<p>In the context of the pursuit of universal accessibility in the information society, the elderly still face many obstacles in using health information systems. This study focuses on applying explainable artificial intelligence (XAI) in a health management system for elderly users. It profoundly explores its impact on trust, compliance, and cognitive load, aiming to improve the elderly’s experience in the health information system and promote the universal accessibility of health information for all. The study adopts an experimental control design to compare the user experience of elderly users using a health management platform with XAI functions and a traditional platform. The results show that XAI significantly enhances the trust of elderly users in the health management system, improves their compliance with health advice, optimizes the overall user experience, and effectively reduces cognitive load. These findings not only enrich the theoretical research on the technology acceptance behavior of the elderly in the field of human–computer interaction and ergonomics but also provide practical guidance for the developers of health management platforms, helping to create more user-friendly and more humane elderly health management technologies, promote the widespread application of intelligent health management systems, relieve the pressure on the medical system, and improve the health status and quality of life of the elderly, to achieve the goal of healthy aging better.</p>