A Systematic Review and Meta-analysis of the Socioeconomic, Lifestyle, and Environmental Factors Associated with Healthy Ageing in Low and Lower-Middle-Income Countries

Population ageing is a growing social and health issue in low and lower-middle-income countries (LLMIC). It will have an impact on rising healthcare costs, unaffordable pension liabilities, and changing healthcare demands. The health systems of many LLMICs are unprepared to meet these challenges and highlighting the modifiable factors that may help decrease these pressures is important. This review assessed the prevalence of healthy ageing and the modifiable factors that may promote/inhibit healthy ageing among older people in LLMIC. A systematic search of all articles published from 2000 to June 2022 was conducted in Scopus, PubMed (MEDLINE), and Web of Science. All observational studies reporting the prevalence of healthy ageing and its associations with socio-demographic, lifestyle, psychological, and social factors were examined. Random-effect models were used to estimate the pooled prevalence of healthy ageing, and meta-analyses were conducted to assess the risk/benefit of modifiable factors. From 3,376 records, 13 studies (n = 81,144; 53% of females; age ≥ 60 years) met the inclusion criteria. The pooled prevalence of healthy ageing ranged from 24.7% to 56.5% with lower prevalence for a multi-dimensional model and higher prevalence for single global self-rated measures. Factors positively associated with healthy ageing included education, income, and physical activity. Being underweight was negatively associated with healthy ageing. Almost half of older people in LLMIC were found to meet healthy ageing criteria, but this estimate varied substantially depending on the healthy ageing measures utilized (multi-dimensional = 24.7%; single indicator = 56.5%). The healthy ageing prevalences for both measures are lower compared to that in high-income countries. Developing health policies and educative interventions aimed at increasing physical exercise, social support, and improving socio-economic status and nutrition will be important to promote the healthy ageing of older people in LLMIC in sustainable ways.