Care needs and preferences among older adults in an eastern Chinese province between 2013 and 2023: a repeated cross-sectional study

Abstract

Background Population aging and shrinking family structures are challenging traditional older adult care arrangements and widening the gap between older adults' care needs and available support. In China, policies promote integrated home, community, and institutional care. Understanding care needs, preferences, and associated factors is essential for developing evidence-informed care systems. Methods We utilized data from an eastern Chinese province collected in the 2013, 2018, and 2023 waves of the China National Health Services Survey. Using the Andersen Behavioral Model as an exploratory conceptual framework, the independent variables were categorized into predisposing, enabling, and need factors. Wave-specific logistic regression models examined factors associated with care needs across all three waves and care preferences in 2018 and 2023. To examine the choice between traditional home care and formal community- or institution-based services, care preference was analyzed primarily as a binary outcome, while supplementary multinomial models retained all three original categories. Sequential blockwise logistic regression assessed the incremental contribution of each Andersen model dimension using pooled 2018 and 2023 data. Results Our study included 10,934, 10,954, and 11,244 older adults in 2013, 2018, and 2023, respectively. Self-reported care needs remained stable at approximately 11%, whereas preferences for home care increased from 85.0% in 2018 to 93.0% in 2023. Need factors made the largest incremental contribution to care needs, while enabling and need factors made modest additional contributions to care preferences. Care needs were associated with age, health utility, chronic diseases, disability, dementia, sensory impairments, physical exercise, and social activity. Regarding care preferences, older age (2018: OR = 1.032; 2023: OR = 1.019) and being married were associated with a greater likelihood of preferring home care. Higher educational level was associated with community care (2018: OR = 1.150; 2023: OR = 1.356), whereas higher household income (2018: OR = 1.059; 2023: OR = 1.134), more chronic diseases (2018: OR = 1.097; 2023: OR = 1.127), and participation in social activity (2018: OR = 1.189; 2023: OR = 1.282) were associated with institutional care. Conclusions Home care remained the predominant preference, while the prevalence of self-reported care needs showed little variation across the survey waves. Our findings underscore the importance of strengthening home-based support while maintaining affordable and accessible community- and institution-based care options.