Towards healthy ageing in ASEAN: the roles of age-friendly communities, social engagement, and healthy behaviors among older adults

ASEAN countries are undergoing rapid demographic transitions toward aged and super-aged societies, heightening the need for community environments that effectively support older adults’ participation, health, and well-being. Age-friendly environments (AFEs) are increasingly recognized as important determinants of active and healthy ageing, and growing evidence has highlighted their associations with social, behavioral, and well-being outcomes. Guided by the World Health Organization’s ecological framework of healthy ageing, this study examined the relationships among AFEs, social engagement (SE), healthy behaviors (HTY), and quality of life (QOL) among older adults in four ASEAN countries. A cross-sectional survey of 2,031 adults aged ≥ 55 years was conducted using multistage random sampling across metropolitan areas in Malaysia, Vietnam, Myanmar, and Thailand. Validated instruments were used to measure AFEs, SE, HTY, and QOL. Path analysis with robust maximum likelihood estimation was conducted to examine direct and indirect relationships among age-friendly environments, social engagement, healthy behaviors, and quality of life, adjusting for age, gender, marital status, education, and country. Indirect effects were estimated using 5,000 bootstrap resamples, and model fit was evaluated using established fit indices. The final model demonstrated good fit (CFI = 0.963, TLI = 0.922, RMSEA = 0.052, SRMR = 0.028). Age-friendly environments (AFEs) were positively associated with social engagement (SE; β = 0.679, p < 0.001), healthy behaviors (HTY; β = 0.106, p = 0.001), and quality of life (QOL; β = 0.194, p < 0.001). Both SE and HTY were positively associated with QOL (β = 0.276 and β = 0.219, respectively; both p < 0.001). When direct and indirect associations were considered together, AFEs showed the largest total association with QOL (β = 0.445). The strongest indirect association involved SE (AFEs → SE → QOL; β = 0.187, p < 0.001), while the indirect association linking AFEs, SE, HTY, and QOL was also statistically significant (AFEs → SE → HTY → QOL; β = 0.041, p < 0.001). More supportive age-friendly environments were associated with better quality of life among older adults, with social engagement and healthy behaviors representing potential interconnected pathways. Social engagement appeared to be an important intermediate factor and was positively associated with healthy behaviors. These findings underscore the relevance of age-friendly physical and social environments. They may guide the development of coordinated, context-sensitive strategies to advance healthy and active ageing across diverse ASEAN settings.