Exploring supply and demand imbalance of community-based older adult care: an observational study in Chongqing, China

Objective Using an urban area in southwest China as a case study, this research investigates and analyzes the supply and demand of community-based older adult care services to provide a basis for optimizing the older adult care service system. Methods A two-stage sampling method was employed to select older participants. Questionnaires, designed based on the Kano model, were administered to participants, and semi-structured interviews were conducted with community senior center managers and services users. The Kano model, Better-Worse index analysis and Analytic Hierarchy Process (Kano-BW-AHP) was used for quantitative analysis, while the two-step cluster analysis was employed for user profiles. Qualitative analysis was based on interview data. Results A total of 259 questionnaires and 16 interview reports were collected. The Kano analysis identified 34 community older adult services, with most categorized as attractive or indifferent attributes, and only emergency assistance was identified as a one-dimensional attribute. The BW analysis revealed 3 must-be, 9 attractive, and 1 one-dimensional service. The top five services, based on the Kano-BW-AHP model, were contact with friends and relatives, emergency assistance, regular medical checkups, older adult canteen and meal delivery, and special policy consultation. A comparison between those who chose community-based older adult care and those who did not showed statistically significant differences in six variables: age, education, employee medical insurance, a regular pension, living status, and services awareness ( p < 0.05). Cluster analysis of participants who chose community older adult care revealed two user profiles: 51 (73.9%) were urban, high-educated users with strong consumption willingness; 18 (26.1%) were rural, low-education individuals with limited income. Community older adult care centers face issues included limited service variety, inadequate beds, insufficient staffing, lack of funding, and no follow-up plans. Additionally, the older adult displayed limited understanding of care services, dissatisfaction with catering, and demand for spiritual support. Conclusion The community-based older adult care system shows a structural imbalance between supply and demand, particularly in terms of service quantity, quality, and efficiency. The findings provides a reference for policy formulation and the improvement of community-based older adult care services.