This research addresses three core questions: (1) How can a comprehensive measurement system for healthy ageing be constructed for China, considering China's unique socioeconomic conditions? (2) What are the temporal trends, structural characteristics, and regional disparities in China's healthy ageing levels? (3) Based on empirical findings, what targeted pathways can be proposed for optimization? To answer these questions, we developed a six-dimensional index encompassing physical health, mental health, social participation, living environment, economic security, and health behaviors and knowledge. The analysis integrates nationally representative microdata from the China Longitudinal Aging Social Survey (CLASS) with macro-level statistics from the China Statistical Yearbook. Entropy method is employed for objective weighting to synthesize a composite Healthy Ageing Index (HAI), and kernel density estimation is utilized to analyze distribution dynamics and regional evolution.
The key findings reveal a steady improvement in China's national HAI, rising from 0.1653 in 2018 to 0.2339 in 2023. However, progress is highly uneven across dimensions and regions. Significant gains were observed in the dimensions of physical health, living environment, and health behaviors and knowledge, which emerged as the primary drivers of overall improvement. In contrast, mental health, social participation, and economic security showed minimal improvement, constituting critical and persistent bottlenecks. Furthermore, healthy ageing among China's older population exhibits significant regional disparities and dimensional imbalances.
Based on these empirical findings, this study proposes five interconnected optimization pathways: (1) strengthening the economic security system to solidify the foundation for healthy ageing; (2) constructing community-based psychosocial support networks to address gaps in mental well-being and social inclusion; (3) promoting life-cycle health management to sustain gains in physical health and behavioral improvements; (4) leveraging smart technologies for inclusive, age-friendly environmental upgrades while bridging the digital divide; and (5) cultivating an interdisciplinary talent pool to support the sustainable operation of service systems.
The contributions of our study are threefold. Firstly, it advances the theoretical framework by integrating the World Health Organization's “functional ability” concept with China's specific contextual factors into a coherent, multi-dimensional measurement system. Secondly, it provides a robust longitudinal and spatial analysis of healthy ageing trends in China using recent nationwide data and objective weighting techniques, offering novel empirical evidence on evolving regional patterns and dimensional bottlenecks. Thirdly, in terms of policy relevance, the findings and proposed pathways offer a data-driven, localized roadmap for policymakers to design targeted interventions, contributing to the strategic goals of “Healthy China 2030” and an effective response to population ageing.
This study advances the life course research by reframing labor force exit as a dynamic process. Methodologically, it uses sequence analysis, multistate modelling, and counterfactual decomposition into a unified framework for trajectory identification, association estimation, and mechanism testing. The findings show that employment-retirement trajectories embody cumulative differences in income, social insurance coverage, and health resilience. In China's context, where social insurance schemes are stratified by employment type and sector, these trajectories reflect systematic differences in access to institutional protection. The results carry policy implications for China's ongoing gradual delay of statutory retirement ages. Targeted labor market support should be extended to peri-retirement workers, especially those in informal employment and long-term non-employment. Expanding social insurance coverage for disadvantaged groups and reducing institutional stratification in benefits could enhance health recovery capacity. Addressing gendered disadvantages requires recognising women's unpaid care work and ensuring more fair pension entitlements.
Results indicate that smart devices significantly improve older adults' perceived convenience of internet-based health management and increase their likelihood of engaging in such behaviors. This conclusion remains robust across a series of rigorous tests. Based on cognitive and behavioral dimensions, older adults are classified into four types: active participants, passive participants, potential participants, and bystanders, with the results confirming clear transition pathways among these types. Specifically, smart devices enhance older adults' perceived convenience of internet-based health management by improving their information search ability and internal health motivation, thereby facilitating the conversion of bystanders into potential participants. Furthermore, smart devices promote the transition from potential participants to active participants by boosting their sense of social adaptation. However, software usage ability does not show a significant mediating effect, suggesting that some older adults with perceived convenience still fail to act due to their insufficient internet operational skills. In addition, substantial heterogeneity is found in the effects of different smart devices on older adults' internet-based health management, and the same device exerts distinctly different effects on their cognition versus actual behavior. For instance, smart wristbands and smart watches tend to encourage older adults to become potential participants, whereas all-in-one smart devices and smart cameras are more likely to facilitate their transition into active participants. These findings highlight the need for tailored interventions that facilitate older adults' adoption of digital technologies in line with their types of internet-based health management. Both community-based digital skills training and intergenerational digital support within families may help enhance older adults' software usage ability.
This study contributes to the literature by advancing the analytical focus from behavior alone to an integrated cognition-behavior perspective. Therefore, this shift clarifies the heterogeneous empowerment pathways of smart devices for older adults' internet-based health management. The findings provide robust empirical evidence for optimizing the supply of internet-based health services for older adults and promoting the development of age-friendly digital health systems.
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