Aging Gracefully: A Qualitative Exploration of Hidden Determinants of Healthy Aging among the Elderly in Lucknow, India

Introduction: With increasing life expectancy, only a fraction of older adults manage to retain optimal health and functionality. Understanding the determinants of healthy aging among elderly individuals who remain free from chronic diseases is critical to promote independence and well-being in later life. To explore lifestyle practices, dietary habits, social behaviours, and personal perceptions of elderly individuals (≥60 years) who have successfully maintained good health without chronic illness. Methods: A qualitative study was conducted from 12 May 2023 to 31 December 2023 in rural and urban areas of Lucknow. Five purposively selected participants aged 60 years and above were interviewed in depth on their lifestyle, diet, social behaviour, and perceptions of health. All interviews were audio-recorded with informed consent, transcribed verbatim, translated into English, and analysed thematically using an inductive approach. Codes and categories were generated through iterative comparison of emerging patterns. Ethical approval and informed consent were obtained. Results: Thematic analysis revealed core themes for healthy ageing including engagement in regular physical activity, structured lifestyle routines, stress and mental health management, abstinence from harmful substances, community health and hygiene awareness, and culturally grounded dietary practices. Across diverse educational and socioeconomic backgrounds, participants reported sustained functional independence, emotional resilience, and a proactive health orientation. Conclusion: Participants perceived physical activity, healthy dietary habits, spiritual practices, avoidance of harmful behaviours, and social connections as important for healthy aging. These findings provide insights for designing community-based strategies and policy initiatives that support healthy aging in the Indian context.

The global demographic landscape is undergoing a significant shift, with the population of older adults rising rapidly. According to the World Health Organization, by 2030, one in six people worldwide will be aged 60 years or above, with this number expected to double by 2050, reaching over 2.1 billion. The number of persons aged 80 years or older is expected to triple between 2020 and 2050 to reach 426 million.^[1,2] India too, is witnessing a similar transition.^[3] Advances in healthcare, nutrition, and living conditions have contributed to increased life expectancy; however, this increase has not always been accompanied by a parallel rise in health expectancy. While many older adults live longer, only a subset of them do so with optimal health, functional independence, and a good quality of life.^[2,4]

Most of the known determinants of healthy aging include genetic factors, lifestyle habits, dietary choices, regular physical activity, sleep hygiene, psychosocial well-being, and social support systems.^[5,6] However, conventional epidemiological research often fails to capture nuanced experiences, beliefs and behaviours. Understanding these factors may inform preventive strategies and lifestyle interventions to promote healthy aging.^[7,8]

This qualitative study was conducted in the rural and urban field-practice areas of a tertiary care teaching institute to explore the factors participants perceived as helping them maintain good health after age 60. It was undertaken to explore these lesser-known or hidden factors that may play a role in maintaining good health among the elderly based on their lived experiences and personal narratives. By identifying common themes and patterns related to lifestyle, psychosocial factors, healthcare-seeking behaviours, and personal beliefs, this research seeks to provide a deeper understanding of the determinants of healthy aging. The findings may offer valuable insights for developing holistic, person-centered strategies to promote well-being in aging populations.^[9-11] Thus, the aim & objectives of the current study was to explore the lifestyle practices, dietary habits, social behaviours, and personal perceptions of healthy elderly individuals that they are practicing and also will focus to search out their experiences of those factors which helped them to live life in good health throughout.

The present study explored the lived experiences and perceptions of elderly individuals who reported maintaining good health without major chronic lifestyle-related diseases. The findings suggest that participants associated healthy aging with several aspects of their everyday lives, including dietary habits, physical activity, regular routines, spiritual beliefs, stress management, and personal hygiene. These practices were often followed for many years and were closely linked to their cultural beliefs and personal experiences. Rather than identifying any single factor, the study highlights how participants perceived a combination of these practices as important for maintaining their health and well-being.

Dietary habits were an important part of participants' experiences, particularly their preference for simple, home-cooked, and traditionally prepared foods. One participant recalled, “In our childhood…wheat, barley, millet was used to make roti…milk was also frequently consumed” (P1), while another shared, “I have always liked vegetarian food since childhood... even paneer, we make it at home, not from the market” (P3). These experiences reflect the importance participants placed on traditional food habits and their preference for homemade meals over commercially prepared foods. Similar findings have been discussed by Eckstrom et al.^[15] and Paddon-Jones et al.,^[16] who emphasized the importance of adequate protein intake for maintaining health in older age. Similarly, Yeung et al.^[17] advocate for traditional dietary patterns, including Asian and Mediterranean diets, for their contribution to metabolic stability and psychological resilience.

Regular physical activity and a structured daily routine were also commonly reported. Participants described walking, farming, cycling, and exercising as part of their everyday lives. One participant stated, “I daily do exercises like Yoga, push-ups… I daily do one hour of exercise in the morning” (P4), while another mentioned, “I used to do cycling daily for about 10–15 km” (P5). These accounts suggest that physical activity was not always viewed as a separate health-related activity but was often integrated into daily routines. Eckstrom et al.^[15] emphasized the importance of regular physical activity in maintaining physical functioning and independence among older adults. Similarly, Bryant et al.^[8] highlighted the role of meaningful daily activities in shaping older adults' perceptions of healthy aging. Our findings support these observations and further illustrate how routine activities, particularly walking and agricultural work, were perceived by participants as important for maintaining an active lifestyle.

Some participants also described using traditional remedies, including herbal preparations, honey, and Ayurvedic practices, as part of their health-related routines. One participant shared, “I like to have decoction of ginger and black pepper… it cures my cough, cold and minor infections” (P1). Another participant described the use of Panchagavya and other traditional preparations (P3). These practices reflect the influence of cultural traditions and knowledge passed down through generations on participants' health-related behaviours. Peel et al.^[18] discussed the importance of health behaviours in healthy aging, while Gianfredi et al.^[19] highlighted the broader role of preventive and public health approaches. Although the effectiveness and safety of the traditional remedies reported by participants were not assessed in this study, their accounts provide insight into how cultural beliefs influence personal health practices among elderly.

Spiritual beliefs and religious practices were another important part of participants' understanding of healthy aging. Several participants described prayer, devotion, and religious activities as ways of maintaining peace of mind and managing everyday stress. One participant stated, “I worship for one hour in the morning… it gives us energy and reduces stress” (P2). This suggests that spiritual practices were valued not only for religious reasons but also for their perceived contribution to emotional well-being. Michel et al.^[20] discussed healthy aging as a broader concept that extends beyond the absence of disease, while Kusumastuti et al. ^[21]examined different perspectives on successful aging. In the present study, spiritual practices appeared to form an important part of participants' personal understanding of health and well-being, reflecting the influence of cultural and religious beliefs on their experiences of aging.

Along with spirituality, participants emphasized the importance of avoiding stress, maintaining a positive outlook, and living a simple life. One participant explained, “I just stay away from people who give me tension… don’t expect much from anyone” (P5), while another advised, “Don’t take tension… don’t be jealous… this is health” (P1). These statements reflect how participants tried to manage emotional stress by avoiding conflict, limiting expectations, and maintaining positive relationships. Westendorp et al.^[22] discussed healthy aging beyond the traditional focus on disease, while the broader literature on successful aging recognizes the importance of psychological and social well-being. Our findings add to this understanding by showing how participants associated emotional balance and the avoidance of unnecessary stress with maintaining good health in later life.

Personal hygiene and environmental cleanliness were also considered important for maintaining health. Participants emphasized regular bathing, wearing clean clothes, and keeping their surroundings clean. One participant shared, “Even during fever, I bathed daily… can’t live without bathing… cleanliness is very important, regular cleaning and wearing clean clothes” (P2). Another participant stated, “A clean-living environment plays a key role in maintaining physical health” (P3). These accounts show that cleanliness was viewed as an essential part of everyday health practices. The broader social determinants of health literature emphasize the importance of living conditions and environmental factors in shaping health outcomes. Similarly, Michel et al.^[20] and Sadana et al.^[23] highlighted the need to address wider determinants of health to promote healthy aging and reduce inequalities. The present findings reflect how older adults connect personal hygiene and their immediate living environment with their perceptions of health and disease prevention.

An interesting finding was that participants not only followed certain health practices themselves but also expressed a desire to share their experiences with younger generations. Their advice mainly focused on maintaining regular routines, eating simple food, exercising, avoiding harmful substances, and maintaining spiritual well-being. One participant advised, “Routine should be systematic… bathe properly… eat digestible food… stay away from addiction” (P3). Another emphasized, “Whatever you eat, you should take it with satisfaction… keep exercising” (P5). These narratives suggest that older adults viewed their lifelong experiences as a source of practical knowledge that could benefit younger generations. This finding is relevant to the broader perspective of healthy aging discussed by Sadana et al,^[23] which recognizes the importance of supportive social environments and opportunities for older adults to remain engaged in society. The participants' willingness to share their experiences also highlights their potential role in community-based health promotion activities.

Overall, the findings suggest that participants understood healthy aging as a combination of physical, psychological, social, and culturally influenced practices developed over their lifetime. This broader understanding is consistent with the public health perspective of healthy aging discussed by Gianfredi et al.^[19] and the geroscience approach described by Kaeberlein et al,^[24] which emphasizes improving health during aging rather than focusing only on individual diseases. Michel et al.^[20] and Sadana et al.^[23] further highlighted the importance of addressing health inequalities and creating supportive conditions for healthy aging. In the present study, participants from different educational and socioeconomic backgrounds described relatively simple and locally accessible practices that they believed helped maintain their well-being. Although these experiences cannot establish a causal relationship between particular behaviours and healthy aging, they provide useful insights into the beliefs and everyday practices of older adults. These findings may help inform culturally appropriate community-based health promotion strategies, while recognizing the need for further research involving larger and more diverse groups of older adults.

This qualitative study provided an in-depth understanding of the lived experiences, lifestyle practices, dietary habits, spiritual beliefs, and social behaviours contributing to healthy aging. The inclusion of both rural and urban participants and the use of semi-structured interviews helped capture culturally rooted and practical determinants of healthy aging. The main limitation of this study was the small sample size, as findings were based on five healthy elderly participants from selected rural and urban areas of one district. The study included only one female participant, which may have limited our understanding of women's experiences and perspectives on healthy aging. Since the information was self-reported, recall bias and social desirability bias may also be present.

Conflicts of Interest: None declared.

Funding: No external funding received.

AI usage declaration: Artificial Intelligence (AI)-based tools were used only for language refinement and formatting assistance during manuscript preparation; no AI tool was used for study design, data collection, analysis or interpretation, and the authors take full responsibility for the accuracy and integrity of the content.