Ageing and conditions for active and healthy living: perceptions of older adults across diverse socio-environmental contexts in a Brazilian municipality

Background Population ageing in Brazil poses significant challenges to promoting quality of life among older adults, requiring intersectoral responses that address their multidimensional needs. Despite normative advances, persistent barriers continue to limit the effectiveness of strategies aimed at ensuring the rights of older people. Incorporating participatory approaches that value older adults’ perceptions, expectations and demands is therefore essential, particularly in territories marked by socio-spatial inequalities that shape living conditions and ageing experiences. This study aimed to analyse older adults’ perceptions of the ageing process and the conditions required for a healthy and active life across different socio-environmental contexts in a Brazilian municipality. Methods This qualitative, descriptive and exploratory study was grounded in the Bioecological Theory of Human Development. It was conducted in Santo André, São Paulo, across two contrasting territories: a central urban area and a peripheral area with low urban connectivity. A total of 44 individuals aged 60 years and over participated (mean age 71.0 years, SD 6.4; range 60–85), recruited with support from the Family Health Strategy. Data were collected between 21 and 30 June 2022 using the Nominal Group Technique, including discussion and prioritisation of elements related to ageing and healthy living, as well as perceived barriers and facilitators. Data were transcribed, thematically organised and interpreted in light of the theoretical framework. Results Five themes emerged: (1) body, immediate relationships and well-being; (2) interactions between family, community and services; (3) institutional and social structures; (4) cultural and symbolic values; and (5) temporal and historical dimensions of ageing. Family, autonomy, self-care, spirituality and social support were central across both contexts. Territorial differences were evident: in the urban area, ageing was associated with adaptation and access to services despite structural barriers, whereas in the low-connectivity area, perceptions emphasised functional decline, isolation, limited transport and reduced state presence, alongside strong reliance on family and community networks. Conclusion Perceptions of ageing are shaped by interactions between individual, social, territorial and institutional factors. The findings highlight the need for territorially sensitive, intersectoral actions that address inequalities and promote autonomy, participation and dignity in ageing.