The Role of Age-Friendly Environment in Promoting Healthy Aging: From Multidimensional Environmental Facets and Psychological Perspective

Abstract

Age-friendly environments are a key determinant of healthy aging, while subjective age is assumed to be a psychological factor affecting one’s behavior and well-being. This study explores how age-friendly environments play a role in promoting healthy aging through (1) putting macro-social and micro-family environments in the same context and (2) examining the moderating role of subjective age. In a random sample of 2,788 older adults, we found that (1) higher levels of age-friendly family and social environments were consistently associated with better health outcomes; (2) subjective age significantly moderated the social environment–frailty relationship (β = −0.26, p < 0.001), with stronger protective effects observed among those feeling older; and (3) specific social environment domains (life security and accessibility) showed particularly pronounced moderation effects by subjective age. These findings demonstrate that environmental and psychological factors jointly influence health states, and underscore the need for integrated interventions that enhance age-friendly environments and foster positive aging perceptions to optimize health in later life.

Keywords

subjective age age-friendly family environment age-friendly social environment multiple health outcomes

What this paper adds

Integrated perspective: The study bridges environmental and psychological domains by demonstrating how age-friendly environments (family and social) interact with subjective age to influence health outcomes, offering a holistic view of healthy aging.

Moderating role of subjective age: It reveals that subjective age moderates the relationship between social environments and frailty, with stronger protective effects for those feeling older, highlighting the compensatory role of environmental support.

Domain-specific effects: The paper identifies distinct health impacts of specific social environment domains (e.g., life security and accessibility), providing nuanced insights for targeted interventions.

Applications of study findings

Policy: Advocates for integrated age-friendly initiatives that combine environmental improvements (e.g., accessibility and social participation) with campaigns to foster positive aging perceptions.

Practice: Encourages gerontological professionals to address both tangible support (e.g., family assistance) and psychological factors (e.g., subjective age) in interventions to reduce frailty and loneliness.

Research: Calls for longitudinal studies to explore causal relationships and the use of mixed-method designs to validate self-reported environmental measures.

Introduction

Demographic aging brings the issue of health heterogeneity among older adults into sharp focus. Some lived with disability and faced a higher mortality risk (Kuper et al., 2024), while some lived with vitality and enjoyed a more favorable life (Zhang et al., 2024). Given these facts, it is not only chronological age frames the health of later life. According to the World Health Organization’s healthy aging paradigm (Rudnicka et al., 2020), environments plays a pivotal role in maintaining function and fostering well-being among older adults. It is supposed that age-friendly environment could empower older adults. For example, for macro-level societal environments, such as Age-Friendly Cities (AFC) initiatives that systematically modify urban environments to support aging populations (Che et al., 2024; Xu et al., 2022), accessible building environments, and affordable social services demonstrated measurable impacts on frailty reduction and life satisfaction (Perek-Biaas et al., 2024). For micro-level relational environments, family support environments (Cai et al., 2023) and neighborhood environments (Gan et al., 2021; Pan et al., 2024) contributed to health maintenance, typically in mental health and self-rated health outcomes (Kyeongmo et al., 2021). Although increasing evidence supported the health potential of age-friendly environments, there is a lack of structural lens on how macro-social and micro-family environments work together in the same context among older adults.

In addition, some researches found distinct roles of age-friendly environments among different older adults groups (Zheng et al., 2022). For example, community-built environments were more directly pronounced in the lower-income older group, while more indirectly pronounced in the higher-income group (Zheng et al., 2022). It indicates that the way about how environments work may differ from groups. The healthy aging initiative provides a conceptual framework about what elements, such as environments, constitute the process of maintaining health and how they link each other. However, it still remains unclear about the pathways through which environments work to promote healthy aging. Individual attitude is important to shape one’s behavior, which may influence one’s health. An increasing number of studies introduced subjective age as a pivotal individual attitude variable which matters in later life. Robust evidence documented its predictive validity for diverse health outcomes (Debreczeni & Bailey, 2021; Westerhof et al., 2023), and figured out its operating ways, such as through self-perception processes that influence health behaviors (Bergman et al., 2020; Shrira et al., 2020). These relationships have been confirmed in Chinese settings for both mental and physical health outcomes (Li et al., 2021; Qiao et al., 2021), and for difference age strata (Liu et al., 2023; Wang & Hu, 2024). It can be assumed that subjective age may play a role in the relationship between age-friendly environment and healthy aging outcomes.

Up to now, there is a lack of understanding of how macro- and micro-level age-friendly environments work in the same context to promote healthy aging outcomes, and whether subjective age affects the environmental influences on health aging outcomes. Such evidence is typically limited from non-Western contexts, particularly rapidly aging societies like China. We made hypotheses that (1) there will exist significant positive associations between micro-family environment, macro-social environment, and healthy aging outcomes among older adults and (2) subjective age may serve as a vital moderating role in these associations. Thus, this study aimed to investigate (1) the relationships between age-friendly environments and healthy aging outcomes from both macro-level environments (AFC policies) and micro-level family support and (2) whether these relationships would be moderated by subjective age.

Methods

Study Design and Participants

From June to September 2022, we conducted a multi-stage stratified random sampling survey of 2,788 older adults (≥60 years) in Zhejiang Province, China. Zhejiang was selected due to its high aging rate (26.17% ≥60 years; 19.06% ≥65 years) and significant urban–rural disparities, making it representative of China’s aging population. The sampling process involved: (1) randomly selecting Hangzhou (developed region, 23.13% ≥60 years) and Quzhou (underdeveloped region, 23.48% ≥60 years); (2) choosing one district/county per city; (3) selecting two streets/towns per district; and (4) recruiting participants from multiple communities/villages to meet sample size requirements. This rigorous sampling strategy ensured the study captured diverse socioeconomic and geographic characteristics of China’s elderly population. According to Sun and Xu (2013), $n = \frac{Z_{α / 2}^{2} * π * (1 - π)}{δ^{2}}$ , while α = 0.05, Z_α/2 = 1.96; δ = 0.1π, π = 0.48 (the average elder health need rate is 0.48 in Zhejiang Province), the desired minimum sample size was 434. Also, in order to fit the overall demographic characteristics of Chinese older adults, the proportion of females and younger elders in the sample was required to be higher than males and older elders. The inclusion criteria included Chinese residents who (1) were aged 60 years or above, (2) could speak Mandarin or had no difficulties in communication, and (3) were able to give consent and agreed to participate in the study. Those who did not understand the content of the questionnaire were excluded.

Data Collection and Instruments

Data were collected through face-to-face interviews using a comprehensive questionnaire that had been validated through cognitive interviews with 30 older adults. The questionnaire consisted of four main sections: demographic characteristics, age-friendly environment assessment, multiple health indicators, and subjective age measurement.

Demographic Characteristics

The demographic characteristics section captured basic individual information including age, gender, education level, income, living arrangements, and marital status, along with elderly care status and health risk factors such as chronic disease prevalence and recent healthcare utilization.

Age-Friendly Environment

The age-friendly environment assessment included family and social dimensions. Family environment was evaluated using the Family APGAR Index, measuring five functional domains (adaptation, partnership, growth, affection, and resolve) through three response options (“often” = 2 to “rarely” = 0), yielding a 0–10 total score (Cronbach’s α = 0.93). Family assistance was assessed via yes/no questions regarding support in daily activities, finances, and emotional needs.

For social environment, we adapted WHO’s Age-Friendly Communities Framework by adding medical accessibility/affordability indicators, creating a 16-item tool. Validation through psychometric analyses (Cronbach’s α = 0.89, factor analysis) led to removing “housing affordability,” resulting in a 15-item scale across four domains: accessibility, information, social participation, and life security. Fourteen binary items (yes = 1/no = 0) and one dichotomized quality-of-life item (poor = 0/good = 1) produced a 0–15 total score, with higher scores indicating greater age-friendliness.

Multiple Healthy Aging Outcomes

This study assessed health using both objective and subjective measures. Physical frailty was measured with the FRAIL Scale (5 items: fatigue, resistance, ambulation, illnesses, and weight loss), scored 0–5 (higher score = worse health). Loneliness was evaluated via a single-item 5-point scale (always-never), dichotomized to “lonely” (always/often) vs “not lonely” (Zhong et al., 2017).

Subjective health used a 5-point self-rating (“very bad” to “very good”), dichotomized to “good health” (good/very good) vs “poor health.” These simplified measures maintained validity while reducing respondent burden for elderly participants.

Subjective Age

We measured subjective age from a single question, “Compared with your real age, how do you think about your position?”. Participants were required to choose from the following three options: same as real age = 1, younger than real age = 2, and older than real age = 3.

Statistical Analysis

The data were summarized by descriptive analyses such as frequency distribution and percentage [n(%)] for categorical variables, and median and inter-quartile range [M(IQR)] for continuous variables. The chi-square test was used to evaluate the correlations between family assistance, subjective age, and categorical health indicators (loneliness and self-rated health). The Mann–Whitney U test was adopted to examine the correlation between subjective age and frailty. The correlations between APGAR, age-friendly social environment, and health indicators were examined by using the Mann–Whitney U test and Spearman correlation test.

We employed multivariable logistic regressions to investigate the associations between age-friendly environment, subjective age, and loneliness and self-rated health. Multiple linear regressions were adopted to examine the associations between age-friendly environment, subjective age, and frailty. For the moderating role of subjective age, we first centralized the continuous variables and the product term of age-friendly environment and subjective age, and then incorporated these variables into the regression models. Finally, we performed regression models with specific dimensions of age-friendly social environment. SPSS version 24 was used in descriptive, correlation, multivariable logistic regressions and multiple linear regression statistical procedures. A significant level of 5% was adopted.

Results

Among 2,788 older adults, 774 (27.8%) elders reported feeling lonely, and 776 (27.8%) rated their health as not good. The mean score of frailty was 0.61 (SD = 1.025). The distribution of demographic characteristics over these health outcomes was shown in STable1 (see in the additional file). There exists no significant difference in the distribution of ethnic groups in three health outcomes. In addition, except for gender, SES, and living arrangement, all of the rest demographic characteristics showed significant correlation with three health outcomes.

Table 1 shows the single factor correlations between age-friendly environment, subjective age, and health outcomes. APGAR, age-friendly social environment, and subjective age demonstrated significant relationships with all health outcomes (p < 0.001). When it comes to specific family assistance, older adults who received financial support from family were less likely to feel lonely, and rated their health as not good. And older adults who received emotional support from family were less likely to feel lonely.

Table 1.

Single Factor Relationship Between Age-Friendly Environment, Subjective Age, and Multiple Health Conditions

Variables	Frailty (continuous variable)		Loneliness			Self-rated health
	ρ/Z	p	Yes	No	Z/χ²	Not good	Good	Z/χ²
Age-friendly social environment (continuous variable)	−0.306	0	7(4)	9(3)	−16.725***	7(3)	9(2)	−20.809***
Accessibility guarantee environment	−0.219	0	3(2)	4(1)	−11.826***	3(2)	4(1)	−14.992***
Information dissemination environment	−0.118	0	1(1)	2(1)	−7.316***	2(1)	2(1)	−7.154***
Social participant environment	−0.262	0	0(0)	0(1)	−10.637***	0(0)	0(1)	−13.686***
Life security environment	−0.23	0	2(2)	3(1)	−15.818***	2(2)	3(1)	−21.097***
Age-friendly family environment
APGAR (continuous variable)	−0.169	0	8(5)	10(1)	−15.944***	9.0(5.0)	10(1)	−12.101***
Daily affairs assistance from family	−0.751	0.453			20.001***			2.179
No	0(1)		204(28.6)	378(20.3)		156(20.4)	394(23.1)
Yes	0(1)		510(71.4)	1,481(79.7)		607(79.6)	1,310(76.9)
Financial assistance from family	−0.487	0.626			6.889**			5.337*
No	0(1)		148(20.8)	477(25.8)		161(21.2)	432(25.5)
Yes	0(1)		562(79.2)	1,370(74.2)		599(78.8)	1,262(74.5)
Emotional assistance from family	−0.92	0.358			11.639**			1.033
No	0(1)		359(50.6)	795(43.1)		358(46.9)	757(44.7)
Yes	0(1)		351(49.4)	1,051(56.9)		405(53.1)	936(55.3)
Subjective age	171.472	0			159.453***			418.018***
Same	0(1)		407(63)	1,055(60.3)		461(31.9)	986(68.1)
Younger	0(1)		94(14.6)	574(32.8)		55(8.4)	601(91.6)
Older	1(3)		145(22.4)	121(6.9)		201(76.7)	61(23.3)

Note. *: p < 0.05; **: p < 0.01; ***: p < 0.001. ρ value was used to reflect the relationship between two continuous variables; Z value was used to reflect the relationship between one continuous variable and one categorical variable; χ² value was used to reflect the relationship between two categorical variables.

Table 2 illustrates the results of logistic regressions between age-friendly environment, subjective age, and loneliness and self-rated health. After controlling demographic characteristics (model 1 and model 4), APGAR and age-friendly social environment showed significant relationships (p < 0.001) with loneliness and self-rated health. Older adults reported higher scores in APGAR presenting less likelihood of loneliness (OR = 0.84, 95% CI: 0.80–0.87) and more likelihood of good self-rated health (OR = 1.10, 95% CI: 1.05–1.15). Higher scores in age-friendly social environment was correlated with less possibilities of loneliness (OR = 0.82, 95% CI: 0.77–0.88) and more possibilities of good self-rated health (OR = 1.43, 95% CI: 1.34–1.53). Family assistance, including daily affairs assistance and financial assistance, presented significant correlation with loneliness. Considering the subjective age (model 2 and model 5), younger subjective age could decrease the likelihood of loneliness (OR = 0.56, 95% CI: 0.41–0.75), and increase the likelihood of good self-rated health (OR = 4.15, 95% CI: 2.98–5.78); while older subjective age would lower the likelihood of good self-rated health (OR = 0.31, 95% CI: 0.21–0.45). The moderating role of subjective age did not exist in the relationship between age-friendly environment, and loneliness and self-rated health.

Table 2.

The Logistic Regression Models About the Relationships Between Age-Friendly Environment, Subjective Age, and Loneliness and Self-Rated Health

	Loneliness (0 = not, 1 = yes)			Self-rated health (0 = not good, 1 = good)
	Model 1	Model 2	Model 3	Model 4	Model 5	Model 6
	OR(95% CI)	OR(95% CI)	OR(95% CI)	OR(95% CI)	OR(95% CI)	OR(95% CI)
APGAR	0.84(0.80,0.87)^***	0.84(0.81,0.88)^***	0.85(0.81,0.90)^***	1.10(1.05,1.15)^***	1.08(1.03,1.13)^***	1.08(1.03,1.14)^**
Daily affairs assistance from family
Yes(ref: no)	0.67(0.49,0.90)^**	0.65(0.48,0.88)^**	0.80(0.55,1.15)	0.81(0.59,1.09)	0.83(0.60,1.13)	0.83(0.60,1.14)
Financial assistance from family
Yes(ref: no)	1.41(1.02,1.95)^*	1.39(1.00,1.93)^*	1.18(0.80,1.73)	1.02(0.76,1.38)	1.08(0.79,1.47)	1.08(0.79,1.47)
Emotional assistance from family
Yes(ref: no)	1.08(0.84,1.38)	1.06(0.82,1.36)	1.05(0.81,1.35)	0.94(0.74,1.19)	0.98(0.77,1.26)	0.98(0.76,1.26)
Age-friendly social environment	0.82(0.77,0.88)^***	0.85(0.79,0.90)^***	0.83(0.77,0.90)^***	1.43(1.34,1.53)^***	1.38(1.29,1.47)^***	1.37(1.27,1.47)^***
Subjective age(ref: same)
Younger		0.56(0.41,0.75)^***	0.99(0.20,4.96)		4.15(2.98,5.78)^***	5.10(1.03,25.35)^*
Older		1.41(0.99,2.00)	1.07(0.26,4.39)		0.31(0.21,0.45)^***	0.21(0.05,0.91)^*
APGAR * subjective age
APGAR * younger			0.94(0.84,1.05)			0.98(0.86,1.13)
APGAR * older			0.99(0.88,1.11)			0.99(0.87,1.13)
Daily affairs assistance from family * subjective age
Yes * younger			0.50(0.25,1.03)
Yes * older			0.57(0.22,1.46)
Financial assistance from family * subjective age
Yes * younger			1.87(0.85,4.10)
Yes * older			1.69(0.62,4.62)
Emotional assistance from family * subjective age
Yes * younger
Yes * older
Age-friendly social environment * subjective age
Age-friendly social environment * younger			1.00(0.85,1.17)			0.99(0.84,1.18)
Age-friendly social environment * older			1.07(0.94,1.22)			1.07(0.90,1.26)

Note. *: p < 0.05; **: p < 0.01; ***: p < 0.001. Model 1 and model 4 presented the relationship between age-friendly environment and health outcomes; model 2 and model 5 considered the role of subjective age; model 3 and model 6 examined the moderating role of subjective age. Only variables significant in Model 2 or 5 were tested for moderation effects.

Table 3 demonstrates the results of linear regressions between age-friendly environment, subjective age, and frailty. After controlling demographic characteristics (model 7), APGAR and age-friendly social environment showed significant relationships (p < 0.001) with frailty. Considering the subjective age (model 8), older subjective age could increase the likelihood of frailty (Beta = 0.59, p < 0.001). And older subjective age played a moderating role between age-friendly social environment and frailty. To be specific, among older adults who felt older than real age, higher scores in age-friendly social environment were correlated to fewer possibilities of frailty (Beta = −0.26, p < 0.001).

Table 3.

The Linear Regression Models About the Relationships Between Age-Friendly Environment, Subjective Age, and Frailty

	Frailty (continuous variable)
	Model 7		Model 8		Model 9
	B(SE)	p	B(SE)	p	B(SE)	p
APGAR	−0.11(0.02)	0.000	−0.08(0.02)	0.000	−0.08(0.03)	0.007
Daily affairs assistance from family(ref: no)
Yes	0.08(0.06)	0.155	0.08(0.05)	0.159	0.07(0.05)	0.172
Financial assistance from family(ref: no)
Yes	−0.07(0.05)	0.231	−0.08(0.05)	0.150	−0.08(0.05)	0.158
Emotional assistance from family(ref: no)
Yes	0.05(0.05)	0.261	0.05(0.04)	0.284	0.05(0.04)	0.244
Age-friendly social environment	−0.26(0.03)	0.000	−0.22(0.03)	0.000	−0.2(0.03)	0.000
Subjective age(ref: same)
Younger			−0.01(0.05)	0.844	−0.03(0.05)	0.593
Older			0.59(0.08)	0.000	0.49(0.08)	0.000
APGAR * subjective age
APGAR * younger					−0.02(0.06)	0.658
APGAR * older					0.05(0.07)	0.472
Daily affairs assistance from family * subjective age
Yes * younger
Yes * older
Financial assistance from family * subjective age
Yes * younger
Yes * older
Emotional assistance from family * subjective age
Yes * younger
Yes * older
Age-friendly social environment * subjective age
Age-friendly social environment * younger					0.03(0.06)	0.586
Age-friendly social environment * older					−0.26(0.07)	0.000

Note. Model 7 presented the relationship between age-friendly environment and health outcomes; model 8 considered the role of subjective age; model 9 examined the moderating role of subjective age. Only variables significant in Model 8 were tested for moderation effects.

In order to have a thorough understanding of the role of age-friendly social environment, the relationships between each facet of social environment factors and health indicators were shown in STable 2 and STable 3 (see the additional files). Higher scores in information dissemination environment (OR = 0.87, 95% CI: 0.77–0.99), social participant environment (OR = 0.79, 95% CI: 0.64–0.96), and life security environment (OR = 0.62, 95% CI: 0.54–0.73) were related to less likelihood of loneliness. Higher scores in accessibility guarantee environment (OR_S = 1.22, 95% CI: 1.09–1.37; Beta_F = −0.14, p < 0.001), social participant environment (OR_S = 1.69, 95% CI: 1.38–2.06; Beta_F = −0.06, p < 0.01), and life security environment (OR_S = 2.48, 95% CI: 2.12–2.91; Beta_F = −0.20, p < 0.001) were related to more likelihood of good self-rated health, and less likelihood of frailty. Younger subjective age played a moderating role between life security environment and loneliness. Among older adults who felt younger than real age, higher scores in life security environment were correlated to fewer possibilities of loneliness (OR = 0.64, 95% CI: 0.42–0.99). Older subjective age played a moderating role between accessibility guarantee environment and frailty. Among older adults who felt older than real age, higher scores in accessibility guarantee environment were correlated to fewer possibilities of frailty (Beta = −0.16, p < 0.01).

Discussion

This study investigated the associations between age-friendly environment and health outcomes, and examined the moderating role of subjective age in these relationships. With a full insight from distal social environment and proximal family environment, and objective and subjective health indicators, this study demonstrated that (1) older adults reporting higher level of family and social environment were more likely to experience better health conditions, both in objective and subjective aspects; (2) subjective age had positive correlations with all health indicators, and it played a moderating role in the relationship between social age-friendly environment and objective health (frailty); (3) when taking a close look at social age-friendly environment, social participant environment and life security environment contributed to both objective and subjective health indicators, while information dissemination environment and accessibility guarantee environment showed single health effect, and among social environment factors, the associations between life security environment, accessibility guarantee environment, and health were moderated by subjective age.

Consistent with existing studies, environmental factors exhibit wide health potential in the elderly group. To be excised, both the perception of family and social age-friendly environment had positive correlations with objective and subjective health indicators. This finding extended the previous knowledge that family and social support could work independently in the same aging context. It confirms the Society Ecosystems Theory, which claims that a multilevel environment should collectively affect individuals’ outcomes. Besides, this result reveals the importance of multi-resource environmental support in maintaining elder health. Previous research found that formal and informal support jointly contributed to a better quality of life for older adults (Dong et al., 2024; Shen et al., 2022), and the effect of informal support was stronger. Taking a close look into the trajectory of later life, the social patterns and social roles of older adults have undergone significant changes. On average, their social network would shrink with age and family linkage would take the predominant role. This may explain why older adults need multiple support and why they prefer informal social support (e.g., support from family members) (Brainová & Chytil, 2024). Different from the perception of family support, the tangible reception of family support is only related to loneliness. Similar to the consensus in social support, the effect of subjective support turns out to be superior to objective support. It is interesting to find that each domain in objective support played a unique role in elder health. In this study, more reception of economic support from family resulted in more likelihood of loneliness, while the reception of daily affairs support showed positive effect. It seems that the financial and instrumental functions lead to different pathways to later life. Instrumental support has been recognized as “positive support” (Chu et al., 2023). It pictures the physical or material transfer from family members to the elder, which produces emotional flow and tight connection (Wu, 2022). On the contrary, financial support sometimes represents “negative support.” It may remind older adults of a decline in their abilities. As reciprocity theory says, receiving when incapable of giving may raise doubt about an individual’s usefulness in a relationship (Gleason et al., 2008; Pillemer, 2019; Uchino, 2010), which may trigger psychological discomfort. This calls for attention to the interaction with older adults when creating age-friendly environment.

This paper confirms that older subjective age took disadvantage in elder health. However, among the elderly group who feel older than real age, age-friendly social environment could reduce the likelihood of frailty. It appears that the association between age-friendly social environment and frailty was stronger for the group with older subjective age, which is contrary to our initial expectation. Younger subjective age was assumed to present higher initiative in daily affairs and social activities (Dang & Zhang, 2022). Previous studies indicated that feeling younger reflects one’s belief in the possibilities of growing and developing (Bergman et al., 2025), while holding older subjective age would express unsure about getting further chances. Previous evidence claimed that feeling younger tends to be closely related to personality resilience, which could protect individuals from external environment, and vice versa in those feeling older. A similar result was found in the moderating role of attitudes to aging between self-sacrifice and hope (Dang & Zhang, 2022). Dang et al. indicated that the association between self-sacrifice and hope was stronger in the elder group with less positive attitudes to physical change. Socioemotional Selectivity Theory (SST) may explain these unexpected results. Feeling older is, in other words, feeling about limited time and opportunities. In this fact, older adults will adjust their priority of goals and put more focus on livelihood affairs, especially on basic health. From this, individuals holding older subjective age may put more attention on utilizing environmental factors to reduce frailty, when compared with those holding a same subjective age. This is an explanation from the perspective of self-selection, and it can also be explained from the perspective of compensation. Age-friendly environment and subjective age may compensate for each other. That is, age-friendly environment may be utilized more to promote health when subjective age is not providing an adequate positive role, and vice versa. Preliminary work has confirmed the health disadvantages of feeling older. People who see themselves as getting old and heading worse way to the future may lead to a loss of life significance. And these persons are specifically the target of age-friendly policies, so they may benefit more from age-friendly environment. Based on the results and explanations above, it is necessary to lead a correct view of aging, and ask the whole society to treat it as a normal stage of life.

Another extension this study made is a thorough view of age-friendly social environment and their associations with elder health. It is widely recognized that social participation could protect older adults from disability and mental disorders (Abe et al., 2023; Choi et al., 2021; Sommerlad et al., 2023) by maintaining their social network, and disposable income could provide older adults with material and spiritual security (Muhammad et al., 2021). That is to say, the social participant environment and life security environment guarantee the prosperity and necessity of life, respectively. This may explain why these two environmental factors exhibit comprehensive health effects in this study. Besides, it is of great significance to build an information dissemination environment and accessibility guarantee environment, so as to break down the physical and information silos of older adults. And the building of an information environment requires more effort. Digital technology has fundamentally changed the operation of society, causing a phenomenon called the “digital divide,” which typically appears among the elderly (Choi et al., 2024; Yang et al., 2024). Bridging the information gap is of great concern in healthy aging. Furthermore, this study calls for attention to the typical effect of life security environment in the feeling younger group, as well as accessibility guarantee environment in the feeling older group.

This study has several limitations. First, the cross-sectional design prevents causal inferences; longitudinal or intervention studies are needed to fully understand subjective age’s role and specific environmental effects. Second, self-reported environmental measures may be biased, suggesting future research should combine objective and subjective assessments (Che et al., 2024). Besides these limitations, this study also provides clear implications for promoting healthy aging by integrating environmental and psychological strategies. For policy, creating multi-faceted age-friendly environments is crucial. Policymakers should prioritize investments in life security and social participation environments, which showed broad health benefits. For practical interventions, the moderating role of subjective age calls for psychologically informed approaches. For older adults who feel older than their age, targeted efforts are needed to connect them with accessible community resources, which can significantly buffer against frailty. For those who feel younger, strengthening their sense of life security is key to reducing loneliness. And for future research, this study identifies a potential pathway for how age-friendly environments work in healthy aging. We propose that their effect may operate through the psychological channel of subjective age. This integrated model advances our understanding of possible routes to healthy aging.

Conclusion

This study demonstrates that healthy aging is shaped by an interplay between environmental and psychological factors. We found that supportive family and social environments are associated with better health in older adults. Crucially, the benefit of the social environment for reducing frailty is particularly strong among those who feel older than their actual age. This indicates that external environmental support can potentially offset the health risks linked to a negative self-perception of age. Therefore, effectively promoting health in later life requires a combined strategy. It is essential to both build multidimensional, age-friendly communities and cultivate positive self-perceptions of aging among the public. A concerted effort focusing on both the external environment and the internal psychological world of older adults is key to achieving the goal of healthy aging.

Supplemental Material

Supplemental Material - The Role of Age-Friendly Environment in Promoting Healthy Aging: From Multidimensional Environmental Facets and Psychological Perspective

Supplemental Material for The Role of Age-Friendly Environment in Promoting Healthy Aging: From Multidimensional Environmental Facets and Psychological Perspective by Jingjing Cai, Minmin Jiang, Qunlong Wang, Hongying Zhu, and Lu Li in Journal of Applied Gerontology.

Footnotes

Acknowledgments

The authors would like to thank all participants for their participation in this research.

ORCID iD

Jingjing Cai

Ethical Considerations

The study received ethical approval from the Medical Ethics Committee of the School of Public Health, Zhejiang University (ID: ZGL202109-3) before initiating data collection.

Consent to Participate

Participants were provided with an explanation of the study’s objectives and their right to withdraw from participation at any point. Informed consent was obtained from all participants who agreed to participate.

Author Contributions

JJC, MMJ, QLW, HYZ, and LL conceived and designed the study. JJC, MMJ, and QLW collected the data. JJC did the statistical analysis and drafted the manuscript. MMJ, HYZ, and LL revised the article and supervised the whole study. All authors have approved the final version of the manuscript for publication.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by Project of Zhejiang Provincial Key Research Base for Philosophy and Social Sciences “Zhejiang Institutes of Modern Services Research Center” (No. 2022JDKTZD44). None of the funding sources had any role in the study design, data analysis, data interpretation, writing of the manuscript, or decisions regarding the submission of this manuscript.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.*

AI Statement

During the preparation of this work, the author(s) have not used any AI tool in scientific writing.

Supplemental Material

Supplemental material for this article is available online.

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