Sleep disturbances are highly prevalent among hospitalized older adults; however, data simultaneously evaluating insomnia, sleep quality, excessive daytime sleepiness (EDS), and obstructive sleep apnea (OSA) risk, particularly in Türkiye, remain scarce. This study evaluated the prevalence of insomnia, poor sleep quality, EDS, and OSA risk and identified factors associated with each outcome, with emphasis on potentially modifiable exacerbating factors. In this cross-sectional study, 400 patients aged ≥ 65 years hospitalized for ≥ 48 h in internal medicine and affiliated wards were enrolled. Insomnia was diagnosed according to ICSD-3 criteria. Sleep quality was assessed with the PSQI, EDS with the ESS, and OSA risk with the Berlin Questionnaire. Univariate and multivariable logistic regression analyses were used to identify factors independently associated with each outcome; multicollinearity was assessed with the variance inflation factor (VIF). Insomnia was present in 74.3
With advances in information technology and the widespread availability of online health resources, access to digital health information has become increasingly common. In this context, the ability of older adults to effectively access, evaluate, and use online health information has emerged as a critically important competence. Since the internet provides easy and often low-cost access to a wide range of information, older adults are increasingly using the internet for health-related purposes. This study aimed to examine the demographic, economic, and personal factors associated with online health information seeking behaviour among older adults in Türkiye. This study used the microdata from the Household Information Technology (IT) Usage Survey conducted by the Turkish Statistical Institute (TurkStat) in 2023 and 2024. Binary logistic regression analysis was performed. Compared with older adults surveyed in 2023, those surveyed in 2024 had lower odds of online health information seeking behaviour (AOR = 0.760; 95
Older adults with hip fracture place considerable physical and emotional strain on family caregivers, particularly during the early post-discharge period. This study aims to identify predictors of high caregiver burden within the first two weeks after hospital discharge among older adults with hip fracture. A retrospective observational cohort study was conducted in caregivers of older adults with hip fracture after hospital discharge at a university-affiliated tertiary care hospital in Thailand between November 2020 and September 2024. Caregiver burden score was assessed using the Short Zarit Burden Interview (ZBI-12), administered two weeks after hospital discharge with scores categorized into low and high burden using a cut-off of ≥ 13. The data included caregiver-related and patient-related data collected during hospitalization before discharge. Multivariable logistic regression identified predictive factors. A total of 185 caregivers of older adults with hip fracture were included; 64.86
Malnutrition is a common but often under-recognized condition in critically ill older adults. Age-related physiological decline, including reduced nutritional reserve and increased vulnerability to stress, may exacerbate its impact; however, data focusing specifically on elderly intensive care unit (ICU) populations remain limited. This study aimed to determine the prevalence of malnutrition and identify associated factors in critically ill elderly patients. We conducted a retrospective cohort study of patients aged ≥ 60 years admitted to the medical ICU, Faculty of Medicine, Chiang Mai University, Thailand, between 1 January 2022 and 31 December 2023. Malnutrition was defined using the Nutrition Triage 2013 (NT2013) tool. Multivariable logistic regression was performed to identify factors associated with malnutrition, reported as adjusted odds ratios (aORs) with 95
Older patients undergoing major non-cardiac surgery are particularly vulnerable to postoperative cardiovascular adverse events because of multimorbidity, reduced physiological reserve, chronic low-grade inflammation, and subclinical cardiovascular disease. Current perioperative risk scores, which rely mainly on conventional clinical variables, may not adequately capture occult cardiovascular vulnerability or geriatric vulnerability in this population. The MEPCOM study aims to investigate the association between preoperative oral microbiome and metabolome profiles and 30-day postoperative cardiovascular adverse events in high-risk older patients undergoing non-cardiac surgery, and to develop a non-invasive oral microbiome-based predictive model for perioperative cardiovascular risk stratification. This is a prospective, multicenter cohort study. We will enroll 2100 patients aged ≥ 60 years who are at high cardiovascular risk and scheduled for elective major non-cardiac surgery. Preoperative samples, including saliva, tongue coating and dental plaque, will be collected and analyzed using full-length 16S rRNA sequencing and untargeted metabolomics. Baseline clinical data, geriatric-related variables, oral health information, and perioperative characteristics will be collected, and patients will be followed up for 30 days postoperatively to record CVEs, defined as a composite endpoint including all-cause mortality, myocardial infarction, myocardial injury, stroke, heart failure, and others. Bioinformatics and integrated analyses will be conducted to explore the relationships between microbial/metabolite characteristics and CVEs. Machine learning algorithms, including random forest and LASSO regression, will be employed to construct a predictive model, with its discriminative ability, calibration, and clinical utility assessed using an independent internal validation set and an external validation cohort. The study has been approved by the Biomedical Ethics Committee of West China Hospital, Sichuan University on 9 September 2025 [Approval No. 2025 Review (1603)] as the primary ethical review authority. All participating centers will obtain approval from their respective local responsible ethics committees in compliance with relevant regulatory requirements. Written informed consent will be obtained from all participants. Results will be published in peer-reviewed international journals. Chinese Clinical Trial Registry, ChiCTR2500109657. Registered on 23 September 2025.
Coronary heart disease (CHD) is a lipid-driven inflammatory disease increasing in individuals. Lipoprotein(a) (Lp[a]) has an interdependence with systemic metabolism and inflammation to increase the risk of CHD. Our study aims to examine the coronary lesion and plaque characteristic in older CHD patients with elevated Lp(a) level by using untargeted metabolomics and proteomics assay. We included 285 consecutive individuals ≥ 65 years who took coronary artery CT scanning, collected blood samples and underwent percutaneous coronary angiography. After restricted exclusion, the enrolled age-matched individuals were randomly divided into two separated cohorts. For the testing cohort, plasma samples of 40 controls and 45 CHD patients were conducted with untargeted metabolomics and proteomics. Another validation cohort including 64 controls and 60 CHD patients was used to verify the link between differential plasma mediators and coronary stenosis and plaque characteristics. Compared with an averaged Lp(a) level of 98.9 nmol/L in controls with age ≥ 65 years, mean level of Lp(a) up to 188.4 nmol/L in age-matched CHD patients. The metabolome analyses revealed that differential plasma metabolites would be involved in the pathophysiological regulation of fatty acid transport, fatty-acid-CoA ligase and lipid transport related to lipid plaque progress. We found that plasma levels of β-Muricholic acid, 23-Nordeoxycholic acid, Docosahexaenoic acid, 7-Ketodeoxycholic acid, LPC (18:0) and LPA 16:1 were significantly altered in CHD group. Then proteomics assays showed positive immune response indicating by enhanced interleukin-18 (IL-18), immunoglobulin lambda joining 3 (IGLJ3) and immunoglobulin heavy variable 3 (IGHV3) levels in CHD patients compared to controls. Among these, β-muricholic acid, 23-nordeoxycholic acid, LPA 16:1 and IL-18 were correlated with coronary stenosis severity. Moreover, the levels of β-muricholic acid, IL-18 and IGLJ3 were associated with low-density noncalcified plaque burden in older CHD patients. We also observed plasma levels of β-muricholic acid, 23-nordeoxycholic acid, 7-Ketodeoxycholic acid and IL-18 altered in older CHD patients with chronic total occlusion (CTO) lesion. Our study demonstrated an altered profiling of plasma metabolites and proteins, and their correlation with coronary stenosis severity and plaque burden in older CHD individuals with elevated Lp(a) level, which may provide potential biomarkers in older CHD patients. Plasma metabolome and proteomics profiling was totally different in older CHD patients. Altered lipid-driven plasma metabolites and proteins were associated with coronary stenosis and plaque burden. Differential metabolites and proteins exhibited potential values linked to coronary stenosis severity and CTO lesion.
Distinguishing dementia severity is a major challenge in community-based geriatric assessment. Even though cognitive and motor impairments are related to dementia progression, how they jointly characterize dementia severity remains insufficiently understood. This cross-sectional study encompassed 103 community-dwelling older adults in Taiwan. Cognitive performance was measured using four serious game-based tasks targeting memory, attention, reaction speed, and logical reasoning. Upper-limb motor performance was evaluated using wearable sensor-derived upper-limb motor measures. Group differences between mild and moderate dementia were examined using Welch’s t-tests with false discovery rate (FDR) correction. Random Forest models were developed using cognitive, motor, and combined multimodal features. Model performance was evaluated using repeated stratified five-fold cross-validation with SMOTE-based class balancing. Fuzzy-set qualitative comparative analysis (fsQCA) identified cognitive–motor configurations associated with mild dementia status. After FDR correction, participants with mild dementia exhibited significantly better performance than those with moderate dementia across three cognitive tasks and multiple upper-limb motor features. Among the predictive models, motor-only and multimodal models exhibited comparable classification performance (AUROC = 0.700). Feature importance analysis was used to identify cognitive and motor variables among the top-ranked predictors. fsQCA revealed a cognitive–motor configuration comprising high TAKA composite performance and a high left shoulder abduction index related to mild dementia status (consistency = 0.92). The findings indicate that cognitive and upper-limb motor indicators offer complementary information for characterizing dementia severity. Integrating serious game-based cognitive assessment with wearable sensor-derived motor measures may offer a scalable and non-invasive approach to complement the characterization of dementia severity in community-based settings. Longitudinal and external validation is required before clinical application.
Older neurology outpatients may be at higher risk of potentially inappropriate medications (PIMs) due to multimorbidity and frequent use of central nervous system (CNS)-active drugs. This study assessed the prevalence of PIMs and the factors associated with PIM use among elderly neurology outpatients in China. A retrospective cross-sectional study was conducted using outpatient prescription data from older outpatients attending the neurology clinic of a tertiary hospital in China between January 1 and September 30, 2025. PIMs were evaluated in parallel using the 2023 American Geriatrics Society (AGS) Beers criteria and the 2017 Chinese PIM criteria. Multivariable logistic regression was performed to identify factors associated with PIM use, and concordance between the two criteria was assessed. A total of 5150 neurology outpatients were included. The prevalence of PIM was 44.31
This study aimed to ascertain the association between subjective well-being (SWB) scores and the cardiometabolic multimorbidity (CMM) risk, and evaluate the potential modifying effect of integrated healthy lifestyle scores among older Chinese adults. A prospective cohort study was designed based on Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2011to 2014. Participants aged ≥ 65 years and CMM-free at baseline were included. SWB was assessed using an 8-item scale covering three dimensions: life satisfaction, positive affect, and negative affect, and CMM was defined as the coexistence of two or more cardiometabolic diseases, including hypertension, diabetes, heart disease, and stroke. Hierarchical regressions based on modified Poisson regressions were performed to assess the association between SWB and CMM risk. Subgroup analyses were performed by individual healthy lifestyles and overlapping integrated healthy lifestyle scores. Sensitivity analyses were conducted to evaluate the robustness of the observed associations. Among 5,470 participants, 544 (9.95
Population aging is increasing worldwide, and adults aged 80 years and older represent a growing group with complex healthcare needs. Although healthcare access among older adults has been widely discussed, qualitative evidence focusing specifically on the experiences of adults aged 80 years and older remains relatively limited. This study aimed to explore healthcare access and care experiences among adults aged 80 years and older attending a Healthy Aging Center within a university-affiliated tertiary care hospital in Türkiye. This qualitative study included adults aged 80 years and older. Participants were recruited using purposive sampling to seek variation in age, sex, educational background, and living arrangement. Data were collected through face-to-face, audio-recorded semi-structured interviews and analyzed using thematic analysis. Recruitment was discontinued when the dataset was considered sufficiently coherent and well supported to address the study aim and additional interviews were unlikely to materially alter the developing thematic structure. Seven main themes were identified: access through appointment and digital systems, physical and transportation burden in reaching care, family support as an enabler of access, communication as a source of trust and feeling valued, hospital processes as a source of physical and organizational burden, expectations for priority, guidance, and age-sensitive care, and positive system appraisals alongside persistent barriers. Participants described healthcare access and care experiences as conditional and multidimensional. Difficulties in obtaining timely appointments, limited ability to use telephone-based or digital appointment systems, physical fatigue, transportation burden, and reliance on family or informal caregiver support shaped access to care. Doctor–patient communication, including being listened to, receiving clear explanations, and being examined, was central to trust and perceived quality of care. Crowding, waiting, and navigation difficulties made hospital use physically demanding, while participants also expressed expectations for priority access, guidance, and age-sensitive service arrangements. Positive evaluations of the healthcare system coexisted with reported barriers and were interpreted cautiously rather than as evidence that unmet needs were absent. Healthcare access among adults aged 80 years and older is shaped by interacting digital, physical, relational, communicative, organizational, and age-related factors. Access was generally not perceived as completely impossible, but as dependent on timely appointments, digital or telephone support, physical capacity, family assistance, and the ability to navigate healthcare processes. These findings highlight the need for age-sensitive healthcare pathways, including simplified appointment systems, support for digital access, physically manageable hospital environments, clear guidance, and respectful communication.
Abstract Background The scope of medical conditions addressed in Emergency Departments (ED) increases with growing numbers of older patients among the ED patient population. More information on their chief complaints and related treatment outcomes is essential to ensure high-quality ED care. The objective of this study was to describe the pattern of chief complaints of older ED patients and evaluate the associations between these complaints and outcomes such as mortality and hospital admission. Methods This secondary analysis is based on the observational ‘Epidemiology of Geriatric patients in Europe’ (EGERS) study. This prospective, routine data cross-sectional study was conducted in 36 EDs across 9 European countries. Data collection from routine clinical records of all patients aged 65 and older over a 7-day period from October 19 to November 30, 2020 during the Covid-19 pandemic. Patients with one documented non-traumatic chief complaint were analyzed. Descriptive statistics, logistic regression, and general linear mixed models were used to assess factors associated with hospital admission and in-hospital mortality. Odds ratios (OR) and 95% confidence intervals (CI) were reported. Results The study population consisted of 2,794 patients with one specified chief complaint. The mean age was 77.4 (± 8.2) years. The most frequent chief complaints were shortness of breath, abdominal pain, chest pain, weakness and fatigue, and extremity pain and numbness, representing 59% of the cohort. Highest age (≥ 85), geriatric risks (i.e. presence of dementia/Alzheimer’s disease (AD), home help service or previous falls), polypharmacy, and shortness of breath increased the odds of being admitted to hospital (OR 1.4 [1.2–1.9]; OR 1.6 [1.3–1.9]; OR 1.3 [1.1–1.6]; OR 3.0 [2.4–3.8]), while female sex was negatively associated with admission (OR 0.7 [0.6–0.8]). Shortness of breath was positively associated with in-hospital mortality (OR 2.2 [1.4–4.3]). Conclusion Older patients frequently require hospital admission. As chief complaints do not reflect underlying condition or severity, structured evaluation, staff training and geriatric specific care pathways may improve care and reduce adverse clinical outcomes.
Hip fracture mortality in older adults reflects biological reserve as well as the acute injury. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score integrates anemia, nutritional status, immune competence, and systemic inflammatory burden. We evaluated whether preoperative HALP was associated with mortality after hemiarthroplasty for intracapsular hip fracture. This single-center retrospective cohort included 906 consecutive patients aged > 60 years who underwent hemiarthroplasty between 1 January 2013 and 1 January 2024. One-year all-cause mortality was the primary outcome and 30-day mortality the secondary outcome. Admission blood samples were obtained before intravenous fluid administration. HALP was log2-transformed because the untransformed score did not satisfy linearity in the logit. Logistic regression adjusted for age and sex; hemoglobin-to-red cell distribution width ratio (HRR) and eosinophil-to-lymphocyte ratio (ELR) were evaluated in an expanded comparison model. Discrimination, calibration, multicollinearity, Kaplan-Meier survival, and Cox regression were also assessed. Thirty-day mortality was 14.3
Intrinsic capacity (IC) reflects the integrated physical and mental capacities of older adults and is a central target of healthy ageing interventions. However, the biological mechanisms underlying IC decline remain poorly understood. Autonomic nervous system (ANS) dysregulation may contribute to decline across multiple IC domains, but whether transcutaneous auricular vagus nerve stimulation (taVNS) improves IC through autonomic regulation remains unknown. This a participant- and assessor-blinded, two-arm, randomized sham-controlled trial will recruit 84 community-dwelling adults aged ≥ 60 years with IC decline from community health service centers in Huzhou, China. Participants will be randomly allocated to taVNS or sham stimulation in a 1:1 ratio. In the taVNS group, electrical stimulation will be delivered to the left cymba conchae for 20 min per session, five times per week for two weeks. Participants in the sham-control group will wear the device in the same manner and follow the same schedule, but no electrical current will be delivered. The primary outcome is IC, assessed across five domains using the WHO Integrated Care for Older People (ICOPE) framework. The secondary outcome is ANS function, assessed via heart rate variability (HRV), primarily quantified using the root mean square of successive differences (RMSSD). Outcomes will be measured at baseline (T0), immediately after the 2-week intervention (T1), and 12-week follow-up (T2). Linear mixed-effects models will be used to evaluate intervention effects, and causal mediation analysis will examine whether HRV changes mediate the effects of taVNS on IC. This trial will be the first randomized controlled trial to evaluate whether taVNS improves IC and autonomic function in community-dwelling older adults. By examining HRV as a potential mediator, it will advance understanding of autonomic regulation as a modifiable physiological pathway underlying IC. The findings may inform mechanism-based, non-pharmacological strategies to promote healthy ageing. Chinese Clinical Trial Registry, ChiCTR 2,600,121,557, registered on April 1, 2026.
Recovery after hip fracture surgery in older adults depends on sustained rehabilitation exercise, yet adherence after discharge is heterogeneous and may change over time. Previous studies have focused on single time points or average changes, which may overlook clinically meaningful heterogeneity. This study aimed to identify trajectories of rehabilitation exercise adherence during the first 6 months after hip fracture surgery and to examine factors associated with trajectory membership. This prospective longitudinal study enrolled 199 older adults undergoing hip fracture surgery at a secondary-level Class A general hospital in Hangzhou, China, June–December 2025. Baseline demographic, clinical, and psychosocial data were collected during hospitalization. Rehabilitation exercise adherence was assessed at 1, 3, and 6 months postoperatively using the Orthopaedic Patient Functional Exercise Compliance Scale. Latent growth mixture modelling identified adherence trajectories. Univariate analyses and multinomial logistic regression were used to examine factors associated with trajectory membership, with binary logistic regression performed as a sensitivity analysis. Follow-up assessments included 196 participants at 1 month, 194 at 3 months, and 191 at 6 months. Mean adherence scores increased steadily, from 30.00 ± 16.49 at 1 month to 38.39 ± 14.95 at 3 months and 48.58 ± 18.85 at 6 months. A 3-class solution was selected as optimal and clinically interpretable, identifying a low-adherence trajectory (11/199, 5.53
The presence of multimorbidity and polypharmacy in older adults (aged 65 years and older) increases their susceptibility to medication harm, particularly during transitions of care. Family members are a source of continuity throughout transitions of care, but their medication competence remains largely underutilized. We sought to explore family members’ perspectives regarding the challenges and possible solutions for improving their engagement in the medication management of older adults during transitions of care. In this qualitative exploratory study, we conducted semi-structured interviews with family members at four hospitals, between October 2024 and January 2025. Interviews were centered around information-seeking, medication decision-making, and medication management. Interviews were audio recorded, transcribed verbatim, and analyzed using Framework Method analysis. Themes and sub-themes were conceptualized from the data. In all, 66 family members completed an interview. Three themes were developed: (1) Disconnect between family members’ medication management expectations and the operational limitations of the healthcare system; (2) Relationship between accessibility to medication information and preparedness for post-discharge medication management; and (3) Opportunity to enhance family members’ capacity and need to engage in medication management. Family members reported that their engagement was restricted by hospital workflow challenges, such as time constraints and staff shortages. They also experienced accessibility challenges. Physicians were not readily contactable, so, as a solution, families suggested having a dedicated telephone line staffed by personnel available to answer medication questions. Where older adults were independent, families questioned the need for their engagement, but suggested that these older adults carry a wallet medication card for emergencies. Many challenges experienced by family members were associated with system pressures, such as rushed hospital discharges. Healthcare professionals and policymakers should consider delegating some medication decision-making responsibility to families, which may help to alleviate pressure on the healthcare system, and create a more family-centered approach to care. Registered in ANZCTR (registration number: ACTRN12624000901505) on the 24th of July 2024.
The clean transformation of traditional energy sources is of great significance for the formation and development of human capital in rural areas. We use 5-wave survey from the China Health and Retirement Longitudinal Study (CHARLS) between 2011 and 2020, and based on the quasi-experiment of the "winter clean heating" policy in northern regions implemented by the Chinese government, construct a staggered difference-in-differences (DID) model to estimate the impact of large-scale clean energy use in northern rural China on cognitive impairment among the elderly. We find that the clean heating policy improved the average cognitive ability of the elderly in rural northern China by 3.3
Urinary tract infections (UTIs) are common among hospitalized older adults and are closely linked to antibiotic exposure and antimicrobial resistance. Loop diuretics are widely prescribed in this population and substantially alter urine volume and composition. However, their potential influence on urinary pathogen patterns or antimicrobial resistance remains unclear. This study evaluated the relationship between chronic loop diuretic therapy, urinary microbiology, and clinical outcomes in hospitalized older adults with UTIs. Patients aged ≥ 65 years who were admitted to acute geriatric wards between 2019 and 2024 with a working diagnosis of UTI and a positive urine culture were included. Patients treated with chronic loop diuretics prior to admission were compared with a control group without loop diuretic therapy (200 per group). Clinical, laboratory, microbiological, and geriatric characteristics were collected. Outcomes included urinary pathogen distribution, rates of third-generation cephalosporin-resistant Enterobacterales (3GCRE) and multidrug-resistant (MDR) isolates, length of stay, and mortality. Overall, 111 patients (27.8
Community meal services can support adequate nutrition among older adults, promote social participation and facilitate ageing in place. However, qualitative evidence on Chinese community-dwelling older adults’ experiences of using these services, the factors shaping their sustained participation and changes in their needs remains limited. This qualitative study used purposive sampling to recruit 16 older adults with experience of using community meal services from four communities across three cities in Guangxi, China. Semi-structured interviews were conducted, and the study was informed by Andersen’s Behavioural Model. Data were analysed using reflexive thematic analysis, supported by NVivo 14.0. Four themes were developed: (1) motivations for participation and life circumstances; (2) resources and the service environment; (3) from basic provision to multidimensional needs; (4) changes in life and needs following participation. Older adults’ participation in community meal services is shaped by multiple factors, including individual needs, family support, service provision and experiences of service use. These services offer benefits beyond nutritional support by promoting social participation and enhancing well-being. Future initiatives should develop community meal services into integrated community-based platforms that support ageing in place and healthy ageing, while responding to older adults’ multidimensional and evolving needs to promote sustained participation.
Abstract Background Dementia places substantial physical, psychological, and social demands on informal caregivers, and caregiving needs may change across the dementia trajectory as cognitive, behavioral, and functional changes alter day-to-day care demands. Digital interventions may not fully address caregivers’ evolving and heterogeneous needs and preferences. This study aimed to develop a user-centered mobile application informed by caregiver-identified needs and preferences across the dementia trajectory and to evaluate its effectiveness. Methods A randomized controlled trial was conducted following a qualitative intervention-development phase. The intervention was developed in accordance with the Medical Research Council framework for complex interventions and informed by principles of person-centered dementia care and qualitative interviews with informal caregivers. The application provided dementia education; communication and daily-care guidance organized to reflect changing caregiving needs; guidance for behavioral and psychological symptoms; caregiver self-care and stress-management resources; information on formal and informal support services; and customizable reminders. Caregivers were randomized to receive usual care with access to the mobile application for 8 weeks or usual care alone. Outcomes included caregiver burden (Zarit Burden Interview), quality of life (WHOQOL-BREF), neuropsychiatric symptoms (Neuropsychiatric Inventory), and caregiver distress related to these symptoms. System usability was assessed post-intervention in the intervention group. Outcomes were assessed at baseline and week 8 using repeated-measures analysis of variance. Results A total of 86 caregivers were randomized, of whom 75 were included in the analysis (intervention, n = 37; control, n = 38). Significant group-by-time interactions were observed for overall quality of life ( p < 0.001) and the psychological domain ( p < 0.001), with greater improvements in the intervention group than in the control group. No significant group-by-time interactions were observed for caregiver burden, neuropsychiatric symptom severity, or caregiver distress. The application demonstrated good usability at week 8. Conclusions The user-centered mobile application was associated with improvements in overall and psychological quality of life among participants included in the 8-week analysis, while no significant intervention effects were observed for caregiver burden, neuropsychiatric symptoms, or caregiver distress. Larger studies with longer follow-up and more detailed assessment of application engagement are needed to evaluate the durability and broader effects of the intervention. Trial registration This trial was registered at ClinicalTrials.gov (Registration number: NCT06179667 , Date of registration: 27 November 2023).
Declining intrinsic capacity may compromise healthy ageing, while opportunities to manage functional change are shaped by social and structural circumstances. Urban-rural differences in the conditions surrounding everyday self-management remain poorly understood. This study explored how social determinants enabled or constrained function-oriented self-management of IC decline in two contrasting communities in Zhejiang Province, China. A qualitative interview study was conducted from August to October 2025 in a metropolitan community in Hangzhou and a village-based community within economically developed Yiwu. Twenty-eight community-dwelling adults aged 70–95 years were recruited through purposive maximum-variation sampling, with 14 from each setting. Eligibility required possible IC decline identified using Step 1 of the World Health Organization Integrated Care for Older People (ICOPE) screening tool. Data from individual, face-to-face, semi-structured interviews were analysed using reflexive thematic analysis. The five-domain Social Determinants of Health (SDOH) framework informed interpretation and reporting rather than initial coding. Twelve subthemes were developed from participants’ accounts and organised within five SDOH domains. In the rural setting, participants linked lower pensions, limited insurance coverage, travel costs, distance to services, and intermittent family accompaniment to postponed assessment, rehabilitation, or follow-up. In the urban setting, participants described digital procedures, inaccessible housing, and sensory or mobility limitations as barriers to independent use of nearby services, with assistance from adult children often required. The older age profile of the urban group was considered when interpreting these patterns. Across settings, functional usability reflected affordability, accessibility, continuity, navigability, and alignment with older adults’ capacities rather than availability alone. Constraints accumulated across domains, although experiences varied within each setting. This study extends the SDOH framework to the everyday management of IC decline. It distinguishes nominal availability from functional usability and highlights the importance of aligning support with older adults’ capacities. The findings support context-sensitive, function-oriented primary care and community services responsive to local barriers and functional needs. These patterns are specific to the two study communities and are not nationally representative.
