Population aging is one of the topmost global successes, a reason to celebrate medical advancements, and social, economic, political, and health achievements in any society. Aging has attracted the attention of the world community as a significant demographic issue (1). According to the World Health Organization, the number of older adults will reach two billion by 2050, with about 80% of them living in less developed or developing countries (2). In Iran, it is predicted that people over 60 years old will make up 21.7 percent of the Iranian population by 2050 (3).

Aging leads to many individual and collective challenges, including increased number of people at risk of chronic diseases (4, 5), decreased physical activity, psychological and social vulnerability, and the health system difficulty in providing health care services (6). Aging will cause social, economic, medical, and health crises if not managed and prevented timely (7).

Active aging is one strategy to manage the increasing rate of old population and its complication (8) and is defined as the process of optimizing opportunities for health, participation, and security to enhance the quality of life as people age (9). The goal of active aging is to empower older adults to become active participants in their health care; therefore, comprehensive and precise planning is necessary to improve active aging (8).

Success in aging programs requires considering the viewpoints of policymakers and older adults, who are the biggest beneficiaries of active aging projects (10) because insufficient information can make any program ineffective (11). Furthermore, policies and programs for older adults should be based on their needs, preferences, and capabilities (9). A qualitative study is more suitable than a quantitative one to reach in-depth viewpoints and maximum data from the participants (12); individuals are the best source for describing their situations, needs, feelings, and experiences in a cultural context (13).

The concept of active aging has been used as a research direction in population studies and as a public policy tool over the last few decades, particularly since it was adopted by the World Health Organization to strengthen health, participation, security and lifelong learning as pillars of quality of life. The definition of active aging is a complex task as it is linked to different theories, built from multiple contents and their interactions, linked to other conceptual frameworks of aging (healthy, productive, successful and positive aging) and according to scientific strategies and the shaping public policies are implemented (14). Active aging in Iran is defined according to the cultural background and beliefs of the older adults: the process of individual and social existentialism that is manifested and realized through existential functionalism, management of home affairs, primary isolation, social participation, physical dynamic and vision dynamic-based learning. Therefore, the concept of active aging has both subjective and objective behavioral dimensions (15).

Active aging in society is defined with its indicators in Asian countries, including employment, social participation, independent living and active environment. The difference in societies is dependent on the active aging capacity of the older population in societies and the provision of age-friendly environments. To measure these indicators in Asian societies, the Asian active aging index (ASIAN AAI) is used to quantify the extent to which older adults enjoy active aging and can determine their potentials (16). Active aging programs are implemented in different countries as follows: a training program on active aging in Portugal (17), the active aging program in nursing homes in Spain (18), Green Care program in Italy (19), A national action plan for active and healthy aging in Scotland (20), Vital Aging program in Mexico (21), intergenerational programs to promote active aging in the UK (22), “I am active” in Mexico (23), Opportunities for the Elderly Project (OEP), Elder Academy Scheme and Neighborhood Active Aging Project in Hong Kong (24), and promoting active aging through university programs in Spain (25).

According to the perspective of active aging, aging is a lifelong approach that starts from the beginning of life and its determinants (needs) include health services, socioeconomic factors, physical environment (place of residence and living conditions), the social environment (formal and informal support networks) in the cultural context of people according to gender, race and ethnicity and other social determinants of health such as access to education, employment and health care (26).

The specific needs of older adults must be met to promote active aging, including physical, psychological, social, environmental, care and health-related needs (27, 28). Ashokkumar et al. (29) indicated that older adults had unmet needs such as adaptation to the living environment, hearing and vision problems, income, daily activities, physical diseases, close association, and self-care, while their therapeutic and medicinal needs were met by the caregivers (29). Various studies showed that many of the social, care, and health needs of older adults remained unmet (30, 31). Unmet needs leads to poor quality of life, dissatisfaction with the services provided, and an increase in care costs; therefore, identifying and meeting the needs of older adults can increase their quality of life and satisfaction (32). A systematic review on nine studies suggested limited studies on the needs of older adults in different countries, with physical and social dimensions being the most and least fulfilled needs, respectively, while the physical and social dimension, and psychological and environmental dimension being the most and the least unmet needs. These studies focused on quantitative methods (cross-sectional) and were carried out in Iran, Brazil, Germany, Thailand, Poland, the Netherlands, and England in 2000–2020. The Camberwell Assessment of Need for the Elderly (CANE) was used to assess met and unmet care needs (27). Qualitative studies can specify people's views and experiences more precisely than quantitative research because they enable participants to express themselves while providing data (12).

Considering the population changes and its consequences, Iran must set priority and plan for active aging based on needs (1, 33), but most studies focused on the health-related needs of older adults (32, 34) and did not address all needs of older adults in the Iranian culture and context (11), and there is no comprehensive qualitative study that examines their needs to achieve active aging from the perspectives of older adults and geriatric experts. Moreover, the literature does not sufficiently address qualitative approaches to identify these needs. More rigorous qualitative studies are essential to assess these needs in active aging programs in different contexts. Therefore, this study aimed to explore the active aging needs from the perspectives of older adults and geriatric experts within the culture and context of Iran.

Forty-one male and female participants, including 20 older adults and 21 geriatric experts were interviewed. Table 3 shows the demographic characteristics of the participants and Table 4 presents the profile of the participants.

Data analysis indicated three themes, including basic individual needs, managerial needs and educational needs with thirteen categories. The themes and categories with some exemplary quotes are shown in Table 5. We interviewed with older adults and geriatric experts to reach a shared perception of active aging and included the codes obtained from the perspectives of the older adults and geriatric experts in similar categories.

The current study aimed to explore the active aging needs from the perspectives of older adults and geriatric experts in Iran. The results of this study were classified into three themes: basic individual needs, managerial needs, and educational needs.

The basic individual needs were physiological, psycho-emotional, and spiritual needs in this study. Older adults experience different physiological needs depending on their age, ability level, and gender (37). According to the literature, most needs of older adults are interdependent (38), so improving physiological needs such as doing regular physical activities and exercise, eating a healthy diet, and sleeping sufficiently all have mutual impacts (39). Physiological needs should be considered when caring for older adults, including access to a balanced diet, a suitable living environment, adequate sleep, and appropriate activity (40). One study emphasized the fulfillment of physiological needs of the older adults (41). Lazarus et al. suggested that regular aerobic exercise met older people's physiological needs and improved their quality of life (42).

The current study found that fulfilled psycho-emotional needs increased motivation of older adults to be active. Several studies showed that meeting the basic psychological needs of older adults could predict their level of wellbeing such as increased compassion and kindness (43), emotional relationships, life satisfaction, mental strength, and vitality (44, 45). Older adults' quality of life and health level can be improved by meeting their basic psychological needs and increasing their motivations (44). Researchers reported numerous studies on the significance of the physical needs of older adults (46–48), which raised public awareness in society, but less attention has been paid to the psychological needs of older adults particularly when considering the role of these needs in achieving active aging (49).

Meeting the spiritual needs of older adults was an important factor in achieving active aging and their beliefs were essential in adapting to the challenges of aging (50); aging increases people's religious beliefs and desire to participate in spiritual rituals (51). According to the literature, the presence and involvement of older people in religious ceremonies and activities can reduce their stress from aging consequences (50), improve their life satisfaction (52), enhance their motivation to create and strengthen self-care behaviors, and subsequently improve their level of health and active aging (53). As a result, spiritual needs should be considered in active aging planning according to the religious context of Iran because spiritual health ensures the integrity of a person characterized by stability in life, peace, tranquility, harmony, and feeling of closeness to God, self, society, and environment.

The managerial needs in this study included political-legal, socio-economic, cultural-spiritual infrastructures, academic strategies, an age-friendly environment, technological services, specialized services, and daycare for older adults. The results of this research emphasize that some acts should be legislated for the rights of older adults as a vulnerable stratum. The government must provide supervisory authorities to deal with the complaints of older people, establish a telephone line as a communication bridge between older adults and the judicial and executive officers to report older adults' rights violations, implement educational programs at the departmental level to honor the older customers and employees, and facilitate applicable administrative processes to protect the rights of older adults (54). Gholipour et al. (55) also emphasized that the government should provide older adults with services to improve the quality of active aging services in a long time. Iran, like other countries, will face an increase in the population of older adults in the coming decades (55).

The study findings showed that the most important point was to create economic security for older adults through employment, the provision of living expenses and health insurance, and free care after retirement (56); many studies focused on employment in active aging programs and policies (57, 58). Therefore, more social support for older adults improves the level of social capital of individuals and related organizations (59). One of the most significant prolonged challenges will be the socioeconomic effects of old age. In Iran, some local activities are entrusted to older adults while involving them in the boards of directors, which will lead to their activity and participation in society and, as a result, the promotion of active aging (60).

Many studies considered older adults' spirituality and spiritual therapy to improve their quality of life and spiritual health, and reduce their anxiety and depression (61, 62). According to the findings, spirituality has a significant impact on one's overall health; thus, religion and spirituality are considered important sources of adaptation to stressful life events (63). As a result, it is imperative to note the beliefs, creeds, and spirituality of older people to promote active aging. One of the critical issues is the presence of a companion and spouse in older people' lives to actively participate in cultural-spiritual activities (64). This reduces the challenges of aging, increases happiness and motivation, and improves the level of physical, mental, and emotional wellbeing (65). Although older adults' remarriage faces many cultural and social obstacles and taboos, particularly in Iran (64), it is recommended to recognize and solve the existing obstacles because it is important in providing active aging and increasing the welfare of older adults. The spiritual viewpoint is only considered a tool in the world to treat disease, but it has a practical definition in Iranian society and culture, which can improve older adults' welfare.

With the corporeal, physical, psychological, and social changes associated with aging, it is necessary to modify and secure the environment for these people (66), so that adaptation to the environment around them is one of the practical components of active aging and leads to a better quality of life in older adults (57). Falling and its complications are one of the major problems for older people because of inadequate safety measures in physical space at home and in society (67), which can lead to mental injuries and worsen their anxiety, fear, social isolation, and, eventually, depression (68), so older people must change their living environments. However, the proportion between the physical conditions of older adults and the environment has not improved in Asian countries (69), so their homes and social spaces must match with each other (66). It is recommended that urban construction engineers use the research findings to provide the required infrastructure and fulfill the needs of older adults. The physical environment is unsafe when caring for older patients, so it is necessary to pay attention to the important role of physical safety in the care centers for the older adults (70).

Providing technological services for older adults was another category of managerial need in the present study. Learning digital technologies is one of the necessities of modern life and plays an effective role in meeting the daily needs of older people, so it is essential to train older people enough information in this field (71). Studies demonstrate that older adults' participation in social media is directly related to their physical and mental health because they remain connected to society, which is beneficial for promoting active aging (72, 73). The rate of acceptance of technology among older adults is noteworthy, but one of the most significant barriers is the difficulty in using some of these tools. Older adults can benefit from the advantages of technologies and be more active on the condition that the offered tools and programs are easy to use for them (74). Thus, older adults should be the target group of technology programmers and designers when designing and creating technologies to improve their abilities while using these tools (75).

Some caregivers provided specialized services and daycare for older adults, indicating that older adults required specialized advice and care services based on the severity of their dependence. Caregivers provide three types of daily services based on the needs of older adults: social services (meals, recreation, and other health-related activities); medical and health services (social activities and medical services), and professional measures (specialized services to older adults) (76). Aseyedali et al. (77) indicated that community-oriented programs, including daycare centers that focused on expanding family, helped older adults prevent their isolation and social exclusion (77). According to the literature, daycare services improve routine activities, life satisfaction, dependency levels, and activity levels in older adults (78), but families are not aware of such centers. Moreover, programs relating to the provision of daycare services may become unstable and reduce access to needed services as a result of a lack of support from policy-making organizations. Most of the integrated geriatric care is directed toward sick older adults, while the care and education of the healthy older people are neglected (79), so this issue should be addressed because it has the potential to reduce the societal costs and diseases while also improving the quality and satisfaction of life for older adults (80).

The educational needs were for three groups: older adults, health care workers, and family. Information about the levels of self-care and self-efficacy in older adults is one of the most important needs and indicators of their independence. Older people, like other groups, need access to information to remain active in society, make informed decisions, maintain and improve health levels, make the right choices, and have an active and effective life (81). Ong-Artborirak and Seangpraw (82) demonstrated that learning self-care and self-efficacy behaviors were critical aspects of a healthy lifestyle because people with high self-care behaviors prioritized their health care (82). Similar to the present findings, a study emphasized the role of empowerment programs in promoting self-efficacy in older adults' self-care behaviors (83). Therefore, older adults must learn self-care and self-efficacy skills to match themselves with old-age conditions and active aging (84).

Studies showed that nurses, who completed continuous education in geriatric nursing care, were more capable of providing care for older adults and had a more positive attitude toward their colleagues, had higher empathy skills, moral sensitivity (85), and communication skills (86). Salar and Ghaljaei (87) supported the current research findings and found that codified educational programs should be included in the agenda of health care workers (87). Many health centers have a passive approach to healthy older people due to the high workload and lack of trained personnel (88). Therefore, given Iran's growing older adult population and the importance of training and empowering staff providing services to older adults, detailed educational planning is required to certify health care workers by planners and nurse managers to achieve active aging (6).

Informing family members to take care of older adults and adapt to the challenges of aging at home can significantly improve older adults' health (93). Park et al. also demonstrated that using family-centered care and training family members in geriatric care and related diseases reduced anxiety, stress, and depression in older people and their families while increasing their proper communication with health care providers (89). Since the family is the most essential pillar of society and is responsible for providing correct and appropriate health care to the patient, the family needs an accurate understanding of the disease when caring for older adults. The family can provide the necessary knowledge, skills, and support to maintain the quality of home care for older adults (90). According to the findings of this research and Ris et al.'s study (91), health officials in health centers should hold training workshops with focus on family empowerment in active aging (91).

The study findings can be used in planning related to the older adults in Iran, including strategic planning. The researchers believe that any active aging program should be based on three foundations: (1) older people and development (participation), which focuses on social needs in order to adapt policies to it, and institutions consider the growth of the older population as an active force, (2) promotion of health and welfare with focus on the need and policies that promote health from childhood to the whole life so that they have a healthy life in old age, (3) insurance of the ability and environmental support (security) that promotes family and community-based policies and provides safe aging (92). According to the study participants, the dynamics of aging and active aging are affected by many interrelated factors such as individual, managerial and educational factors. Today, due to the growing aging population, a special attention should be paid to the phenomenon of aging with special needs. Governments and policymakers need to provide relevant infrastructure and programs and allocate sufficient resources for this purpose. The findings indicated sufficient awareness of the needs and tried to better understand the experiences of older adults and how they became more active in this period. Considering the importance of old age and the need to progress active aging in Iran with regard to specific cultural and religious values, providing special services (federal planning, community planning and family arrangement with environmental support) to this group can help to create suitable conditions for improving the active lifestyle of the older adults.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving human participants were reviewed and approved by the Ethics Committee of Isfahan University of Medical Sciences approved this study (Approval ID: IR.MUI.NUREMA.REC.1400.131). Written informed consent was obtained from the individual(s) and/or minor(s)' legal guardian/next of kin for the publication of any potentially identifiable images or data included in this article. The patients/participants provided their written informed consent to participate in this study.

SA-M was responsible for data collection and completed a draft report of the findings. SA-M, JF, and ME-B drafted the manuscript. All authors contributed to the revisions of the manuscript, read, and approved the final version of the manuscript for submission, are accountable for all aspects of the accuracy and integrity of the manuscript following ICMJE criteria, and contributed to the study conception, design, analysis, and interpretation of the data.