combine welfare, recreation, health, and civic services—can support continuous social participation and reduce avoidable mobility burdens. Such environments shift the island’s spatial logic from isolated points of activity to a network of “mobility-enabled living spaces,” enabling older adults to engage more freely with their surroundings.

By integrating Life-Space Theory with Environmental Press and push–pull frameworks, this study proposes a holistic conceptual pathway: functional decline → environmental press → push pressures → demand for integrated hubs → life-space expansion as adaptive resolution. This integrated interpretation offers a theoretically coherent explanation for the emerging desire for community-based living and the restructuring of Yeonpyeong’s residential environment.

5.3. Policy Discussion

5.3.1. Integrating Regional Care Policy with Age-Friendly Housing Renewal

The challenges faced by Yeonpyeong’s older population result not only from aging but also from the structural absence of coordinated care systems. Housing renewal efforts must therefore be embedded within regional care strategies, rather than treated as isolated physical interventions.

A hybrid model that integrates home modification, energy services, preventive healthcare, nutritional support, and mobility assistance is essential to sustain aging in place. Local governments must acknowledge that spatial improvements and social welfare delivery are mutually constitutive policy domains. Combining these domains can enhance policy legitimacy, improve implementation efficiency, and ensure continuity of care—even in geographically isolated environments. Thus, a governance approach linking land use, housing welfare, and care policy is required to establish a locally grounded, island-tailored aging-in-place model.

5.3.2. Administrative Challenges in Building Integrated Care Infrastructure

Residents’ strongest expressed needs—service diversity, accessible spaces, multi-functional programs—point to the necessity of creating a spatially integrated care infrastructure. This entails moving beyond siloed administrative departments to a collaborative, inter-sectoral governance model.

Yeonpyeong’s infrastructural limitations (low accessibility, workforce shortages, limited medical capacity) further necessitate:

• ICT-supported remote care systems,
• Mobile regional service networks,
• Community manager or “village care coordinator” roles,
• Cross-agency budget pooling.

Such administrative restructuring is not merely institutional housekeeping; it represents a systemic transition toward a sustainable community care ecosystem—one that allows residents to receive care without being forced off the island.

5.3.3. A Sustainable Housing Welfare Model for Aging Island Communities

The Yeonpyeong case demonstrates that older residents can clearly articulate their needs for improved housing and community structures even in remote island contexts. To translate these perceptions into policy, a distributed and small-scale community housing model is required—emphasizing proximity, relational support, and environmental safety.

Rather than relying on large centralized facilities, this model would establish a network of shared residences, micro-hubs, and community commons that collectively deliver comprehensive welfare within residents’ daily life-space. A governance-based housing welfare approach—integrating land, welfare, health, and culture sectors—would help mitigate regional disparities while fostering a resident-led implementation structure. This represents a shift from a supply-driven welfare model to a territorial, community-driven housing welfare system tailored to aging island communities.

5.4. Practical Implications and Research Limitations

5.4.1. Practical Implications and Applicability

This study shows that residents’ perceptions of environmental inadequacy can function as a catalyst for community-level change. The findings offer practical insights for designing age-friendly housing, planning community welfare facilities, and developing public design and urban regeneration strategies.

The concept of Emerging Concern, introduced in this study, provides a novel analytic tool for detecting latent shifts in awareness as early indicators of environmental transformation. Similarly, the Push–Pull analytic framework developed here can be applied to other rural or coastal aging communities, offering a scalable approach to designing integrated care housing models. These implications position the study as a bridge between empirical evidence and actionable planning, reinforcing the value of perception-based community diagnostics.

Beyond the immediate environmental improvements identified in this study, emerging national policies highlight how advanced technologies may offer viable pathways to support aging-in-place in severely isolated communities. According to the Autonomous Mobility Innovation Roadmap [61], autonomous shuttles are expected to be deployed first in declining and mobility-vulnerable regions, ensuring safe and universal access to multi-service community hubs regardless of residential location. Similarly, a recent Ministry of Health and Welfare report [49] emphasized that telehealth systems should be prioritized in medically underserved rural and island areas, where constructing permanent clinics is neither feasible nor sustainable. Together, these technological directions suggest that aging-friendly community environments must integrate both spatial restructuring and digital infrastructure, enabling older adults in isolated regions to maintain autonomy, access essential services, and reduce health risks linked to geographic isolation.

5.4.2. Research Limitations and Future Research Directions

Several limitations of this study should be acknowledged. First, the research was conducted in a single island community, which limits the generalizability of the findings to other regional or national contexts. While Yeonpyeong Island provides a critical and information-rich case of extreme aging under geographic isolation, comparative multi-regional studies are necessary to examine the transferability of the observed patterns.

Second, although the study employed a primarily quantitative survey design as its core empirical method, the sample size constrained the application of advanced statistical modeling and causal inference techniques. As a result, the quantitative findings were interpreted mainly through descriptive statistics and subgroup comparisons, complemented by theory-driven interpretation rather than multivariate prediction models. This limitation does not undermine the quantitative nature of the study, but it does indicate the need for larger-scale datasets in future research to enable more sophisticated inferential analyses.

Future studies should therefore pursue multi-site comparative designs, integrate longitudinal data to track how emerging perceptions translate into behavioral change over time, and expand sample sizes to support advanced statistical testing. In addition, the use of AI-based participatory platforms and digital data-collection tools may allow for more granular measurement of environmental experience, mobility patterns, and resident participation. Such approaches would strengthen both the methodological rigor and policy relevance of research on aging-friendly environments in geographically isolated communities.

6. Conclusions and Recommendations

6.1. Conclusions

This study investigated housing-related needs among older adults in Yeonpyeong Island as socio-spatial signals of residential press and emerging mobility orientations in a medically isolated aging community. Using an integrated framework combining Environmental Press Theory, Push–Pull Theory, and the Life-Space concept, the findings show that residents’ housing demands operate not merely as technical requests but as anticipatory judgments about future living arrangements under accumulated person–environment misfit. Perceived limits of home modification functioned as a critical push factor, while interest in alternative housing emerged as a latent pull factor, indicating prospective—rather than immediate—residential change. Overall, housing-related needs can be interpreted as preventive indicators that inform early, staged interventions to support sustainable aging-in-place in super-aged and service-limited island regions.

6.2. Recommendations

6.2.1. Academic Implications

This study contributes to environmental gerontology by integratively applying Environmental Press Theory, Push–Pull Theory, and the Life-Space concept to aging in medically isolated island communities. Extending Lawton’s competence–environment balance perspective, it empirically frames housing-related needs as proactive socio-spatial signals articulated by older adults, capturing how environmental misfit is cognitively recognized and translated into future-oriented preferences. By conceptualizing these needs as anticipatory judgments linked to residential mobility orientations, the study connects environmental gerontology with broader discussions on preventive environmental intervention and later-life autonomy in constrained settings. The findings further support an Integrated Environment–Participation perspective, in which environmental awareness and appraisal are treated as part of a dynamic ecological process that may precede engagement with alternative living arrangements. Future research may strengthen this perspective through longitudinal designs and participatory approaches, clarifying how perceived deficits evolve into learning, empowerment, and co-created solutions in later life.

6.2.2. Policy Recommendations

The Yeonpyeong case suggests that fragmented care, welfare, and housing-improvement programs have limited effectiveness in island regions where services are spatially dispersed and access is constrained. A more coherent approach is needed—one aligned with competence–environment balance and consistent with global age-friendly frameworks emphasizing participation and integrated support systems. Policy strategies should therefore prioritize a Local Integrated Care System that links housing safety upgrades, mobility support, meal services, health monitoring, and energy assistance within residents’ daily living zones. Implementation should shift from unilateral service provision toward participatory governance (e.g., resident-involved living labs) that enables older adults to identify priorities, test feasible solutions, and inform locally appropriate rollout. Such a structure may serve as a scalable reference for other aging island regions as well as declining mainland communities with similar service limitations.

6.2.3. Practical Recommendations

Practically, improvements should move beyond isolated repairs toward establishing Living Environment Labs where older adults can experience, evaluate, and co-design improvements to homes and community facilities.

Based on the findings, the following actions are recommended:

• Prioritize In-Home Safety: Implement universal design upgrades (grab bars, non-slip flooring, and level-difference remediation), prioritizing residents with mobility limitations (e.g., ≥70 years old).
• Establish Multi-functional Micro-Hubs: Upgrade existing senior centers (Gyeongrodang) into multi-service micro-hubs, enabling access to essential supports (basic health monitoring, meal-related assistance, and administrative linkage) within a 10-min walking radius (~500 m).
• Deploy Digital Inclusion Services: Introduce ICT-enabled remote care and community communication platforms, coupled with structured digital literacy training to reduce the digital divide.
• Enhance Mobility Connectivity: Provide senior-friendly shuttle services (or context-appropriate shared mobility options) connecting peripheral residences with micro-hubs to ensure safe and universal access.

6.2.4. Suggestions for Future Research

Future research should extend beyond a single-case context and adopt a multi-scalar framework:

• Micro level: Longitudinal studies capturing individual adaptation processes, health variation, and day-to-day environmental negotiation.
• Meso level: Evaluation of specific interventions (housing safety upgrades, mobility supports, community programming) using pre–post designs.
• Macro level: Comparative studies across rural, mountainous, and peripheral urban regions to assess transferability and inform a Korean Ageing Community Framework (K-Ageing Model).

In addition, community-based participatory research (workshops, design charrettes, and resident-led living labs) should be expanded to strengthen resident empowerment and implementation relevance. Accumulating mixed evidence over time will further clarify how environmental awareness translates into behavioral change and feasible community transformation pathways. Ultimately, the Yeonpyeong case can evolve from a localized study into a reference model for resilient, sustainable, and community-driven aging environments.