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Background <p>China’s community care system is expanding rapidly under the “9073” framework, yet service allocation remains anchored to chronological age rather than to functional heterogeneity. Frailty and disability are typically measured as separate constructs, and unmet community care needs are rarely examined across empirically derived health strata. This study identified health strata among urban community-dwelling older adults in China using frailty and ADL indicators, and examined whether service needs, perceived availability, and need-availability mismatch differed across strata.</p> Methods <p>A cross-sectional survey was conducted between May 2024 and March 2025 among 969 community-dwelling adults aged ≥ 60 years across eight cities in Jiangsu Province. Latent class analysis (LCA) was applied to 11 binary indicators from the FRAIL scale and the Katz ADL index to identify health strata. Service needs across four domains (medical and health services, daily living support, professional care, psychosocial support), perceived availability, and need-availability mismatch were assessed at the domain level. Multivariable logistic regression estimated associations between health strata and each outcome, adjusting for demographic and socioeconomic covariates.</p> Results <p>LCA identified three strata: healthy and vigorous (75.9%), frail without disability (17.1%), and frail with disability (6.9%). Reported needs differed significantly across strata for all four domains (all <i>P</i> &lt; 0.001; analytic <i>n</i> = 919). The frail-without-disability group already had elevated adjusted odds of service need across domains (ORs 2.87–4.47), while the frail-with-disability group showed the steepest gradient for professional care (OR 16.65). Perceived availability did not differ significantly across strata. Need-availability mismatch was highest in the frail-without-disability group for medical and health services (61.7%), daily living support (61.7%), and psychosocial support (51.9%); for professional care, mismatch was highest in the frail-with-disability group (57.6%).</p> Conclusions <p>Community care needs were strongly patterned by empirically derived health strata, whereas perceived availability varied little across strata. The concentration of high mismatch among frail older adults without ADL disability suggests a potential service recognition gap before disability becomes established. Brief frailty screening and clearer referral pathways may help identify older adults with elevated community care needs earlier.</p>

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Health-stratified community care needs and need-availability mismatch among urban older adults in China: a latent class analysis along the frailty-disability continuum

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月8日

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  • Sha Sha,
  • Yao Pan,
  • Tingting Lian,
  • Yifan Mao,
  • Yi Ling,
  • Yating Zang,
  • Erfeifei Ma

摘要

Background

China’s community care system is expanding rapidly under the “9073” framework, yet service allocation remains anchored to chronological age rather than to functional heterogeneity. Frailty and disability are typically measured as separate constructs, and unmet community care needs are rarely examined across empirically derived health strata. This study identified health strata among urban community-dwelling older adults in China using frailty and ADL indicators, and examined whether service needs, perceived availability, and need-availability mismatch differed across strata.

Methods

A cross-sectional survey was conducted between May 2024 and March 2025 among 969 community-dwelling adults aged ≥ 60 years across eight cities in Jiangsu Province. Latent class analysis (LCA) was applied to 11 binary indicators from the FRAIL scale and the Katz ADL index to identify health strata. Service needs across four domains (medical and health services, daily living support, professional care, psychosocial support), perceived availability, and need-availability mismatch were assessed at the domain level. Multivariable logistic regression estimated associations between health strata and each outcome, adjusting for demographic and socioeconomic covariates.

Results

LCA identified three strata: healthy and vigorous (75.9%), frail without disability (17.1%), and frail with disability (6.9%). Reported needs differed significantly across strata for all four domains (all P < 0.001; analytic n = 919). The frail-without-disability group already had elevated adjusted odds of service need across domains (ORs 2.87–4.47), while the frail-with-disability group showed the steepest gradient for professional care (OR 16.65). Perceived availability did not differ significantly across strata. Need-availability mismatch was highest in the frail-without-disability group for medical and health services (61.7%), daily living support (61.7%), and psychosocial support (51.9%); for professional care, mismatch was highest in the frail-with-disability group (57.6%).

Conclusions

Community care needs were strongly patterned by empirically derived health strata, whereas perceived availability varied little across strata. The concentration of high mismatch among frail older adults without ADL disability suggests a potential service recognition gap before disability becomes established. Brief frailty screening and clearer referral pathways may help identify older adults with elevated community care needs earlier.