Unmet needs for proactive health services among older adults with functional impairment in Chinese long-term care facilities (LTCFs): a qualitative study

Abstract

Objective Proactive health, as an important strategy for addressing population aging in China, has not yet developed into a systematic service model for the care of older adults with functional impairment in LTCFs. This study aimed to systematically explore the unmet needs of proactive health services among older adults with functional impairment in LTCFs through a qualitative approach, and to provide a theoretical basis for the construction of a capability-based care system. Methods A combination of purposive and maximum variation sampling was used to recruit 15 older adults with functional impairment (mild to severe) and 13 frontline nursing staff from an LTCF in Chongqing for semi-structured interviews conducted between July and September 2025. The interview data were analyzed using qualitative content analysis. Results Four interrelated main themes were identified, covering individual capacity, psychosocial support, and systemic resource dimensions: autonomy and health decision-making involvement, health literacy enhancement and cognitive empowerment, psychological motivation and social connectedness, and structural health promotion resources and service systems. Conclusion These unmet needs collectively hinder the transition from passive compensatory care to proactive health management. Meeting the proactive health needs of older adults with functional impairment in LTCFs requires the construction of a three-dimensional empowerment system of “individual-institution-society”: restoring autonomy through decision-making empowerment, enhancing cognitive capacity through tiered health education, strengthening psychological connection through social network reconstruction, and integrating service resources through mechanisms for coordinating medical and older adult care.