The vision of younger-seniors-based elderly care in rural China: based on population aging predictions from 2020 to 2050

Population aging is an irreversible global trend. Within the “2030 Agenda for Sustainable Development” framework that strives for global prosperity, the rapidly growing elderly population is a vulnerable group. The globally increasing aging trends are expected to intensify over the coming decades (UNDESA, 2022). In 2021, the global population aged 65 and above stood at 761 million, projected to reach 1.6 billion by 2050 (UNDESA, 2023; Chen et al., 2022). Due to improvements in health and healthcare, increased educational opportunities, and declining fertility rates, life expectancy is on the rise (Bai et al., 2023). Population aging is predictable, yet countries are at different stages of this transition. Many elderly individuals still lack access to essential resources, and barriers (such as intergenerational inequality and income disparities) between urban and rural areas remain during social activities (Pivodic et al., 2024; Hannah, 2024; Kriebs, 2023). Ensuring the equal participation and benefit of elderly individuals in national development and enacting sustainable development goals has become a global focus.

Contemporary global studies indicate that traditional elderly care systems confront dual structural crises under converging demographic pressures of rapid population aging and sustained fertility decline. Both state-sponsored welfare programs and family-based support mechanisms exhibit diminishing capacity to address escalating eldercare demands (Kwangyong, 2024). The concept of mutual support eldercare has gained traction as a viable response to global population aging, grounded in interdisciplinary theories such as social capital and active aging. Social capital theory posits that trust, reciprocity, and network-building within communities empower older adults to collectively address care needs, fostering resilience through shared resources and collaborative relationships (Huang et al., 2024). Concurrently, the World Health Organization’s active aging framework emphasizes sustaining autonomy and social participation in later life, aligning with mutual support models that prioritize elderly agency and intergenerational solidarity. As an emergent governance model, mutual-support eldercare harnesses social capital reconstruction to reconfigure aging societies through intergenerational reciprocity and community empowerment, manifesting culturally-adaptive implementations across welfare regimes (Wang and Yan, 2024). Western industrialized nations predominantly adopt institutionalized approaches: Germany’s Multi-Generation Houses establish statutory cohabitation communities where seniors exchange care services for subsidized housing (De Lange, 2015), while U.S. initiatives deploy market-based mechanisms through Time Banking systems that quantify care hours as tradable credits (Adarsh, 2020). Conversely, East Asian societies integrate cultural capital into their frameworks: Japan’s senior volunteer programs institutionalize cross-temporal reciprocity where pre-seniors (70–75 years) accumulate redeemable care credits (Mika et al., 2024), whereas South Korea’s state-mediated Filial Support Scheme transforms traditional obligations into subsidized intergenerational contracts (Chung et al., 2017). The rural mutual-support paradigm demonstrates particular transformative potential by converting latent community resources into self-sustaining care networks. This model repositions seniors as co-producers through social reengagement, simultaneously alleviating fiscal burdens and enhancing psychosocial well-being. Theoretically grounded in social exchange principles, such configurations operationalize Active Aging paradigms by fostering solidarity-based collectivism – proposing an alternative to individualistic care models while addressing rural service fragmentation through institutionalized reciprocity mechanisms.

As a populous nation, China is undergoing unprecedented demographic shifts and is projected to remain the country with the largest elderly population for at least the next 50 years. Population aging implies a shift people from “producer-consumer” to “consumer-producer,” leading to the weakening and aging of rural entities such as agricultural workers and grassroots cadres (Liu et al., 2024). Aging in China is characterized by three main features: a large elderly population, rapid growth in the number and proportion of older adults, and even faster growth among those aged 80 years and above (UNPD, 2017). With the rapid socioeconomic development in China, the welfare of older adults has improved (Zhao and Li, 2024). However, inequalities persist among different elderly groups in health, safety, and social participation due to disparities in urban-rural areas, regions, genders, and generations (Kriebs, 2023; Zhang et al., 2019). In the Global AgeWatch Index 2015 Insight Report of 96 surveyed countries, China ranked 52nd overall, particularly low at 75th in income security (UNFPA, 2015). Moreover, China’s aging phenomenon occurred earlier in its economic development than in other countries. When China entered an aging society, its GDP was only 7% of Japan’s GDP when it crossed the same threshold. China’s proportion of the elderly population grew from 10% to 20% in just 25 years, while it took France 115 years and Sweden 85 years to experience the same (UNPD, 2017). The rapid aging of the population has sharply increased the pressure on eldercare in China (Tang et al., 2024). The pressure is more severe in rural areas due to population outflow and inadequate facilities (Rachel and Margaret, 2016; Ma et al., 2022). The preferences toward care facilities for older adults are a core factor influencing of aging societies (Kundu et al., 2022; Rawson et al., 2022). In 2020, only 0.73% of China’s elderly population lived in nursing homes, with the proportion in rural areas even lower at 0.66% (aged 65 and above); and only 3.79% of the population that was unable to live independently (aged 60 and above) lived in nursing homes. Therefore, updating the concept of elderly care and utilizing rural resources effectively are pressing issues that multiple Chinese sectors urgently need to address in response to rural aging.

Compared to developed countries, China’s elderly care development is slightly lagging, with severe deficiencies in rural care supply (Zhou and Cao, 2023; Li et al., 2012). China has gradually established a hierarchical classification system and construction standards for eldercare facilities in recent years. The layout of these facilities was based on population distribution characteristics (Li et al., 2023). However, the challenges brought by rural aging in China are complex. The main obstacles to addressing rural aging are the weakening of traditional family eldercare functions, limited opportunities to access resources, and slow development of the eldercare service market (Cheng et al., 2011; Li et al., 2024; Song, 2014). The rural elderly are not a homogeneous social group, and their demand for social eldercare services increases with age (Liu and Yi, 2023; Elena and Juan, 2020). Due to the heterogeneity of population structure and socioeconomic environment, addressing rural eldercare issues requires a regional perspective (Nidadavolu and Walston, 2021). Currently, China’s social eldercare service system is mainly led by county-level governments, with eldercare institutions as the core (Wang et al., (2023)). It overlooks township governments, village collectives, and local communities, failing to respect older adults’ personal wishes and needs adequately (Liu et al., 2020). Existing research has explored trends in nationwide aging, spatial disparities, influencing mechanisms, and the spatial layout of eldercare facilities and accessibility at the urban scale (Chen et al., 2024; Ma et al., 2022; Cui et al., 2022). Some studies have examined the preferences of older adults for eldercare methods under peculiar needs (Lee and Burns, 2022; Liu et al., 2021; Song et al., 2020). However, existing research on the prediction of rural aging trends and the construction of eldercare service systems that consider local culture in rural areas is meager. Predicting the developmental trend of rural aging at the national and provincial levels and integrating traditional cultural values into eldercare concepts and systems to address rural aging phenomena have become urgent issues, especially for populous countries like China.

Based on data from the Seventh National Population Census of China, this study predicts the trends in rural aging in 31 provinces from 2021 to 2050, clarifying eldercare pressures and spatial heterogeneity. It analyzes the spatial layout and utilization status of eldercare resources, dissecting the phenomenon of mismatches in eldercare resources. Finally, a new vision for elderly care in rural areas is proposed to address the future aging population. The results of this study can provide the necessary theoretical basis and decision-making references for China to achieve the Sustainable Development Goals (SDGs) and experiential reference for other countries worldwide to address rural aging.