Health Literacy Emerges as a Key Driver of Active and Successful Aging in Older Adults

What separates older adults who merely grow old from those who thrive in later life? A new study from Türkiye points to an answer that is as practical as it is surprising: the ability to find, understand, and use health information. In research published in BMC Geriatrics, Şengül Akdeniz of Akdeniz University and Karin Wolf-Ostermann of the University of Bremen examined how health literacy relates to two of the most influential frameworks in modern gerontology, active aging and successful aging, among 306 older adults attending a municipal Active Aging Service Center in Antalya. Their findings suggest that health literacy is not simply a background characteristic but a central lever that shapes how well people age.

The two frameworks at the heart of the study are related but distinct. Successful aging, a concept with deep roots in gerontological research, emphasizes physical health, the avoidance of disease and disability, and the maintenance of high cognitive and physical function. Active aging, a broader model promoted heavily in European policy circles, extends the picture to include social participation, security, and continued engagement with life. The researchers set out to determine how health literacy, often described as a vital tool for achieving good outcomes in later life, relates to both paradigms simultaneously, and to identify which factors are associated with higher levels of active aging in a real-world community setting.

The study was designed as a descriptive and cross-sectional survey, conducted between October 2024 and May 2025 at the Metropolitan Municipality’s Active Aging Service Center in Antalya. Participants were 306 adults aged 65 and over, with an average age of 67.79 years and a standard deviation of 3.56. The sample was predominantly female, with women making up 79.4 percent of participants, and highly educated, as 70.6 percent were university graduates. Data were collected through a demographic information form and three validated instruments: the Active Ageing Scale, the Successful Ageing Scale, and the Turkish Health Literacy Scale.

The statistical toolkit was conventional but comprehensive. Descriptive statistics summarized the sample, independent samples t-tests and Chi-square tests explored group differences, Pearson correlation analysis quantified the relationships between the three main constructs, and multiple linear regression identified the independent predictors of active aging. This combination allowed the team to move beyond simple associations and estimate how much each factor contributed to active aging when all others were held constant.

The portrait that emerged of the participants was one of a relatively health-engaged group of older adults. A majority, 66.0 percent, reported living with a chronic illness, and 64.7 percent took medication regularly, reflecting the disease burden typical of this age group. Yet the same participants reported high levels of protective behavior: 58.5 percent engaged in regular physical exercise and an impressive 80.7 percent engaged in regular mental activities. The mean total score on the Active Ageing Scale was 190.10 with a standard deviation of 39.37, the Successful Ageing Scale mean was 57.74 with a standard deviation of 7.61, and the Health Literacy Index mean was 32.97 with a standard deviation of 9.53.

The bivariate analyses revealed a consistent pattern. Higher levels of education and income were significantly associated with better health literacy and better aging outcomes, as were regular physical exercise and regular mental activity, with all of these associations reaching statistical significance at the p < 0.05 level. More striking still, the researchers found positive correlations among active aging, successful aging, and health literacy that were significant at the p < 0.01 level. In other words, older adults who understood health information better tended to score higher on both aging frameworks, and the two frameworks themselves rose and fell together, supporting the idea that they capture complementary dimensions of a single underlying phenomenon.

The regression analysis provided the study’s headline result. The full model statistically significantly predicted active aging and explained 56.4 percent of the total variance, a substantial proportion for research in this field, with an R² of 0.564 and p < 0.05. Within that model, three variables stood out as significant predictors: age, mental activity, and health literacy. Perhaps the most intriguing finding was what fell away. Education and regular physical exercise, both strongly associated with aging outcomes in the bivariate analyses, were no longer significant once health literacy and the other variables were accounted for. This suggests that health literacy may sit on the causal pathway through which education and exercise exert their influence, or at least that it captures something those measures miss.

Why would the ability to navigate health information matter so much for how people age? The technical literature offers several plausible mechanisms. Older adults with stronger health literacy are better equipped to understand medication instructions, interpret symptoms, evaluate prevention advice, and communicate with health professionals, which supports the disease management that successful aging demands. The same skills may also underpin the confidence and autonomy that fuel social participation, a core component of active aging. Conversely, limited health literacy can create a cascade of misunderstanding, poor adherence, and disengagement that erodes both physical health and social connection over time. The Antalya findings cannot prove causation, since the design was cross-sectional, but the strength and consistency of the correlations, together with the regression results, make health literacy a compelling target for intervention.

The study also carries a pointed message for the institutions that serve older adults. The authors conclude that health literacy is a key factor of active and successful aging, and that older adult care centers should prioritize health literacy if they want to promote active aging. That recommendation is notable because active aging service centers are precisely the kind of community infrastructure where health literacy can be built: through accessible health education, plain-language communication, and programs that teach older adults how to evaluate and apply health information in daily life. The Antalya center’s own participants, with their high rates of mental and physical activity, illustrate the kind of engaged population such centers can cultivate.

The researchers were transparent about the study’s boundaries. The perspectives of individuals registered with the Active Aging Service Center who have lived experience were sought during the analysis and validation of the research data, helping interpret the findings from a real-world perspective, though there was no direct patient or public involvement in the study’s initial design, conduct, or writing. The sample, drawn from a single municipal center in a city where most participants were university-educated women, may not represent the broader older population, and the cross-sectional design means the direction of the relationships cannot be established with certainty. Ethics approval was obtained from the Akdeniz University Clinical Research Ethics Committee, and all participants provided verbal and written informed consent. The study received no external funding, and the authors declare no competing interests. Even with those caveats, the core result stands out: in a statistical model explaining more than half of the variance in active aging, health literacy was among the significant predictors, while more commonly cited advantages like education lost their edge. As populations across the world age at unprecedented speed, the study suggests that one of the most powerful investments societies can make in their older members is not more medical care but better health understanding, delivered in the community spaces where aging actually happens.

Subject of Research: The relationship between health literacy and active and successful aging among older adults attending an active aging service center

Article Title: The relationship between health literacy and active and successful aging: a cross-sectional study of active aging service center

Article References: Akdeniz, Ş., & Wolf-Ostermann, K. (2026). The relationship between health literacy and active and successful aging: a cross-sectional study of active aging service center. BMC Geriatrics, 26(1), Article 1232. https://doi.org/10.1186/s12877-026-08341-6

Image Credits: AI Generated

DOI: 10.1186/s12877-026-08341-6

Keywords: health literacy, active aging, successful aging, older adults, geriatrics, gerontology, public health, cross-sectional study, health education, social participation, chronic illness, healthy aging