Toward inclusive healthy ageing: a systematic review of equity in healthy ageing interventions

Health inequities arising from social determinants such as income, education, gender, and socioeconomic status profoundly affect disease burden and ageing outcomes. Despite global efforts to promote equitable healthy ageing, substantial gaps remain. This systematic review examined how equity-related factors, defined by the PROGRESS framework: Place of residence, Race/ethnicity, Occupation, Gender/sex, Religion, Education, Socioeconomic status, and Social capital, are incorporated into evaluations of healthy ageing interventions and how outcomes vary across these dimensions.

PubMed, Embase, and Scopus were searched from database inception through August 12, 2024, for quantitative evaluations of healthy ageing interventions.

Of 5,892 screened studies, 66 met inclusion criteria, most published after 2018 and involving older adults (mean age 71.4 years). The most frequently reported PROGRESS factors were gender/sex (N = 66, 100%), education (N = 49, 74%), and race/ethnicity (N = 38, 58%). Twenty-five studies (38%) reported PROGRESS-related data without analysing outcomes by PROGRESS factors, whereas 41 studies (62%) analysed intervention outcomes by at least one PROGRESS dimension. Across 254 extracted outcome results, 98 (38.6%) suggested decreased inequity, 146 (57.5%) were non-significant, and 10 (3.9%) suggested increased inequity. Physical activity interventions were the most frequently studied and showed the largest number of favourable findings, whereas social connectedness interventions showed the highest proportion of unfavourable outcomes. Intersectional analyses were rare, and only six studies examined more than one PROGRESS dimension jointly.

Equity considerations are increasingly present but remain inconsistently integrated into healthy ageing intervention research. Greater attention to underrepresented PROGRESS dimensions, improving standardised equity reporting, and expanding intersectional analyses is needed to ensure interventions contribute to reducing, rather than reinforcing, inequities.

The protocol was registered with PROSPERO (CRD42024585709) before the final search.