Psychosocial and economic factors related to better health among older adults in Europe – a systematic review

Abstract

Introduction Healthy and positive aging are increasingly recognized in public health as multidimensional processes that integrate physical, psychological, and social resources to support autonomy, active engagement, and quality of life in later life. This systematic review synthesizes recent European evidence on psychosocial and socioeconomic determinants of healthy aging among older adults and contributes to the conceptualization of positive aging from a public health perspective. Methods A systematic search of PubMed, Web of Science, and Embase identified empirical studies published in English between 2019 and 2024. Inclusion criteria encompassed studies conducted in European populations and involving adults aged 65 years and older. Studies focused exclusively on individuals under 65 years of age, samples with conditions likely to distort the examined relationships (e.g., dementia or severe mental disorders), ethnic minority groups, non-European populations, non-English publications, and other systematic reviews were excluded. Studies that included participants aged 65 years and older alongside younger age groups were retained (n = 19; 52.7%). Risk of bias was assessed using the Newcastle-Ottawa Scale for quantitative studies and the Critical Appraisal Skills Programme (CASP) checklist for qualitative designs, while two studies were evaluated using criteria consistent with the ROBINS-I framework. A narrative synthesis approach was applied. Results Two overarching thematic clusters were identified: (1) psychosocial and economic determinants, including loneliness and social isolation, social support and social capital, socioeconomic status, autonomy and independence, and life-course context; and (2) social programs and community-based interventions. Across studies, consistent evidence highlighted the protective role of social networks, social integration, and reduced loneliness in shaping health, well-being, and cognitive functioning. Autonomy and independence emerged as central elements of positive aging, influencing perceived control, meaning in life, and overall quality of life, while engagement in social, physical, and occupational activities supported the maintenance of resources in later adulthood. Discussion The findings underscore the need for public health policies and community environments that support positive aging through integrated physical, psychosocial, and social strategies. By emphasizing modifiable social determinants and contextual resources, this review advances the conceptual understanding of healthy aging and informs holistic, equity-oriented public health approaches for aging populations. Systematic review registration https://osf.io/ytgqw; doi: 10.17605/OSF.IO/YTGQW.