Satisfying the multiple needs of older adults in rural China through the adaptation of dual polycentric systems

Global ageing is accelerating, with one in six people projected to be over 65 by 2050. Older adults in rural areas face heightened risks due to greater care needs and fewer services. In China, 13.5% of the population was aged 65+ in 2020, with about 40% living in rural areas, making rural ageing a major policy and service delivery challenge. Existing solutions often involve external inputs, high costs, and limited sustainability. The study reframes rural care through the lens of dual polycentric systems rooted in intergenerational relations: adult offspring balancing their own nuclear family’s sustainable development with meeting parents’ multifaceted needs (daily care, economic well-being, spiritual fulfillment). Drawing on Ostrom’s polycentric theory, the study asks: (RQ1) How to construct polycentric systemic models around the respective life patterns of adult offspring and their older parents in rural Chinese families? (RQ2) How might these distinct polycentric systems be adapted and managed to capitalize on spontaneous order? The authors propose a conceptual framework and use fsQCA to identify critical nesting points to integrate the systems, aiming for proactive, sustainable solutions to rural ageing.

Care for older adults in rural areas: Prior studies document multiple determinants of older adults’ well-being (physical and mental health, social and leisure participation, culture and filial piety, policy contexts such as the one-child policy and NRCMS). Rural–urban migration can improve parental access to resources via remittances but increases workload, reduces social engagement, and is associated with lower happiness and greater loneliness among left-behind parents. Policy responses include China’s New Rural Pension Scheme (NRPS) and efforts to integrate rural–urban insurance systems, which can reduce disparities; international experiences (e.g., Italy’s home care delegation; privatization and PPPs in Western contexts) suggest quality improvements but may not directly translate to rural China. Polycentricity and framework: Polycentricity denotes multiple autonomous decision centers operating under shared rules, generating spontaneous order. The framework applies polycentric theory at two levels: (1) older parents’ polycentric needs—daily care, economic well-being, spiritual fulfillment; (2) adult offspring’s polycentric centers guiding strategies for family development—traditional mindset (e.g., son preference), social activities, engagement with market economy, government-related policies, and filial piety (reciprocal and authoritative). Misalignment between systems disrupts intergenerational care. The study posits that alignment depends on identifying nesting points (combinational configurations) where offspring’s centers match parents’ needs. The authors outline how each center can affect parents’ outcomes and justify using fsQCA to capture configurational causality. They also propose, conceptually, an organizational-level polycentric system leveraging multiple actors (families, enterprises, social organizations, government) to institutionalize nesting points across organizations.

Design: Fuzzy-set Qualitative Comparative Analysis (fsQCA) to discover configurations (nesting points) linking adult offspring’s centers to older parents’ outcomes. fsQCA is suitable for complex causal relations and medium sample sizes. Data collection: Surveys and interviews conducted Oct 2021–May 2022 across 44 villages in Shandong, Anhui, Jiangsu, and Jiangxi, China. With 15 student volunteers, 150 families were visited; after excluding invalid responses, 129 valid dyadic cases remained, including 128 older adults (62 female, 67 male) and 129 caregivers (adult children: 36 female, 93 male). Each case includes responses from an older adult and one or two caregivers. Measures: Outcome variables—perceived daily care (reliability CR=0.806; based on CGSS 2017), perceived economic well-being (self-rated satisfaction and monthly disposable income), and perceived spiritual fulfillment (reverse-coded loneliness frequency; participation in cultural/recreational activities). Antecedent variables—five centers for adult offspring: traditional mindset (son preference, number of sons; aggregated objective and subjective indicators), market economy (distance from parents, weekly work hours, frequency of financial support), government-related policies (older adults’ NRPS pension amount; presence of eldercare-related infrastructure), social activities (number of friends; frequency of social events), filial piety (reciprocal and authoritative dimensions; validated scales, reliabilities 0.750 and 0.782). For multi-item scales, item averages were used. Variable processing: Objective indicators converted to five-point Likert scales and aggregated with subjective items to composite scores. Calibration: All variables calibrated to fuzzy sets using the 5th percentile (full non-membership), 50th percentile (crossover), and 95th percentile (full membership). Analysis: Necessary condition analysis (consistency >0.90 threshold for necessity). Truth table analysis with frequency cutoff=2 and consistency cutoff=0.90; sufficiency threshold (solution consistency) set at >0.75. Reported solution coverages: daily care 0.707 (consistency 0.866), economic well-being 0.434 (consistency 0.914), spiritual fulfillment 0.729 (consistency 0.873). Robustness: Predictive validity via random subsample (delete 1/3 cases), derive configurations, test on full sample (most pathways consistent >0.75). Additional robustness by increasing frequency threshold from 2 to 3; main pathways remained stable.

• No single antecedent was a necessary condition for any outcome (perceived daily care, economic well-being, spiritual fulfillment), confirming multi-centric, configurational causality. - Perceived daily care: Six sufficient pathways across four types. Government-policy-led (A1–A3): core presence of Cent-Gov, with differing peripheral patterns (e.g., A1: presence Cent-Mark and absence Cent-Trad and Auth-FP; A2: presence Cent-Trad, Recip-FP, Auth-FP; A3: presence Cent-Soci, Recip-FP, Auth-FP). Harmonious family with market co-lead (B): core presence Cent-Mark and Recip-FP; absence Cent-Trad, Cent-Soci, Auth-FP. Sociable children and traditional mindset co-led (C): core presence Cent-Trad and Cent-Soci; peripheral presence Cent-Mark and absence of both filial piety forms; care arises via sociable networks. Traditional rural proximity (D): peripheral presence Cent-Trad and Cent-Gov; absence Cent-Mark, Cent-Soci, Recip-FP, Auth-FP; care arises from proximity despite weak filial culture. Solution coverage 0.707; consistency 0.866. - Perceived economic well-being: Two similar pathways with core presence of Cent-Gov and Cent-Soci and core absence of Auth-FP; peripheral absence of Cent-Trad and presence of Cent-Mark. Reciprocal filial piety absent in A1 and indifferent in A2. Indicates pensions/infrastructure plus sociable children and engagement with market economy, without authoritative filial norms, drive parents’ perceived economic well-being. Solution coverage 0.434; consistency 0.914. - Perceived spiritual fulfillment: Six pathways grouped into three types. Sociable-children-led (A1–A2): core presence Cent-Soci; peripheral absence of Recip-FP and Auth-FP; A1 also has peripheral presence Cent-Mark; A2 has peripheral absence Cent-Trad and Cent-Gov. Reciprocal-filial-piety-led (B1–B3): core presence Recip-FP; peripheral conditions vary (e.g., B1 presence of Cent-Trad, Cent-Gov, Auth-FP; B2 absence of Cent-Trad, Cent-Gov, Auth-FP, Cent-Soci; B3 presence Cent-Mark and Cent-Gov, absence Cent-Trad and Auth-FP). Co-led model (C): core presence Cent-Soci and Recip-FP; peripheral presence Cent-Gov and Auth-FP. Solution coverage 0.729; consistency 0.873. - Aggregated nesting points (Table 9): Most frequent core conditions across outcomes are Cent-Soci (4 occurrences), Recip-FP (3), Cent-Gov (2), Cent-Mark (1). Cent-Trad appears positively once but conflicts with contemporary values; Auth-FP appears as absence and should be minimized. - Robustness checks show good predictive validity and stability of main configurations.

The findings support modeling rural eldercare as alignment between two polycentric systems: older parents’ multi-needs and adult offspring’s multi-centers. No single pathway simultaneously maximizes daily care, economic well-being, and spiritual fulfillment, reflecting real-world complexity. However, recurrent nesting points—sociable children (Cent-Soci), reciprocal filial piety (Recip-FP), supportive government policies (Cent-Gov), and engagement with the market economy (Cent-Mark)—enable partial alignments that enhance specific outcomes. Policy and practice implications include orchestrating an organizational-level polycentric arrangement that mobilizes actors at their comparative-advantage nesting points: village self-governance to cultivate social activities and networks; government to provide pensions and infrastructure, including services supporting spiritual life; businesses to decentralize and invigorate rural market opportunities; schools and media to promote reciprocal (rather than authoritative) filial piety. Traditional son preference and authoritative filial piety generally hinder alignment and should be discouraged. By leveraging spontaneous order across multiple centers and organizations, stakeholders can move beyond one-dimensional, high-cost, reactive approaches toward sustainable, adaptable care ecosystems.

This study reframes rural eldercare in China as the problem of aligning two polycentric systems—adult children’s strategy centers and older parents’ multi-dimensional needs—via empirically identified nesting points. Using fsQCA on 129 family cases across four provinces, the study identifies key nesting points: sociable children, reciprocal filial piety, government support, and engagement with the market economy. It recommends constructing an organizational-level polycentric system wherein families, village organizations, government agencies, businesses, educational institutions, and media each activate these nesting points according to their comparative advantages, allowing spontaneous order to facilitate alignment. Although no single configuration satisfies all needs simultaneously, the approach offers a proactive, sustainable pathway to improve daily care, economic well-being, and spiritual fulfillment among rural older adults. Future work could pilot and evaluate such polycentric interventions and examine transferability beyond Confucian-influenced rural contexts.

• Methodological: fsQCA’s Boolean simplifications can reduce interpretability and detail, and pathway parsimony may mask nuances. - External validity: Findings are specific to rural China and contexts shaped by Confucian culture; generalizability to other settings may be limited. - Conceptual to practical gap: The proposed organizational-level polycentric framework is conceptual and requires real-world implementation and longitudinal evaluation to verify effectiveness.