Frontiers in Public Health · Nov 4, 2026
Associations of intrinsic capacity and an age-friendly environment with healthy aging among community-dwelling older adults in Yanzhou District, eastern China: a cross-sectional study of the potential indirect role of health-promoting behavior
By Yuan Dong, Linxi Tang
Background: The Healthy Aging Framework recognizes that intrinsic capacity and a supportive age-friendly environment are important foundations for achieving healthy aging. However, the links between these two factors and healthy aging, especially the possible indirect role of health-promoting behavior, are still unclear. This study uses the data from older adults in the community to explore the relationships among these variables. Methods: From September 2024 to January 2025, a community-based cross-sectional study was carried out in Yanzhou District, Jining City, Shandong Province, China. The research participants were older adults aged ≥60 years. The Healthy Aging Questionnaire, the reverse-scored 10-item Chinese Frailty Screening Scale, the Age-Friendly Cities and Communities Questionnaire, and the simplified Chinese version of the Health-Promoting Behavior Scale for Older Adults were used to evaluate healthy aging, intrinsic capacity, the age-friendly environment, and health-promoting behavior, respectively. The Pearson correlation coefficients were calculated, and the unadjusted and covariate-adjusted structural equation models were used as co-primary analyses. Covariates included age, sex, type of residence, marital status, education level, personal monthly income and the number of chronic diseases. The confidence intervals and p values for structural associations accounted for community clustering and urban/rural stratification. Results: A total of 806 older adults were included. There were positive correlations among the scores of the four scales (r = 0.523–0.630, p < 0.001). After adjustment for covariates, each hypothesized main structural path remained positive and statistically significant. In the unadjusted model, the standardized indirect associations of intrinsic capacity and the age-friendly environment with healthy aging through health-promoting behavior were 0.118 and 0.154, respectively (both p < 0.001). In the adjusted model, these associations were attenuated, but they remained statistically significant: the indirect association for intrinsic capacity was β = 0.054 (95% CI: 0.023–0.084, p = 0.0013), and the indirect association for the age-friendly environment was β = 0.087 (95% CI: 0.059–0.115, p < 0.001). Conclusion: Higher healthy aging scores are associated with higher intrinsic capacity scores, a more favorable age-friendly environment, and higher participation in health-promoting behaviors. The results are consistent with the hypothesized indirect associations through health-promoting behavior, but these results cannot establish causal mediation.