The aging of society is a global trend. South Korea is no exception: 11.4% of its population was elderly in 2011, but this figure is anticipated to approximately double to 24.3% by 2030.¹ An aging society is accompanied by increased social and economic burdens. For example, the cost to support the elderly was 15.0% of Korea's Gross Domestic Product in 2010, meaning that every 6.6 economically active people (aged 15-64 years) maintained one elderly person, and it is predicted that every two working people will support each elderly person in 2040 if low birth rates in Korea continue. Due to the extension of life spans, geriatric diseases have become more prevalent than before, and these further contribute to the increasing social burden related to aging. In Korea, medical expenses from national health insurance for patients over 64 years of age in 2009 accounted for 30.5% of total medical costs.

Recently, as the elderly population has grown rapidly and their social costs have increased, the lives of elderly people have come to receive more attention than before. In particular, the health problems of old age have become important public issues.²³⁴ However, current public health policies for the elderly have been focused on physical disorders such as hypertension, cerebrovascular diseases, and diabetes mellitus. In addition to the fact that mental health has not been given enough public attention, current mental health services and research merely focus on mental diseases and their associated morbidity. Many aspects of the lives of the elderly deserve attention. There have been few previous studies on the happiness of elderly people, and we aimed to investigate the factors and perspectives associated with happiness among the community-dwelling elderly in Korea.

This research contributes to the literature in several ways. First, we provide an analysis of the determinants of happiness in the Korean elderly, particularly in relation to depression. Second, we provide insights for policy makers and professionals to improve their perception and understanding of the lives of the Korean elderly. Third, our results could be used as information for creating programs to promote and provide suitable services to enhance the happiness of the elderly.

We investigated the perceived levels of happiness and the factors influencing happiness among the community-dwelling elderly in Korea. The mean VAS score, representing subjects' levels of happiness, was 64.74 (±26.25). In the present study, the mean age of the happy group was significantly lower than that of the not-happy group, but overall, age was not correlated with the happiness score. This may be a result of the fact that our study was limited to elderly individuals aged 62-88 years. Previous studies that covered all age groups reported a consistent degree of happiness across age groups.¹² One study concluded that older people may have greater resilience derived from various past experiences or a stronger likelihood of engaging in religious activities than younger people.¹³ Further studies that include all age groups or use unified measures are needed.

Two sociodemographic variables, having a partner and a high level of education, were significantly associated with greater happiness scores in the present study. The subjects who had partners (married, remarried, or cohabiting) reported greater happiness than those who did not. A previous study also emphasized the importance of living with a partner, especially in old age, because it more strongly predicted happiness among older people than among younger people.¹²

Subjects without any school education or with fewer years of education (≤9 years) felt lower levels of happiness than subjects who completed more than 16 years of education, and there seemed to be an overall trend of more educated subjects being happier. When divided into happy and not-happy groups, the subjects belonging to the happy group had significantly higher levels of education than those who belonged to the not-happy group. Similar results have been reported in other studies,¹⁴¹⁵ and the educational level or qualifications may be associated with economic or mental resources useful for coping.

One remarkable finding of the present study was the association between family and the level of perceived happiness. The happiest personal situations for most individuals, in order of frequency, were "getting together with family members" and "living in peace with family members (well-being)." Moreover, 20.5% of subjects (n=145) chose "being with family" as the most essential condition for happiness, making it the second-most-frequent answer to the fourth question of the HQ. Additionally, the third-most-frequent reason for subjects not being happy was economic problems of their children (n=17, 14.8%).

Many Korean people, particularly the elderly, place a high value on family, a tendency that supposedly originated in Confucian culture. Until several decades ago, an extended family system was very common, and taking good care of one's parents and children and having good relationships with family members were thought to be virtues. In a large-family system with a Confucian culture, people are bothered when the close bond between family members is interrupted or filial duty is neglected. Therefore, in this culture, family may be an important factor associated with the perception of happiness. Moreover, considering that loneliness was the reason that 14.0% (n=16) of not-happy subjects were not happy, the importance of family is still more apparent.

Another important happiness-associated factor was economic status. Unlike family factors, economic aspects were mentioned less often as personal happiest conditions or essential conditions for happiness. However, subjects answered that their own economic problems or those of their children were leading causes of their not being happy, accounting for 31.3% (n=36) of such responses. This discrepancy could be explained by two factors: attitudes toward materialistic values and the concept of happiness. In Korea, the idea that money is all-important, or the expression of excessive interest in money, has been regarded as worldly or shameful according to the traditional system of values. Therefore, it is possible that subjects were reluctant to refer to money (economy) directly when they were asked about their personal happiest conditions or their opinions on essential conditions for happiness. However, when the question about subjects' reasons for not being happy was asked, many subjects revealed that they were troubled by economic matters. Therefore, we guessed that money played as important a role in happiness as family, although this was not overtly expressed by the subjects. In that sense, the HQ has strength, as it questions subjects about happiness from several angles with slightly different wordings, and because of this, the subjects cannot help disclosing their real-life situations or honest values. On the other hand, the concept of happiness varies depending on the cultural and social background of each country.⁴¹⁶¹⁷ The word "happy" is not so familiar to Korean people, and some people regard it as too abstract and vague, as if it is connected only with goodness and beauty; further, the word is not spoken frequently in everyday life. Therefore, another possibility is that subjects were prone to focus on other factors than money when asked about happiness. Actually, the poverty rate among elderly Korean people is estimated to be at least 37.1%, based on the minimum cost of living from the Poverty Statistics Yearbook (2009); this is a very high rate compared with those of the other countries in the Organization for Economic Cooperation and Development (20% overall in 2009). Such a social condition may ensure the contribution of economic matters to perceived levels of happiness.

A third important factor for happiness was health, which was the most frequent answer to 2 questions on the HQ, namely, reasons for not being happy and essential conditions for happiness. The strong role of health was not surprising: the more aged a person becomes, the more medical diseases he/she develops, so health problems may have an inseparable relationship with happiness among the elderly. Moreover, health issues could cause conflicts with caregivers or family members and increase economic burdens, so good health may be an absolutely indispensable component of the sense of happiness.

On the other hand, symptoms of depression were associated with happiness levels. The differences in happiness scores between the depressive group and the non-depressive group were significant. Moreover, in the not-happy group, the prevalence of probable depression according to the BDI or GDS was also significantly higher than that in the happy group. Moreover, the scores of the BDI or GDS were associated with happiness scores. It is known that happiness is closely connected to mental health; conversely, depressive disorder is known to affect quality of life (QOL) and negative emotion, which are linked to the perception of happiness.¹⁸¹⁹ Considering that in traditional Korean culture, suppression or internalization of one's emotions (like depression or not being happy) is considered a virtue, an exact assessment of the relationship between the happiness level and depression might not have been achi-eved. Further studies that take cultural background into consideration are needed in order to investigate the relationship between happiness and mental disorders like depression.

Of course, the condition of being happy does not merely mean the absence of depression, anxiety, and other mental health problems; rather it is associated with satisfaction with life as a whole and the frequency and intensity of the experience of joy.²⁰ There are some differences in terms of which factors are associated with happiness according to endemic moral culture and social strata.²¹ According to a study from India, economic status has no relationship with happiness.²² In China, the elderly feel happy when they stay with their children.²³ A report from Hong Kong suggested that economic problems and primary support groups are important factors involved with the promotion of happiness among the elderly, findings that are similar to our results.²⁴

Our study has some limitations. First, subject sampling was not conducted by a nationwide, stratified method; instead, the study was limited to a small suburban area. In addition, elderly individuals who were institutionalized or could not move by themselves were excluded. Therefore, the findings of the present study may have been affected by the properties of the suburban area and might not represent all elderly people, and we need to be cautious not to make generalizations based on the findings of this study. In addition, certain aspects of Korean culture, like the vague concept of happiness among Koreans, negative views of materialist values, and Confucian backgrounds could have affected the results, as mentioned previously. Finally, recall bias cannot be excluded.

Despite these limitations, the present study has strengths in assessing the happiness status of the Korean elderly and the factors and perspectives associated with their happiness. We used the HQ, which contained 4 questions about happiness, each of which took a delicately different angle to avoid the influence of cultural backgrounds and personal attitudes. Good relationships with family, economic stability, and good health were the most important factors associated with perceived levels of happiness. Among objective variables, having a partner and having completed a higher level of education were related to greater feelings of happiness.

Most previous studies that measured happiness levels targeted the general adult population, especially middle-aged adults. However, elderly people have unique features of their own, and the factors in their happiness differ from those of the general adult population. Few tools for measuring the happiness level of the elderly population have been suggested, but further studies on the factors of their happiness are required, and a concrete scale for measuring such factors must be developed. The preliminary scale [Happy (Haeng-Bok, 幸福) aging scale] in this study may help establish such a measuring tool. Further studies on the validity and reliability of this scale may be needed in the future. Measurements of the happiness level of the elderly population may be used for assessment and treatment in the geriatric psychiatry field.

Mental health service providers and policy makers need to take more interest in non-illness conditions such as happiness. Promoting such conditions could be a step that prevents the development of diseases, and that could be one way to reduce the enormous social burden of the elderly population in this aging society. Further studies using nationwide samples are required.