Holistic well-being of older adults as a multidimensional system based on life experiences in the context of urban Indonesia

Abstract

Objective

The framework for healthy aging is still largely normative and developed in the context of high-income countries, thus failing to capture the life experiences of older adults in middle- and low-income countries. This study aims to explore the meaning of holistic well-being in Makassar City, shaped in accordance with the local urban context of Indonesia.

Method

This study used a qualitative approach with in-depth interviews of 45 participants consisting of older adults and older adult cadres selected using purposive sampling in 15 sub-districts in Makassar City. Data were analyzed using thematic analysis with MAXQDA 2024 software.

Results

This study identified a hierarchical model of holistic well-being comprising eight dimensions organized into four functional layers: Enabling Conditions (Functional Physical Well-Being, Financial Security), Engagement Pathways (Social Participation, Productive Engagement, Lifelong Learning Engagement), Mediating Core (Spiritual Life Orientation, Family-Centered Happiness, Social Embeddedness), Subjective Outcome (Psychological Serenity and Emotional Regulation).

Conclusion

This study offers an empirically grounded, contextually situated understanding of well-being among older adults in an urban Indonesian setting, extending existing frameworks by foregrounding lived experience and relational interdependence.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s12877-026-07864-2.

Introduction

Within the UN Decade of Healthy Ageing (2021–2030), the global population aged 60 years and over is projected to increase by 34%, rising from 1 billion in 2019 to 1.4 billion. By 2050, the global population of older individuals will more than double to 2.1 billion [54]. By 2025, the WHO states that 900 million people aged 60 or over will live in developing countries [14, 34]. Population aging is recognized as a complex and multifactorial issue that goes beyond individual health concerns and encompasses significant social, economic, and environmental dimensions [13, 15, 57, 58].

Traditional interventions for older adults well-being still predominantly emphasize biomedical indicators and only view well-being as freedom from disease, physical function, and clinical outcomes [49, 52]. This study is in line with the global policy framework of the Decade of Healthy aging (2021–2030), which emphasizes the importance of facilitating older people to maintain their functional abilities through supportive environments, integrated care, and increased community participation throughout the life cycle [20, 28, 48].

Furthermore, well-being in old age is understood as a static state that must be achieved [27]. Although there are currently many healthy aging frameworks, they are still normative, top-down, and mostly developed in high-income countries [8, 24]. The space to incorporate the lived experiences of older adults as they are felt is limited in existing frameworks because they focus only on policy standards [12, 62]. As a result, empirical evidence capturing how older adults themselves interpret and give meaning to well-being in their daily lives is still scarce.

This gap is particularly evident in urban contexts in low and middle-income countries, such as Indonesia, which is strongly influenced by collective cultural values [22, 45]. This study aims to explore the meaning of holistic well-being as shaped by the local context of Makassar City.

Methods

Study design

A qualitative approach was used in this study. It then explored a deep understanding of the life experiences, perceptions, and meaning-making processes of older adults regarding the concept of well-being, older adults' participation in social communities, and the potential application of the social prescription model in Makassar City [6]. To enhance methodological transparency and accuracy, this study follows contemporary qualitative reporting guidelines and best recommendations for thematic analysis [9, 41]. The qualitative approach in this study is the initial stage for developing interventions that are sensitive to the local context. This technique will enable the development of an intervention framework rooted in the narratives and interpretations of the older adults [39].

Study setting

This research was conducted in Makassar, a coastal metropolitan city in Eastern Indonesia that serves as the economic, cultural, and transportation center of South Sulawesi province. The city is characterized by rapid urbanization, high population density, and strong spatial social heterogeneity, making it a relevant context for studying the welfare of older people in a complex urban environment. As shown in Fig. 1, the city area covers a dense urban core, a rapidly developing peri-urban zone, and small island communities in the Sangkarrang archipelago. We took the visualization results from the coordinates of the research locations in 15 sub-districts in Makassar City using Google Maps. These coordinate data were then processed and analyzed using Q-GIS software (Version 3.20), a geographic information system used to determine the research location [33].

Fig. 1.

Spatial distribution of study setting across the subdistricts of Makassar

Inclusion and exclusion criteria

Prior to data collection, participants were selected based on predetermined inclusion and exclusion criteria to ensure that those recruited represented the target population and had experience relevant to the research objectives. The complete inclusion and exclusion criteria are presented in (Table 1).

Table 1.

Inclusion and exclusion criteria for participants

Category	Inclusion Criteria	Exclusion Criteria
Age	Aged ≥ 60 years	Aged < 60 years
Residence	Resided in Makassar City for at least the last 1 year	Did not reside in Makassar or resided there for < 1 year
Cognitive Status	Able to communicate verbally well and give informed consent	Experienced severe cognitive impairment that hindered the interview process
Social involvement	Has experience interacting within the family and/or community	Does not have social experience relevant to the research focus
Time availability	Willing to set aside time for interviews/FGD	Unwilling or withdraws from participation

Participant recruitment

Purposive sampling was used to recruit older adults and health cadres who could provide in-depth information relevant to the research objectives. This approach was chosen to ensure that participants had direct experience of the aging process in the local context of Makassar City and were able to reflect on issues related to well-being, social participation, family life, and community support. The recruitment process was carried out through direct contact with older adults health cadres in 15 sub-districts. They were then given a research information sheet explaining the study objectives, data collection procedures, ethical considerations, and an explanation of participant rights.

Community health cadres were included as contextual informants rather than co-equal participants in well-being meaning-making. Their narratives served a triangulating function to verify, contextualize, and enrich findings derived primarily from older adult participants. Accordingly, all core analytical claims about the meaning of well-being are anchored in older adult quotations; cadre data is used only to corroborate or provide observational context for patterns identified in older adult narratives.

Data collection

Data collection was conducted through in-depth interviews to obtain more detailed information about the participants experiences, perceptions, and processes of interpreting the well-being of the older adults. The interview guide was compiled based on the research objectives and a review of literature related to holistic well-being, aging, and community-based interventions. Data collection continued until thematic saturation was reached, defined as the point or code at which no further conceptual insights emerged. We conducted three interviews namely, male elderly, female elderly, and elderly cadres representing each sub-district. Data collection was carried out between July and August 2025. All interviews were conducted in Indonesian and recorded with the participants' consent, lasting approximately 15–30 min.

Data analysis

Qualitative data was analyzed using a thematic analysis approach to explore patterns of meaning in depth while considering the context. The interview recordings were transcribed verbatim. The transcripts were read repeatedly to gain a comprehensive understanding of the data. Initial coding was then carried out inductively, based on the participants' narratives without using predetermined theoretical categories. The initial codes were then compared, refined, and grouped into broader categories. These categories were then developed into initial themes. Data analysis was performed using MAXQDA 2024. Eight dimensions were identified (Fig. 2) following repeated and reflective thematic analysis. Open coding produced 124 substantive codes that were inductively induced by the participants' narratives. The process then produced 26 codes in conceptual categories through constant comparison between interviews. Based on repeated team discussions and pattern identification, these were then abstracted into eight high-level themes representing the dimensions of holistic well-being in older adults.

Fig. 2.

Overview of holistic well-being framework

Discrepancies were resolved through discussion in fortnightly debriefing sessions attended by all six authors. A structured codebook was maintained throughout. Thematic saturation was operationalized as the point at which three consecutive interviews yielded no additional codes; this threshold was reached at the fifth interview, with three additional interviews conducted across geographically distinct sub-districts (Sangkarrang, Mamajang, and Ujung Pandang) to confirm transferability across varied urban contexts.

Researcher reflexivity and trustworthiness

To enhance credibility, triangulation was employed. The principal investigator focused on healthy aging, supported by the diverse expertise of several other researchers (psychology, biostatistics, healthy cities, and behavioral science). Debriefing sessions were held among research team members to review coding consistency and theme development. We also conducted member checking with both participants and relevant stakeholders.

Result

Participant characteristics

This study involved 45 participants consisting of older adults and community-based older adult cadres. This mix of informants allowed for the exploration of firsthand experiences of aging and the community's perspective on supporting older adults' well-being. The older adult participants (n = 30) ranged in age from 60 to 80 years, with a mean age of 67.8 years (SD ≈ 5.9). The minimum age for inclusion as an older adult participant was 60 years, consistent with the WHO definition of older adults. The community health cadres (n = 15) ranged in age from 25 to 57 years. Across all 45 participants, the overall age ranged from 25 to 80 years, with a mean age of 60.7 years. Participants ranged in age and included both men and women. To maintain confidentiality, each informant was given an anonymous code. A summary of the participants' characteristics is presented in Table 2.

Table 2.

Participant characteristics

No	Initials	Subdistrict	Position/As	Gender	Age	Code
1	HA	Manggala	Older Adult	M	72	(I1, L/72)
2	JS	Manggala	Older Adult	F	69	(I2, L/69)
3	WI	Manggala	Community Health Cadre	F	43	(I3, KL/43)
4	NS	Mamajang	Older Adult	F	75	(I4, L/75)
5	AS	Mamajang	Older Adult	M	79	(I5, L/79)
6	FI	Mamajang	Community Health Cadre	F	35	(I6, KL/35)
7	AS	Tamalanrea	Older Adult	M	62	(I7, L/62)
8	NA	Tamalanrea	Older Adult	F	70	(I8, L/70
9	S	Tamalanrea	Community Health Cadre	F	51	(I9, KL/51)
10	H	Bontoala	Older Adult	M	67	(I10, L/67)
11	R	Bontoala	Community Health Cadre	F	47	(I11, KL/47)
12	SD	Bontoala	Older Adult	F	65	(I12, L/65)
13	HU	Ujung Tanah	Older Adult	F	61	(I13, L/61)
14	BA	Ujung Tanah	Older Adult	M	68	(I14, L/68)
15	NA	Ujung Tanah	Community Health Cadre	F	57	(I15, KL/57)
16	HR	Panakukkang	Older Adult	F	74	(I16, L/74
17	KM	Panakukkang	Older Adult	M	63	(I17, L/63)
18	AR	Panakukkang	Community Health Cadre	F	55	(I18, KL/55)
19	HB	Wajo	Older Adult	M	74	(I19, L/74)
20	HS	Wajo	Older Adult	F	67	(I20, L/67)
21	JA	Wajo	Community Health Cadre	F	57	(I21, KL/57)
22	RI	Tallo	Community Health Cadre	F	50	(I22, KL/50)
23	AR	Tallo	Older Adult	M	80	(I23, L/80)
24	HI	Tallo	Older Adult	F	64	(I24, L/64)
25	AS	Biringkanaya	Older Adult	F	63	(I25, L/63)
26	AA	Biringkanaya	Older Adult	M	63	(I26, L/63)
27	FA	Biringkanaya	Community Health Cadre	F	50	(I27, KL/50)
28	IA	Mariso	Older Adult	M	68	(I28, L/68)
29	JH	Mariso	Older Adult	F	60	(I29, L/60)
30	DN	Mariso	Community Health Cadre	F	25	(I30, KL/25)
31	HE	Rappocini	Older Adult	M	63	(I31, L/63)
32	AA	Rappocini	Community Health Cadre	F	50	(I32, KL/50)
33	PI	Rappocini	Older Adult	F	61	(I33, L/61)
34	MK	Sangkarrang	Older Adult	F	71	(I34, L/71)
35	MM	Sangkarrang	Older Adult	M	68	(I35,L/68)
36	HM	Sangkarrang	Community Health Cadre	F	55	(I36, KL/55)
37	MJ	Tamalate	Older Adult	F	65	(I37, L/65)
38	SP	Tamalate	Older Adult	M	72	(I38, L/72)
39	MS	Tamalate	Community Health Cadre	F	44	(I39, KL/44)
40	JJ	Makassar	Older Adult	M	66	(I40, L/66)
41	IM	Makassar	Older Adult	F	67	(I41, L/67)
42	RD	Makassar	Community Health Cadre	F	43	(I42, KL/43)
43	MJ	Ujung Pandang	Older Adult	M	68	(I43, L/68)
44	WU	Ujung Pandang	Community Health Cadre	F	33	(I44, KL/33)
45	NH	Ujung Pandang	Older Adult	F	70	(I45, L/70)

Overview of holistic well-being among older adults

The findings indicate that the well-being of older adults is not a single condition. Rather, it is a multidimensional condition with interrelated aspects. Thus, we found eight dimensions in Fig. 2, namely Spiritual Life Orientation of Older Adults, Social Embeddedness of Older Adults, Family-Centered Happiness, Functional Physical Well-Being of Older Adults, Productive Engagement of Older Adults, Lifelong Learning Engagement of Older Adults, Psychological Serenity and Emotional Regulation of Older Adults, and Financial Security of Older Adults.

In these dimensions, we found that older adults are active subjects in holistic well-being. Specifically, these dimensions are formed from several indicators based on empirical data. The indicators in Fig. 3 are the results of thematic analysis that reflect the life experiences, meanings, and daily activities of older adults.

Fig. 3.

Dimensions and indicators holistic well-being

In tandem with this, we then grouped these indicators into a conceptual structure that reflects their functional role in the life experiences of older adults. We grouped them into supporting conditions, engagement pathways, mediating core dimensions, and subjective outcomes.

Enabling conditions

Functional physical well-being of older adults

Physical well-being is a functional dimension that forms the basis of holistic well-being. This dimension is not only seen as freedom from illness but also reflects the ability of older people to remain active, independent, and involved in daily life.

“I am happy when I have my health check-ups… everyone comes to the health center because it is considered enjoyable and beneficial” (I2, L/69). “I am happy because I am always healthy” (I9, KL/51).

shows that bodily function is the foundation upon which emotional and social well-being can be built. These findings suggest that physical health is a driver for other dimensions.

Financial security of older adults

Financial security is the second key condition in the framework of holistic well-being, creating a sense of stability, peace of mind, and the ability of older people to participate meaningfully in daily life. Our findings state that financial security is a form of emotional security characterized by freedom from worry, certainty, and assurance that basic needs will be met. We identified three indicators: Family-Provided Financial Protection, Debt-Free Financial Peace, and Intergenerational Financial Support. One informant stated that

“...it is forbidden to work with children because later the children will give their income” (I20, L/67).

Some older adults described their children as providing regular financial assistance, a claim supported by statements.

“Yes, happy, because the child always gives money, but it is forbidden to work with the child because the child will provide the income” (I20, L/67).

This is reinforced by the statement of the cadre:

“Happy because there are no worries about debts...” (I44, KL/33).

These findings indicate that financial security operates as a crucial facilitating condition that underpins other dimensions of holistic well-being.

Engagement pathways

Social participation of older adults

Social participation is the active role of older adults in shaping their own well-being. There are three indicators that we found in this study, namely community participation, perceived social safety and comfort, and meaningful social interaction.

Several informants stated:

“…..besides that, we gather with friends and neighbors, joke around with friends. If you ask me, we each have our own happiness” (I10, L/67) and “Gathering with friends and I have many friends here” (I28, L/68).

Our findings illustrate how social gatherings serve as a daily source of emotional support. Social participation confirms older adults' desire for recognition and involvement in community life, which holds deep significance for them.

Productive engagement of older adults

Productive engagement is the ability of older adults to remain useful and engage in meaningful activities. When they participate in productive activities, these become sources of enjoyment, identity, and emotional satisfaction. We identified three interrelated indicators: meaningful recreational engagement, everyday productive activity engagement, and skill-based productive activities. Informants stated that participating in recreational activities, such as travel, brought them happiness and stress relief.

“I like working, walking alone” (I23, L/80), while others described tending to plants as a personally meaningful activity (I43, L/68). source of personal satisfaction for the older adults.

Productive household activities such as tending to plants and doing chores are a source of personal satisfaction for the older adults.

“It really lets me unwind and makes me feel happier” (I3, KL/43).

Lifelong learning engagement of older adults

The ability of older adults to maintain curiosity, adaptability, and a sense of relevance in their lives in old age. According to informants, learning is not viewed as a formal activity limited to a certain age but rather as a continuous process that can be implemented in everyday life. We found four main indicators, namely participatory health education activities, caregiver-focused health education, faith-based learning communities, and senior learning programs for empowerment. One of the informants in our study stated that.

“…happy when their health is checked. Especially when they are told that there will be a health check, everyone brings them to the health center, which is well attended because it is considered enjoyable and beneficial” (I21, KL/57).

“The more skills given to the elderly, the better.” (I1, L/72)

This finding reflects the elderly’s positive orientation toward continuous learning and skill acquisition as part of active and meaningful aging.

“Those who were not understood before became understood” (I13, L/61)

Mediating core

Spiritual life orientation of older adults

This dimension is a central mediating dimension interpreted through their living conditions, regulating emotions and building a sense of meaning in later life. In this dimension, we found acceptance, gratitude, inner peace, and continuous contribution to others. We found generative contribution, religious community engagement, inner peace and worldly detachment, and spiritual acceptance and surrender. Informants.

The importance of being useful to others is being emphasized.

“...we can be useful, bring happiness, and impart knowledge, especially to family, neighbors, and the surrounding

community. In addition, we will be happy if we can be useful and beneficial and

impart knowledge to the entire community...” (I1, L/72)

Learning in religious activities is also often followed by parents as a form of spiritual well-being, such as reading the Qur'an or attending majelis taklim (religious gatherings). One informant explained that.

“...They also participate in other activities such as religious gatherings and reciting the Quran, where they feel happy because they are still active and able to do things. But if you look at it, the most dominant activity is indeed the religious gatherings...” (I3, KL/43)

Ultimately, spiritual acceptance and surrender are forms of emotional resilience.

“...enjoy facing it. I mean, we accept everything with sincerity” (I18, KL/55).

Learning activities among older adults contribute to self-improvement and enhance their sense of competence and confidence.

Family-centered happiness of older adults

Family relationships are central to the emotional well-being of older adults. We identified three indicators: emotional comfort through family presence, family-based emotional fulfillment, and relational priority of family. Some older adults stated that the physical and emotional presence of their children and grandchildren was a major source of happiness and peace of mind. One older adult described how regular visits from children and grandchildren create a sense of joy in their daily lives.

Family-based emotional fulfillment was expressed by the older adults in our study as playing with and caring for their grandchildren.

“I’m happy because I’m healthy, I have no complaints, and I live with my children and take care of my grandchildren, such as their school uniforms.” (I41, L/67).

The priority of family relationships is strongly emphasized because older adults often place family above other sources of happiness. One older adult stated,

“Being with family is the most important thing” (I10, L/67).

“…and then I always have children and grandchildren coming to my house, because I have four children, three of whom are married so they no longer live with me, but my grandchildren often come to visit me too…” (I44, KL/33).

“Of course, what makes the older adults happy is gathering with their children, in-laws, and grandchildren…” (I32, KL/50).

Social embeddedness of older adults

A sense of belonging is built not by the number of social contacts and frequency of interactions, but rather by the quality of interpersonal relationships, feelings of acceptance, and the perception of being part of a meaningful social world. There are three interrelated sub-themes: perceived social security and comfort, meaningful social interaction, and relational continuity. Many participants stressed that feeling recognized and emotionally secure in their environment is vital to their well-being. Meaningful social interaction further strengthens this sense of belonging.

“We also always hold the values of sipakalebbi , sipakatau , sipakainge, so we don't only respect the rich or the poor, but we all value them equally.” (I2, L/69)

This statement is confirmed by the following informants:

“If we get together, the time will be relaxing, after all, if we are alone, many thoughts can be stressful.” (I26, L/63)

Participants often described casual conversations, shared laughter, and spontaneous gatherings as emotionally healthy experiences. Participants described feeling more comfortable when surrounded by people who knew their personal history, values, and life stories. This continuity reduced the need to constantly explain themselves and allowed them to be socially ‘understood’ without effort.

Subjective outcome

Psychological serenity and emotional regulation of older adults

Emotional security, spiritual grounding, and social appreciation support the tranquility experienced by older adults. Older adults often emphasize that tranquillity arises when they feel emotionally supported, spiritually grounded, and socially appreciated. For example, expressions of tranquility are often embedded in stories about being listened to by family members, participating in community activities, or engaging in religious reflection.

Above all, serenity is also linked to a redefinition of success in old age. Participants no longer define success in terms of economic achievement or social status but in terms of emotional stability, meaningful relationships, and inner peace.

“We are grateful for what it is. Feeling happy with what we have.” (I17, L/63)

“I am a relaxed person and not burdened with negative thoughts.” (I10, L/67)

This shift reflects a qualitative transformation in how well-being is evaluated throughout the life cycle. From a functional perspective, psychological serenity serves as an internal stabilizer within the broader well-being system. When participants experience peace of mind, they are better able to cope with health limitations, financial worries, and interpersonal conflicts.

“Don't like to be frustated, always tell stories with family, children, and grandchildren.” (I19, L/74)

The informants' narratives clearly show that psychological calmness does not stem from a single dimension of holistic well-being, even though psychological calmness is considered the subjective pinnacle of holistic well-being. Physical capacity, financial stability, active involvement, spiritual orientation, family relationships, and social involvement lead to calmness. Consequently, the next section will discuss how these dimensions are interrelated and how they form the overall structure of holistic well-being, as illustrated in Fig. 4.

Fig. 4.

Interconnectedness of d,imensions

Discussion

The findings indicate that the well-being of older adults in Makassar City is not merely a singular condition but is shaped by various interconnected factors encompassing physical, financial, social, spiritual, and familial dimensions, as identified through the lived experiences of participants [60]. This hypothesis extends existing theories on healthy aging from the WHO, which places the well-being of older individuals solely on functional abilities such as meeting basic needs, staying active, building relationships, learning, and continuing to contribute, all of which are greatly influenced by the environmental context and social support [50, 56]. Despite this, the UN Decade of Healthy Ageing 2021–2030 agenda also places older adults at the center of change, focusing on age-friendly environments, integrated services, and community support to maintain functional abilities [55].

Taken together, the eight dimensions found in this study show that older adults are active actors who consciously manage their social needs, such as social participation, meaningful productivity, lifelong learning, and meaning-making to achieve psychological well-being [17]. The perspective of older adults as actors here is consistent with the strengthening of the contemporary older adult health paradigm, which views well-being as the result of a relational and cross-contextual process that has outputs that are not only clinical, especially in the framework of the Decade of Healthy Ageing research, which places the social and community environment as core components [7, 26, 57, 58]. In the context of middle- to low-income urban countries, these findings are increasingly important because social conditions and access inequalities (services, public spaces, support networks) can strengthen or weaken certain dimensions of well-being. This approach is in line with the WHO's social determinants of health framework, which emphasizes the role of social structures and inequalities in shaping health and well-being experiences [54].

Enabling conditions as a structural foundation

Functional physical well-being of older adults

In the functional physical well-being dimension in the older adults in this study, informants stated that health is a source of happiness. The older adults understand that physical health is a way to maintain organ function so that they can avoid various diseases. These findings are in line with studies conducted by [5, 29] in China, which stated that physical activity among older adults is positively related to their quality of life, especially in terms of mental health. Research [40, 63] shows that walking interventions in older adults communities can reduce frailty and improve cognitive function and quality of life in the older adults, while research conducted [44] shows that most older adults programs related to physical activities such as aerobics and traditional sports significantly improve the quality of life and mental health of the older adults.

Financial security of older adults

This study also found that financial security for older adults includes not having to work as a form of care from their children, not having debt or economic problems, and receiving financial support from their children. This study is in line with research conducted in Turkey [11] that poverty and economic limitations are associated with increased symptoms of depression and decreased quality of life in older adults. This information is confirmed by research conducted in France, which found that various forms of financial pressure (debt, difficulty meeting basic needs, money worries) are consistently associated with depression in the older adults [2, 18, 43].

Engagement pathways

Social participation of older adults

Our findings show that social participation among older adults is not only viewed as a formal activity but also as a daily relational practice that maintains emotional balance [32]. Informal interactions such as interacting with neighbors, attending religious gatherings, or participating in community routines [21, 25, 42] Older adults describe involvement in social life as dependent on their ability to remain present and accepted in social spaces [3, 50, 61].

Productive engagement of older adults

This study also found a dimension of participation in productive activities. This finding is in line with research conducted by [59], which found productive patterns among older adults, namely working, caring, and contributing to the community, as well as several patterns related to their well-being. Another study [1] shows that productive activities carried out by older adults, such as helping their families or communities in their neighborhood, play an active role in eliminating loneliness or feelings of isolation among older adults.

Lifelong learning engagement of older adults

The dimension of lifelong learning in this study is illustrated by the participation of older adults in Makassar City in activities such as seminars, counseling, other educational activities, health education for families and caregivers, religious gatherings and recitations as places of learning, and schools for older adults as a means of learning and empowerment, which are forums for learning to maintain cognitive function. Mapping of the lifelong learner program among the older adults was also conducted in the study [36] and showed its benefits for cognitive function, emotional support, and social inclusion. These findings are in line with research showing that seniors who participate in lifelong learning programs at the Osher Lifelong Learning Institute have higher cognitive reserves and more successful aging compared to seniors who do not participate. Meanwhile, research conducted by [51] shows that senior participation in non-formal education can improve quality of life, senior welfare, and cognitive function.

Mediating core

Spiritual life orientation of older adults

In the first aspect, namely spiritual needs and inner peace, it appears that older adults in Makassar City are active in participating in spiritual activities such as recitation of the Quran, religious gatherings, and improving the quality of worship as a way to calm their hearts and accept their condition in old age. The results of this study are supported by research showing that spirituality in the older adults is associated with lower symptoms of depression and anxiety and can improve the quality of life of the older adults [30]. Religion- and spirituality-based practices can also strengthen mental and psychosocial health, especially when facilitated in the form of community-based programs [46].

Family-centered happiness of older adults

Another dimension found in this study is family-centered happiness among the older adults. Research conducted in China states that families play an important role in the mental well-being support system for the older adults [10]. The results of the study show that family support is a source of peace when children and grandchildren visit often, and emotional support from family is the main source of happiness for the older adults in Makassar City.

Social embeddedness of older adults

This study also found a dimension of social connectedness for older adults, as demonstrated by participation in community activities, a safe and comfortable social environment, and interacting and gathering with friends. The results of this study are in line with [16] states that seniors who do not participate socially are 2.07 times more likely to experience depression than seniors who do participate socially. Other studies show that seniors who participate in social communities have a direct relationship with their life satisfaction, as well as reduced depression and improved cognitive function [35]. Older adults who live in communities with good security and high social trust are less affected by negative emotions and tend to have good mental health [31].

Subjective outcome

Psychological serenity and emotional regulation of older adults

The dimension of psychological well-being in this study includes the ability of older adults to control feelings of loneliness, avoid stress and conflict, feel calm and free of worries, and not be a burden to others. This is in line with the concept of psychological well-being in older adults, which emphasizes self-acceptance. A study conducted by [37] shows that high psychological well-being in older adults is associated with a reduction in symptoms of depression. Other findings reinforce these research results [38] describe good physical condition as being associated with higher psychological well-being and lower levels of depression.

Contextual meaning making in urban Indonesian ageing

The prominence of spiritual life orientation, family-centered happiness, and social embeddedness in the present findings reflects the deep integration of Islamic values and Bugis-Makassar cultural identity. particularly the ethical concepts of siri' (honor and dignity) and pesse (collective solidarity) in the everyday lives of older adults in Makassar City [4]. From an Islamic gerontological perspective, aging is understood as a spiritually privileged phase of life in which religious engagement, Quranic recitation, and participation in majelis taklim are not supplementary activities but constitutive expressions of living well [47], a view that challenges dominant biomedical frameworks which that tend to treat spirituality as an unmeasurable variable among the lowest globally [53]. In collectively oriented settings, well-being is constituted not through autonomy and self-sufficiency but through valued interdependence. expressed in the present study through practices of gotong royong (communal cooperation) and silaturahim (maintenance of relational bonds), which participants described not merely as activities that promote well-being but as the very medium through which well-being is experienced [23]. This collective orientation equally reframes the meaning of financial security in this context: receiving financial support from adult children was not experienced as dependency but as relational success. evidence of dutiful children fulfilling their obligations under both Islamic ethics (birrul walidain). Taken together, these contextual factors suggest that the model of holistic well-being identified in this study represents a form of valued interdependence that is irreducibly relational, spiritually grounded, and embedded in collective moral economies. This study extends existing healthy aging frameworks by demonstrating dimensions of well-being that are underrepresented in those developed in high-income, individualistic contexts [19].

Theoretical contributions to healthy ageing scholarship

The findings align with and extend existing frameworks by demonstrating relatedness to healthy aging based on the life experiences of older adults in urban contexts in the Global South. These findings differ from the WHO healthy aging framework, which prioritizes functional status. Our findings place psychological well-being as the end result that emerges from structurally supported and relationally mediated well-being. This research focuses on spirituality, family dependence, and social engagement, rather than biomedical optimization. It challenges the dominant paradigm and provides a contextual understanding of aging outside the context of high-income Western countries.

Conclusion

This study indicates that the well-being of older adults in the context of Makassar City, urban Indonesia, is a multidimensional, relational, and dynamic system. This study identified a hierarchical model of holistic well-being comprising eight dimensions organized into four functional layers: Enabling Conditions (Functional Physical Well-Being, Financial Security), Engagement Pathways (Social Participation, Productive Engagement, Lifelong Learning Engagement), Mediating Core (Spiritual Life Orientation, Family-Centered Happiness, and Social Embeddedness), Subjective Outcome (Psychological Serenity and Emotional Regulation). This study has limitations, including the restriction to Makassar City and its implications for transferability to rural settings, smaller cities, and other cultural contexts, Social desirability bias as a potential influence on responses regarding family relationships and religious observance, given the cultural centrality of these values in the Bugis-Makassar context, The relatively brief interview duration (15–30 min) is a limitation for deep qualitative inquiry, particularly for themes such as psychological serenity and social embeddedness, The methodological implications of including both older adults and health cadres in a single dataset, include the challenge of maintaining clear analytical boundaries between participant roles.

Authors’ contributions

Conceptualization: Mutia Nur Rahmah, Sukri Palutturi, Indra Fajawarti Ibnu, Stang, Veni Hadju, Ichlas Nanang Afandi Data collection: Mutia Nur Rahmah, Indra Fajawarti Ibnu Data analysis: Mutia Nur Rahmah, Stang, Ichlas Nanang Afandi Writing—original draft: Mutia Nur Rahmah Writing—review & editing: Sukri Palutturi, Indra Fajawarti Ibnu, Stang, Veni Hadju, Ichlas Nanang Afandi Cross-cultural adaptation supervision: Mutia Nur Rahmah, Sukri Palutturi, Indra Fajawarti Ibnu, Stang, Veni Hadju, Ichlas Nanang Afandi Scale development and theoretical framework: Mutia Nur Rahmah, Sukri Palutturi, Indra Fajawarti Ibnu, Stang, Veni Hadju, Ichlas Nanang Afandi.

Funding

This research received a research grant from the Ministry of Education, Culture, Research, and Technology, Indonesia with grant number 069/C3/DT.05.00/PL/2025.

Data availability

Data is provided within the manuscript or supplementary information files.

Declarations

Ethics approval and consent to participate

Informed consent was obtained from all individual participants included in this study. All participants were informed about the purpose of the study, their right to withdraw at any time, and the confidentiality of their data before providing written informed consent.

This study was conducted in accordance with the Declaration of Helsinki and all relevant national and institutional guidelines and regulations governing research involving human participants. Ethical approval was obtained from the Health Research Ethics Committee of the Faculty of Public Health, Hasanuddin University. Written informed consent was obtained from all research participants prior to data collection. All participants were informed about the purpose of the study, data collection procedures, their right to withdraw at any time without consequence, and the confidentiality of their personal information.

Consent for publication

This manuscript does not contain any identifying images, personal photographs, or personal clinical details of individual participants that could compromise participant anonymity. All participants were assigned anonymous codes to protect their identity.

Competing interests

The authors declare no competing interests.