Abstract
Background: In rapidly aging societies like Japan, socioeconomic status (SES) plays a critical role in shaping older adults' health behaviors. Disparities in SES influence access to healthcare, engagement in health-promoting activities, and the adoption of digital health technologies. This narrative review synthesizes current evidence on how SES affects health behaviors among older adults and highlights challenges in promoting equitable and sustainable healthcare in aging populations. Methods: A PubMed search was conducted for English-language articles published up to May 2025 using the keywords "socioeconomic status", "older adults", and terms related to health behaviors. Studies were included if they focused on individuals aged 65 or older and examined associations between SES and healthcare use, digital health, complementary and alternative medicine (CAM), supplements, or lifestyle behaviors. Results: A total of 24 articles were identified. Higher SES-typically measured by income, education, and occupation-was consistently associated with an increased use of preventive services, digital health tools, CAM, and healthier lifestyle behaviors such as diet, physical activity, and sleep. In contrast, lower SES was linked to healthcare underuse or overuse, digital exclusion, and less healthy behaviors. Structural and regional disparities often reinforce individual-level SES effects. Comorbidity burden and shifting health perceptions with age may also modify these associations. Conclusions: SES is a key determinant of health behavior in older adults. Policies should focus on redistributive support, digital inclusion, and SES-sensitive health system strategies to reduce disparities and promote healthy aging in super-aged societies.