<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE article PUBLIC "-//NLM//DTD Journal Publishing DTD v2.0 20040830//EN" "journalpublishing.dtd"><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" dtd-version="2.0" xml:lang="en" article-type="review-article"><front><journal-meta><journal-id journal-id-type="nlm-ta">Interact J Med Res</journal-id><journal-id journal-id-type="publisher-id">i-jmr</journal-id><journal-id journal-id-type="index">3</journal-id><journal-title>Interactive Journal of Medical Research</journal-title><abbrev-journal-title>Interact J Med Res</abbrev-journal-title><issn pub-type="epub">1929-073X</issn><publisher><publisher-name>JMIR Publications</publisher-name><publisher-loc>Toronto, Canada</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">v15i1e94085</article-id><article-id pub-id-type="doi">10.2196/94085</article-id><article-categories><subj-group subj-group-type="heading"><subject>Review</subject></subj-group></article-categories><title-group><article-title>Enhancing Healthy Longevity: Scoping Review of Practices and Interventions</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name name-style="western"><surname>Leung</surname><given-names>Angela Yee Man</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name name-style="western"><surname>Cheung</surname><given-names>Karen Siu Lan</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name name-style="western"><surname>Ou</surname><given-names>Kai-ling</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name name-style="western"><surname>Zhao</surname><given-names>Ivy Yan</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name name-style="western"><surname>Qiu</surname><given-names>Min</given-names></name><degrees>MA</degrees><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name name-style="western"><surname>Wan</surname><given-names>Ka Ming</given-names></name><degrees>MPH</degrees><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author"><name name-style="western"><surname>Montayre</surname><given-names>Jed</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="aff" rid="aff2">2</xref><xref ref-type="aff" rid="aff4">4</xref></contrib><contrib contrib-type="author"><name name-style="western"><surname>Huang</surname><given-names>Yaqi</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="aff" rid="aff2">2</xref></contrib></contrib-group><aff id="aff1"><institution>WHO Collaborating Centre for Community Health Services, School of Nursing, The Hong Kong Polytechnic University</institution><addr-line>5th Floor, Core G, Hung Hom, Kowloon</addr-line><addr-line>Hong Kong</addr-line><country>China (Hong Kong)</country></aff><aff id="aff2"><institution>School of Nursing, The Hong Kong Polytechnic University</institution><addr-line>Hong Kong</addr-line><country>China (Hong Kong)</country></aff><aff id="aff3"><institution>University of British Columbia</institution><addr-line>Vancouver</addr-line><addr-line>BC</addr-line><country>Canada</country></aff><aff id="aff4"><institution>JBI Hong Kong Centre of Evidence-based Healthcare Excellence, School of Nursing, The Hong Kong Polytechnic University</institution><addr-line>Hong Kong</addr-line><country>China (Hong Kong)</country></aff><contrib-group><contrib contrib-type="editor"><name name-style="western"><surname>Balcarras</surname><given-names>Matthew</given-names></name></contrib></contrib-group><contrib-group><contrib contrib-type="reviewer"><name name-style="western"><surname>Gueven</surname><given-names>Emine</given-names></name></contrib><contrib contrib-type="reviewer"><name name-style="western"><surname>Tambo</surname><given-names>Willians</given-names></name></contrib></contrib-group><author-notes><corresp>Correspondence to Angela Yee Man Leung, PhD, WHO Collaborating Centre for Community Health Services, School of Nursing, The Hong Kong Polytechnic University, 5th Floor, Core G, Hung Hom, Kowloon, Hong Kong, China (Hong Kong), 852 27665587; <email>angela.ym.leung@polyu.edu.hk</email></corresp></author-notes><pub-date pub-type="collection"><year>2026</year></pub-date><pub-date pub-type="epub"><day>8</day><month>9</month><year>2026</year></pub-date><volume>15</volume><elocation-id>e94085</elocation-id><history><date date-type="received"><day>24</day><month>02</month><year>2026</year></date><date date-type="rev-recd"><day>16</day><month>07</month><year>2026</year></date><date date-type="accepted"><day>16</day><month>07</month><year>2026</year></date></history><copyright-statement>&#x00A9; Angela Yee Man Leung, Karen Siu Lan Cheung, Kai-ling Ou, Ivy Yan Zhao, Min Qiu, Ka Ming Wan, Jed Montayre, Yaqi Huang. Originally published in the Interactive Journal of Medical Research (<ext-link ext-link-type="uri" xlink:href="https://www.i-jmr.org/">https://www.i-jmr.org/</ext-link>), 8.9.2026. </copyright-statement><copyright-year>2026</copyright-year><license license-type="open-access" xlink:href="https://creativecommons.org/licenses/by/4.0/"><p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by/4.0/">https://creativecommons.org/licenses/by/4.0/</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Interactive Journal of Medical Research, is properly cited. The complete bibliographic information, a link to the original publication on <ext-link ext-link-type="uri" xlink:href="https://www.i-jmr.org/">https://www.i-jmr.org/</ext-link>, as well as this copyright and license information must be included.</p></license><self-uri xlink:type="simple" xlink:href="https://www.i-jmr.org/2026/1/e94085"/><abstract><sec><title>Background</title><p>Over the past 2 decades, concerns have arisen about the distinction between health span and lifespan, highlighting that longevity does not necessarily equate to good health, a concept often referred to as &#x201C;healthy longevity.&#x201D; While various strategies have been explored to promote healthy aging and achieve healthy longevity, it remains uncertain which practices are most effective.</p></sec><sec><title>Objective</title><p>This scoping review identifies the existing and emerging practices and interventions that promote healthy longevity, identifies the key components of these practices and interventions, and considers how stakeholders contribute to these practices and interventions.</p></sec><sec sec-type="methods"><title>Methods</title><p>A scoping review of the literature was conducted using Arksey and O&#x2019;Malley&#x2019;s 6-stage framework. The Joanna Briggs Institute Population-Concept-Context framework was used to define the eligibility criteria and select studies reporting practices or interventions aimed at achieving a long health span or promoting healthy longevity carried out in the community. Data were manually extracted by 2 independent reviewers to detail the characteristics of these practices and interventions and guide the data charting process and narrative synthesis. Six databases (PubMed, Web of Science, Embase, Scopus, CINAHL, and Google Scholar) were searched for academic papers published between January 2010 and February 2025.</p></sec><sec sec-type="results"><title>Results</title><p>A total of 21 studies met the inclusion criteria. Most studies (n=15, 71%) were published after 2020 and were predominantly conducted in high-income settings (n=17, 81%) across North America, Europe, and Asia. Four study types were identified: interventional (n=7, 33%), intervention development (n=4, 19%), association (n=5, 24%), and descriptive (n=5, 24%). Interventional and intervention development studies primarily described multicomponent programs targeting individual and social determinants of health and generally reported beneficial effects on physical, cognitive, and psychosocial outcomes. Association studies linked micro-, meso-, and macro-level factors (eg, nutrition, household expenditure, housing quality, health insurance, and public financing policy) to healthy longevity indicators. Descriptive studies highlighted themes across the micro and meso levels, including finance, physical activity, mental and spiritual health, digital literacy, independent living, safety, social support, and health care support.</p></sec><sec sec-type="conclusions"><title>Conclusions</title><p>The identified community-based strategies, practices, and policies that extend health span represent the joint efforts of multiple stakeholders and disciplines. The implementation of these practices and policies is worthy of being supported. More studies in diverse socioeconomic contexts are needed.</p></sec></abstract><kwd-group><kwd>healthy longevity</kwd><kwd>strategies</kwd><kwd>practices</kwd><kwd>policies</kwd><kwd>community-based</kwd><kwd>review</kwd></kwd-group></article-meta></front><body><sec id="s1" sec-type="intro"><title>Introduction</title><sec id="s1-1"><title>Background</title><p>The concept of health span has increasingly attracted considerable attention within communities as longevity rises; however, not all individuals experience good health in their later years. Health span is defined as the duration of life spent in good health, encompassing psychological well-being, functional independence, cognitive integrity, and the absence of overt disease and disability [<xref ref-type="bibr" rid="ref1">1</xref>]. These conditions are generally perceived positively within communities, as older adults tend to use fewer resources, such as health care services, rehabilitation, and social care support. An extended health span is highly esteemed due to its association with overall well-being, enhanced quality of life, and increased levels of life satisfaction in late adulthood [<xref ref-type="bibr" rid="ref1">1</xref>,<xref ref-type="bibr" rid="ref2">2</xref>].</p><p>In the past 2 decades, concerns have emerged regarding the distinction between health span and lifespan, emphasizing that longevity does not inherently equate to health, often termed &#x201C;healthy longevity.&#x201D; Some researchers argue that the gap between lifespan and health span is widening [<xref ref-type="bibr" rid="ref3">3</xref>]. Lifespan refers to the duration of an individual&#x2019;s life from birth to death, focusing solely on the number of years lived, irrespective of health conditions. Although lifespan has increased, many individuals spend the latter decade of their lives contending with significant health challenges [<xref ref-type="bibr" rid="ref3">3</xref>]. Consequently, these individuals experience what is termed a &#x201C;long lifespan but short health span,&#x201D; suffering the consequences of prolonged ill health that necessitates intensive care or rehabilitation. This disparity between health span and lifespan is increasingly recognized as a global phenomenon. Recent data indicate that the health span-lifespan gap has expanded among 183 World Health Organization (WHO) member states, averaging 9.6 years, posing significant challenges to healthy longevity worldwide [<xref ref-type="bibr" rid="ref3">3</xref>]. Notably, women exhibit a larger health span-lifespan gap compared to men, primarily owing to a greater burden of noncommunicable diseases [<xref ref-type="bibr" rid="ref3">3</xref>].</p><p>To narrow the health span-lifespan gap, governments have sought to promote healthy aging by mobilizing community members and resources to support individuals to lead healthy and independent lives. This initiative aims to address declines in intrinsic capacity and maximize functional ability through interactions with the environment. Key strategies for promoting healthy aging include encouraging regular exercise, maintaining a healthy diet, and increasing social interaction among older adults. The United Nations Decade of Healthy Aging (2021&#x2010;2030) seeks to shift the global focus from mere longevity to healthy longevity [<xref ref-type="bibr" rid="ref4">4</xref>,<xref ref-type="bibr" rid="ref5">5</xref>]. Investments in initiatives that support healthy aging are crucial for preventing health deterioration alongside increasing longevity, which can lead to functional dependency and disability. Ultimately, such efforts benefit society by reducing overall health care costs.</p><p>Joint efforts from the community to achieve healthy longevity (or a long health span) have been consistently advocated. Some community-based practices are culturally specific and initiated by Indigenous Peoples, rooted in their beliefs and local resources. While these practices may be descriptive and lack thorough efficacy analysis, they should nonetheless be valued and respected. Additionally, initiatives from nonhealth sectors, such as housing and finance, contribute important perspectives to the concept of healthy longevity. However, the most effective practices or interventions to support healthy longevity for community-dwelling older adults&#x2014;enabling them to maintain health, safety, and independence while engaging in cherished activities&#x2014;remain unclear. To date, no scoping review has been conducted to examine existing and emerging practices and interventions that promote healthy longevity. This study addresses this critical knowledge gap by identifying useful practices and interventions, thereby providing a theoretical foundation to guide healthy longevity initiatives.</p></sec><sec id="s1-2"><title>Objective</title><p>This scoping review aims to identify existing and emerging practices and interventions that promote healthy longevity, highlight the key components of these interventions, and describe the actions stakeholders should take for the development and implementation of these practices or interventions in the community.</p></sec></sec><sec id="s2" sec-type="methods"><title>Methods</title><sec id="s2-1"><title>Design</title><p>A scoping review was chosen instead of a systematic review because it is particularly suited to exploring emerging topics, such as practices that promote healthy longevity, for which conceptual and empirical clarity is still limited [<xref ref-type="bibr" rid="ref6">6</xref>]. This approach provides a comprehensive overview of the existing literature on the subject, reviews evidence rapidly, and identifies knowledge gaps. The scoping review process followed the guidance of the 6-stage framework described by Arksey and O&#x2019;Malley [<xref ref-type="bibr" rid="ref7">7</xref>] and further refined by subsequent authors, including (1) identifying the research questions; (2) identifying relevant studies; (3) selecting studies; (4) charting the data; (5) collating, summarizing, and reporting the results; and (6) the consultation exercise. The review protocol was not preregistered. Ethical approval was not required for this review of the existing literature. The review was reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist (<xref ref-type="supplementary-material" rid="app1">Checklist 1</xref>). A retrospective protocol was registered on OSF [<xref ref-type="bibr" rid="ref8">8</xref>].</p></sec><sec id="s2-2"><title>Scoping Review Questions</title><p>The specific review questions were as follows: (1) What existing or emerging community-based practices and interventions support healthy longevity? (2) What are the key components of these practices and interventions? (3) How do different stakeholders contribute to these practices and interventions? Framework Stage 1: Identifying the Research Questions.</p></sec><sec id="s2-3"><title>Inclusion and Exclusion Criteria</title><p>Eligibility criteria were defined according to the Joanna Briggs Institute Population-Concept-Context framework [<xref ref-type="bibr" rid="ref9">9</xref>].</p><p>Population: The included studies focused on middle-aged and older populations (aged 50 years and older), irrespective of gender, socioeconomic status, or health conditions.</p><p>Concept: The scope of this review was informed by the conceptual distinction between lifespan and healthy longevity and by the WHO&#x2019;s healthy aging framework [<xref ref-type="bibr" rid="ref10">10</xref>]. Lifespan refers to the duration of an individual&#x2019;s life from birth to death [<xref ref-type="bibr" rid="ref11">11</xref>], whereas healthy longevity, health span, or healthy lifespan emphasizes the period of good health and performance [<xref ref-type="bibr" rid="ref12">12</xref>]. WHO defines healthy aging as the process of developing and maintaining the functional ability that enables well-being in older age. This framework emphasizes home, community, and broader societal environments as key contexts that support older adults&#x2019; functional ability [<xref ref-type="bibr" rid="ref10">10</xref>].</p><p>In line with these frameworks, this review focused on practices, programs, strategies, or interventions intended to enhance health span, healthy aging, healthy longevity, or healthy life expectancy in community or home settings. Studies focusing solely on biological lifespan extension, or antiaging pharmacological or medication treatments were excluded because they did not address the community-based and health span&#x2013;oriented focus of this review. Similarly, studies targeting a single clinical risk or disease outcome without reference to broader healthy aging or health span&#x2013;related aims were outside the scope of this review. Such studies were eligible only when they were explicitly framed as contributing to healthy aging, health span, healthy longevity, or healthy life expectancy or when relevant outcomes related to these concepts were reported.</p><p>In this review, practices were defined as activities adopted by older individuals or communities, including those shaped by cultural beliefs, values, or everyday routines. Interventions were defined as structured activities, programs, strategies, or initiatives developed based on empirical evidence, theories, or pilot tests in selected populations. Interventions that were under development or being evaluated in trials were also eligible.</p><p>Context: All geographic locations and countries across various income levels (low-, middle-, and high-income) were included. Consistent with the WHO healthy aging framework, this review focused solely on strategies, programs, and initiatives that took place in community or home settings. Practices in institutions, including hospitals, clinics, long-term care institutions, or residential care homes, were excluded because resources in these in settings differ from those everyday living environments.</p><p>All study designs (such as randomized controlled trials, quasi-experimental studies, cohort studies, observational studies, and qualitative research) were included to capture the breadth of the literature. Only studies published in English between January 2010 and February 2025 were considered for inclusion. These studies had to explicitly indicate that the aims or outcomes of the practices or interventions were related to improving health span, healthy lifespan, healthy longevity, or healthy aging, be published in peer-reviewed English-language journals, and be conducted in community settings. Animal studies and in vitro research were excluded. Framework Stage 2: Identifying Relevant Studies.</p></sec><sec id="s2-4"><title>Search Methods</title><p>A comprehensive search and review of the literature published between January 2010 and February 2025 were conducted using databases and platforms including PubMed, Web of Science, Embase, Scopus, CINAHL, and Google Scholar, and searched the reference lists of the included studies. Proximity operators were used in the search strategy (eg, longev* was used to search for longevity).</p><p>The search strategy was intentionally bounded by the WHO healthy aging framework and the distinction between lifespan and health span. The aim was to identify community- and home-based practices, programs, strategies, and interventions that support health span, healthy aging, or healthy longevity, rather than biological lifespan extension alone. The Boolean search combined 3 concept blocks: (1) healthy longevity&#x2013;related terms referring to the review of the health span definition [<xref ref-type="bibr" rid="ref12">12</xref>], (2) intervention or practice-related terms, and (3) settings. The core search string was: (healthspan OR healthsp* OR &#x201C;healthy aging&#x201D; OR &#x201C;healthy aging&#x201D; OR &#x201C;healthy ag*&#x201D; OR &#x201C;healthy longevity OR &#x201C;healthy longev*&#x201D; OR &#x201C;healthy life expectancy&#x201D; OR &#x201C;healthy life exp*&#x201C;) AND (intervention* OR practice* OR program* OR program*) AND (community OR home) NOT (hospital OR clinic OR &#x201C;institutional setting&#x201D; OR &#x201C;residential care homes&#x201D; OR institutions), including MeSH and keywords. The term &#x201C;longevity&#x201D; was retained as a supplementary broad aging term to capture studies in which health span&#x2013;related outcomes were described. Search strings were adapted to the syntax and field tags of each database. The search was further refined using relevant subject categories, such as Health Care Science Services, Health Policy Services, and Good Health and Wellbeing, wherever it was available in the database. Framework Stage 2: Identifying Relevant Studies.</p></sec><sec id="s2-5"><title>Search Selection and Outcome</title><p>Following the search, all identified articles were collated in EndNote [<xref ref-type="bibr" rid="ref13">13</xref>] and uploaded into the online systematic review software Covidence [<xref ref-type="bibr" rid="ref14">14</xref>]. Two authors independently screened titles and abstracts against the inclusion criteria, followed by full-text review. Any disagreements between the authors at each stage of the selection process were resolved through discussion. If consensus could not be reached, a third author reviewed the study to make a final decision. Studies that did not meet the Population-Concept-Context criteria were excluded. Framework Stage 3: Selecting Studies.</p></sec><sec id="s2-6"><title>Data Extraction and Abstraction</title><p>After selection, the included articles were extracted by 2 authors using a predesigned data extraction form in Microsoft Excel. Study characteristics included the following details: authors, year, country, income level, study design, age, other conditions, and sample size. Additional details were extracted based on the study type. For interventional studies, we extracted the following information: authors, year, study design, funding of the program, and strategies, practices, or policies related to healthy aging. For intervention development studies, we recorded authors, year, study design, framework, and strategies, practices, or policies. For association studies, we extracted authors, year, study design, outcomes, and significant or nonsignificant factors related to healthy longevity. Additionally, the key themes identified in descriptive studies were categorized into micro-, meso-, and macro-level framework. Any discrepancy between the 2 reviewers was resolved through discussion, or by an additional member of the project team. Formal quality appraisal of the included studies was not undertaken, consistent with common practice in scoping reviews. These data are presented in the <italic>Results</italic> section. Framework Stage 4: Charting the Data.</p></sec><sec id="s2-7"><title>Synthesis</title><p>The recurring themes identified in the reviewed studies focused on the key components of the practices (interventions), the individuals involved in their delivery, the strategies employed, and the outcomes observed following implementation. Next, we conducted a narrative synthesis of the charted data. Strategies, practices, policies, and associated factors identified were mapped onto micro-, meso-, and macro-level determinants of healthy longevity to summarize patterns across study types (Framework Stage 5: Collating, Summarizing, and Reporting the Results). Using the micro-, meso-, macro-level framework, we applied established definitions for each level: the micro level is about individuals and one-on-one interactions, the meso level is about the community level, and the macro level is the societal level, including policy [<xref ref-type="bibr" rid="ref15">15</xref>]. The optional Framework Stage 6 (Consultation Exercise) was not undertaken in this review.</p></sec></sec><sec id="s3" sec-type="results"><title>Results</title><sec id="s3-1"><title>Study Selection</title><p>A total of 644 titles and abstracts were identified and screened to remove duplicates. After title screening, 504 articles were excluded. Sixty-three full-text articles were retrieved, of which 42 were excluded as they did not fulfill the eligibility criteria. Finally, 21 articles were included in this scoping review. <xref ref-type="fig" rid="figure1">Figure 1</xref> details the results of the search, and the inclusion process is reported in full according to the PRISMA-ScR flow diagram [<xref ref-type="bibr" rid="ref16">16</xref>].</p><fig position="float" id="figure1"><label>Figure 1.</label><caption><p>PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) flowchart of the literature search strategy.</p></caption><graphic alt-version="no" mimetype="image" position="float" xlink:type="simple" xlink:href="i-jmr_v15i1e94085_fig01.png"/></fig></sec><sec id="s3-2"><title>Study Characteristics</title><p>The studies included in this review were published between January 2010 and February 2025, with most published after 2020 (15/21, 71.4%). Most of the studies were conducted in high-income countries or economies (17/21, 81.0%), and the rest were in middle-income countries (4/21, 19.0%), with about one-third in North America (8/21, 38.1%), one-third in Europe (7/21, 33.3%), and Asia (6/21, 28.6%). Four of 21 (19.0%) studies were conducted in rural or low-income communities. Studies&#x202F;conducted in low-income communities mainly focused on basic preventive health risk practices using existing resources, while programs in other affluent settings implemented multidomain approaches. Among the 20 studies recruiting participants, 15 (75%) recruited participants or informants aged 60 years or older, and 10 (50%) studies had additional criteria for target participants: had chronic diseases, lived independently at their own home or lived alone, or lived in low-income areas.</p><p>In the review, we identified 4 approaches to the study of interventions for healthy aging: interventional studies (n=7), intervention development studies (n=4), association studies (n=5), and descriptive studies (n=5). First, interventional studies are those that used experimental designs to assess the impact of a specific intervention to improve healthy aging outcomes, including active aging, physical performance, cognitive performance, preventive health behaviors, survival rate, and health service utilization. Second, intervention development studies include those that reported the development of a specific intervention for healthy aging without empirical examination of its impact. Third, association studies used longitudinal studies examining factors associated with measures of healthy aging, such as mortality, disability-adjusted life years (DALYs), Activities of Daily Living/Instrumental Activities of Daily Living, and depression. Fourth, descriptive studies using qualitative methods illuminated participant perspectives and identified themes associated with interventions of healthy aging, such as safety environment, finances, and support systems. Each of these four approaches offers important insights into interventions affecting healthy aging. The sample sizes ranged from 30 to 462 for the 7 interventional studies, 18 to 112 for 4 intervention development studies, and were at least 3000 in 4 of the 5 association studies which had provided the information. For the descriptive studies, the sample sizes ranged from 19 to 47. Details of study characteristics are provided in <xref ref-type="table" rid="table1">Table 1</xref>.</p><table-wrap id="t1" position="float"><label>Table 1.</label><caption><p>Study characteristics (n=21).</p></caption><table id="table1" frame="hsides" rules="groups"><thead><tr><td align="left" valign="bottom">Authors, year</td><td align="left" valign="bottom">Country</td><td align="left" valign="bottom">Income</td><td align="left" valign="bottom">Study design</td><td align="left" valign="bottom">Age (y)</td><td align="left" valign="bottom">Other conditions</td><td align="left" valign="bottom">Sample size</td></tr></thead><tbody><tr><td align="left" valign="top" colspan="7">Interventional studies</td></tr><tr><td align="char" char="." valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Davodi et al [<xref ref-type="bibr" rid="ref17">17</xref>], 2023</td><td align="left" valign="top">Iran</td><td align="left" valign="top">Middle</td><td align="left" valign="top">RCT<sup><xref ref-type="table-fn" rid="table1fn1">a</xref></sup></td><td align="left" valign="top">&#x2265;60</td><td align="char" char="." valign="top">&#x2014;<sup><xref ref-type="table-fn" rid="table1fn2">b</xref></sup></td><td align="left" valign="top">60</td></tr><tr><td align="char" char="." valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Newman et al [<xref ref-type="bibr" rid="ref18">18</xref>], 2010</td><td align="left" valign="top">United States</td><td align="left" valign="top">High</td><td align="left" valign="top">Pre-and-post</td><td align="left" valign="top">&#x2265;65</td><td align="left" valign="top">Low-income high-risk community</td><td align="left" valign="top">389</td></tr><tr><td align="char" char="." valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Zgibor et al [<xref ref-type="bibr" rid="ref19">19</xref>], 2017</td><td align="left" valign="top">United States</td><td align="left" valign="top">High</td><td align="left" valign="top">Cluster RCT</td><td align="left" valign="top">&#x2265;50</td><td align="left" valign="top">Arthritis and multimorbidity</td><td align="left" valign="top">462</td></tr><tr><td align="char" char="." valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Lee et al [<xref ref-type="bibr" rid="ref20">20</xref>], 2022</td><td align="left" valign="top">Taiwan</td><td align="left" valign="top">High</td><td align="left" valign="top">Secondary data analysis of RCT</td><td align="left" valign="top">&#x2265;65</td><td align="left" valign="top">At least 3 chronic diseases</td><td align="left" valign="top">297</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Moriyama et al [<xref ref-type="bibr" rid="ref21">21</xref>], 2023</td><td align="left" valign="top">Japan</td><td align="left" valign="top">High</td><td align="left" valign="top">Quasi-experimental</td><td align="left" valign="top">&#x2265;65</td><td align="left" valign="top">Not receiving support/certification for long-term care</td><td align="left" valign="top">307</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Carter et al [<xref ref-type="bibr" rid="ref22">22</xref>], 2021</td><td align="left" valign="top">United States</td><td align="left" valign="top">High</td><td align="left" valign="top">Pre-and-post</td><td align="left" valign="top">&#x2265;55</td><td align="left" valign="top">Live in low-income housing</td><td align="left" valign="top">30</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Lucifora and Villar [<xref ref-type="bibr" rid="ref23">23</xref>], 2024</td><td align="left" valign="top">Italy</td><td align="left" valign="top">High</td><td align="left" valign="top">Quasi-experimental</td><td align="left" valign="top">&#x2265;65</td><td align="left" valign="top">Retirees of a private company</td><td align="left" valign="top">356</td></tr><tr><td align="left" valign="top" colspan="7">Intervention development studies</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Joymangul et al [<xref ref-type="bibr" rid="ref24">24</xref>], 2024</td><td align="left" valign="top">Italy,&#x202F;Romania,&#x202F;and&#x202F;Portugal</td><td align="left" valign="top">High</td><td align="left" valign="top">Mixed methods observational</td><td align="left" valign="top">No info</td><td align="left" valign="top">&#x2014;</td><td align="left" valign="top">112</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Orellano-Col&#x00F3;n et al [<xref ref-type="bibr" rid="ref25">25</xref>], 2014</td><td align="left" valign="top">Puerto Rico</td><td align="left" valign="top">High</td><td align="left" valign="top">Mixed methods</td><td align="left" valign="top">&#x003E;70</td><td align="left" valign="top">Older adults who lived alone</td><td align="left" valign="top">Older adults: 8, community key members: 4; researchers: 6</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Gwyther et al [<xref ref-type="bibr" rid="ref26">26</xref>], 2018</td><td align="left" valign="top">Greece, Italy, the Netherlands, Poland, Portugal, Spain, the United Kingdom</td><td align="left" valign="top">High</td><td align="left" valign="top">Mixed methods</td><td align="left" valign="top">N/A<sup><xref ref-type="table-fn" rid="table1fn3">c</xref></sup></td><td align="left" valign="top">N/A</td><td align="left" valign="top">21 project partners</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Ashikali et al [<xref ref-type="bibr" rid="ref27">27</xref>], 2024</td><td align="left" valign="top">Switzerland</td><td align="left" valign="top">High</td><td align="left" valign="top">A participatory approach</td><td align="left" valign="top">&#x2265;65</td><td align="left" valign="top">&#x2014;</td><td align="left" valign="top">36 (older adults: 4; HCPs<sup><xref ref-type="table-fn" rid="table1fn4">d</xref></sup>: 13; SCPs<sup><xref ref-type="table-fn" rid="table1fn5">e</xref></sup>: 9; community representatives: 10)</td></tr><tr><td align="left" valign="top" colspan="7">Association studies</td></tr><tr><td align="char" char="." valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Nie et al [<xref ref-type="bibr" rid="ref28">28</xref>], 2021</td><td align="left" valign="top">China</td><td align="left" valign="top">Middle</td><td align="left" valign="top">Longitudinal</td><td align="left" valign="top">&#x2265;60</td><td align="left" valign="top">&#x2014;</td><td align="left" valign="top">8839</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Wu and Grundy [<xref ref-type="bibr" rid="ref29">29</xref>], 2025</td><td align="left" valign="top">United Kingdom</td><td align="left" valign="top">High</td><td align="left" valign="top">Longitudinal</td><td align="left" valign="top">&#x2265;65</td><td align="left" valign="top">&#x2014;</td><td align="left" valign="top">4710</td></tr><tr><td align="char" char="." valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Zai [<xref ref-type="bibr" rid="ref30">30</xref>], 2024</td><td align="left" valign="top">United States</td><td align="left" valign="top">High</td><td align="left" valign="top">Longitudinal</td><td align="left" valign="top">&#x2265;65</td><td align="left" valign="top">At risk of requiring long-term care</td><td align="left" valign="top">3000</td></tr><tr><td align="char" char="." valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Dragos et al [<xref ref-type="bibr" rid="ref31">31</xref>], 2022</td><td align="left" valign="top">26 European countries</td><td align="left" valign="top">High</td><td align="left" valign="top">Longitudinal panel</td><td align="left" valign="top">No info</td><td align="left" valign="top">&#x2014;</td><td align="left" valign="top">No information</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>McIntyre et al [<xref ref-type="bibr" rid="ref32">32</xref>], 2021</td><td align="left" valign="top">United States</td><td align="left" valign="top">High</td><td align="left" valign="top">Longitudinal</td><td align="left" valign="top">&#x2265;18</td><td align="left" valign="top">&#x2014;</td><td align="left" valign="top">Training: 2634; validation: 2505</td></tr><tr><td align="left" valign="top" colspan="7">Descriptive studies</td></tr><tr><td align="char" char="." valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Ienca et al [<xref ref-type="bibr" rid="ref33">33</xref>], 2021</td><td align="left" valign="top">Switzerland</td><td align="left" valign="top">High</td><td align="left" valign="top">Semistructured interviews</td><td align="left" valign="top">&#x2265;65</td><td align="left" valign="top">Lived independently in their own home</td><td align="left" valign="top">19</td></tr><tr><td align="char" char="." valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Solhi et al [<xref ref-type="bibr" rid="ref34">34</xref>], 2022</td><td align="left" valign="top">Iran</td><td align="left" valign="top">Middle</td><td align="left" valign="top">Semistructured interview</td><td align="left" valign="top">45&#x2010;59</td><td align="left" valign="top">&#x2014;</td><td align="left" valign="top">21</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Puplampu et al [<xref ref-type="bibr" rid="ref35">35</xref>], 2022</td><td align="left" valign="top">Canada</td><td align="left" valign="top">High</td><td align="left" valign="top">Semistructured interviews</td><td align="left" valign="top">&#x2265;65</td><td align="left" valign="top">&#x2014;</td><td align="left" valign="top">19</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Somrongthong et al [<xref ref-type="bibr" rid="ref36">36</xref>], 2014</td><td align="left" valign="top">Thailand</td><td align="left" valign="top">Middle</td><td align="left" valign="top">Semistructured interviews with site observation</td><td align="left" valign="top">&#x2265;65</td><td align="left" valign="top">Rural community</td><td align="left" valign="top">47 (older adults: 16; family: 17; volunteers: 11; staff: 3</td></tr><tr><td align="char" char="." valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Bacsu et al [<xref ref-type="bibr" rid="ref37">37</xref>], 2012</td><td align="left" valign="top">Canada</td><td align="left" valign="top">High</td><td align="left" valign="top">Ethnographic approach with interviews</td><td align="left" valign="top">&#x2265;65</td><td align="left" valign="top">Rural community</td><td align="left" valign="top">42</td></tr></tbody></table><table-wrap-foot><fn id="table1fn1"><p><sup>a</sup>RCT: randomized controlled trial.</p></fn><fn id="table1fn2"><p><sup>b</sup>Not available.</p></fn><fn id="table1fn3"><p><sup>c</sup>N/A: not applicable.</p></fn><fn id="table1fn4"><p><sup>d</sup>HCP: health care professional.</p></fn><fn id="table1fn5"><p><sup>e</sup>SCP: social care professional.</p></fn></table-wrap-foot></table-wrap></sec><sec id="s3-3"><title>Interventional and Intervention Development Studies</title><p>Seven studies described specific interventions to improve healthy aging, with various study designs, including RCTs or cluster RCTs (n=3), quasi-experiment with control group (n=2), and a predesign and postdesign (n=2) (<xref ref-type="table" rid="table2">Table 2</xref>). No study aimed at the macro level, 1 study targeted integration of care at meso level [<xref ref-type="bibr" rid="ref22">22</xref>], 2 studies targeted lifestyle modifications at the micro level [<xref ref-type="bibr" rid="ref20">20</xref>,<xref ref-type="bibr" rid="ref21">21</xref>], and the remaining 4 studies examined multidomain interventions, with most components at the micro level, including physical exercise, nutrition, stress/depression management, and preventive health behaviors, and also one component (social contact/engagement) at the meso level [<xref ref-type="bibr" rid="ref17">17</xref>-<xref ref-type="bibr" rid="ref19">19</xref>,<xref ref-type="bibr" rid="ref23">23</xref>]. Outcome measures were divided into two categories: (1) epidemiological outcomes such as active aging scores [<xref ref-type="bibr" rid="ref17">17</xref>], survival rate [<xref ref-type="bibr" rid="ref21">21</xref>], and disability-free life expectancy [<xref ref-type="bibr" rid="ref23">23</xref>], and (2) physio-psychosocial outcomes: physiological measures [<xref ref-type="bibr" rid="ref18">18</xref>], cognitive performance [<xref ref-type="bibr" rid="ref20">20</xref>], social engagement [<xref ref-type="bibr" rid="ref17">17</xref>,<xref ref-type="bibr" rid="ref19">19</xref>,<xref ref-type="bibr" rid="ref23">23</xref>], and mental health [<xref ref-type="bibr" rid="ref23">23</xref>].</p><table-wrap id="t2" position="float"><label>Table 2.</label><caption><p>Details and outcomes of the interventional studies (n=7)<sup><xref ref-type="table-fn" rid="table2fn1">a</xref></sup>.</p></caption><table id="table2" frame="hsides" rules="groups"><thead><tr><td align="left" valign="bottom">Authors, year</td><td align="left" valign="bottom">Funding of the program</td><td align="left" valign="bottom">Strategies/practices/policies of healthy aging</td><td align="left" valign="bottom">Outcomes</td></tr></thead><tbody><tr><td align="left" valign="top">Davodi et al [<xref ref-type="bibr" rid="ref17">17</xref>], 2023</td><td align="left" valign="top">Research study</td><td align="left" valign="top">Micro<list list-type="bullet"><list-item><p>Intervention:</p><list list-type="bullet"><list-item><p>Nutrition</p></list-item><list-item><p>Physical activity</p></list-item><list-item><p>Responsibility for preventive behaviors</p></list-item><list-item><p>Stress management</p></list-item><list-item><p>Spiritual aspects</p></list-item></list></list-item><list-item><p>Control:</p><list list-type="bullet"><list-item><p>Routine care</p></list-item></list></list-item></list><break/>Meso<list list-type="bullet"><list-item><p>Communications</p></list-item></list></td><td align="left" valign="top"><list list-type="bullet"><list-item><p>(+)&#x202F;Total active-aging score increased (68.5&#x00B1;3.0 &#x2192; 85.0&#x00B1;8.3, <italic>P</italic>&#x003C;.001)</p></list-item><list-item><p>(+)&#x202F;Significant improvements were observed in active-mind maintenance&#x202F;(9.0&#x00B1;2.0&#x202F;&#x2192; 13.0&#x00B1;4.0,&#x202F;<italic>P</italic>&#x003C;.001), physical-functional activity&#x202F;(15.0&#x00B1;4.0&#x202F;&#x2192;&#x202F;16.0&#x00B1;4.0,&#x202F;<italic>P</italic>=.03), social contact&#x202F;(11.5&#x00B1;&#x202F;4.0&#x202F;&#x2192;&#x202F;16.0&#x00B1;3.3,&#x202F;<italic>P</italic>&#x003C;.001), productive engagement&#x202F;(13.5&#x00B1;6.0&#x202F;&#x2192;&#x202F;19.0&#x00B1;6.0,&#x202F;<italic>P</italic>&#x003C;.001), and social-institutional participation&#x202F;(6.0&#x00B1;1.0&#x202F;&#x2192;&#x202F;9.0&#x00B1;4.0,&#x202F;<italic>P</italic>&#x003C;.001).</p></list-item><list-item><p>(=)&#x202F;No significant difference in agent attitude&#x202F;(13.7&#x00B1;1.60 &#x2192;13.6&#x00B1;1.60, <italic>P</italic>=.96)</p></list-item></list></td></tr><tr><td align="left" valign="top">Newman et al [<xref ref-type="bibr" rid="ref18">18</xref>], 2010</td><td align="left" valign="top">No funding</td><td align="left" valign="top">Micro<break/>The 10 keys:<list list-type="bullet"><list-item><p>Blood pressure control</p></list-item><list-item><p>Smoking cessation</p></list-item><list-item><p>Immunization</p></list-item><list-item><p>Cancer screening</p></list-item><list-item><p>Regulating blood glucose</p></list-item><list-item><p>Regulating cholesterol</p></list-item><list-item><p>Physical activity</p></list-item><list-item><p>Maintaining healthy bones, joints, and muscles</p></list-item><list-item><p>Combating depression</p></list-item></list><break/>Meso<list list-type="bullet"><list-item><p>Promoting social contact</p></list-item></list></td><td align="left" valign="top"><list list-type="bullet"><list-item><p>(&#x2191;) Improvements were seen for the proportion of participants meeting goals for low-density lipoprotein cholesterol (+43%), blood pressure control in hypertensives (+17%), blood glucose control in diabetics (+50%), and colon cancer screening (+13%). Among those without prior vaccination, influenza vaccine increased by 25% and pneumonia vaccine by 20%</p></list-item></list></td></tr><tr><td align="left" valign="top">Zgibor et al [<xref ref-type="bibr" rid="ref19">19</xref>], 2017</td><td align="left" valign="top">Research grant</td><td align="left" valign="top">Micro<list list-type="bullet"><list-item><p>AEEP<sup><xref ref-type="table-fn" rid="table2fn2">b</xref></sup> sessions</p><list list-type="bullet"><list-item><p>Combining exercise</p></list-item><list-item><p>Health education on chronic disease prevention and healthy aging</p></list-item></list></list-item><list-item><p>The 10 keys</p><list list-type="bullet"><list-item><p>Blood pressure control</p></list-item><list-item><p>Smoking cessation</p></list-item><list-item><p>Immunization</p></list-item><list-item><p>Cancer screening</p></list-item><list-item><p>Regulating blood glucose</p></list-item><list-item><p>Regulating cholesterol</p></list-item><list-item><p>Physical activity</p></list-item><list-item><p>Maintaining healthy bones, joints, and muscles</p></list-item><list-item><p>Combating depression</p></list-item></list></list-item></list><break/>Meso<list list-type="bullet"><list-item><p>Promoting social contact</p></list-item></list></td><td align="left" valign="top"><list list-type="bullet"><list-item><p>(=) Both groups improved, with no significant between-group differences in Short Physical Performance Battery (9.7&#x00B1;2.4&#x202F;&#x2192;&#x202F;9.9&#x202F;&#x00B1;&#x202F;2.3;&#x202F;<italic>P</italic>=.07) or Western Ontario and McMaster Universities Osteoarthritis Index (23.8&#x00B1;17.9&#x202F;&#x2192;&#x202F;21.2&#x00B1;17.4;&#x202F;<italic>P</italic>=.92) at&#x202F;6&#x202F;months;</p></list-item><list-item><p>&#x202F;(&#x2191;) Hypertension control increased from 60.1&#x202F;&#x2192;&#x202F;76.7% (AEEP/10&#x202F;keys) and 76.5&#x202F;&#x2192;&#x202F;84.9% (AEEP&#x202F;alone), and diabetes control from 15.0&#x202F;&#x2192;&#x202F;34.9% and 15.5&#x202F;&#x2192;&#x202F;34.1%, respectively.</p></list-item><list-item><p>These community-based programs showed similar improvements in preventive health, mobility, and arthritis outcomes</p></list-item></list></td></tr><tr><td align="left" valign="top">Lee et al [<xref ref-type="bibr" rid="ref20">20</xref>], 2022</td><td align="left" valign="top">Research grant to the original RCT<sup><xref ref-type="table-fn" rid="table2fn3">c</xref></sup></td><td align="left" valign="top">Micro<list list-type="bullet"><list-item><p>Integrated geriatric care plus multidomain intervention</p><list list-type="bullet"><list-item><p>Physical exercise</p></list-item><list-item><p>Cognitive training</p></list-item><list-item><p>Diet education</p></list-item><list-item><p>Chronic condition management</p></list-item></list></list-item></list></td><td align="left" valign="top">Physio-Cognitive Decline Syndrome<list list-type="bullet"><list-item><p>(+)&#x202F;Significant improvement in global cognition&#x202F;(&#x0394;=1.1,&#x202F;95%&#x202F;CI&#x202F;0.4&#x2010;1.8;&#x202F;<italic>P</italic>=.003); domain-specific gains in concentration&#x202F;(0.3,&#x202F; 95% CI 0.1&#x2010;0.5;&#x202F;<italic>P</italic>=.01), language&#x202F;(0.2, 95% CI 0.1&#x2010;0.3;&#x202F;<italic>P</italic>=.006), abstraction&#x202F;(0.1,&#x202F; 95% CI 0.0&#x2010;0.3;&#x202F;<italic>P</italic>=.03), and orientation&#x202F;(0.2,&#x202F;95% CI 0.0&#x2010;0.4;&#x202F;<italic>P</italic>=.01).</p></list-item><list-item><p>(=)&#x202F;No significant change in visuospatial, naming, or delayed memory domains.</p></list-item><list-item><p>(&#x202F;+&#x202F;)&#x202F;Improved physical-role-limitation domain of QoL<sup><xref ref-type="table-fn" rid="table2fn4">d</xref></sup> (&#x0394;=5.3,&#x202F;95% CI 0.3&#x2010;10.4;&#x202F;<italic>P</italic>=.04).</p></list-item><list-item><p>Cognitive impairment, no dementia (CIND)</p></list-item><list-item><p>(&#x2013;)&#x202F;Significant reduction in frailty&#x202F;(&#x0394;=&#x2013;0.3,&#x202F;95%&#x202F;CI&#x202F;&#x2013;0.5&#x202F;to&#x202F;&#x2013;0.1;&#x202F;<italic>P</italic>=.01).</p></list-item><list-item><p>Mobility impairment, no disability (MIND)</p></list-item><list-item><p>(&#x2013;)&#x202F;Significant reduction in frailty&#x202F;(&#x0394;=&#x2013;0.3,&#x202F;95%&#x202F;CI&#x202F;&#x2013;0.4&#x202F;to&#x202F;&#x2013;0.1;&#x202F;<italic>P</italic>=.004)</p></list-item></list></td></tr><tr><td align="left" valign="top">Moriyama et al [<xref ref-type="bibr" rid="ref21">21</xref>], 2023</td><td align="left" valign="top">Local Government</td><td align="left" valign="top">Micro<list list-type="bullet"><list-item><p>Tai Chi Yuttari exercise performs in sitting or standing position</p></list-item></list></td><td align="left" valign="top"><list list-type="bullet"><list-item><p>(+) Participation in Tai&#x202F;Chi&#x202F;Yuttari classes was associated with significantly longer survival&#x202F;(<italic>&#x03C7;</italic>&#x00B2;=8.782,&#x202F;<italic>P</italic>=.003)&#x202F;and longer long-term care duration&#x202F;(<italic>&#x03C7;</italic>&#x00B2;=5.354,&#x202F;<italic>P</italic>=.02)&#x202F;compared&#x202F;to&#x202F;nonparticipants;&#x202F;effect&#x202F;of survival duration is significant&#x202F;in&#x202F;men&#x202F;only&#x202F;(<italic>&#x03C7;</italic>&#x00B2;=7.875, <italic>P</italic>=.005).</p></list-item><list-item><p>Participation in Tai Chi Yuttari exercise might be effective in delaying death, especially in men, and new certification for long-term care</p></list-item></list></td></tr><tr><td align="left" valign="top">Carter et al [<xref ref-type="bibr" rid="ref22">22</xref>], 2021</td><td align="left" valign="top">Research grant</td><td align="left" valign="top">Meso<list list-type="bullet"><list-item><p>University unit partners with low-income housing to establish a clinic in the housing estate so that older people can easily access health services, forming an integrated network of care and promoting aging-in-place</p></list-item></list></td><td align="left" valign="top">After 1 year<list list-type="bullet"><list-item><p>&#x202F;(=) Emergency visits and hospitalizations remained stable, but the reasons for emergency visits shifted toward acute issues.</p></list-item><list-item><p>(&#x2191;)&#x202F;Follow-up adherence improved slightly, while missed appointments increased a bit.</p></list-item><list-item><p>(+) Use of ancillary services (physiotherapy, occupational therapy, home care, nutritional counseling, behavioral health, etc) expanded significantly.</p></list-item><list-item><p>(&#x2191;) Vaccination rates showed a modest improvement overall</p></list-item></list></td></tr><tr><td align="left" valign="top">Lucifora and Villar [<xref ref-type="bibr" rid="ref23">23</xref>], 2024</td><td align="left" valign="top">Private company</td><td align="left" valign="top">Micro<list list-type="bullet"><list-item><p>Personalized medical health plans</p><list list-type="bullet"><list-item><p>Physical domain (physical activity courses and Tai Chi classes)</p></list-item><list-item><p>Mental well-being domain (activity for boosting creativity and memory)</p></list-item><list-item><p>A multidimensionality of the healthy aging intervention</p></list-item></list></list-item></list><break/>Meso<list list-type="bullet"><list-item><p>Social domain (activities for improving social engagement)</p></list-item></list></td><td align="left" valign="top"><list list-type="bullet"><list-item><p>(&#x2191;) Increased healthy lifestyle adoption by&#x202F;23%&#x2010;25% and social engagement by&#x202F;18%&#x2010;19%</p></list-item><list-item><p>(&#x2193;)&#x202F;Reduced poor physical health by&#x202F;3%&#x2010;4% and poor mental well-being by&#x202F;16%&#x2010;17% &#x202F;(in&#x202F;&#x2265;75&#x202F;years)</p></list-item><list-item><p>(&#x2191;) Extended disability-free life expectancy by&#x202F;&#x2248;5&#x202F;years (14&#x202F;vs&#x202F;9 years)</p></list-item></list></td></tr></tbody></table><table-wrap-foot><fn id="table2fn1"><p><sup>a</sup>(+)=significant increase/improvement (<italic>P</italic>&#x003C;.05);&#x202F;(&#x2013;)=significant reduction&#x202F;(<italic>P</italic>&#x003C;.05);&#x202F;(&#x2191;)/(&#x2193;)=nonsignificant trend toward increase/reduction&#x202F;(<italic>P</italic>&#x2265;.05);&#x202F;(=)=no significant change/difference.</p></fn><fn id="table2fn2"><p><sup>b</sup>AEEP: Arthritis Foundation Exercise Program.</p></fn><fn id="table2fn3"><p><sup>c</sup>RCT: randomized controlled trial.</p></fn><fn id="table2fn4"><p><sup>d</sup>QoL: quality of life.</p></fn></table-wrap-foot></table-wrap><p>Six out of 7 studies involved physical activity in interventions [<xref ref-type="bibr" rid="ref17">17</xref>-<xref ref-type="bibr" rid="ref21">21</xref>,<xref ref-type="bibr" rid="ref23">23</xref>] for healthy aging program. One quasi-experimental study found that Tai Chi participation could significantly increase survival duration especially in male participants [<xref ref-type="bibr" rid="ref21">21</xref>]. This suggests that demographic characteristics, such as sex, should be explicitly considered when designing and targeting healthy aging interventions. The only cluster RCT in this review showed that preventive interventions addressing hypertension and diabetes control, lifestyle modification, and social contacts could be executed by community health workers, resulting in improvement in mobility, arthritis outcomes, blood pressure, and blood glucose [<xref ref-type="bibr" rid="ref19">19</xref>]. Another pre-post intervention study using similar preventive strategies for chronic condition management, delivered by local medical staff and community health counselors, also demonstrated improvements in goal attainment for low-density lipoprotein cholesterol, blood pressure control, blood glucose control, and colon cancer screening [<xref ref-type="bibr" rid="ref18">18</xref>]. These 2 studies illustrate the manpower needed to support health span or healthy aging in communities.</p><p>Another illustrative intervention for promoting aging-in-place and minimizing health disparity is the pilot cohort study in America, in which a university unit partnered with a housing operator to set up a primary care clinic in a low-income housing development. One-year follow-up showed that the use of ancillary services (such as physiotherapy, nutritional counseling, etc) increased significantly [<xref ref-type="bibr" rid="ref22">22</xref>]. This indicates the importance of the removal of transportation barriers to accessing health services in the community.</p><p>Three RCT studies designed and implemented a multidomain health promotion education program incorporating components on nutrition [<xref ref-type="bibr" rid="ref17">17</xref>,<xref ref-type="bibr" rid="ref20">20</xref>], physical activity [<xref ref-type="bibr" rid="ref17">17</xref>,<xref ref-type="bibr" rid="ref20">20</xref>,<xref ref-type="bibr" rid="ref23">23</xref>], smoking and tobacco control [<xref ref-type="bibr" rid="ref17">17</xref>], mental well-being [<xref ref-type="bibr" rid="ref17">17</xref>,<xref ref-type="bibr" rid="ref23">23</xref>], social communication [<xref ref-type="bibr" rid="ref17">17</xref>,<xref ref-type="bibr" rid="ref23">23</xref>], spiritual activities [<xref ref-type="bibr" rid="ref17">17</xref>], and chronic condition management [<xref ref-type="bibr" rid="ref20">20</xref>]. These interventions significantly improved active and healthy lifestyles, physical health, and social participation [<xref ref-type="bibr" rid="ref17">17</xref>,<xref ref-type="bibr" rid="ref23">23</xref>], reduced physio-cognitive syndrome as well as cognitive and mobility impairment [<xref ref-type="bibr" rid="ref20">20</xref>], and extended disability-free life expectancy [<xref ref-type="bibr" rid="ref23">23</xref>]. These findings indicate that, beyond the macro-level strategies, active and healthy aging can be effectively promoted through multidimensional interventions at the micro- and meso-levels, underscoring the need for person- and community-level programs in routine practice. Among these interventions, 57% (4/7) of interventions demonstrated significant improvements in health outcomes. Improvements were effective when they incorporated multidimensional supports, involved participants with preserved functional capacity, and were delivered in settings backed by local community infrastructure.</p><p>Four studies reported the development of interventions designed to promote healthy aging (<xref ref-type="table" rid="table3">Table 3</xref>). All of them were multicomponent, with 1 study covering only components at the micro level (cognition, nutrition, depression, and physical performance) [<xref ref-type="bibr" rid="ref27">27</xref>], and the other 3 studies intending to address components at the micro- and meso-levels [<xref ref-type="bibr" rid="ref24">24</xref>-<xref ref-type="bibr" rid="ref26">26</xref>]. One study emphasized the combination of in-person visits with technology in preparing personalized intervention for physical activity, self-management, social engagement, and digital literacy [<xref ref-type="bibr" rid="ref24">24</xref>]. Another study focused on a culturally appropriate intervention to promote physical and mental health and spiritual issues at the micro level and social engagement and safety at the meso level [<xref ref-type="bibr" rid="ref25">25</xref>]. Three studies developed their interventions based on a conceptual framework [<xref ref-type="bibr" rid="ref24">24</xref>,<xref ref-type="bibr" rid="ref25">25</xref>,<xref ref-type="bibr" rid="ref27">27</xref>].</p><table-wrap id="t3" position="float"><label>Table 3.</label><caption><p>Intervention development studies (n=4).</p></caption><table id="table3" frame="hsides" rules="groups"><thead><tr><td align="left" valign="bottom">Authors, year</td><td align="left" valign="bottom">Framework</td><td align="left" valign="bottom">Strategies/practices/policies</td></tr></thead><tbody><tr><td align="left" valign="top">Joymangul et al [<xref ref-type="bibr" rid="ref24">24</xref>], 2024</td><td align="left" valign="top">Active Ageing and Personalised (AGAPE)</td><td align="left" valign="top">Micro<list list-type="bullet"><list-item><p>A supervised learning algorithm combines in-person and technologically personalized intervention on 4 aspects:</p><list list-type="bullet"><list-item><p>Physical activity</p></list-item><list-item><p>Digital literacy</p></list-item><list-item><p>Self-management</p></list-item></list></list-item></list><break/>Meso<list list-type="bullet"><list-item><p>Social engagement</p></list-item></list></td></tr><tr><td align="left" valign="top">Orellano-Col&#x00F3;n et al [<xref ref-type="bibr" rid="ref25">25</xref>], 2014</td><td align="left" valign="top">Person Environment Occupational Performance Model</td><td align="left" valign="top">Meso<list list-type="bullet"><list-item><p>A culturally appropriate intervention in language, facilitator, metaphors, and content on 6 aspects:</p><list list-type="bullet"><list-item><p>Activity, Health, and Active Aging (Impact of activity on health, Impact of aging on activities routines)</p></list-item><list-item><p>Maintaining Physical and Mental Wellbeing through Occupations (Keeping mentally active, Keeping physically active, Nutrition)</p></list-item><list-item><p>Social Relationships (Building social support through activity participation, Effective communication and social interactions, Coping with loneliness)</p></list-item><list-item><p>Home and Community Safety (Protection against crimes at home and the community, Fall hazards and home safety, Activity adaptative, assistive devices and home modifications for safety)</p></list-item><list-item><p>Participation in the Home and Community (Leisure and voluntary activities and health, Transportation use, Finance management, Resources in the community for participation in activities)</p></list-item><list-item><p>Personal enablers of occupational participants (Role of personal attributes in daily participants, Spirituality as an enabler for occupational participants)</p></list-item></list></list-item></list></td></tr><tr><td align="left" valign="top">Gwyther et al [<xref ref-type="bibr" rid="ref26">26</xref>], 2018</td><td align="left" valign="top">&#x2014;<sup><xref ref-type="table-fn" rid="table3fn1">a</xref></sup></td><td align="left" valign="top">Micro<list list-type="bullet"><list-item><p>Physical activity</p></list-item><list-item><p>Cognitive function</p></list-item><list-item><p>Nutrition</p></list-item><list-item><p>Psychology support</p></list-item></list><break/>Meso<list list-type="bullet"><list-item><p>Intergeneration activities</p></list-item><list-item><p>Social care</p></list-item></list></td></tr><tr><td align="left" valign="top">Ashikali et al [<xref ref-type="bibr" rid="ref27">27</xref>], 2024</td><td align="left" valign="top">WHO&#x2019;s<sup><xref ref-type="table-fn" rid="table3fn2">b</xref></sup> ICOPE<sup><xref ref-type="table-fn" rid="table3fn3">c</xref></sup> approach</td><td align="left" valign="top">Micro<list list-type="bullet"><list-item><p>Identify SMART<sup><xref ref-type="table-fn" rid="table3fn4">d</xref></sup> goals based on personal priority regarding:</p><list list-type="bullet"><list-item><p>Cognitive decline</p></list-item><list-item><p>Limited mobility</p></list-item><list-item><p>Hearing loss</p></list-item><list-item><p>Malnutrition</p></list-item><list-item><p>Vision impairment</p></list-item><list-item><p>Depressive symptoms</p></list-item></list></list-item></list></td></tr></tbody></table><table-wrap-foot><fn id="table3fn1"><p><sup>a</sup>Not applicable.</p></fn><fn id="table3fn2"><p><sup>b</sup>WHO: World Health Organization.</p></fn><fn id="table3fn3"><p><sup>c</sup>ICOPE: Integrated Care for Older People.</p></fn><fn id="table3fn4"><p><sup>d</sup>SMART: Specific, Measurable, Attainable, Realistic, and Time-bound.</p></fn></table-wrap-foot></table-wrap></sec><sec id="s3-4"><title>Association Studies</title><p>We found 5 studies that reported associations of important variables with various measures of healthy aging [<xref ref-type="bibr" rid="ref28">28</xref>-<xref ref-type="bibr" rid="ref32">32</xref>]. In these studies, measures were used to conceptualize healthy aging, such as Chinese Healthy Aging Index, Activities of Daily Living or Instrumental Activities of Daily Living, depression, DALYs, and biological age. These studies included 5 variables at the micro level, 2 at the meso level, and 5 at the macro level (<xref ref-type="table" rid="table4">Table 4</xref>). At the micro level, 4 out of the 5 variables were statistically and significantly associated with measures of healthy aging. Two variables, household expenditure and nutrition, were positively related to measures of healthy aging [<xref ref-type="bibr" rid="ref28">28</xref>,<xref ref-type="bibr" rid="ref32">32</xref>]. One study showed alcohol consumption and overwork were positively correlated with DALY, whereas eating habits showed nonsignificance [<xref ref-type="bibr" rid="ref31">31</xref>]. People with more limitations in Activities of Daily Living were more likely to acquire housing adaptations at Meso level [<xref ref-type="bibr" rid="ref29">29</xref>]. At the macro level, low housing quality, such as housing poverty, was associated with decreased healthy aging [<xref ref-type="bibr" rid="ref28">28</xref>], while health insurance coverage and public financing policies were negatively associated with unhealthy ageing [<xref ref-type="bibr" rid="ref30">30</xref>,<xref ref-type="bibr" rid="ref31">31</xref>].</p><table-wrap id="t4" position="float"><label>Table 4.</label><caption><p>Association studies (n=5).</p></caption><table id="table4" frame="hsides" rules="groups"><thead><tr><td align="left" valign="bottom">Authors, year</td><td align="left" valign="bottom">Outcomes</td><td align="left" valign="bottom">Factors associated with the outcome</td></tr></thead><tbody><tr><td align="left" valign="top">Nie et al [<xref ref-type="bibr" rid="ref28">28</xref>], 2021</td><td align="left" valign="top">CHAI<sup><xref ref-type="table-fn" rid="table4fn1">a</xref></sup> (Unhealthy Aging)</td><td align="left" valign="top">Micro<list list-type="bullet"><list-item><p>Significant</p><list list-type="bullet"><list-item><p>(+) Household expenditure</p></list-item></list></list-item></list><break/>Macro<list list-type="bullet"><list-item><p>Significant</p><list list-type="bullet"><list-item><p>(+) Housing poverty</p></list-item></list></list-item></list></td></tr><tr><td align="left" valign="top">Wu and Grundy [<xref ref-type="bibr" rid="ref29">29</xref>], 2025</td><td align="left" valign="top">Slower Activities of Daily Living/Instrumental Activities of Daily Living development</td><td align="left" valign="top">Meso<list list-type="bullet"><list-item><p>Significant</p><list list-type="bullet"><list-item><p>(+) Acquiring housing adaptation</p></list-item></list></list-item><list-item><p>Nonsignificant</p><list list-type="bullet"><list-item><p>Sex</p></list-item></list></list-item></list></td></tr><tr><td align="left" valign="top">Zai [<xref ref-type="bibr" rid="ref30">30</xref>], 2024</td><td align="left" valign="top">Poor health; Mobility limitation; Instrumental Activities of Daily Living limitation; Depression</td><td align="left" valign="top">Macro<list list-type="bullet"><list-item><p>Significant</p><list list-type="bullet"><list-item><p>(&#x2212;) Medical Aging Waiver program expenditure per capita</p></list-item></list></list-item></list></td></tr><tr><td align="left" valign="top">Dragos et al [<xref ref-type="bibr" rid="ref31">31</xref>], 2022</td><td align="left" valign="top">Disability-adjusted life years (DALY)</td><td align="left" valign="top">Micro<list list-type="bullet"><list-item><p>Significant</p><list list-type="bullet"><list-item><p>(+) Alcohol consumption</p></list-item><list-item><p>(+) Overwork</p></list-item></list></list-item><list-item><p>Nonsignificant</p><list list-type="bullet"><list-item><p>Eating habits</p></list-item></list></list-item></list><break/>Macro<list list-type="bullet"><list-item><p>Significant</p><list list-type="bullet"><list-item><p>(&#x2212;) Voluntary health insurance</p></list-item><list-item><p>(&#x2212;) Quality of institutions</p></list-item><list-item><p>(&#x2212;) Public financing (voluntary health insurance)</p></list-item></list></list-item></list></td></tr><tr><td align="left" valign="top">McIntyre et al [<xref ref-type="bibr" rid="ref32">32</xref>], 2021</td><td align="left" valign="top">Biological age deceleration</td><td align="left" valign="top">Micro<list list-type="bullet"><list-item><p>Significant</p><list list-type="bullet"><list-item><p>(+) Nutritional components: fiber, magnesium, and vitamin E intake</p></list-item></list></list-item></list></td></tr></tbody></table><table-wrap-foot><fn id="table4fn1"><p><sup>a</sup>CHAI: Chinese Healthy Aging Index.</p></fn></table-wrap-foot></table-wrap></sec><sec id="s3-5"><title>Themes From Descriptive Studies</title><p>Five studies were descriptive studies that explored participants&#x2019; perceptions of healthy aging [<xref ref-type="bibr" rid="ref33">33</xref>-<xref ref-type="bibr" rid="ref37">37</xref>]. A total of 6 themes at the micro level and 5 at the meso level were identified, but none at the macro level, and they were similar to the interventional components in the interventional, intervention development, and association studies. The 6 micro-level themes included finance, nutrition, physical activity, mental and psychological management, spiritual aspect, and digital literacy, whereas the 5 meso-level themes were independent living/housing, safety, communication, support systems, and health care support (<xref ref-type="table" rid="table5">Table 5</xref>).</p><p><xref ref-type="fig" rid="figure2">Figure 2</xref> summarizes the key findings of this review.</p><table-wrap id="t5" position="float"><label>Table 5.</label><caption><p>Descriptive studies (n=5).</p></caption><table id="table5" frame="hsides" rules="groups"><thead><tr><td align="left" valign="bottom">Micro-, meso-, macro-level framework</td><td align="left" valign="bottom">Themes identified from the descriptive studies</td></tr></thead><tbody><tr><td align="left" valign="top">Micro</td><td align="left" valign="top"><list list-type="bullet"><list-item><p>Finance [<xref ref-type="bibr" rid="ref34">34</xref>,<xref ref-type="bibr" rid="ref37">37</xref>]</p></list-item><list-item><p>Nutrition [<xref ref-type="bibr" rid="ref34">34</xref>]</p></list-item><list-item><p>Physical activity [<xref ref-type="bibr" rid="ref34">34</xref>]</p></list-item><list-item><p>Mental and psychological management [<xref ref-type="bibr" rid="ref34">34</xref>,<xref ref-type="bibr" rid="ref35">35</xref>]</p></list-item><list-item><p>Spiritual aspect [<xref ref-type="bibr" rid="ref34">34</xref>]</p></list-item><list-item><p>Digital literacy [<xref ref-type="bibr" rid="ref33">33</xref>,<xref ref-type="bibr" rid="ref35">35</xref>]</p></list-item></list></td></tr><tr><td align="left" valign="top">Meso</td><td align="left" valign="top"><list list-type="bullet"><list-item><p>Housing and community environment for independent living [<xref ref-type="bibr" rid="ref33">33</xref>,<xref ref-type="bibr" rid="ref37">37</xref>]</p></list-item><list-item><p>Safety [<xref ref-type="bibr" rid="ref33">33</xref>,<xref ref-type="bibr" rid="ref35">35</xref>,<xref ref-type="bibr" rid="ref36">36</xref>]</p></list-item><list-item><p>Communication [<xref ref-type="bibr" rid="ref34">34</xref>,<xref ref-type="bibr" rid="ref35">35</xref>]</p></list-item><list-item><p>Support system [<xref ref-type="bibr" rid="ref35">35</xref>,<xref ref-type="bibr" rid="ref37">37</xref>]</p></list-item><list-item><p>Health care support [<xref ref-type="bibr" rid="ref36">36</xref>,<xref ref-type="bibr" rid="ref37">37</xref>]</p></list-item></list></td></tr></tbody></table></table-wrap><fig position="float" id="figure2"><label>Figure 2.</label><caption><p>Strategies, practices, and policies of healthy aging at the micro-, meso-, and macro-levels. ADL: activities of daily living.</p></caption><graphic alt-version="no" mimetype="image" position="float" xlink:type="simple" xlink:href="i-jmr_v15i1e94085_fig02.png"/></fig></sec></sec><sec id="s4" sec-type="discussion"><title>Discussion</title><sec id="s4-1"><title>Principal Findings</title><p>This scoping review mapped the existing evidence on practices and interventions for healthy aging and health lifespan between 2010 and 2025. We identified 21 studies, of which 15 (71%) were published after 2020 and all studies were conducted in high- and middle-income countries, with 17 (81%) in high-income communities. Four study designs were evident: interventional studies, intervention development studies, association studies, and descriptive studies. Among these practices and interventions, 13 (62%) focused on micro-level factors (eg, physical activity, nutrition, mental and psychological management, spirituality), 11 (52%) focused on meso-level factors (eg, social engagement, support systems, housing and health care support). Very few practices (n=2, 9.5%) addressed macro-level determinants such as public financing or policy. Overall, the findings suggest a growing interest in multidomain programs that integrate micro- and meso-level components, but with important gaps in evidence from low-resource settings and in macro-level strategies.</p></sec><sec id="s4-2"><title>Micro&#x2011; and Meso&#x2011;Level Factors</title><p>Multidomain interventions, including physical exercise, nutrition, emotional management, lifestyle modification, and social engagement, were the most frequently reported interventions that bring benefits to older people to extend health span. This finding is consistent with previous research, showing that interventions can improve physical performance, cognitive function, nutritional status, mood, cardiovascular risk profiles, and overall quality of life at-risk of functional decline [<xref ref-type="bibr" rid="ref38">38</xref>-<xref ref-type="bibr" rid="ref40">40</xref>]. From a mechanistic perspective, the rationale for multidomain interventions is also plausible. Aging is driven by multiple hallmarks, resulting from both endogenous and exogenous stress [<xref ref-type="bibr" rid="ref41">41</xref>]. Multidomain interventions may act simultaneously on several of these hallmarks [<xref ref-type="bibr" rid="ref42">42</xref>]. For example, physical activity and nutrition can enhance metabolic regulation, cognitive and social engagement can reduce neuroinflammation, and psychological support can improve stress resilience. Although the included studies rarely measured biological mechanisms directly, this framework provides an explanation for why interventions targeting multiple domains can produce broader benefits of healthy longevity [<xref ref-type="bibr" rid="ref41">41</xref>].</p><p>Nevertheless, multidomain interventions should not be implemented as fixed, one-size-fits-all packages. Their effects may vary according to population characteristics, delivery modes, study settings, intervention intensity, and outcome measures [<xref ref-type="bibr" rid="ref43">43</xref>,<xref ref-type="bibr" rid="ref44">44</xref>]. Therefore, how practices and interventions are delivered appears to be important. In this review, evidence across interventional, developmental, associative, and descriptive studies further highlighted the importance of social environmental factors at the meso level, including culture [<xref ref-type="bibr" rid="ref25">25</xref>], home and community safety [<xref ref-type="bibr" rid="ref25">25</xref>], housing conditions [<xref ref-type="bibr" rid="ref29">29</xref>], support systems [<xref ref-type="bibr" rid="ref35">35</xref>], social care services [<xref ref-type="bibr" rid="ref26">26</xref>], access to health services [<xref ref-type="bibr" rid="ref22">22</xref>], and social engagement, etc. Culturally adapted interventions can improve adherence because they are more likely to fit older adults&#x2019; language, food habits, family structure, religious beliefs, and social expectations [<xref ref-type="bibr" rid="ref45">45</xref>,<xref ref-type="bibr" rid="ref46">46</xref>]. Similarly, housing quality and neighborhood safety are important for aging in place. Large-scale analyses have shown that environmental factors account for a substantially greater proportion of variation in mortality risk than genetic predisposition (around 17% vs &#x003C;2%) [<xref ref-type="bibr" rid="ref47">47</xref>]. Poor housing may increase exposure and exert particularly strong effects on diseases of the lung, heart, and liver [<xref ref-type="bibr" rid="ref47">47</xref>], while unsafe homes and communities may increase falls, disability, and hospitalization [<xref ref-type="bibr" rid="ref48">48</xref>]. In contrast, safe and accessible neighborhoods may support social engagement, mental health, and quality of life [<xref ref-type="bibr" rid="ref49">49</xref>,<xref ref-type="bibr" rid="ref50">50</xref>]. Moreover, community-based interventions create opportunities for social interaction to mitigate loneliness and social isolation and thereby influence both psychosocial and biological pathways [<xref ref-type="bibr" rid="ref51">51</xref>,<xref ref-type="bibr" rid="ref52">52</xref>]. Given the heterogeneity in intervention components observed in this review, more studies can examine which combinations and dosages of multidomain interventions are most effective for specific populations and delivery conditions.</p><p>Our review found that interventions delivered by community health workers improved preventive health behaviors and increased the use of health services [<xref ref-type="bibr" rid="ref18">18</xref>,<xref ref-type="bibr" rid="ref22">22</xref>]. These findings indicate that healthy aging interventions also need to be supported by accessible community services and local workforce capacity. Considering both micro- and meso-level factors, future interventions should adopt person-centered designs that match components to older adults&#x2019; intrinsic capacity, goals, preferences, and social environments, etc. Personalized approaches, such as the ICOPE (Integrated Care for Older People) framework [<xref ref-type="bibr" rid="ref53">53</xref>], may support the codevelopment of tailored care plans and help translate multidomain interventions into routine practice.</p></sec><sec id="s4-3"><title>Macro&#x2011;Level Factors</title><p>At the macro level, long-term care financing policy and health system financing policy, such as medical insurance waiver programs and voluntary health insurance, influence healthy lifespans by reducing financial barriers and improving access to care. Similar to previous multicountry studies, this review found that universal health coverage was positively associated with both life expectancy at birth and healthy life expectancy [<xref ref-type="bibr" rid="ref54">54</xref>]. Evidence from China further showed that health insurance was associated with higher end-of-life medical expenditure among older adults, suggesting improved access to medical services [<xref ref-type="bibr" rid="ref55">55</xref>]. However, because all the involved studies were from high-income countries, unequal insurance benefits across different income settings need to be further explored. In addition, none of the interventional and qualitative studies targeted macro-level practices. Future research should move beyond micro- and meso-level approaches and examine how policy, public hospital authority intervention, financing systems, support for low-income housing, and equitable access to services can support healthy longevity. This gap is also important from a life-course perspective. Although most included studies focused on later-life practices and interventions, protection policies are needed to ensure that health-promoting environments and resources are available throughout the life course [<xref ref-type="bibr" rid="ref56">56</xref>]. Early macro-level interventions aimed at reducing socioeconomic disparities helped narrow health gaps in older age [<xref ref-type="bibr" rid="ref57">57</xref>]. This is particularly important for older adults living in low-income, rural, minority, or otherwise underserved communities.</p></sec><sec id="s4-4"><title>Evidence Gaps in Low&#x2011;Resource Settings</title><p>All studies included in this review were from high- or middle-income countries. While evidence from low-income countries was limited. This limits our understanding of how healthy longevity interventions operate in settings with fewer financial, technological, and service resources. Studies&#x202F;conducted in low-income communities in this review appeared to focus mainly on basic health risk prevention and the use of locally available resources, whereas programs in more affluent settings were more likely to adopt multidomain, service-integrated, or technology-enhanced approaches. This disparity is worthy of attention. Limited financial, health workforce, and technological capacity constrains the feasibility of multidomain interventions in resource-poor settings, which places populations at risk of widening inequalities in access to healthy aging support [<xref ref-type="bibr" rid="ref37">37</xref>]. Therefore, there is a genuine need for developing and testing low-cost, high-reach strategies for healthy aging, such as community-based, peer-led, and integrated primary care to support older people&#x2019;s functional capacities. Sustained strategies that promote health span require integrated care and collaboration across sectors, including health care professionals, social workers, community organizations and policymakers, particularly for older adults with lower socioeconomic status and multimorbidity. As discussed above, ICOPE is a potential approach [<xref ref-type="bibr" rid="ref53">53</xref>] to enhance access to care and support intrinsic capacity, but its implementation depends on cross-sector collaboration. Pilot programs in several regions have demonstrated feasibility and acceptability [<xref ref-type="bibr" rid="ref58">58</xref>]. Future research should draw on implementation science and mixed methods approaches to systematically document the facilitators and barriers to intersectoral collaboration, assess readiness and feasibility of related models in diverse health care systems [<xref ref-type="bibr" rid="ref59">59</xref>]. These steps are crucial to move from small-scale trials toward sustainable system-level practice.</p></sec><sec id="s4-5"><title>Future Directions</title><p>Based on the findings of this review, we propose a conceptual framework that summarizes how healthy aging and healthy lifespan may be supported through multilevel practices (<xref ref-type="fig" rid="figure3">Figure 3</xref>). At the center of the framework is intrinsic capacity, which is shaped by individual-level behaviors and multidomain interventions, meso-level environments and services, and macro-level policies and financing systems. The framework also highlights the importance of cross-sector collaboration among government, public and private sectors, academia, communities, and international organizations.</p><fig position="float" id="figure3"><label>Figure 3.</label><caption><p>Conceptual framework summarizing multilevel practices supporting healthy aging and healthy lifespan.</p></caption><graphic alt-version="no" mimetype="image" position="float" xlink:type="simple" xlink:href="i-jmr_v15i1e94085_fig03.png"/></fig></sec><sec id="s4-6"><title>Limitations</title><p>This scoping review had a few limitations. First, we focused on studies that explicitly framed their practices or interventions around health span, healthy aging, lifespan, or longevity. So, treatment-oriented interventions such as fall prevention, frailty intervention, or multimorbidity management may have been excluded if they did not explicitly use health span or related terminology, even though such interventions may contribute to healthy longevity. Therefore, the findings should be interpreted as mapping explicitly health span or healthy aging-oriented practices rather than providing a comprehensive review of all interventions that may promote healthy longevity. Second, the components of some initiatives were not well-documented, which may lead us to overlook key elements necessary for extending health span. Third, most included studies (17/21, 81.0%) were conducted in high-income settings, which may limit generalizability. The results should therefore be interpreted with caution, particularly when applying these findings to low-resource contexts. Fourth, the terminological fragmentation observed across studies, where terms such as healthy aging, active aging, successful aging, and healthy life expectancy were used interchangeably. This inconsistent concept may hinder evidence synthesis. Therefore, establishing more standardized terminology would enhance comparability and translation of evidence into practice. Finally, healthy longevity practices or programs that are not documented in peer-reviewed literature were not included. Expanding this review to include gray literature could provide a broader understanding of effective practices in healthy longevity, including those executed by underrepresented populations.</p></sec><sec id="s4-7"><title>Conclusion</title><p>This scoping review identified key components of community-based strategies, practices, and policies aimed at extending health span and promoting healthy longevity, which warrant further testing and implementation. Overall, the existing evidence suggests that promoting healthy longevity in the community requires cooperation among multiple stakeholders, as well as the provision of integrated, multilevel services or support for older people. Contributions from different sectors and disciplines across all levels are equally important.</p><p>Existing interventions remain concentrated in high-income settings and at the micro level, particularly through the use of technology and multidomain integrated services to support older people in living independently and healthily within their communities. In contrast, strategies in low-income contexts largely focus on basic health risk prevention and the mobilization of local resources, such as volunteers, family members, and neighbors to support older people.</p><p>Macro-level strategies are especially critical, as policies at this level can promote health equity and reduce socioeconomic inequalities. There is an urgent need to further investigate and develop meso- and macro-level interventions across diverse socioeconomic contexts.</p></sec></sec></body><back><ack><p>Poe (GPT-5) was used to assist with proofreading and language editing of this manuscript.</p></ack><notes><sec><title>Funding</title><p>This project was funded by AIA International (Hong Kong) Limited.</p></sec></notes><fn-group><fn fn-type="con"><p>Conceptualization: AYML, KSLC, JM, IYZ. Funding acquisition: AYML, KSLC. Investigation: AYML, KSLC, JM, IYZ, KLO. Methodology: AYML, KLO, KSLC, JM, IYZ, MQ, KMW, YH. Project administration: KLO, MQ. Resources: AYML, KSLC, JM. Supervision: AYML, JM. Validation: AYML, KLO, JM, IYZ. Visualization: YH, IYZ. Writing &#x2013; original draft: KLO, MQ, KMW, YH. Writing &#x2013; review &#x0026; editing: AYML, JM, IYZ, KSLC</p></fn><fn fn-type="conflict"><p>Part of the preliminary findings was presented at the Healthy Ageing Conference 2025 in May 2025 in Hong Kong. The funding body had no role in the study design, data collection, analysis, interpretation, or manuscript preparation. To minimize potential bias, the research team conducted the review and analysis independently and was not informed of the funding source during the research process. 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