Background <p>The Age-Friendly Hospitals Scale (AFHS) was developed with three main factors: care processes, communication and service, and physical environment. It provides a benchmark for optimizing resources and guiding quality improvements. This study evaluated older adults’ satisfaction with hospital services using the AFHS as an assessment tool.</p> Methods <p>This study used a cross-sectional survey design and recruited a convenience sample of 330 older adults from a regional teaching hospital. Participants met the inclusion criteria of being aged 65 or older, cognitively able, fluent in Chinese or Taiwanese, and willing to participate. Data were collected using structured questionnaires, including the AFHS, the Barthel Index, the Lawton Instrumental Activities of Daily Living (IADL) Scale, and the Geriatric Depression Scale Short Form (GDS-SF). Descriptive statistics were applied to examine participant demographics, including frequencies, percentages, means, and standard deviations. Independent t-tests and one-way ANOVA were used to assess satisfaction differences across demographics. Multiple linear regression models were used to identify factors associated with AFHS, adjusting for demographic and health-related variables such as age, gender, economic status, Barthel Index, IADL, and GDS-SF scores.</p> Results <p>The mean AFHS score was 4.34 (SD ± 0.46). Among domains, the care process scored lowest at 4.20 (SD ± 0.56), while communication and service scored highest at 4.56 (SD ± 0.45). Catholics had significantly higher satisfaction scores across all domains than Buddhists. Females reported higher satisfaction in the care process, while participants over 85 had the lowest scores in the physical environment. After adjusting for demographic and health-related factors, overall, AFHS was positively associated with Catholicism and Barthel Index dependency. Female gender and Catholicism correlated with higher satisfaction in care processes, while communication and service satisfaction was associated with Catholicism, economic sufficiency, and Barthel dependency.</p> Conclusions <p>Satisfaction with age-friendly hospital services among older adults was influenced by factors like Catholicism, female gender, financial sufficiency, and Barthel Index dependency. Lower satisfaction with the physical environment was observed in patients aged 85 and above. These findings highlight the need for tailored, culturally sensitive, and economically accessible age-friendly healthcare environments.</p>