<p>This study aimed to identify the impact of age and cognitive features of healthcare symbols on users’ comprehension and contribute to the design of an age-friendly hospital signage system. In this study, 50 younger and 50 older participants were recruited to interpret the meanings of 42 healthcare symbols and rate them on five cognitive characteristics. Healthcare symbols were categorized by cluster analysis into “three categories: high-performing symbols,moderate-performing symbols, and low-performing symbols”.The results of the test showed that younger adults outperformed older adults (74% vs. 57% correct rate, respectively; 9.55&#xa0;s vs.11.92&#xa0;s reaction time, respectively), with the age difference being most pronounced for moderate and low-performing symbols. Correlation analyses showed that all five cognitive features positively predicted symbol comprehension accuracy, but their predictive strength increased with symbol difficulty. Older adults relied more on familiarity, concreteness, and semantic accuracy when decoding low-performance symbols. Multiple regression confirmed identification accuracy as the primary predictor of cognitive ratings, with age and education also contributing significantly. Based on these findings, we recommend designing healthcare symbols for familiarity and concreteness, optimizing semantic precision, appropriately disseminating healthcare signage knowledge and training, and advancing the design of a universal healthcare signage system. The findings of this study may contribute to future hospital signage improvements and help to further improve the wayfinding dilemma of elderly users in healthcare environments.</p>