Fostering active aging in older adults: results of a communication and social skills program

Abstract

Background

Active aging empowers older adults to maintain physical, social, and psychological well-being as they age, enabling them to participate in social activities according to their preferences and capabilities. However, many older adults face communication and social skills challenges, necessitating interventions to minimize social communication barriers and promote active aging. Despite the importance of communication and social skills in active aging, further studies are essential to explore older adults’ perspectives and develop strategies that support active aging and address potential barriers. Therefore, this study aimed to investigate the effect of communication and social skills training on the active aging of older adults.

Methods

This quasi-experimental trial with randomized allocation study involved 80 older adults from two daycare centers in southeastern Iran in 2024. Participants were randomly assigned to either a control or an intervention group. The intervention group received an eight-session communication and social skills training program, conducted twice a week for two hours in groups of 20. Both groups completed the Iranian Active Aging Measurement Instrument before and one month after the intervention.

Results

The mean ages of participants in the intervention and control groups were 68.94 ± 7.27 and 67.13 ± 5.09 years, respectively. Training in communication and social skills led to a significant increase in the total score of active aging (98.18 ± 17.77) and its dimensions (mindfulness, active insight, physical-functional dynamics, interactionism, role-playing, and social participation) during the post-test stage compared to the pre-test (148.97 ± 13.19), (t = -25.87, p < 0.001) and the control group (1.101 ± 8.18), (t = 1.35, p = 0.18).

Conclusion

This study contributes valuable evidence supporting psychosocial interventions for active aging. To advance this field, further research should focus on the long-term impact, cultural adaptability, and multimodal strategies that comprehensively address physical, cognitive, and social domains.

Introduction

The global population of older adults is on the rise, attributable to increased life expectancy and decreased mortality rates. Data indicates that in 2020, there were 727 million individuals aged 65 and older worldwide, a figure anticipated to exceed 1.5 billion by 2050 [1]. Concurrently, Iran is undergoing significant demographic transformations, with forecasts suggesting that the proportion of the older population will reach between 25% and 30% by the year 2030 [2, 3]. By 2050, individuals aged 65 and older are projected to constitute 21.7% of the Iranian population [4]. In response to this challenge, numerous countries have endeavored to make the older adult period more active by mitigating the negative consequences associated with demographic shifts [3]. Active aging is recognized as a crucial element in reducing the incidence of disability and morbidity among the elderly population [5]. The World Health Organization (WHO) defines active aging as the process of maximizing opportunities for the health, participation, and safety of older adults, thereby improving their overall quality of life [6]. The goal of active aging is to empower older adults to become active participants in their healthcare. Therefore, comprehensive and precise planning is essential for enhancing active aging [7].

Aging can impair communication due to illness, neurological issues, or physical decline [8]. Beyond its social impact, aging also affects cognitive function, which influences how individuals communicate [9]. As the aging grows, this can lead to consequences such as physical frailty, loneliness, isolation, reduced social support, decreased ability to perform daily activities, and diminished communication skills. These challenges can result in reduced active participation of older adults in society and diminished their social roles, ultimately disrupting social development and overall health [10–13], while imposing significant costs and financial burdens on older adults, their families, and the healthcare system [14].

Social participation in various aspects of life such as social, professional, and family interactions is crucial for active aging [15]. Quality of life for older adults is closely tied to their ability to maintain independence in daily activities, especially in social interactions [16]. Effective communication plays a key role in enabling social participation and is essential for active aging [17], yet many older adults struggle to communicate effectively, particularly in noisy environments [18–20]. Communication difficulties can pose significant barriers for older adults in accessing healthcare services and addressing health concerns effectively. Healthcare providers should recognize and understand the specific communication needs of older patients to ensure effective interactions [21, 22].

Various researchers have implemented and evaluated active aging programs in different countries, such as active aging programs in nursing homes in Spain [23], facilitating an active old age through Danish co-creation initiatives in Denmark [24], green care informal learning program in Italy [25], promotion of active aging through artificial agents in Portugal [26], video games designed to promote active aging in Spain [27], the e-VITA project in Europe [28], the RESILIEN-T in Italy [29]. Moreover, Agustí et al. (2023) reported that the levels of physical activity, functional skills, frequency of use of social and health services, and physical-emotional state are predictive variables of health satisfaction among active older adults in Spain [30]. The goal of these programs is to enhance the well-being of older adults and to investigate factors associated with active aging, such as physical and cognitive function, nutrition, and quality of life. This is achieved by improving social communication skills, which enable them to adapt their communication strategies to various situations [31].

Communication and social skills can be learned, practiced, and integrated for use in social, clinical, and healthcare settings [32]. By recognizing older populations as a valuable resource, the population aging can be seen as more than just a social and economic burden; it can be viewed as a valuable social asset. Aging can be a stage of productivity characterized by lifelong personal growth and development. Older adults have their potential to actively address community challenges, meet their own needs, and maintain independence [33]. However, research on the impact of communication and social skills training on active aging in Iran remains limited. Given the importance of active aging and the limited research on interventions to improve it, further studies are needed to investigate active aging from the perspective of older adults and to develop strategies to promote active aging and address future challenges. This study aimed to investigate the effect of communication and social skills training on the active aging of older adults.

Methods

Design and participants

This quasi-experimental trial with randomized allocation and equivalent groups was conducted in two daycare centers for older adults in Kerman, Iran. There were three daycare centers in Kerman and one of them was not participated in the research because it provided nursing and rehabilitation services, counseling, health education, and physical check-ups to the elderly at home. The selected daycare centers offered various programs, including counseling, health education, physical check-ups, recreational activities, thanksgiving, yoga, and social events (reading poems and books, listening to music, watching films, and exercising). While there was no gender restriction for membership in the daycare centers, the majority of older adults were women. The study lasted from August 2023 to February 2024.

Sample size and sampling

The study population consisted of 200 older adults from the two mentioned above centers. The sample size was calculated according to a previous study [34] and the sample size formula. Considering the parameters of α = 0.05, test power of 80%, and a moderate effect size (Cohen d = 0.5), a sample size of 40 was required for each of the intervention and control groups. Participants were randomly assigned 1:1 to the intervention or control group using a computer-generated random number sequence (via https://www.random.org/). To ensure balanced allocation across centers, randomization was performed separately for each center. To minimize selection bias, an independent researcher (not part of the study team) generated the randomization sequence and maintained allocation concealment using sealed, opaque envelopes. This process resulted in 80 participants (40 per group), with equal representation from each center (20 intervention and 20 control participants per center). Recruitment concluded when we reached our predetermined sample size target that provided adequate power while allowing for rigorous intervention implementation and outcome assessment. To minimize assessment bias, trained research assistants who were blinded to group allocation conducted all outcome measurements. Participants were instructed not to discuss their group assignments during the assessments. The randomization key remained concealed from both assessors and analysts until the completion of data collection and primary analyses. Figure 1 illustrates the CONSORT diagram of the study.

Fig. 1.

CONSORT flow diagram of participant recruitment, allocation, follow-up, and data analysis

Inclusion criteria included the ability to communicate and complete a questionnaire or respond to an interviewer (by self-declaration), absence of mental illness or psychoactive drug use (by self-declaration), willingness to participate, and familiarity with mobile technology and social media such as telegram and WhatsApp (by self-declaration). Exclusion criteria included substance abuse or dependency that could affect participation or adherence to the program (by self-declaration or observable behavior). Simultaneous engagement in comparable programs: individuals who are currently participating in alternative interventions designed to enhance communication or social skills to mitigate potential confounding effects. Non-availability for Follow-up: participants who plan to relocate or are unavailable during the study and follow-up assessments. Living in institutionalized settings or under legal guardianship, where daily routines, support systems, and communication dynamics differ significantly from those of community-dwelling older adults [35].

Data collection instruments

The study used a two-part questionnaire to collect data. The first part, demographic information, included questions about age, gender, marital status, living arrangement, education, employment, income level, chronic diseases, type of chronic diseases, health insurance, and number of children.

The second part used the Iranian Active Aging Measurement Instrument (IAAMI). The IAAMI, developed by Mohammadi et al. (2018), is rooted in the Iranian cultural understanding of active aging, which emphasizes both objective and mental dimensions. This measure consists of 40 expressions organized into six factors, demonstrating strong validity and reliability. In contrast to other measures, that predominantly focus on objective and behavioral aspects while overlooking the mental dimension, this approach is specifically designed for the Iranian elderly community and acknowledges the importance of the mental dimension of active aging alongside objective-behavioral factors. Structural validity, assessed through exploratory factor analysis, revealed that the final measure includes 40 questions across six subscales: socialization (particularly social-institutional participation) (4 item), mind exercise (6 item), interactivity (7 item), active insight (7 item), role-playing (8 item), and physical-functional dynamics (8 item), explaining 56% of the total variance in active aging. Each item is rated on a 5-point Likert scale (1 to 5). The IAAMI has a maximum score of 200 and a minimum score of 40. A higher score indicates a more active aging style. Based on these parameters, a score of 40 to 93 is considered unfavorable active aging, 94 to 147 is considered relatively favorable active aging, and 148 to 200 is considered favorable active aging. The IAAMI’s validity and reliability were established in a sample of 350 Iranian older adults. The validity was assessed using the content validity ratio and the content validity index, with a total content validity index of 0.90. Face validity was confirmed through expert and senior reviews of the scale’s clarity, simplicity, appearance, and grammar, and construct validity was verified using exploratory factor analysis. Reliability was demonstrated by a Cronbach’s alpha coefficient of 0.88 and a test-retest with correlation coefficient of 0.95 [36].

Intervention

A senior geriatrics nurse and an associate professor from the department of Community Health Nursing at Razi School of Nursing and Midwifery, Kerman University of Medical Sciences, conducted an intervention program at daycare centers for older adults. Before the first training session, all participants provided their written informed consent and received instructions on how to complete the questionnaires. In cases where individuals were unable to read or write, the researcher conducted interviews and filled out questionnaires on their behalf. For these individuals, fingerprint impressions were utilized as a substitute for signatures to document informed consent in the presence of a witness, thereby ensuring that ethical standards and participant autonomy were maintained. One month after the intervention, the researcher contacted both the intervention and control groups to complete the questionnaires.

The intervention group received an eight-session in-person communication and social skills training program, with sessions conducted in groups of 20 participants twice a week for two hours. The educational content was delivered by two researchers who were a senior geriatrics nurse and an associate professor (JF and MHK). The training methods included a mix of theoretical and practical elements such as lectures and tutorials, PowerPoint presentations, case reports sharing, video clips and short movies, audio-visual materials, films, role-playing, group discussions, and questions and answers. Participants and their caregivers (for illiterate older adults) also received an educational brochure covering communication and social skills, personal and family interactions, and follow-up strategies. Table 1 indicates the training content. The research team utilized existing resources, including literature review [17, 37–51] and the guide to improving the lifestyle of older adults, proposed by the Ministry of Health and Medical Education of Iran [52]. The program was developed collaboratively by medical, and educational professionals, and social workers and validated by two geriatricians and experts in social and communication skills at Kerman University of Medical Sciences. The first face-to-face training session played an important role in increasing participants’ willingness to learn the impact of social and communication skills training on active aging.

Table 1.

Themes covered in the communication and social skills training program

Sessions	Main topic	Content
1, 2	Communication and social skills	-Providing theoretical training in communication skills for older adults, which includes: -The role of communication in daily life, common communication barriers, different communication styles and their effectiveness, verbal and non-verbal communication techniques, and interpersonal communication skills. -Effective communication with older adults, managing caregiver’s stress and its impact on interpersonal relationships, expressing needs and concerns effectively (older adults and caregivers). - Establishing eye contact, speaking clearly and at a suitable pace, using simple language, prioritizing key points; repeating important information, encouraging participation, and asking questions.
3, 4	Regular meeting for older adults to interact and discuss topics of interest Formation of a peer group for reminiscing and collaborative activities Identification and coordination with local community centers for older adults	-Regular meetings for older adults to interact, discussing topics, and forming peer groups for reminiscing and collaborative activities. -Visiting local community centers for older adults. -Conducting educational needs assessments through group discussions, covering topics such as: Facts about aging and its biological and social aspects, comparing the body’s current state to its past. -Development of necessary skills like emotional expression, empathy, self-control, decision-making, ability to assert and reject, change in behavior, and protection of rights against others.
5, 6	Organizing meetings between young people to facilitate communication and share experiences	-Bringing together young people and older adults for communication and shared experiences, training and encouraging the use of social networks to improve personal and social relationships, which include: -Addressing stigma and improving communication and social skills among older adults. -Promoting intergenerational learning to reduce anxiety and increase self-confidence in using technology. -Fostering a cooperative learning environment to improve social relations, creativity, and knowledge exchange. -Using experience-based learning to share experiences, opinions, and expectations.
7, 8	Organizing joint activities between kindergartens and older adults	-Bringing together kindergartens and older adults for joint activities like making paper flowers, playing, and fostering effective interaction to strengthen interpersonal relationships among older adults. -Acquiring mentor roles to guide children, share knowledge, teach cultural traditions, improving self-confidence, self-acceptance, and self-respect through social interaction and appreciation, and overcoming fears of interacting with younger people and avoiding self-absorption. -Conducting storytelling sessions with older adults using objects to aid in recalling memories, strengthening social interaction, reducing emotional loneliness, improving quality of life, promoting positive attitudes toward the future, and enhancing the sense of purpose in older adults.

Each training session was divided into three phases: (a) an introductory phase, (b) an experiential phase, and (c) a final evaluation phase. Due to potential cognitive challenges, the educational content was repeated throughout the sessions. The researchers provided emotional support to older adults, including active listening, reassurance, and encouragement. Older adults and caregivers could ask any questions they had through phone or virtual platforms like WhatsApp and Telegram. Weekly phone calls were conducted to assess progress and schedule the next session. Follow-up evaluations after the final session allowed for ongoing nursing care and psychological support. Phone calls reinforced the educational content and monitored participants’ active aging and progress. The researcher encouraged older adults to use social networks such as Telegram and WhatsApp in order to provide educational videos available to them. The control group received routine care, including counseling, health education, physical check-ups, recreational activities, thanksgiving, yoga, and social events. To prevent information sharing, the groups were kept separate throughout the study. We also asked older adults to limit interactions with those outside their designated group to isolate the effects of the intervention and control conditions. Furthermore, other methodological precautions were recommended to minimize potential bias, such as treating both groups equally and measuring outcomes objectively. To ensure ethical compliance and educational fairness, the control group was managed as a waiting list control group. All control group participants received the full educational content after final data collection, to ensure fairness and reduce any harm to this vulnerable group.

Data analysis

Data were analyzed using SPSS27. Descriptive statistics (frequency, percentage, mean, and standard deviation) were used to summarize the data. The Kolmogorov-Smirnov test assessed normality, while chi-square (or Fisher’s exact test) and independent samples t-tests were used to compare demographic variables between groups at baseline. Independent samples t-test was used to compare active aging scores between groups before and after the intervention, and paired t-test was used to compare scores within each group. Cohen’s d was calculated to assess effect size, and a significance level of ≤ 0.05 was used.

Results

Demographic information

Of the 80 participants, 76 older adults completed the study. Four participants were dropped out (two participants from the control group and two from the intervention group) due to unstable physical conditions (acute changes in vital signs and hospitalization), lost to follow-up, failure to attend more than two sessions, and incorrect responses (with a response rate of 95%). The mean ages of participants in the intervention and control groups were 68.94 ± 7.27 and 67.13 ± 5.09 years, respectively. In addition to reporting age as a continuous variable, we categorized age into four groups (60–65, 66–70, 71–75, and > 75 years) to facilitate comparisons between the intervention and control groups. This approach was adopted due to the non-normal distribution of age and the relatively small sample size, which limited the statistical power of parametric tests on continuous variables. The selected age bands represent clinically meaningful categories commonly used in geriatric research and helped ensure adequate subgroup sizes for analysis. The groups were comparable in terms of demographic characteristics (P > 0.05) (Table 2).

Table 2.

Comparison of baseline demographic and clinical characteristics between two control and intervention groups

Variables		Categories	Intervention (n = 38)	Control (n = 38)	Statistical test	P-value b
			n (%)	n (%)	X 2a
Age groups	60–65		16 (42.1)	18 (47.4)	6.67	0.08
	66–70		7 (18.4)	10 (26.3)
	71–75		5 (13.2)	8 (21.1)
	> 75		10 (26.3)	2 (5.3)
Gender	Female		34 (89.5)	34 (89.5)	0	1
	Male		4 (10.5)	4 (10.5)
Marital status	Single		4 (10.5)	2 (5.3)	2.09	0.35
	Married		18 (47.4)	24 (63.20)
	Widowed		16 (42.1)	12 (31.6)
Place of residence	Apartment		11 (28.9)	11 (28.9)	0	1
	Home		26 (68.4)	26 (68.4)
	Hospice		1 (2.6)	1 (2.6)
Living situation	Single		11 (28.9)	10 (26.3)	1.33	0.72
	With wife		20 (52.6)	20 (52.6)
	With other relatives		7 (18.5)	8 (21.1)
Education	Illitrate		8 (21.1)	8 (21.1)	11.31	0.74
	Elementary/lower secondary		8 (21.1)	5 (13.1)
	Diploma		19 (50)	20 (52.7)
	Bachelor		3 (7.9)	5 (13.2)
Employment status	Self-employed		0	1 (2.6)	12.34	0.33
	Retired		16 (42.1)	17 (44.7)
	Unemployed		0	2 (5.3)
	Houswife		22 (57.9)	18 (47.4)
Income Level ($)	> 2.63		0	4 (10.5)	5.58	0.23
	1.97–2.63		14 (36.8)	11 (28.9)
	1.31–1.97		20 (52.6)	21 (55.3)
	0.65–1.31		3 (7.9)	2 (5.3)
	> 0.65		1 (2.6)	0
Chronic disease	Yes		25 (65.8)	18 (47.4)	2.62	0.10
	No		13 (34.2)	20 (52.6)
Type of chronic disease	Cardiovascular		15 (60)	10 (55.6)	5.80	0.4
	Musculoskeletal		10 (40)	8 (44.4)
	Hearing/vision		5 (20)	3 (16.7)
	Pulmonary/asthma		6 (24)	4 (22.2)
	Digestive		7 (28)	5 (27.8)
	Metabolic		9 (36)	6 (33.3)
	Renal/urinary		3 (12)	2 (11.1)
	Reproductive		1 (4)	1 (5.6)
	Central nervous system		2 (8)	1 (5.6)
	Cancer		1 (4)	1 (5.6)
	Other		2 (8)	2 (11.1)
Insurance	Social security		19 (50)	11 (28.9)	7.08	0.06
	Healthcare services		15 (39.5)	26 (68.4)
	Others		3 (7.9)	1 (2.6)
	No insurance		1 (2.6)	0
Number of children	1–2		5 (13.2)	7 (18.4)	6.94	0.07
	3–4		20 (52.6)	27 (71.1)
	5–6		10 (26.3)	4 (10.5)
	> 6		3 (7.9)	0

^aChi-square/fisher exact test

^bP-values are significant at a level of ≤ 0.05

Outcomes

Comparison of changes in the aging active

The following analysis compares changes in active aging scores between intervention and control groups before and after a targeted training program, shedding light on the impact of such programs on older adults’ engagement levels. Table 3 presents the levels of active aging and subscale scores for both the intervention and control groups before and after the training program. Initially, there was no significant difference in the scores of active aging between the intervention (98.18 ± 17.77) and control groups (103.84 ± 15.18). Active aging scores of both groups were at a relatively favorable level (94–147) based on the aging active questionnaire scoring (t =−1.49, p = 0.14).

Table 3.

Comparing active aging scores and its dimensions between the intervention and control groups in the pretest and posttest stages

	Time	Pre-test	Post-test
Variables	Groups	M ± SD a	M ± SD a	Within group differences	ESb (Cohen d)	P- value c
Total active aging	Intervention	17.77 ± 98.18	13.19 ± 148.9	50.78	3.24	< 0.001
	Control	15.18 ± 103.84	8.18 ± 101.10	2.73	0.22	0.18
	P-valued	0.14	< 0.001
	ESb (Cohen d)	0.34	4.36
Mindfulness	Intervention	3.95 ± 13.36	3.9 ± 20.63	7.26	1.85	< 0.001
	Control	3.67 ± 14.71	3.15 ± 14.05	0.65	0.19	0.24
	P-valued	0.13	< 0.001
	ES* (Cohen d)	0.35	1.85
Active insight	Intervention	3.97 ±18.42	3.5 ± 27.07	8.65	2.31	< 0.001
	Control	4.50 ± 19.5	3.85 ± 19.86	0.36	0.08	0.55
	P-valued	0.27	< 0.001
	ESb (Cohen d)	0.25	1.95
Physical-functional dynamics	Intervention	4.22 ± 19.47	3.53 ± 30.71	11.23	2.88	< 0.001
	Control	5.49 ± 18.78	4.34 ± 17.15	1.63	0.32	0.14
	P-valued	0.54	< 0.001
	ESb (Cohen d)	0.14	3.42
Interactionism	Intervention	4.55 ± 18.65	2.99 ± 27.13	8.47	2.2	< 0.001
	Control	4.92 ± 19.68	2.95 ± 18.97	0.71	0.17	0.39
	P-valued	0.34	< 0.001
	ESb (Cohen d)	0.21	2.74
Role-Playing	Intervention	4.6 ± 18.6	3.93 ± 27.86	9.26	2.16	< 0.001
	Control	5.51 ± 20.28	3.81 ± 20.71	0.42	0.09	0.65
	P-valued	0.15	< 0.001
	ESb (Cohen d)	0.33	1.84
Social participation	Intervention	3.09± 9.65	2.72 ± 15.55	5.89	2.02	< 0.001
	Control	3.29 ± 10.86	2.26 ±10.34	0.52	0.18	0.08
	P-valued	0.10	< 0.001
	ESb (Cohen d)	0.37	2.08

Bold P-values are significant at a level of ≤ 0.05

^aSD, Standard deviation, and M, Mean

^bES, Effect size, and ES of 0-0.2 = small effect, ES of 0.2–0.5 = moderate effect, ES of > 0.5–0.7 = large effect, and ES of > 0.7 = very large effect

^cPaired t-test

^dIndependent t- test

After the training program, the intervention group (147.97 ± 13.19) showed a significant increase in the score of active aging compared to the control group (101.1 ± 8.18), with a large effect size (Cohen d = 4.36, t = 19, p = < 0.001). Furthermore, the intervention group’s subscale scores of active aging improved after the training program, with effect sizes ranging from 1.85 to 3.24, indicating a favorable level of active aging (148–200) based on the questionnaire.

The total mean aging score remained relatively stable in the control group, with no significant difference between the pre-test (103.84 ± 15.18) and post-test (101.1 ± 8.18) scores. Participants in the control group maintained a relatively favorable active aging level throughout the study (Table 3).

An ANCOVA was conducted to account for potential pretest effects. The results revealed that the significant increase in active aging among the intervention group was due to the communication and social skills training (Table 4).

Table 4.

Result of analysis of covariance for the two groups of control and intervention

		Type III sum of square	Df	Mean square	F	P-value
Active aging score	Intercept	12410.88	1	12410.88	183.79	< 0.001 a
	Before intervention	3993.26	1	3993.26	59.13	< 0.001
	Group	46821.44	1	46821.44	693.4	< 0.001
	Error	4929.28	73	67.52
Mindfulness	Intercept	454.14	1	454.14	56.35	< 0.001
	Before intervention	342.41	1	342.41	42.48	< 0.001
	Group	990.83	1	990.83	122.94	< 0.001
	Error	588.32	73	8.05
Active insight	Intercept	688.74	1	688.74	75.37	< 0.001
	Before intervention	338.05	1	338.05	3699	< 0.001
	Group	1123.51	1	1123.51	122.95	< 0.001
	Error	667.04	73	9.13
Physical-functional dynamics	Intercept	1820.46	1	1820.46	122.76	< 0.001
	Before intervention	76.37	1	76.37	5.15	0.02
	Group	3400.13	1	3400.13	229.29	< 0.001
	Error	1082.49	73	14.82
Interactionism	Intercept	1704.78	1	1704.78	203.13	< 0.001
	Before intervention	42.68	1	42.68	5.08	0.02
	Group	1300.30	1	1300.30	154.94	< 0.001
	Error	612.63	73	8.39
Role-Playing	Intercept	1365.05	1	1365.05	118.25	< 0.001
	Before intervention	269.47	1	269.47	23.34	< 0.001
	Group	1121.53	1	1121.53	97.15	< 0.001
	Error	842.68	73	11.54
Social participation	Intercept	370.4	1	370.4	106.62	< 0.001
	Before intervention	212.33	1	212.33	61.12	< 0.001
	Group	627.52	1	627.52	180.62	< 0.001
	Error	253.61	73	3.47

^aBold P-values are significant at a level of ≤ 0.05

Discussion

This study examined the effect of communication and social skills training on active aging in older adults. Our findings indicated that the training program significantly enhanced the level of active aging, shifting participants in the intervention group from a relatively favorable to a favorable status. While these results underline the importance of such interventions, it is crucial to critically contextualize them. Consistent with the results of the present study, several studies reported the effectiveness of educational interventions on active aging in older adults [53–55]. Our improvements align with the findings of Ying-Chen Chi et al. (2021), who reported sustained benefits from a cross-disciplinary intervention over 19 weeks, our study did not evaluate long-term outcomes [55]. However, a study by de Souto Barreto et al. (2021) revealed that multidomain interventions had minimal effects on functional health and social participation among older adults. This finding suggests that not all intervention models are equally effective, particularly when participant motivation and program adherence are low. The study conducted an intervention that relied heavily on self-guided online participation, with limited interpersonal interaction and real-time social support [56]. Notably, their program may have lacked culturally adapted content and a clear focus on social skills. These are key features of our intervention and may explain the stronger outcomes we observed. In contrast, our study likely benefited from having facilitators, peer support, and culturally relevant materials. These aspects could have contributed to enhancing the motivation and the interest of the participants. The gap in results could be explained by the differences in the delivery of the programs as well as by the variances in the supervision and motivation. On the whole, this evidence shows the importance of integrating social interaction and organized support. This approach may be more effective than fully web-based formats, especially for older adults with limited digital skills.

Our program’s delivery method emphasized interpersonal interaction. Participants described the daycare centers as familial spaces. Hsu et al. (2019) found that person-to-person interventions led to improved adaptation and coping compared to digitally assisted methods [57]. While our findings align with this research, we did not conduct a direct comparison, which limits our ability to make conclusive recommendations. Czaja et al. (2018) demonstrated the potential of technology-based interventions to enhance social connectivity and reduce loneliness among older adults [58]. Furthermore, the approach utilized by Czaja et al. [58] emphasized independent technology use, which provided limited opportunities for structured social interaction. In contrast, we combined digital skills training with emotional and social support. This gave participants immediate opportunities for connection and reinforcement—elements that are essential for sustaining behavioral change. Future studies should compare different delivery formats and use hybrid methods that match participants’ preferences and technological skills, in order to increase generalizability.

Our study found improvements in mindfulness dimensions within the intervention group, supporting the notion that enhanced mental health promotes health-responsible behaviors. However, we did not directly measure variables such as self-efficacy or perceived health threats, which are central to behavior modification models like the Health Belief Model (HBM) and Social Cognitive Theory (SCT). These constructs could have been assessed using validated scales. For instance, the General Self-Efficacy Scale (GSE) could be employed to evaluate confidence in health behavior change, while the Perceived Susceptibility/Severity Scale (derived from HBM) could assess risk perception [59, 60]. Within the HBM framework, perceived threats and self-efficacy serve as catalysts for action. SCT also highlights self-efficacy in sustaining behavior change [61]. The literature supports these psychological components as catalysts for active aging [62]. Two studies demonstrated that utilizing stress management techniques and coping skills significantly improved mental health, mindfulness, and social participation [63, 64]. These enhancements highlight the significance of mental and social engagement in promoting overall well-being. Recognizing health risks (a key part of HBM) can motivate self-care, which is crucial as individuals age. Additionally, strong family connections and good mental health, both emphasized in SCT, help older adults to adopt and maintain health-promoting behaviors [65]. Future research should incorporate these theoretical mediators to clarify their mechanistic roles in mindfulness-based interventions. Choi et al. (2014) found that problem-solving therapy delivered via telehealth resulted in short-term reductions in depressive symptoms; however, it did not lead to long-term improvements in social engagement or mindfulness [66]. Similarly, Lenze et al. (2022) reported no significant long-term cognitive benefits from mindfulness or exercise interventions over an 18-month period [67]. One possible explanation for these null findings is that these studies may have lacked culturally adapted content. Additionally, they did not explicitly address communication, social interaction, and emotional support, which are distinctive components of the present intervention.

Our study significantly enhanced older adults’ active insight, improving their ability to critically evaluate life experiences and apply the lessons learned. This enhancement likely stemmed from educational sessions focused on problem-solving, emotional expression, and intergenerational dialogue, with intergenerational activities further enriching participants’ perspectives. Our findings align with those of Dumitrache et al. (2017), who reported that reflective thinking, cognitive stimulation, and structured group activities enhance older adults’ adaptability, resilience, and cognitive function [68]. These outcomes underline the importance of structured group activities. However, research by Wang et al. (2022) indicates that such interventions necessitate intrinsic motivation and community support to achieve lasting behavioral change [69]. Our participants were already relatively socially active and cognitively capable, which may have enhanced the effectiveness of the intervention. These differences in the study population, the nature of social engagement, and the methodological approach likely account for the variation in results. This suggests that, in addition to structured training, creating opportunities for ongoing peer interaction and meaningful engagement is essential.

Our results showed that there was a significant improvement in the domain of physical-functional dynamics. This enhancement may be attributed to the motivational and behavioral activation effects of the training. The communication techniques taught during the sessions, including verbal and non-verbal expression, assertiveness, and stress management, can indirectly enhance self-care and functional autonomy. Previous research supports the notion that psychological engagement and enhanced social functioning positively contribute to the physical capabilities and independence of older adults [70–73].

Our study significantly enhanced older adults’ social participation and role-playing capacities. The integration of information and communication technology is increasingly recognized as a vital enabler of active aging. By teaching older adults to use internet-based tools such as WhatsApp and Telegram, the program empowered participants to access health information, engage in cognitive activities, and maintain ongoing connections with family and friends. These digital tools extended communication opportunities beyond the classroom, supporting peer interaction and continuity of social engagement. Complementing the digital component, role-playing activities such as storytelling, mentoring younger generations, and sharing cultural experiences offered participants meaningful opportunities to assert identity, express themselves, and reinforce intergenerational ties. These outcomes are consistent with prior research indicating that both structured social involvement and digital literacy significantly contribute to improved mental health and active aging [8, 74, 75]. However, Goodarzi et al. (2023) found that while low to moderate levels of online social participation reduced loneliness among older adults, high levels of online engagement could intensify feelings of loneliness, suggesting a U-shaped relationship. This indicates that excessive reliance on online interactions without adequate offline social participation may not yield the desired benefits and could potentially exacerbate feelings of isolation. They also find that the impact of social participation modes varies considerably between younger and older groups [76]. While our study proved effective among relatively healthy and socially active older adults, its generalizability to more vulnerable or digitally inexperienced populations remains uncertain. This implies that online tools are to facilitate, rather than to completely substitute in-person interactions. Our participants used digital tools purposefully and under guidance, which mitigated the risk of isolation. In contrast, Goodarzi et al. [76] examined unstructured, independent online usage. This difference likely contributed to the variation in outcomes. These findings confirm that digital interventions are most effective when combined with interpersonal interaction and structured support.

The review of these studies reveals both consistent themes and key differences. The discrepancy between results of the above-mentioned studies and the present study can be due the differences in community, sampling method, participants’ previous skills, study design and educational content, data collection tools and conditions. The results highlight practical implications for improving the active aging of older adults through interventions, and future research. Healthcare providers should develop integrated communication and social skills training healthcare service to promote active aging of older adults.

Strengths and limitations

The study offers several strengths. One of the key strengths is the group-based educational program designed to enhance healthy living, social participation, and active aging among older adults. Furthermore, the intervention program was developed collaboratively by medical, educational professionals, and social workers to address the specific needs of the community.

Despite these strengths, several limitations should be considered when interpreting the findings. First, the results were specific to older adults in two daycare centers in southeastern Iran, and contamination between two groups may have affected the results. Despite efforts to reduce contamination, differences in results between the groups suggest that the intervention was still effective. Second, the majority of participants (89.5%) were women, which may limit the generalizability of the results. Other variables such as relationships between children and the older adults, experiences with or without children were not examined. Third, the evaluation relied on self-reported measures and the short duration of the intervention may not capture long-term effects of the intervention on active aging indicators. Further research is needed to explore the lasting impact of the intervention. Fourth, the study focused on older adults attending daycare centers in Kerman, which may limit the generalizability of the results to the broader Iranian older adult population. Fifth, while our sample size met power requirements, larger studies may be needed to detect smaller effect sizes and enhance generalizability. However, the educational content was tailored for Iranian older adults, providing a starting point for adapting the program to different populations. While the program may have modest impact on some outcomes due to these limitations, it serves as an initial step in evaluating the effectiveness of communication and social skills training in promoting active aging across cultures.

Conclusion

This study provides valuable evidence supporting communication and social interventions aimed at promoting active aging. The intervention, which emphasized facilitator-guided support, significantly improved participants’ active aging status by enhancing mindfulness, social connectedness, and stress management. The findings suggest that integrating digital literacy with real-world social activities not only enhances participation but also prevents over-reliance on technology. Therefore, it is recommended that this model be implemented in elderly day care centers and senior centers as part of community-based aging support strategies. The results highlight that increased interpersonal engagement, structured group activities, and the integration of culturally adapted educational content are key elements in fostering psychological, functional, and social well-being among older adults. Predictors such as enhanced social affiliation, emotional support, and functional autonomy are essential contributors to health satisfaction and the likelihood of healthy active aging. The expanded use of such interventions, supported by longitudinal research and comparative studies can facilitate sustainable active aging and promote behavioral change across diverse aging populations.

Abbreviations

IAAMI

Iranian Active Aging Measurement Instrument

HBM

Health Belief Model

SCT

Social Cognitive Theory

GSE

General Self-Efficacy Scale

Authors’ contributions

MHK, SAM, and JF contributed to conceiving and designing the research. The data were collected, analyzed, and interpreted by MHK, SAM, HM, and JF. MHK, SAM, HM, and JF contributed equally in writing and revising the manuscript and approved. All authors have read and approved the final manuscript.

Funding

This research received no specific grants from any funding agency in the public commercial or not-for-profit sectors.

Data availability

The data are available upon request to the corresponding author after signing appropriate documents in line with ethical applications and the decision of the ethics committee.

Declarations

Ethics approval and consent to participate

The present study (No. 402000189) was approved by the Ethics Committee of Kerman University of Medical Sciences (IR.KMU.REC.1402.204). All steps and procedures adhered to the Declaration of Helsinki and the Committee on Publication Ethics (COPE). Necessary permissions were obtained from study settings. At the beginning of the study, all older adults provided written informed consent to participate. Participants were assured of confidentiality and voluntary participation with the right to withdraw from the study at any time without consequences.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.