China’s elderly mutual aid model: an active ageing perspective

Shuo Wang, Bingwen Yan

Quality in Ageing and Older Adults

ISSN: 1471-7794

Open Access. Article publication date: 4 December 2024

453

Abstract

Purpose

China’s rural elderly care system faces significant challenges in addressing the needs of an ageing population, particularly in resource-limited areas. This study aims to critically examine the rural mutual aid elderly care model in China through the lens of active ageing principles. It explores how this model tackles elder care challenges in rural areas by emphasising health, participation and security, aiming to assess its effectiveness in reducing care costs while fostering self-reliance and mutual assistance.

Design/methodology/approach

A qualitative research methodology was used, focusing on document analysis to explore the rural mutual aid elderly care model within an active ageing framework. The study reviewed policy documents, academic literature and organisational records, using thematic analysis to understand the historical context, policy evolution and institutional support for this model.

Findings

The research identifies a significant shift from traditional passive care models to those grounded in active ageing principles. The rural mutual aid model, centring on health, participation and security, enables elderly individuals to engage in self-help and mutual assistance, thereby enhancing autonomy and reducing dependency. Key success factors include strong community networks and culturally resonant support systems. However, challenges such as resource limitations and regional disparities suggest areas for further improvement.

Research limitations/implications

The reliance on document analysis may not fully capture the experiences of elderly participants or account for regional variations in the model’s implementation. Future research could incorporate mixed methods, including interviews or case studies, for a more nuanced understanding of elderly care in rural China. The findings emphasise the need for scalable and adaptable policies to enhance the model’s effectiveness and support culturally appropriate care strategies.

Practical implications

The research presents significant implications for policymakers and practitioners regarding the rural mutual aid elderly care model. It emphasises the need for scalable policies that address resource limitations and enhance community engagement to improve care effectiveness. Key implications include promoting financial and social sustainability by fostering self-reliance among older adults, prioritising active ageing initiatives to enhance quality of life and community cohesion and adopting localised strategies that consider regional disparities. Moreover, these findings offer a blueprint for other countries facing similar ageing challenges, advocating for a culturally sensitive and community-driven approach to elderly care across East Asia.

Social implications

The study’s findings significantly impact how ageing is perceived and managed in rural Chinese communities. The shift from traditional, passive elderly care models to those grounded in active ageing principles reflects a societal transformation in valuing and supporting older adults. By promoting health, participation and security, the rural mutual aid elderly care model creates inclusive environments where the elderly actively contribute to their well-being and that of others. This approach challenges perceptions of ageing as a decline, fostering autonomy and meaningful engagement, ultimately reducing social isolation and enhancing cohesion through strengthened intergenerational relationships and shared responsibilities.

Originality/value

This study contributes to the literature by focusing on the rural mutual aid elderly care model in China through active ageing principles, addressing a notable gap in the non-Western application of these concepts. The findings offer valuable recommendations for policymakers and practitioners, emphasising community-driven approaches to ageing challenges in rural areas.

Keywords

Citation

Wang, S. and Yan, B. (2024), "China’s elderly mutual aid model: an active ageing perspective", Quality in Ageing and Older Adults, Vol. ahead-of-print No. ahead-of-print. https://doi.org/10.1108/QAOA-08-2024-0051

Publisher

:

Emerald Publishing Limited

Copyright © 2024, Shuo Wang and Bingwen Yan.

License

Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/legalcode


Introduction

The landscape of elderly care in East Asia, particularly in Japan, South Korea and China, presents diverse and evolving approaches to addressing the needs of ageing populations. Japan’s model blends medical and community-based care, with an emphasis on home-centred services, whereas South Korea prioritises home-based care complemented by a comprehensive pension system (). In contrast, China is experiencing rapid demographic changes that are driving the diversification of elderly care services, including the integration of innovative technologies and the development of supportive policy environments (; ; ). These transitions challenge traditional care structures and highlight the urgent need for adaptive responses to shifting demographics. This research addresses the central problem of inadequate traditional elderly care models in rural China, which are often characterised by limited accessibility, underfunding and a lack of personalised care. Existing studies indicate that these models frequently fail to meet the diverse needs of elderly residents, resulting in increased isolation, neglect and dissatisfaction (; ). For instance, emphasise that existing institutional care facilities are often ill-equipped to provide quality services, leading to a reliance on family support that is increasingly unsustainable because of urban migration and changing family structures. In contrast, the rural mutual aid pension system emerges as a promising innovative solution that leverages community resources and fosters self-help among the elderly (Chen and Wu, 2019). This model not only addresses the shortcomings of traditional care by promoting social networks and mutual support among elderly individuals but also aligns with the principles of active ageing, emphasising autonomy, participation and security (). Therefore, the mutual aid system represents a critical step towards reimagining elderly care in rural China, making it more sustainable and culturally relevant.

This research focuses specifically on the rural mutual aid elderly care model in China, exploring its significance within the active ageing framework. Grounded in traditional communal support systems, this model promotes self-help and mutual assistance among rural elderly populations, offering a paradigm shift from traditional, passive care models to one that emphasises autonomy, participation and security (). Understanding this model’s efficacy in addressing the challenges of an ageing society in rural China is crucial for developing sustainable care solutions.

The necessity for innovative elderly care models arises from rapid demographic shifts and the inadequacies of traditional care systems, especially in rural areas. These conventional models often manifest as underfunded and poorly managed care centres, failing to meet the diverse needs of elderly residents and resulting in dissatisfaction and neglect (; ). Shifting from passive support to active ageing principles is essential not only for enhancing the quality of life for the elderly but also for creating sustainable, culturally appropriate care strategies adaptable to various rural settings (). While traditional models have been effective in certain contexts, the limitations in addressing the realities of rural life necessitate the exploration of alternative systems like mutual aid. This study aims to investigate the historical evolution, policy frameworks and practical challenges associated with rural mutual aid pension models, bridging the gap between theory and practice. By contributing to the development of solutions that promote dignity and well-being for elderly individuals in rural China, this research underscores the significance of community-driven approaches in responding to the evolving needs of an ageing population.

Using a qualitative approach, this research uses document analysis to examine the development, implementation and impact of rural mutual aid elderly care models. By systematically reviewing historical documents, policy reports and academic literature, the study aims to provide insights into the promotion and realisation of these models within the active ageing framework (). This research underscores the importance of innovative, community-driven approaches in addressing the evolving needs of China’s ageing population and offers valuable recommendations for policymakers, practitioners and stakeholders involved in elderly care.

Japanese elderly care model

In Japan, over 24 million people are ageing at home, with a significant portion experiencing multiple chronic diseases (). The Japanese elderly care model integrates medical and elderly care services, emphasising home-based care influenced by traditional family responsibility. Owing to demographic changes such as declining birth rates and urbanisation, Japan has expanded its model to include home, community and institutional care, supported by the Long-Term Care Insurance (LTCI) system. This system categorises care into health, residential and nursing types based on the elderly’s needs (; ).

A key feature of Japan’s model is the outsourcing of medical services to specialised institutions, allowing nursing homes to focus on LTC and rehabilitation while managing severe cases in collaboration with hospitals (). With the elderly population at 29% as of October 2022, Japan introduced the “Regional Comprehensive Care System” to sustain the LTCI (). Elderly care facilities are classified into local government-established nursing homes, commercial nursing homes and elderly apartments, all integrated into a broader pension and care system (; ). Japan also incorporates technology into elderly care through telemedicine and smart home technologies, enhancing care convenience and efficiency. Practical guidance, such as being patient and providing written instructions, is essential for elderly use of technology (). The model is increasingly international, attracting foreign residents and promoting Japanese care approaches abroad ().

Overall, Japan’s elderly care model is diversified and systematic, focusing on comprehensive, personalised services for the elderly.

South Korean elderly care model

South Korea’s elderly care model is primarily centred around home-based care, reflecting the country’s cultural preference for family involvement in elder care. Elderly individuals often live in their own homes or with their children, supported by community services that provide essential care, such as meal delivery, health monitoring and daily assistance (; ; ). This emphasis on home-based care aligns with traditional South Korean values, where respect for elders is deeply ingrained in the culture (). In addition to home-based care, South Korea offers a range of institutional care options, including nursing homes and convalescent homes. Nursing homes provide comprehensive care for elderly individuals who require more extensive support than what home-based care can offer, while convalescent homes cater to those needing long-term medical care because of chronic illnesses or post-surgery recovery (; ; ). Another unique aspect of South Korea’s elderly care system is the “Respectful Homes”, which emphasises the dignity and quality of life for elderly residents, reflecting the nation’s cultural values regarding elder care (; ).

South Korea’s elderly care model is supported by a robust pension system, which includes the National Pension System, enterprise annuities and personal savings, providing comprehensive retirement security for the elderly (; ; ). Additionally, the country has developed unique care facilities, such as elderly day care centres and comprehensive elderly welfare centres, which focus on improving the physical and cognitive abilities of the elderly through various activities (; ).

In summary, South Korea’s elderly care model is a diversified and comprehensive system aimed at providing comprehensive care and security for the elderly. At the same time, South Korea’s pension system also provides strong support for its elderly care models.

Current situation of China’s elderly care market

China’s elderly care market is facing a complex set of challenges as the country’s population rapidly ages. The traditional family-based care model, which has been the backbone of elderly care in China for centuries, is under strain because of significant demographic shifts, including urbanisation, the one-child policy’s legacy and increasing life expectancy. These factors have led to a growing demand for formal elderly care services, both in urban and rural areas.

Urban–rural disparities

One of the most critical issues in China’s elderly care market is the stark disparity between urban and rural areas. In urban regions, elderly care services are relatively well-developed, with a variety of options ranging from home-based care to institutional care facilities. However, in rural areas, the situation is dire. Rural elderly populations often lack access to adequate care services because of insufficient infrastructure, limited professional caregivers and financial constraints. Many elderly individuals in rural areas rely on community-based mutual aid, which is often underfunded and inadequately staffed. This system is also hampered by the “empty nest” phenomenon, where younger generations have migrated to cities, leaving behind elderly parents without adequate support (, ; ).

Financial constraints and policy gaps

Financial limitations pose a major challenge in China’s elderly care market. Despite government efforts to develop elderly care services, the financial burden on families remains high. The pension system is unevenly distributed, favouring urban retirees over their rural counterparts (). Rural areas in China typically have limited financial resources, making it difficult to fund comprehensive elderly care services. This mirrors trends seen globally, where LTC services are expensive and often out of reach for older adults with low incomes. While private sector involvement is growing, the high costs of private care make it inaccessible to many ().

Technological integration and innovation

Despite financial challenges, technology integration in elderly care offers promising solutions. Smart technologies such as wearable devices, telemedicine and AI-driven health monitoring systems are being adopted to enhance care quality and efficiency. These technologies enable continuous health monitoring and early detection of health issues, reducing hospital visits (; ). However, their adoption is more prevalent in urban areas than in rural ones.

Role of the government and private sector

The Chinese Government significantly shapes the elderly care market through policymaking and funding initiatives, such as the National Medium- and Long-Term Pension Insurance Development Plan (2024–2050) and the National Development and Reform Commission’s guidelines, aimed at creating a more sustainable elderly care system (). However, policy implementation gaps remain, especially in rural areas where local governments often lack the necessary resources (). The private sector’s role in elderly care is expanding, with an increasing number of private facilities and service providers. These entities tend to be more flexible and innovative, offering diverse services to meet the needs of the elderly. However, the high costs of private care are still prohibitive for many middle- and low-income families.

Future prospects

The future trajectory of China’s elderly care sector is poised to be influenced by a confluence of policy reformations, technological innovations and the expanding role of private sector investment, collectively fostering a more resilient and adaptive care framework. There is a pressing need for more equitable distribution of resources and services between urban and rural areas, as well as more robust financial support for the elderly. The successful integration of technology into elderly care will also be crucial in addressing the challenges posed by China’s rapidly ageing population. The market’s development will require a coordinated effort between the government, private sector and communities to ensure that the elderly receive the care they need. This includes addressing the current shortcomings in rural elderly care, improving the quality and accessibility of services and ensuring that all elderly individuals, regardless of the location or financial situation, can live with dignity and security in their later years.

Methods

This study uses a qualitative research approach to explore the value and implementation of rural mutual aid pension systems in China through the lens of active ageing. The qualitative method is well-suited for this research, as it allows for a nuanced understanding of complex social phenomena, particularly those concerning ageing and community-based support systems (; ). To analyse China’s rural mutual aid elderly care model, this study adopts the World Health Organisation’s (WHO) Active Ageing model, focusing on its key domains of health, participation and security. These themes were chosen because they align with the critical aspects of elderly care in rural settings, promoting autonomy, social inclusion and safety for older adults.

Theoretical framework and historical context

The research is grounded in the principles of active ageing, which emphasise optimising opportunities for health, participation and security as individuals age (). This study examines the historical evolution of rural mutual aid pension models in China, tracing the development from traditional ageing theories to contemporary active ageing perspectives. Understanding this historical context is essential for analysing the shifts in policy and practice that have shaped the current rural pension systems (; ).

Data collection and document analysis

Document analysis was the primary research method, allowing for a systematic review and interpretation of historical documents, policy reports and academic literature related to rural mutual aid pension models in China (). The data collection process was conducted in the following steps:

  • Search strategy development: A comprehensive search strategy was developed to identify documents relevant to the rural mutual aid model and active ageing. The search terms were derived from the key themes of the study and included combinations of keywords such as “rural mutual aid elderly care”, “active aging”, “community-based elderly care”, “elderly care policy”, “aging population health” and “pension systems in rural China”. Synonyms and variations of these terms were also used to ensure a broad yet targeted search.

  • Sources of data: The searches were conducted across multiple databases and repositories. For academic articles, peer-reviewed databases such as PubMed, Scopus and Google Scholar were used. Policy documents were sourced from official government portals, including national and regional government websites, such as the Ministry of Civil Affairs of China and the National Health Commission. Organisational reports and grey literature, such as program reports from community-based elderly care programs, were retrieved from non-governmental organisations, international organisations such as the WHO and the OpenGrey database for unpublished studies and reports.

  • Inclusion and exclusion criteria: The documents included in this study were selected based on their relevance to the rural mutual aid model and active ageing principles. To be included, the documents needed to (a) focus on rural elderly care in China, (b) address the implementation of mutual aid models or similar community-based care systems and (c) be published in the past 20 years (2003–2023) to ensure current relevance. Excluded were records that did not specifically address elderly care or that were primarily focused on urban or non-mutual aid systems.

  • Document selection process: The initial search yielded 125 records, which were then screened for relevance. After removing duplicates and applying the inclusion/exclusion criteria, 56 records were selected for in-depth analysis. These included 15 policy documents from national and regional governments, 20 academic articles from peer-reviewed journals and 10 organisational reports from community-based elderly care programs. An additional 11 documents, comprising case studies, government advisories and conference proceedings, were included to provide broader context and insights into the implementation of rural mutual aid elderly care models.

This method provides a comprehensive examination of the development, implementation and impact of these models over time (). The data collection process involved sourcing relevant documents from libraries, online databases and official government websites, including historical records, government reports, academic articles and policy documents ().

Data analysis

The selected documents were systematically coded and analysed using thematic analysis techniques (). This process involved identifying recurring themes, patterns and trends related to rural mutual aid pension initiatives, enabling the extraction of key findings and insights. Themes such as health, participation and security were used as the framework for the coding process, ensuring alignment with the WHO Active Ageing model. Thematic analysis facilitated a deeper understanding of the evolution of rural mutual aid pension systems and their significance within the broader context of active ageing (Clarke and Braun, 2014). By using a qualitative approach and focusing on document analysis, this study offers a comprehensive exploration of the rural mutual aid pension model in China, highlighting the interplay between historical, policy and social factors that influence the promotion and realisation of this model from an active ageing perspective ().

Results

The results of this study demonstrate that traditional elderly care models in rural China fall short of addressing the needs of an ageing population, particularly in resource-constrained settings. The rural mutual aid elderly care model, underpinned by active ageing principles, has emerged as a promising alternative to these conventional approaches. The model, centred on “self-help mutual assistance”, effectively supports older adults in rural communities by fostering self-reliance, mutual care and active participation in communal life (; ). Data indicate that the model’s integration of health, social engagement and economic participation significantly enhances the quality of life for older adults in these communities.

Promoting rural mutual aid pension from the perspective of active ageing

The rural mutual aid pension model addresses critical health challenges faced by the elderly in rural China, such as limited access to healthcare and the prevalence of chronic illnesses. Centralised living arrangements within the model facilitate better healthcare access and promote health education, enabling residents to receive basic healthcare services (). Furthermore, mutual caregiving among residents enhances informal care structures, easing the burden on formal health systems. The model’s emphasis on community-building activities has also been shown to improve mental health, reducing isolation and improving psychological well-being among participants (). These improvements align with the active ageing framework, which promotes health as a foundation for active participation and autonomy in later life.

Health outcomes under the rural mutual aid pension model

The model has had notable effects on health outcomes, addressing challenges such as chronic illness and inadequate health-care access in rural areas. Analysis reveals that centralised living conditions have facilitated better access to health-care services, including basic health education and mutual caregiving among elderly residents (). Furthermore, the implementation of community-building activities has contributed to improved mental health, reducing isolation and enhancing psychological well-being among elderly participants (). These findings support the active ageing framework by demonstrating how health outcomes improve through both formal and informal care structures within the model.

Participation in social and economic activities

The results highlight increased social and economic participation among elderly residents within the mutual aid pension system. Elderly individuals have been actively involved in community activities, such as cultural and recreational events, which have fostered a sense of belonging and reduced social isolation (). Economic participation, particularly through small-scale farming and crafting activities, has provided supplemental income, promoting financial independence and reinforcing the elderly’s role as productive community members (). This economic engagement aligns with the active ageing philosophy of promoting continued contribution to society, even in later years.

Improvements in security and financial stability

In terms of security, the mutual aid model has effectively addressed the financial vulnerabilities faced by elderly populations in rural areas. The financial vulnerabilities of rural elderly populations are mitigated by the rural mutual aid pension model through innovative mechanisms such as the “time bank” system. This system allows elderly residents to exchange caregiving services for credits, which they can later redeem for similar services, thus enhancing both financial and social security (). Moreover, the establishment of a multi-tiered funding mechanism, involving contributions from both governmental and societal sources, has been instrumental in ensuring the long-term sustainability of the model. This approach not only complements national social security schemes but also strengthens intergenerational solidarity, as younger community members may contribute to the system (). These findings illustrate the model’s capacity to complement national social security schemes and improve the overall quality of life for the rural elderly.

Cultural and historical relevance

The success of the rural mutual aid pension model is further supported by its alignment with China’s historical and cultural traditions of mutual aid. Rooted in concepts dating back to the Zhou Dynasty, this model integrates traditional values with modern innovations to create a sustainable and culturally relevant solution for rural elderly care (). In regions such as Hebei Province, initiatives such as the “Happiness Home” exemplify how this model effectively addresses the unique challenges of rural ageing, providing a blueprint for similar programs across China.

These findings underscore the potential of the rural mutual aid pension model to enhance elderly care in rural China by promoting active ageing principles. By fostering health, participation and security, the model addresses the complex needs of older adults while remaining economically and culturally sustainable.

Discussion

Limitations of traditional elderly care models in rural China

This study underscores the limitations of conventional elderly care models in rural China, emphasising the pressing need for alternative approaches such as rural mutual aid elderly care, which align with active ageing principles. The traditional models, which rely heavily on family-based care, are increasingly inadequate because of demographic changes, particularly the urban migration of younger generations. The rural mutual aid model, rooted in historical practices of “self-help mutual assistance”, offers a viable strategy for addressing the evolving challenges of elderly care in resource-constrained settings (; ). This care model emphasises the integration of older adults into community-based care systems that allow for more participation and a sense of autonomy, reshaping perceptions of ageing as a period of dependency and decline ().

Promoting active ageing through rural mutual aid pension

The rural mutual aid pension model addresses the shortcomings of fully socialised pension systems in rural China by leveraging community resources and the abilities of the elderly population. By fostering centralised living arrangements and encouraging self-management, the model enables older adults to remain active participants in their communities. This shift aligns with the active ageing framework, which reframes older adults as contributors rather than passive recipients of care (). Moreover, the model supports intergenerational solidarity and self-reliance, helping to narrow the generational divide and enhancing the dignity and fulfilment of older adults in their later years (). The integration of traditional cultural values with modern care approaches strengthens the model’s relevance and sustainability, reflecting long-standing Chinese principles of mutual aid dating back to the Zhou Dynasty ().

Health and well-being in the rural mutual aid pension model

The findings reveal that centralised living arrangements in the rural mutual aid pension model significantly enhance the physical and mental health of elderly residents. By facilitating access to basic health-care services and promoting health education, the model alleviates some of the chronic disease challenges prevalent in rural areas, where health-care access is often limited (). Additionally, mutual support among elderly residents during illness or recovery reduces the strain on formal health-care systems, while community-building activities foster mental well-being by mitigating loneliness, a major risk factor for mental health issues among the elderly (). The model thus offers a cost-effective solution to improving both physical and mental health outcomes, supporting the key health pillar of active ageing ().

Social and economic participation of the elderly

The rural mutual aid pension model encourages social and economic participation, vital components of the active ageing framework. By bringing elderly individuals together in communal living arrangements, the model enhances their opportunities for social interaction and reduces isolation (). Activities such as cultural and recreational programs not only promote a sense of community but also provide older adults with a platform for social engagement, reinforcing their social capital. Moreover, the model’s inclusion of income-generating activities, such as crafting and small-scale farming, helps older adults maintain financial independence and contributes to their sense of self-worth (). This aspect of the model supports the active ageing philosophy, which advocates for the continued economic productivity of older adults, allowing them to remain valuable members of their communities.

Political participation and governance involvement

An important aspect of the rural mutual aid pension model is the political participation of the elderly. By integrating elderly residents into village governance structures, the model ensures that they retain a voice in local decision-making processes, contributing to their sense of agency and inclusion (). This participation not only enhances their social engagement but also strengthens community governance, as older adults bring valuable perspectives to local issues. The involvement of the elderly in governance aligns with the broader goals of active ageing, which seeks to maintain the social and political engagement of older adults as a means of improving their quality of life.

Financial and social security challenges

Security as a pillar of active ageing, is crucial in addressing the vulnerabilities faced by rural elderly populations. Many older adults in rural China face financial instability due to insufficient formal pension systems and the rising cost of living. The rural mutual aid pension model offers innovative solutions, such as the “time bank” system, where elderly individuals earn credits for providing care to others, which they can redeem for similar services in the future (). This system, alongside the establishment of a multi-level investment mechanism involving contributions from both government and private sectors, ensures the financial sustainability of the model. These findings highlight the potential for the rural mutual aid pension system to complement national social security frameworks and enhance the overall security and quality of life for elderly populations (). Additionally, the proposed model promotes intergenerational solidarity, encouraging younger community members to contribute to the system, which reinforces social cohesion and mutual responsibility ().

Implications for policy and practice

The insights gained from this study provide several valuable insights for policymakers aiming to redefine elderly care paradigms in China:

  • Redefining elderly care paradigms: This study challenges traditional elderly care models in rural China by highlighting the inadequacies of passive “relief type” collective systems. It advocates for a shift towards proactive, community-based care approaches rooted in active ageing principles, which align with contemporary social policy objectives ().

  • Promoting rural mutual aid elderly care: The study emphasises the significance of rural mutual aid initiatives, which foster self-help among elderly individuals. This community-driven approach addresses the shortcomings of elder care in resource-limited areas, suggesting a rational and effective pathway to improve the quality of life for older adults ().

  • Addressing the needs of China’s ageing society: By emphasising the necessity for new elder care models prioritising the active engagement and well-being of older individuals, this research provides actionable insights into meeting the evolving demands of China’s ageing population amid significant demographic shifts ().

Limitations and future research directions

While this study uses document analysis to provide historical and contextual insights, this method may limit the exploration of lived experiences among elderly individuals engaged in rural mutual aid initiatives. The focus on rural settings may also restrict the applicability of findings to urban environments with different socioeconomic and cultural dynamics. Furthermore, regional variations in the implementation of the rural mutual aid elderly care model could affect its effectiveness in ways not fully examined here. Future research should adopt a mixed-methods approach, incorporating qualitative interviews or case studies, to capture a more nuanced understanding of elderly care in rural China (Li et al., 2023).

Practical implications

The implications of this research are substantial for both policymakers and practitioners. It highlights the necessity for policies that facilitate the scalability and adaptability of the rural mutual aid elderly care model across diverse regions. Additionally, it underscores the importance of addressing challenges such as resource limitations and community engagement levels to enhance the effectiveness of this care model. These insights can inform the development of more tailored and sustainable elderly care strategies, contributing to the broader discourse on ageing and social policy not only in China but also in other East Asian countries ():

  • Financial and social sustainability: The successful implementation of the rural mutual aid elderly care model demonstrates its potential to reduce the financial and social burdens of elderly care by fostering self-reliance and mutual support among older adults. Policymakers should leverage this model to craft cost-effective and sustainable care solutions that align with the cultural and social frameworks of rural communities ().

  • Promotion of active ageing: The emphasis on active ageing principles – such as promoting health, participation and security – suggests that elderly care programs should prioritise initiatives that empower the elderly to actively engage in their communities. This approach not only improves the quality of life for older adults but also strengthens community cohesion and support networks (Zhou and Li, 2021).

  • Localised strategies: The study underscores the importance of tailoring elderly care strategies to local contexts, considering regional disparities and community-specific needs. This localized approach ensures that the mutual aid model is adaptable and effective across different rural settings. Policymakers and practitioners are encouraged to provide the necessary resources and training to communities to support the successful adoption of this model ().

  • Global relevance: The research findings can serve as a blueprint for other countries facing similar challenges with ageing populations, particularly in rural areas. By adopting and adapting the rural mutual aid elderly care model, other East Asian countries can benefit from a culturally sensitive and community-driven approach to elderly care ().

Social implications

The findings of this study have profound social implications, particularly regarding how ageing is perceived and managed within rural communities in China. The transition from traditional, passive elderly care models to one grounded in active ageing principles represents a broader societal shift in how the elderly are valued and supported. By promoting health, participation and security, the rural mutual aid elderly care model fosters a more inclusive and supportive community environment where the elderly are active contributors to their well-being and that of their peers. This model challenges the conventional notion of ageing as a period of decline and dependence, instead highlighting the potential for older adults to maintain autonomy and engage meaningfully in their communities. This shift may reduce social isolation and enhance social cohesion, as intergenerational relationships are fortified through mutual support and shared responsibilities ().

Original contribution and future research directions

This study significantly contributes to the fields of gerontology and social policy by providing a detailed analysis of the rural mutual aid elderly care model in China through the lens of active ageing principles. Unlike existing literature that often focuses on urban settings and institutional care, this research addresses the unique challenges of ageing in rural areas grappling with economic and social disparities. By exploring how active ageing concepts – health, participation and security – are integrated into a community-driven model, the study offers new insights for developing sustainable, culturally appropriate ageing solutions in rural contexts. Additionally, it fills a gap in the literature regarding the application of active ageing principles in non-Western environments, offering practical recommendations for addressing similar demographic challenges in East Asia and beyond. The emphasis on mutual aid and community engagement provides a valuable framework for rethinking rural elderly care, significantly contributing to global ageing and social policy discussions (Li et al., 2023).

Recommendations

To effectively address the unique needs of China’s ageing population, the following recommendations are proposed:

  • Expand rural mutual aid elderly care programs: Encourage the growth of initiatives focused on “self-help mutual assistance”, empowering the elderly to actively participate in their care and support networks.

  • Integrate active ageing principles: Incorporate health, participation and security into rural elderly care initiatives by educating communities on active ageing and encouraging healthy lifestyle practices.

  • Advocate for policy support and funding: Seek government and stakeholder support, including financial incentives and resources, to sustain these programs and create conducive regulatory frameworks.

  • Enhance community engagement and collaboration: Foster cooperation among local residents, organisations, health-care providers and government bodies to leverage resources and expertise for program success.

  • Promote further research and evaluation: Support ongoing research to evaluate the effectiveness of these programs on the well-being of the elderly, using comprehensive assessments to guide policy and practice.

Implementing these recommendations can help develop sustainable rural mutual aid elderly care programs that effectively meet the needs of China’s ageing population.

References

Al-Khafajiy, M., Baker, T., Chalmers, C., Asim, M., Kolivand, H., Fahim, M. and Waraich, A. (2019), “Remote health monitoring of elderly through wearable sensors”, Multimedia Tools and Applications, Vol. 78 No. 17, pp. 24681-24706.

Amri, S. and Sihotang, J. (2023), “Impact of poverty reduction programs on healthcare access in remote AR-EAS: fostering community development for sustainable health”, Law and Economics, Vol. 17 No. 3, pp. 170-185.

Atkinson, P. (2018), “The clinical experience (1997)”, The Construction and Reconstrucion of Medical Reality, Routledge, New York, NY.

Braun, V. and Clarke, V. (2006), “Using thematic analysis in psychology”, Qualitative Research in Psychology, Vol. 3 No. 2, pp. 77-101.

Campbell, J.C. and Ikegami, N. (2000), “Long-term care insurance comes to Japan”, Health Affairs, Vol. 19 No. 3, pp. 26-39.

Campbell, J.C., Ikegami, N. and Kwon, S. (2009), “Policy learning and cross-national diffusion in social long-term care insurance: Germany, Japan, and the Republic of Korea”, International Social Security Review, Vol. 62 No. 4, pp. 63-80.

Cao, F. (2018), Elderly Care, Intergenerational Relationships and Social Change in Rural China, Springer, Cham.

Chen, H., Hagedorn, A. and An, N. (2023), “The development of smart eldercare in China”, The Lancet Regional Health–Western Pacific, Vol. 35.

Cho, S.H. (2005), “Older people’s willingness to use home care nursing services”, Journal of Advanced Nursing, Vol. 51 No. 2, pp. 166-173.

Chon, Y., Lee, S.H. and Kim, Y.Y. (2024), “Long-Term care insurance for older adults in terms of community care in South Korea: using the framework method”, Healthcare, Vol. 12 No. 13, p. 1238.

Chung, J., Thompson, H.J., Joe, J., Hall, A. and Demiris, G. (2017), “Examining Korean and Korean American older adults’ perceived acceptability of home-based monitoring technologies in the context of culture”, Informatics for Health and Social Care, Vol. 42 No. 1, pp. 61-76.

Creswell, J.W. and Creswell, J.D. (2017), Research Design: Qualitative, Quantitative, and Mixed Methods Approach, Sage publications, London.

Cui, W., Feng, L., Liang, H., Lin, Y., Lu, T. and Wu, R. (2024), “The implication of Japan’s combined medical and elderly care model for the elderly care industry in Meizhou city”, 2023 2nd International Conference on Public Service, Economic Management and Sustainable Development (PESD 2023), Atlantis Press, pp. 424-430.

Denzin, N.K., Lincoln, Y.S., Giardina, M.D. and Cannella, G.S. (Eds) (2023), The Sage Handbook of Qualitative Research, Sage publications, London.

Feng, Z., Glinskaya, E., Chen, H., Gong, S., Qiu, Y., Xu, J. and Yip, W. (2020), “Long-term care system for older adults in China: policy landscape, challenges, and future prospects”, The Lancet, Vol. 396 No. 10259, pp. 1362-1372.

Gibson, C. and Gordon, A. (2018), “Rural cultural resourcefulness: how community music enterprises sustain cultural vitality”, Journal of Rural Studies, Vol. 63, pp. 259-270.

Glinskaya, E. and Feng, Z. (2018), Options for Aged Care in China: Building an Efficient and Sustainable Aged Care System, World Bank Publications, Washington, DC.

Guo, X., Pan, T. and Guo, S. (2023), “Socialized care services for the aged population: system construction and support measures”, Frontiers of Engineering Management, Vol. 10 No. 2, pp. 339-353.

He, H. and Song, Q. (2021), “The model and development trend of mutual-aid service for the older adults in rural China”, 2021 International Conference on Public Management and Intelligent Society (PMIS), IEEE, pp. 1-6.

Hestevik, C.H., Molin, M., Debesay, J., Bergland, A. and Bye, A. (2020), “Older patients’ and their family caregivers’ perceptions of food, meals and nutritional care in the transition between hospital and home care: a qualitative study”, BMC Nutrition, Vol. 6 No. 1, pp. 1-13.

Jeon, B. and Kwon, S. (2017), “Health and long-term care systems for older people in the Republic of Korea: policy challenges and lessons”, Health Systems & Reform, Vol. 3 No. 3, pp. 214-223.

Jiang, H., Liu, C., Wu, X., Zhang, H. and Liu, J. (2023), “The development of assistive product policies in China from the perspective of the assistive product industry”, Disability and Rehabilitation: Assistive Technology, Vol. 18 No. 8, pp. 1266-1280.

Jing, S., Xiaoqing, Z. and Hongying, L. (2023), “Research on the rural mutual aid elderly care model of ‘time bank’”, International Journal of Frontiers in Sociology, Vol. 5 No. 5.

Kim, W., Chun, S.Y., Lee, J.E., Lee, T.H. and Park, E.C. (2019), “Factors related to the institutionalization of older aged individuals using home-and community-based care services: data from the South Korea long-term care insurance program, 2008–2013”, Journal of Aging & Social Policy, Vol. 31 No. 4, pp. 321-337.

Kim, A., Kim, Y., Rhee, J., Lee, S., Jeong, Y., Lee, J., Yoo, Y., Kim, H., So, H. and Park, J. (2022), “A study on emotions to improve the quality of life of South Korean senior patients residing in convalescent hospitals”, International Journal of Environmental Research and Public Health, Vol. 19 No. 21, p. 14480.

Lee, E.J. and Park, S.J. (2020), “Immersive experience model of the elderly welfare centers supporting successful aging”, Frontiers in Psychology, Vol. 11, p. 8.

Liu, J. and Cook, J. (2020), “Ageing and intergenerational care in rural China: a qualitative study of policy development”, Contemporary Social Science, Vol. 15 No. 3, pp. 378-391.

Liu, Y., Zhang, X. and Zhang, Y. (2022), “Service supply chain optimization of community elderly care-A case study in Beijing”, International Conference on Logistics, Informatics and Service Sciences, Springer Nature Singapore, Singapore, pp. 487-511.

Majumder, S., Aghayi, E., Noferesti, M., Memarzadeh-Tehran, H., Mondal, T., Pang, Z. and Deen, M.J. (2017), “Smart homes for elderly healthcare—recent advances and research challenges”, Sensors, Vol. 17 No. 11, p. 2496.

Ministry of Health, Labour and Welfare (2020), “Ministry of health, labour and welfare report survey on situation of long-term care insurance service”, available at: www.mhlw.go.jp/topics/kaigo/osirase/jigyo/20/dl/r02_zenkokukei.pdf

Morgan, H. (2022), “Conducting a qualitative document analysis”, The Qualitative Report, Vol. 27, pp. 64-77.

National Development and Reform Commission (2024), “National medium – and long term pension insurance development plan (2024-2050)”, Beijing: National Development and Reform Commission.

Pak, T.Y. (2020), “Social protection for happiness? The impact of social pension reform on subjective well-being of the Korean elderly”, Journal of Policy Modeling, Vol. 42 No. 2, pp. 349-366.

Park, D. (Ed.) (2012), Pension Systems in East and Southeast Asia: promoting Fairness and Sustainability, Asian Development Bank, Vol. 480.

Patton, M.Q. (2014), Qualitative Research & Evaluation Methods: Integrating Theory and Practice, Sage publications, London.

Pei, X. and Tang, Y. (2012), “Rural old age support in transitional China: efforts between family and state”, Aging in China: Implications to Social Policy of a Changing Economic State, Springer, New York, NY, pp. 61-81.

Schwiter, K., Brütsch, J. and Pratt, G. (2020), “Sending granny to Chiang Mai: debating global outsourcing of care for the elderly”, Global Networks, Vol. 20 No. 1, pp. 106-125.

Sung, K.T. (1995), “Measures and dimensions of filial piety in Korea”, The Gerontologist, Vol. 35 No. 2, pp. 240-247.

Tamiya, N., Noguchi, H., Nishi, A., Reich, M.R., Ikegami, N., Hashimoto, H., Shibuya, K., Kawachi, I. and Campbell, J.C. (2011), “Population ageing and wellbeing: lessons from Japan’s long-term care insurance policy”, The Lancet, Vol. 378 No. 9797, pp. 1183-1192.

Tanaka, M., Ishii, S., Matsuoka, A., Tanabe, S., Matsunaga, S., Rahmani, A., Dutt, N., Rasouli, M. and Nyamathi, A. (2024), “Perspectives of Japanese elders and their healthcare providers on use of wearable technology to monitor their health at home: a qualitative exploration”, International Journal of Nursing Studies, Vol. 152, p. 104691.

Tsutsui, T. and Muramatsu, N. (2005), “Care-needs certification in the long-term care insurance system of Japan”, Journal of the American Geriatrics Society, Vol. 53 No. 3, pp. 522-527.

Walker, A. and Foster, L. (2013), “Active ageing: rhetoric, theory and practice”, The Making of Ageing Policy, Edward Elgar Publishing, Cheltenham, pp. 27-52.

Wang, K., Ke, Y., Sankaran, S. and Xia, B. (2021), “Problems in the home and community-based long-term care for the elderly in China: a content analysis of news coverage”, The International Journal of Health Planning and Management, Vol. 36 No. 5, pp. 1727-1741.

World Health Organisation (2002), “Active ageing: a policy framework: world health organisation”, Noncommunicable Disease Prevention and Health Promotion Department.

Wu, C., Gao, L., Chen, S. and Dong, H. (2016a), “Care services for elderly people with dementia in rural China: a case study”, Bulletin of the World Health Organization, Vol. 94 No. 3, pp. 167-173, doi: 10.2471/BLT.15.160929.

Wu, J., Li, H., Cheng, S. and Lin, Z. (2016b), “The promising future of healthcare services: when big data analytics meets wearable technology”, Information & Management, Vol. 53 No. 8, pp. 1020-1033.

Xie, Q. and Yuan, X. (2023), “Outdoor activity-friendly environments for older adults with disabilities: a case study in China from a functioning perspective”, Building Health and Wellbeing, Routledge, New York, NY, pp. 164-192.

Yao, K.R., Yin, X.H., Qin, L., Tang, X. and Tan, X.Z. (2021), “Factors influencing the mutual-support willingness and needs among the rural elderly in China: a Cross-Sectional study”, BMC Health Services Research, Vol. 22 No. 1, p. 302.

Yi, Y.M., Park, Y.H., Cho, B., Lim, K.C., Jang, S.N., Chang, S.J., Ko, H., Noh, E.Y. and Ryu, S.I. (2021), “Development of a community-based integrated service model of health and social care for older adults living alone”, International Journal of Environmental Research and Public Health, Vol. 18 No. 2, p. 825.

Yin, R.K. (2018), Case Study Research and Applications: Design and Methods, 6th ed. Sage, London.

Yoon, J.Y., Kim, H., Jung, Y.I. and Ha, J.H. (2016), “Impact of the nursing home scale on residents’ social engagement in South Korea”, International Psychogeriatrics, Vol. 28 No. 12, pp. 1965-1973.

Yu, W., Wang, Q. and Qiao, Z. (2024), “Study on the time and scale of mutual aid for aging care under the background of active aging”, Frontiers in Public Health, Vol. 11, p. 1196411.

Zhan, H.U. and Xizhe, P. (2020), “Strategic changes and policy choices in the governance of China’s aging society”, Social Sciences in China, Vol. 41 No. 4, pp. 185-208.

Zhang, Z., Wang, Z. and Qiu, Z. (2023), “Unveiling the evolution of eldercare facilities in rural China: tracing the trajectory from eldercare support pattern and service to facilities for the aging population”, In Healthcare, Vol. 11 No. 18, p. 2474.

Zhou, Z., Wang, L. and Dong, Y. (2023), “Research on innovative design of community mutual aid elderly care service platform based on Kano model”, Heliyon, Vol. 9 No. 5.

Further reading

China Social Security Network (2024), “China’s elderly population statistics and forecast report”, Beijing: China Social Security Network.

Meng, J., Lin, Z. and Wang, T. (2022), “Retracted] the framework of a rural pension system based on a mutual aid network”, Wireless Communications and Mobile Computing, Vol. 2022 No. 1, p. 4954185.

Ministry of Health, Labour, and Welfare (2024), “Regarding housing for the elderly [EB/OL] [2014-06-11]”, available at: www.mhlw.go.jp/file/05-Shingikai-12601000-Seisakutoukatsukan-Sanjikanshitsu_Shakaihoshoutantou/0000048000.pdf

Walker, A. (2002), “A strategy for active ageing”, International Social Security Review, Vol. 55 No. 1, pp. 121-139.

Yan, B., Gao, X. and Shen, Z. (2018), “Prospective living arrangement of China’s urban elderly and development of an agent-based simulation (ABS) model for elderly care needs”, International Review for Spatial Planning and Sustainable Development, Vol. 6 No. 1, pp. 63-82.

Corresponding author

Bingwen Yan is the corresponding author and can be contacted at: yanb@cput.ac.za

About the authors

Shuo Wang is based at Business School, Shanghai Dianji University, Shanghai, China. Shuo Wang is an associate professor and the Director of International Cooperation Office in Business school, Shanghai Dianji University. His research areas cover international economics and trade, business model innovation and modern enterprise resource optimization.

Bingwen Yan is based at Faculty of Engineering and The Built Environment, Cape Peninsula University of Technology, Cape Town, South Africa. Bingwen Yan is a professor and the Head of the Department of Industrial and Systems Engineering at the Faculty of Engineering and Built Environment, Cape Peninsula University of Technology, South Africa. His research spans a wide range of fields, including industrial engineering, engineering management, public administration and business management.

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