| Summary: | Healthy aging (HA) is increasingly recognized as a critical objective in
addressing the challenges of global aging populations. This study examines the status,
determinants and perspectives of HA among older adults in mountainous regions of
Lishui China, thereby addressing an existing research gap. A mixed-methods
exploratory sequential design was employed across two phases. Phase I aimed to
determine the prevalence of HA and its associated factors. A cross-sectional survey
was conducted in Liandu District using a multicentre stratified cluster sampling
method. Data were collected from 389 participants (99.7% response rate) through
structured questionnaires incorporating the healthy aging index (HAI),
sociodemographic variables, lifestyle behaviours, self-perceived healthy aging
(SPHA), and eight validated instruments measuring health, environmental and
individual-environment (IE) interactions. Data was analyzed using SPSS version 27.0
with linear regression to identify factors associated with HA. The mean HAI score was
136.5 (SD = 18.22), with 65.5% of respondents classified as having a high level of HA.
Thirteen factors were significantly associated with HA scores (p < 0.05). Protective
factors included economic independence, medical insurance, physical activity, good
self-rated health, basic psychological need satisfaction (BPNS) competence,
community participation, social support, HSM-consciousness, HSM-behaviour, and
SPHA. Risk factors were alcohol consumption, depression, and perceived barriers to health promotion activities. Phase II involved in-depth interviews with 36 older adults
and 26 informal caregivers. Thematic analysis revealed four themes: (1) perceptions
of HA, including lived experiences, dependencies, and consequences of unmet needs;
(2) influencing factors, categorized as facilitators, barriers, and fate-related elements;
(3) changes following the common prosperity agenda, such as improved health, living
conditions, and trust in government, though some gaps persisted; and (4)
recommendations for strengthening HA through individual, environmental, and IE
interaction-based strategies. Findings highlight the multidimensional and dynamic
nature of HA, shaped by sociodemographic, individual, environmental, cultural, and
historical influences. Importantly, perspectives from both older adults and caregivers
underscore the need for culturally relevant, community-sensitive strategies. In
conclusion, this research provides an integrative perspective on HA in the mountainous
communities, highlighting the necessity for targeted, multi-level interventions that
address local challenges while supporting the physical, psychological, social, and
environmental well-being of older adults
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