Objective <p>Guided by the World Health Organization’s (WHO) Age-Friendly Health Systems Model, this study explores the emergency department (ED) experiences and treatment adherence of adults aged 65 and older arriving by ambulance at a rural Turkish hospital, in a low-literacy, religious context.</p> Methods <p>This qualitative descriptive study used semi-structured interviews and culturally tailored emotion cards with 30 purposively sampled participants (mean age: 71.2, SD = 4.8; 53.3% female; 33% rural, 43% district center, 24% city center). Data were thematically analyzed using MAXQDA 2022, with in vivo and in vitro coding. Reliability was ensured via Cohen’s Kappa (0.90) and transcript verification; validity was supported by maximum variation sampling and data triangulation. The study adhered to the COREQ checklist.</p> Findings <p>Four themes emerged: ED access journey, treatment and adherence experiences, staff communication dynamics, and age-friendly service perceptions. Participants experienced an emotional arc from fear (88%) during ambulance transport to trust (76.7%) at triage and relief (92%) at discharge, supported by rapid triage, staff empathy, and family support, but challenged by navigational barriers and accessibility issues for disabled participants (23.3%). Cultural idioms (e.g., “I felt intense fear”) and the prayer-bead icon highlighted spiritual coping. Participants perceived rapid triage as enhancing feelings of safety, fostering trust.</p> Conclusions <p>Rapid triage and empathetic communication fostered trust and adherence, while navigational and accessibility barriers persisted. Findings advocate for culturally sensitive, age-friendly ED designs, offering scalable tools like emotion cards and triage protocols for rural healthcare equity globally, aligned with SDG 3.</p>