{
  "abstract": "Objectives To identify the key factors associated with admission to elderly medical-welfare facilities in South Korea and to evaluate their relative importance using machine learning techniques, providing an evidence base for policy in a rapidly ageing society.Design A cross-sectional secondary data analysis.Setting The analysis was conducted using the National Health Insurance Service -Senior database, a large-scale public dataset constructed to be statistically representative of the elderly population in South Korea.Participants A total of 48 614 elderly individuals aged 60–80 years, selected through a scientifically rigorous stratified random sampling method.Primary and secondary outcome measures The primary outcome was the binary classification of an individual’s long-term care arrangement: admission to a facility-based service versus utilisation of home-based care. The secondary outcome was the relative importance and contribution of a wide range of demographic, health-status and care-related variables in predicting facility admission.Results After addressing severe class imbalance with the synthetic minority over-sampling technique, our final random forest model demonstrated excellent predictive power, achieving a sensitivity of 0.856 and a balanced accuracy of 0.921. An analysis of feature importance using Shapley Additive Explanations (SHAP) revealed that the most dominant predictor was an individual’s cohabitation with institutional staff (mean SHAP value ≈ 0.180), indicating pre-existing contact with the formal care system. Other critical factors included the absence of a primary caregiver (≈ 0.056), being fully dependent due to dementia (≈ 0.017) and the degree of functional impairment as measured by the activities of daily living (ADL) score (≈ 0.017).Conclusion Admission to medical-welfare facilities in South Korea is a multifactorial issue, most strongly driven by the erosion of informal care support systems combined with severe health decline, particularly in cognitive and physical function. These evidence-based findings highlight the need for policy interventions that strengthen community-based integrated care and enhance support for family caregivers. Such strategies are essential for promoting ageing-in-place, ensuring the long-term sustainability of the public long-term care system and ultimately improving the quality of life for the nation’s growing elderly population.",
  "authors": [
    {
      "affiliations": [
        "Inha University, Incheon, Korea (the Republic of)"
      ],
      "name": "Ji Young Lim"
    },
    {
      "affiliations": [
        "Gangneung-Wonju National University, Wonju-si, Korea (the Republic of)"
      ],
      "name": "Eun Joo Kim"
    },
    {
      "affiliations": [
        "Gangneung-Wonju National University, Wonju-si, Korea (the Republic of)"
      ],
      "name": "Seong Kwang Kim"
    }
  ],
  "title": "Factors associated with admission to elderly medical-welfare facilities in South Korea: a cross-sectional machine-learning study",
  "uid": "0380e481-9bf8-527c-9e64-0003cca7e6a7"
}