Transforming aged care in China: insights from a TF-IDF-based data mining analysis of national policies (2018–2022)

Abstract

Background

As China grapples with rapid demographic shifts due to an aging population, the urgency for innovative aged care policies has intensified.

Objective

This study addresses a significant research gap by employing a text mining approach based on the Term Frequency-Inverse Document Frequency (TF-IDF) method, quantitatively analyzing a broad array of policy documents from 2018 to 2022.

Methods

It identifies key trends and shifts, using core feature words to construct co-occurrence and heterogeneity matrices analyzed via multidimensional scaling techniques.

Results

Research results from 2018 to 2022 highlight China’s focus on epidemic prevention, integrated care tailored to Chinese contexts, innovative social security and financial products, and the advancement of smart aged care against a backdrop of multifaceted demands. By analyzing policy changes surrounding significant political events and conducting comparative analysis with previous studies, this study delineates the evolution of policy priorities and anticipates future directions, highlighting the need to integrate advanced technologies and financial mechanisms to strengthen service delivery systems. These adjustments not only meet current demands but also strategically position China to navigate the complexities of an aging society.

Conclusions

This research provides critical insights for global policymakers facing similar demographic challenges, advocating for a resilient, holistic, and inclusive aged care system.

Introduction

As of 2022, China's demographic landscape is undergoing a profound transformation, with individuals aged 60 and above and 65 and above numbering more than 280 million (19.8% of the total population) and 209.78 million (14.9% of the total population), respectively. The Chinese government anticipates that the nation's population will reach a peak of 1.46 billion in 2029, with those aged 60 and older and 65 and older projected to surpass 460 million (approximately 32% of the total population) and 270 million (about 18.6% of the total population), respectively [8]. As the population of older adults rapidly expands, China is on the brink of entering a super-aged society. This demographic trend underscores the escalating challenge of aging, placing China on a fast track to becoming one of the nations with the fastest-growing aged population in the coming three decades. Such a demographic evolution has sparked a burgeoning interest among scholars in the dynamic shifts within aging policy frameworks. Researchers are increasingly focusing on dissecting the complex interplay between demographic trends and policy responses, aiming to unravel the nuanced dynamics of policy evolution in the face of aging populations[10, 13, 37]. For instance, Xu et al. [46] emphasize the urgent need for adaptive policy frameworks to effectively manage the implications of aging societies, arguing for a more nuanced understanding of policy adaptation to demographic changes. Similarly, Stoumpos et al. [41] explore the role of technological innovation in addressing the needs of an aging population, suggesting that policy evolution must incorporate advances in technology and healthcare to remain effective. These studies highlight a critical gap in our understanding of how policies adapt and evolve in response to the aging challenge, underscoring the importance of a multidimensional analysis that considers demographic, technological, and healthcare perspectives [6].

In previous studies, Chinese scholars primarily compiled comprehensive reviews of aged care policies [52] or conducted content analysis using policy tools [7]. However, due to technological constraints, these studies often lacked a thorough analysis of the patterns in policy texts, especially when dealing with large volumes of documents. While qualitative methodologies have historically dominated the exploration of China’s aged care policies, the emergence of digital analytics heralds a paradigm shift towards more quantitative analyses [33]. This methodological evolution is indicative of a broader trend in policy research, where the granularity offered by quantitative analysis permits a deeper dive into the textual intricacies of policy documents [9, 32, 49]. The incorporation of statistical software for policy quantification has unlocked new dimensions of insight, enabling researchers to systematically analyze qualitative texts with unprecedented precision and depth. Notably, the work of Johnson & Onwuegbuzie [19] advocates for the integration of quantitative and qualitative methodologies, arguing that such a mixed-methods approach enhances the robustness and comprehensiveness of policy analysis. Further, leveraging advanced computational techniques, as demonstrated by Li et al. [23], facilitates the dissection of policy evolution through the quantification of policy documents, revealing both overt and latent policy orientations and priorities. This shift towards a more data-driven analysis paradigm is crucial for navigating the complex landscape of aged care policies, where nuanced changes in language and emphasis can signal significant shifts in governmental priorities and strategies [25]. Moreover, the pioneering efforts of Wu et al. [44][ in developing a comprehensive framework for policy document quantification underscore the potential of combining literature quantification with content analysis to holistically assess the external attributes and internal semantic structures of public policies [53]. These methodological innovations highlight the evolving nature of policy analysis, moving from traditional manual coding towards more sophisticated, efficient, and accurate text mining approaches that promise to redefine our understanding of policy dynamics in the face of demographic transformations [17, 22, 42, 47].

Thus, building on the research conducted by He, Bai, & Zhu [18] on China’s aged care policies from 2013 to 2017, this study delves deeper into what the trajectory of China’s aged care policies looked like from 2018 to 2022, following major political events. It examines how the content of China’s aged care policies has evolved during this new phase and identifies the emerging characteristics compared to earlier findings. By applying text mining techniques and conducting a comparative analysis with previous studies, the study not only maps the trajectory of aged care policy development in China but also offers critical insights to inform future policy directions. This approach enhances the study’s objectivity, offering a detailed exploration of aged care policies and extending the capabilities of semantic text mining.

Methods

Data sources

Our study concentrates on the policy texts relating to China’s aged care, spanning from 2018 to 2022, a period postdating the 19th National Congress of the Communist Party of China (CPC) in 2017. This study retrieves central-level policy documents containing the keywords “aged care” and “older adults” from the official websites of the State Council and various central ministries. The choice of “aged care” as a keyword reflects the large volume of policy texts related to aged care, aimed at enhancing the efficiency of policy document selection while ensuring no relevant texts closely related to the research theme are omitted. To uphold the integrity and relevance of the data, we implemented a rigorous screening process for the policy texts:

Focus on national policies

The analysis prioritizes policies developed by central government ministries and departments, deliberately excluding those from local governments and other unrelated entities. These central policies, adapted and implemented by provinces, cities, and autonomous regions, have a nationwide impact that extends beyond specific sectors like aged care companies or pension insurance firms. This approach ensures the policies are highly effective and authoritative, enhancing their reach and enforceability across the country.

Policy categorization

We categorized the collected aged care policy documents into four main types: commands, announcements, notices, and opinions. Commands are authoritative, directive policies issued by senior governing bodies or leaders with compulsory enforcement power, generally used for enacting administrative regulations or announcing major compulsory measures [24]. Announcements are used to declare significant or statutory information to both domestic and international audiences, having a broader reach than notices. Notices are principal and executable, often disseminating requirements for subordinate agencies to follow, thus facilitating swift administrative efficiency. Opinions have weaker enforceability and are typically used to adjust or regulate social relations and behaviors; they tend to be more flexible and vaguer, focusing on encouraging and guiding the implementation of aged care policies [57].

Content selection and exclusion criteria

In this study, we have carefully selected policies with significant content directly relevant to aged care, excluding those with only peripheral mentions of aged care issues. This approach ensures our analysis is tightly focused on the primary subject of aged care policy. Moreover, we have excluded specific categories of documents to maintain the dataset's clarity and relevance. These exclusions include responses from central ministries to motions from the National People’s Congress representatives and members of the Chinese People’s Political Consultative Conference, as well as policy interpretations, management standards, guidelines for aged care institutions, rewards, and unrelated attachments. The rationale behind these exclusions is multifaceted: Responses to motions often reflect political or procedural nuances rather than direct policy implications. Management standards or guidelines, while crucial, typically focus on operational details that may not substantially contribute to an understanding of the broader policy trends or thematic priorities in aged care. Additionally, to avoid redundancy and ensure the distinctiveness of each policy document included in the study, we have also omitted documents that replicate content from other policy texts. This step is essential to prevent overlapping analyses and to maintain a streamlined focus on unique policy elements, thus enhancing the depth and accuracy of the study. Finally, the content of the policies must closely align with the theme of"aged care,"encompassing significant portions that reflect the objectives, methods, and measures of aged care policy. Policies that only briefly mention aged care should be excluded from the collection.

Number and representativeness of included policy documents

Using targeted keyword searches and a rigorous inclusion and exclusion process, we manually screened and ultimately collected 112 policy documents from the official websites of the State Council and relevant central ministries. We believe these 112 documents provide sufficient granularity to capture the evolution of China’s aged care policies over the five-year period from 2018 to 2022, and are representative for the following reasons: (1) A prior quantitative study on China’s aged care policies from 2013 to 2017 included 106 documents, a number comparable to this study [18]. (2) In practice, the number of aged care policy documents issued at the national level each year in China is relatively limited. This study specifically focuses on national-level policy trends, therefore, only documents issued by the State Council and central ministries were included. While the total number of documents is modest, they represent a core dataset reflecting the policy intentions and authority of the Chinese central government in the field of aged care, lending credibility to our findings. (3) The research employed precise retrieval and stringent screening procedures based on keywords, document types, and policy themes. Under the premise of ensuring data quality, we included as many qualified documents as possible. (4) The 112 policy documents included in the study were evenly distributed over the five-year period, with an average of approximately 20 documents per year—consistent with the actual pace of policy issuance in the field of aged care in China.

Research scope and policy time frame

The research encompasses policies that address aspects of senior citizens'lives, including age-friendly designs in urban and rural areas, while also considering other relevant policies. The timeframe for policy analysis is based on the publication dates specified in the policy documents themselves, rather than the date of their upload to the websites.

Research methodology

This paper analyzes China’s aged care policies from a quantitative perspective of policy texts, outlining the feature of these policies through the volume and characteristics of documents. It identifies and summarizes key themes within the policy texts. The analytical framework comprises two dimensions: external policy features and thematic features. External policy features include policy evolution, policy institutions, and policy forms, providing a systematic overview of the development of aged care policies in China. Thematic features involve key policy terms and clusters, which facilitate a clear understanding of the specific approaches implemented in aged care policies. The paper also conducts a comparative analysis of policy cycles, segmented by political milestones.

In this paper, the analysis of China’s aged care policies utilizes bibliometric methods, content analysis, and co-word analysis. Bibliometric methods infer and predict trends and patterns in literature by examining explicit data like issuing bodies, publication times, and document formats [36]. Content analysis interprets social realities through frequency analysis of certain words or concepts within texts [1, 38]. Co-word analysis explores the thematic scope within a field by analyzing the intrinsic connections between words across documents [34].

This study adopts a mixed-method research approach, integrating both qualitative and quantitative methodologies to analyze China’s aged care policy landscape. Specifically, the research unfolds in three methodological stages:

Analysis of external characteristics of policies

Initially, we meticulously collected 112 policy documents related to aged care from the official websites of the State Council and various ministries using targeted keywords. These documents were then comprehensively analyzed, considering attributes such as the issuing bodies, formats, and publication dates. This process systematically traced the temporal feature of China’s aged care policies, establishing a foundational understanding of the policy landscape.

Analysis of thematic features of policies

Following the initial data collection, we conducted an in-depth textual analysis using techniques such as word cloud decomposition and the TF-IDF (term frequency-inverse document frequency) algorithm. This process involved extracting and identifying high-frequency and core feature words from the policy texts. The purpose of this stage was to pinpoint the most emphasized themes within China’s aged care policies, laying the groundwork for subsequent multidimensional scaling analysis.

In the analysis of policy texts, feature words represent terms that frequently appear, signaling the central themes of the policy. This study employs the TF-IDF algorithm for feature words extraction, using these feature words as policy labels. TF-IDF, a weighted method, evaluates term frequency weights across documents to highlight significant features. Its strength lies in distinguishing impactful words from common, less meaningful terms, ensuring more precise and objective results than basic word frequency analysis. The calculation of TF-IDF is grounded in a specific mathematical formula [1, 12], as shown in Formula (1). This approach allows for a deeper understanding of policy interrelations and emerging research themes.

$$TF-IDF=\frac{N_{i,j}}{{\sum }_1^k{N}_{k,j}}\times log\frac{D}{DF+1}$$ 1

Co-occurrence and dissimilarity analysis

Expanding on the initial textual analysis, we utilized MATLAB software to perform co-occurrence analysis and construct co-occurrence and dissimilarity matrices for the core feature words, based on the Ochiai coefficient [14, 20, 27, 55]. This approach allowed us to deeply analyze the interrelationships and distinct differences among the key terms identified in the policy texts. Weighting using the Ochiai coefficient can help reflect the co-occurrence strength of the two core feature words. These coefficients measure the strength of co-occurrence between two feature words. For the dissimilarity matrix, subtract the Ochiai coefficient from 1. This step was crucial in quantifying the degree of difference or similarity between the feature words, which are determined using the given Formula (2):

$$\begin{array}{c}OchiaiCoefficient=\frac{thefrequencyofsimultaneousoccurrenceofAandB}{\sqrt{theoveralloccurrencefrequencyofA}\times \sqrt{theoveralloccurrencefrequencyofB}}\end{array}$$ 2

The analytical phase also involved importing the dissimilarity matrix into IBM SPSS Statistics 23.0 software. Here, we conducted multidimensional scaling analysis. The dissimilarity matrix was imported into IBM SPSS Statistics 23.0 software for multidimensional scaling (MDS) analysis, with the data normalized and converted into Z-scores. Euclidean distance was used as the measurement metric, allowing for an accurate assessment of the differences between data points. MDS primarily examines the distances and similarities (or dissimilarities) between individuals. The reliability and validity of the MDS results are estimated using the Stress and RSQ values. These statistical methods enabled us to categorize the feature words into meaningful clusters and to spatially represent the inter-relationships among them, thus offering deeper insights into the thematic structure of the policies.

Policy cycle comparative analysis

Utilizing major political events in China as markers, and building on the analysis of external policy features and thematic characteristics, this study contrasts the results obtained by He, Bai, & Zhu [18] to further explore the evolution and shifts in China’s aged care policies since 2018. The research process is illustrated in Fig. 1.

Fig. 1.

Flowchart for the study of policy texts on aged care policies in China

Results

Analysis of external characteristics of policies

Policy release date

Following the 19th National Congress, China intensified its focus on aged care, as evidenced by the significant increase in policy documents, particularly in 2018, 2019, and 2022, as detailed in Table 1. These years, especially 2019, saw peak releases, influenced by both the immediate post-Congress focus and later, the COVID-19 pandemic's impact on policy priorities and implementation rhythms. By 2022, policy activity resumed with the easing of pandemic restrictions.

Table 1.

Annual statistical data of China’s aged care policy releases during 2018–2022

Year	2018	2019	2020	2021	2022
Number of policies	22	30	17	16	27

Policy forms

Analysis shows that notices dominate the policy landscape, constituting 80% of all documents, indicative of a centralized guidance strategy. Other forms include opinions, departmental orders, and announcements, reflecting a structured, top-down approach to governance [31, 50], as seen in Table 2. The types of documents used for policy dissemination, such as “notices” and “opinions”, indicate the central government’s high expectations for policy implementation in aged care. These forms suggest that the central government initially proposes general solutions through notices and opinions, which are then adapted and implemented by relevant departments and localities based on practical conditions. This approach encourages regions to actively experiment with local policies, continuously exploring and identifying opportunities to optimize aged care. The relative scarcity of commands and announcements indicates a lack of diversity in central-level aged care policies.

Table 2.

Forms of aged care policies in China during 2018–2022

Category	Notices	Opinions	Departmental orders	Announcements
Number of policies	89	16	1	6

Policy issuing authority

A review of 112 aged care policies revealed a division between independently and jointly issued policies, with key contributions from the Ministry of Civil Affairs and the China Banking and Insurance Regulatory Commission. This collaborative effort across multiple departments underlines the complexity and multifaceted nature of addressing aged care challenges in China, as shown in Table 3.

Table 3.

Policy issuing authorities that independently issued aged care policies in China during 2018–2022

Department name	Number of policies issued	Department name	Number of policies issued
State Council	2	Ministry of Housing and Urban–Rural Development	6
General Office of the State Council	4	Ministry of Natural Resources	1
China Banking and Insurance Regulatory Commission	13	Ministry of Human Resources and Social Security	2
Ministry of Industry and Information Technology	5	State Taxation Administration	1
Ministry of Civil Affairs	20	National Development and Reform Commission	3
Ministry of Finance	3

Analysis of thematic features of policies

Feature words extraction

In this study, a feature word extraction process was performed on 112 policy texts related to aged care, yielding a list of 1,000 high-frequency feature words. Each high-frequency feature words accompanied by its respective TF-IDF score, reflecting their relevance within the policy texts. The TF-IDF scores range from higher values for terms like “aged care” to lower scores for terms like “strengthen”, demonstrating the varying degrees of emphasis placed on different aspects within the policies.

The high-frequency feature words list generated from computer language processing may include common but non-contributory terms, necessitating manual data cleaning. Additionally, the identification and uniform processing of emerging terms unrecognized by computers are required to enhance the accuracy and scientific validity of the research.

Based on the TF-IDF values, through manual screening, a total of 44 core feature words were selected, including “aged care”, “community”, “health”, “pension insurance”, “home-based”, “retirement benefits”, and more. The following table displays a partial list of core feature words (see Table 4). This paper further combines the research purpose of cluster analysis with semantic representativeness, and finally retains 17 core feature words with strong representativeness and high differentiation for subsequent analysis.

Table 4.

Core keywords of China’s aged care policies during 2018–2022 (partial)

Keywords	TF-IDF Scores	Keywords	TF-IDF Scores
Aged care	0.016249	Intelligent	0.003293
Community	0.005923	Insurance company	0.002949
Health	0.005782	Epidemic	0.002835
Pension insurance	0.005631	Prevention and control	0.002707
Home-based	0.005270	Information technology	0.002543
Retirement benefits	0.004746	Enrolment	0.002451
Standards	0.003974	Smart	0.002362
Investment	0.003856	Health	0.002321
Service facilities	0.003495	Nursing	0.002088
Demonstration	0.003465	Care	0.002007
…	…	…	…

Feature word co-occurrence analysis

In this study, feature word pairs that frequently appear together in the same document are analysed through feature word co-occurrence, revealing their interconnection and popularity. Co-occurrence analysis, hinging on feature word frequency, identifies research hotspots by mapping high-frequency feature words and their interrelations. We executed this analysis on core feature words, creating co-occurrence matrices to visualize these connections and understand their significance in aged care policy research (see Table 5). In the table, the diagonal represents the frequency of each word’s occurrence, while the frequency at the intersection of two words indicates the number of times those two words co-occur.

Table 5.

Co-occurrence matrix of core keywords (partial)

	Aged care	Pension insurance	Smart	Information	Epidemic	Health	Care	Service quality	Nursing	Practitioners	Pneumonia
Aged care	3025	197	586	136	472	253	303	594	390	148	208
Pension insurance	197	465	0	0	1	0	22	0	3	2	0
Smart	586	0	211	75	0	45	9	1	11	0	0
Information	136	0	75	160	0	85	4	4	9	0	0
Epidemic	472	1	0	0	146	6	6	0	0	1	197
Health	253	0	45	85	6	145	9	15	10	6	1
Care	303	22	9	4	6	9	110	3	152	10	1
Service quality	594	0	1	4	0	15	3	102	4	7	0
Nursing	390	3	11	9	0	10	152	4	100	6	0
Practitioners	148	2	0	0	1	6	10	7	6	48	0
Pneumonia	208	0	0	0	197	1	1	0	0	0	45
Prevention and control	516	5	0	0	466	9	0	4	1	1	189

By transposing the co-occurrence matrix, a dissimilarity matrix can be generated (see Table 6). The differences represented by the vocabulary in this matrix can serve as the basis for multidimensional scaling analysis.

Table 6.

Matrix of dissimilarity between core keywords (partial)

	Aged care	Pension insurance	Smart	Information	Epidemic	Health	Care	Practitioners
Aged care	0	0.834	0.268	0.805	0.295	0.618	0.291	0.611
Pension insurance	0.834	0	1	1	0.996	1	0.986	0.987
Smart	0.268	1	0	0.591	1	0.742	0.924	1
Information	0.805	1	0.591	0	1	0.441	0.924	1
Epidemic	0.29	0.996	1	1	0	0.959	1	0.988
Health	0.618	1	0.742	0.441	0.959	0	0.917	0.928
Care	0.291	0.986	0.924	0.929	1	0.917	0	0.913
Practitioners	0.611	0.987	1	1	0.988	0.928	0.913	0

The dissimilarity matrix was computed using the same software and served as the input for the multidimensional scaling analysis, which was employed to generate the multidimensional scaling plot of the core feature words (see Fig. 2). The results of the multidimensional scaling analysis show that RSQ = 0.87759, exceeding the 0.6 threshold, and Stress = 0.16453, below the 0.2 standard. This indicates that the fit of the multidimensional scaling analysis for China's aged care policies is relatively ideal, allowing the policies to be distinctly categorized into four characteristic groups.

Fig. 2.

Multidimensional scaling plot of the core feature words in China’s aged care policies during 2018–2022

Meanwhile, to ensure the scientific validity and accuracy of the four-cluster classification in the multidimensional scaling model, this study further employed hierarchical clustering for verification. The resulting dendrogram shows that at a distance threshold of 10, the core feature words can be roughly divided into four groups, which generally align with the conclusions drawn from the multidimensional scaling analysis (see Fig. 3).

Fig. 3.

Hierarchical diagram of core feature words in China’s aged care policies based on cluster analysis

The first category of core feature words includes terms like “epidemic”, “environment”, “quality”, and “door-to-door service”. A typical policy example is the “Notice from the General Office of the Ministry of Civil Affairs on Strengthening Care Services for Older Adults in Special Difficulty During the Epidemic Prevention and Control Period”. This policy prioritizes the inclusion of older adults with special needs in the epidemic prevention and control efforts, conducting thorough surveys to ensure they receive targeted care and support through door-to-door services and digital platforms like WeChat. It also emphasizes the importance of high-quality aged care services by supporting nursing homes in accommodating those who cannot care for themselves. Although epidemic-related terms are present, they rank lower on average compared to other features. This suggests that while China’s aged care policies from 2018 to 2022 were influenced by public health emergencies, epidemic-related content had a relatively limited impact on policy formulation and implementation. This finding suggests that the Chinese government places greater emphasis on addressing other long-term and structural issues in the field of aged care.

The second cluster of feature words, including terms like “health”, “care”, and “rehabilitation”, aligns with China’s Healthy China initiative and the concept of healthy aging. A representative policy, the “14th Five-Year Plan for National Aging Development and Aged Care Services System”, emphasizes the gradual establishment of a long-term care insurance system, the development of health and rehabilitation services, innovation in older adult education, enhancement of recreational and cultural activities, and the promotion of accessible and age-friendly public environments to create a supportive society for older adults.

The third cluster of core feature words includes terms like “pension insurance”, “supervision and management”, and “pilot programs”. Representative policies such as the “Opinions on Promoting the Development of Individual Pensions” from the State Council and the “Notice on the Pilot Program for Commercial Pension Business by Pension Insurance Companies” from the China Banking and Insurance Regulatory Commission illustrate efforts to promote voluntary, market-driven individual pensions. These initiatives aim to coordinate with basic pension insurance and enterprise annuities, thereby enhancing the multi-level, multi-pillar pension insurance system to meet diverse public needs for retirement security.

The fourth feature word cluster, comprising terms like “smartification”, “informatization” and “demonstration”, underscores the long-term focus on smart aged care. The fourth cluster of core feature words, including “smartification”, “informatization”, and “demonstration”, highlights the long-term emphasis on smart aged care. A representative policy is the “Action Plan for the Development of the Smart Health and Aged Care Industry (2021–2025)” issued by the Ministry of Industry and Information Technology, the Ministry of Civil Affairs, and the National Health Commission. This plan promotes the integration and application of new-generation information technologies in health and aged care, enhancing the intelligence level of related products and services. The policy mandates pilot projects in over 150 demonstration streets (towns) and 50 demonstration bases, focusing on key areas such as enriching smart health services and designing intelligent products for older adults, to lead and drive broader adoption.

Discussion

Policy characteristics

The multidimensional scaling plot of core feature words reveals four key characteristics of China’s aged care policies from 2018 to 2022:

Integration with epidemic prevention

Following the 19th National Congress, China has heightened its focus on aged care, particularly under the pressures of the COVID-19 pandemic. The surge in policy issuance in 2018, 2019, and 2022 reflects a responsive environment addressing both advisory inputs and pandemic challenges. Policies were implemented to protect the health and safety of older adults, particularly those unvaccinated, with a focus on nursing homes and home-based healthcare. Core feature words like “epidemic”, “environment”, and “quality” emphasize the need for flexible policy frameworks that can effectively address public health emergencies. Since the implementation of enhanced disease prevention policies for older adults, local governments have adopted innovative approaches to promote disease prevention among this population. Through a variety of measures—such as public education on epidemic prevention, COVID-19 vaccination campaigns, home visits by family doctors, chronic disease management, and health counseling—older adults’ health literacy and knowledge of disease prevention have significantly improved [16]. These efforts have helped establish a safety net for disease prevention and effectively safeguarded the lives and health of older adults during the pandemic.

Increasing emphasis on integrated care

Aligned with the Healthy China 2030 initiative, the emphasis on “health”, “care”, and “rehabilitation” advances a holistic approach to aged care, integrating health care and social care services. This cluster underscores the evolving, holistic approach to integrated aged care services in China, which integrates health care and social care and aims to provide comprehensive, multi-tiered, personalized services for older adults [30]. This includes not only basic medical treatments, but also extends to health education, prevention, rehabilitation, cultural and recreational activities, mental support, and more. This integration aims to enhance the quality of life for older adults, supported by the development of the “Yiyang Jiehe” model, which, despite its challenges, offers insights into establishing an integrated care system in resource-limited settings like China. Since 2022, building on the foundation of national pilot programs for integrated care, the National Health Commission has spearheaded the development of integrated care demonstration projects. These efforts involve the establishment of demonstration provinces (autonomous regions and municipalities), demonstration counties (cities and districts), and demonstration institutions across the country. The goal is to guide and encourage local governments to further advance the implementation of integrated care for older adults. The scope and coverage of pilot regions have steadily expanded. Concurrently, various localities have developed diverse models of integrated care—such as integrating social care services within healthcare institutions, embedding healthcare services within social care settings, and establishing health-social care communities. These varied approaches have laid a foundation for identifying and scaling up a nationally applicable model of integrated care for older adults [48].

Continuous innovation in social security and financial services

Significant changes in China’s pension insurance policies from 2018 to 2022, particularly driven by the China Banking and Insurance Regulatory Commission, highlight the evolution of long-term care insurance models. These range from social insurance-based to commercial and hybrid models. China’s approach, especially its focus on social insurance-based long-term care, plays a crucial role in its national social security system, offering innovative pathways for addressing demographic challenges globally [40]. Since 2022, pension insurance policies in China have continued to undergo innovation and refinement. By the end of 2023, the number of participants in the basic pension insurance schemes for urban employees and for urban–rural residents had reached 1.84 times and 1.64 times their respective figures in 2011. The coverage and reach of pension insurance have steadily expanded, resulting in broader benefits for the population. Concurrently, the level of pension subsidies has increased, benefit payments have continued to grow, and older adults have experienced a significantly enhanced sense of security and well-being as beneficiaries of the system [54].

Smart aged care as a long-term focus

The integration of modern information technology with aged care services represents an emerging digital governance model for aging societies [56]. However, challenges persist, particularly in the adoption of smart technologies by older adults due to their complexity. Addressing the digital divide and ensuring digital literacy remain critical policy focuses [43], as highlighted by studies in both the U.S. and Europe [2, 3]. Additionally, safeguarding the financial wellbeing of older adults, including protection against financial risks and fraud, is crucial, as supported by proactive approaches outlined in this study [11]. Since 2022, significant progress has been made in the development of smart aged care, with numerous exploratory practices and exemplary cases emerging. For instance, at the municipal level, Shanghai has established the “Shanghai Aged Care Service Platform” website and launched the “Shanghai Aged Care Consultant” WeChat public account, which enable older adults to conveniently access information on service fees and locations of care institutions [15]. In Zhejiang Province, support has been provided for the development of smartphone service applications such as “One-Click Aged Care” and “Zheli Office” [29]. These various smart aged care platforms, mobile applications, and intelligent care products not only offer older adults real-time, convenient, efficient, low-cost, and intelligent services, but also greatly enrich the application scenarios of smart aged care, thereby fostering the rapid development of the smart aged care service industry.

Previous studies examining the thematic evolution of China’s aged care policies have also identified similar policy issues. For example, Li et al. [26] conducted a quantitative textual analysis of Chinese government policies on aged care issued between 2005 and 2019, identifying four core themes: smart aged care, social security, medical and health care, and aged care services. Similarly, He et al. [18] found that in recent years, China’s aged care policies have primarily focused on medical and health care and social security, while the government has increasingly emphasized the development of the smart aged care industry through a series of strategic guidelines and planning documents. These findings corroborate the scientific rigor and accuracy of the present study, while also suggesting a high degree of continuity in China’s aged care policy landscape.

In particular, the policy themes of pension reform and the construction of the aged care service system have consistently featured systematic and sustained planning. Existing research has shown that pension reform has long been a central task in China’s aged care agenda. The government has persistently advanced reforms—from establishing a unified urban–rural pension system to strengthening the regulation and supervision of pension products [5]. In terms of the service system, policies have evolved from proposing a care model based on “home-based care as the foundation, community services as support, and institutional care as the supplement”, to advocating for integrated care models and promoting innovation such as “Internet Plus Smart Aged Care”. These shifts reflect the government’s continuous efforts to integrate and refine the aged care service system under policy guidance.

In addition to continuity, China’s aged care policies also exhibit considerable flexibility. In response to public health emergencies, the government has promptly introduced policies focused on disease prevention and protecting older adults’ health. This demonstrates the policy system’s ability to evolve with changing circumstances and address practical issues in a timely manner. Overall, the findings suggest that China’s aged care policies strive to strike a balance between short-term responsiveness and long-term strategic planning—reflecting both continuity and flexibility—thereby supporting the sustainable development of aged care in a scientifically coordinated manner.

Policy comparative analysis: impact of important political milestones

In the comparative analysis examining the impact of key political milestones on aged care policy, this research builds on earlier studies, such as the quantitative analysis of China’s aged care policy from 2013 to 2017 of He et al. [18]. This prior phase focused on the developments following the 18th National Congress, marking the nascent stages of smart healthcare and aged care industries, and the initial formation of related policy frameworks. However, it also revealed shortcomings in the social security system for older adults, marked by a limited policy scope and insufficient emphasis. This analysis underscores the importance of historical context in understanding the trajectory and focal points of aged care policy evolution in China.

This study applies a TF-IDF-based analysis to China’s aged care policies from the post-19th National Congress period (2018–2022), offering fresh insights into the recent phase. By comparing this phase with earlier research findings, the study reveals shifts in China’s strategic direction and future priorities in aged care social governance. To focus on the unique aspects of the current phase, common core feature words were eliminated through manual data cleaning. The analysis found that the core keywords in aged care policies from 2013–2017 primarily included “Traditional Chinese Medicine”, “Medicine”, “Service industry”, “Medical institutions”, “Education”, “Grassroots”, “Service system”, “Information platform”, “Family Planning Commission”, “Talent development”, “Public welfare fund”, and “Health status”. In contrast, the core keywords from 2018–2022 were “Investment”, “Demonstration”, “Smart”, “Insurance company”, “Epidemic”, “Prevention and control”, “Enrolment numbers”, “Rehabilitation”, “Insurance Regulatory Commission”, “Quality”, “Caregivers”, and “Barrier-free”. The comparison reveals four significant differences in aged care policies post the 19th National Congress: a focus on epidemic prevention and control, the implementation of integrated care, an emphasis on social security and financial products for older adults, and the development of smart aged care. These shifts reflect evolving societal needs and technological advancements, as well as changes in policy focus responding to the challenges of an aging population and the impact of the COVID-19 pandemic.

The findings of this study help clarify the Chinese political core’s planning approach towards aged care and demonstrate the important proposition that changes in China’s aged care policies are closely related to specific political events. As early as 2017, the 19th National Congress of CPC explicitly proposed improving the basic pension insurance system, achieving nationwide pension insurance coordination, and promoting aged care through the integration of medical care and smart technology, which aligns closely with the 2018–2022 policy themes identified in this study’s multidimensional scaling analysis.

As a concentrated embodiment of the CPC’s political agenda and action plan, the Party Congress serves as a major political milestone, profoundly influencing the evolution and development of China’s aged care policies. The future governmental directions and work arrangements it outlines are of significant reference value for understanding the gradual evolution of China’s aged care policies. Since the 19th National Congress, the construction of socialism with Chinese characteristics has entered a new historical context, prompting adjustments in the deployment of aged care work and policy focus. “Promoting the integration of medical care and aged care, developing smart aged care, and continually innovating social security and financial services for older adults” have replaced policy themes from the 18th National Congress era, such as “Traditional Chinese Medicine, smart healthcare, and information platform construction”, as the new governance direction and policy focus in the field of aged care.

According to the Multiple Streams Framework (MSF), political dynamics are a critical driver of policy change, with policy windows often opening when significant shifts occur in the political stream. Prior studies have shown that policy evolution in other subfields of public administration—such as administrative management—is also profoundly shaped by changes in political conditions [45]. In this context, the substantial transformation of the political stream between the 18th and 19th National Congresses provided a solid foundation for initiating a new policy agenda in the field of aged care. This underscores the pivotal role of major political milestones—particularly the Party Congresses—in shaping policy trajectories. Future research should pay closer attention to how these key events influence the evolution of aged care policies. Given the agenda-setting function and predictive capacity of such political landmarks, particular emphasis should be placed on tracking policy developments in the wake of the 20th National Congress to anticipate the next phase of China's aged care agenda.

Political cycle theory further posits that the formulation and implementation of policies are driven by the cyclical rhythm of political events, as policymakers adjust policy priorities at critical junctures to fulfill strategic objectives. In particular, during transitional periods, decision-makers tend to reshape policy agendas to address salient societal and economic challenges [35, 39]. Within the Chinese context, political cycle theory offers a compelling lens through which to interpret the periodic influence of major events—especially the Party Congress. For example, Kong [21] found that the predictable five-year cycle of Party Congresses alters the incentive structures and behavior of local officials, prompting them to adopt strategies that improve public services—such as environmental conditions—prior to the Congress, thereby enhancing local governance performance.

Additionally, an emerging body of literature has examined the influence of the Party Congress political cycle on policy attention in domains such as agriculture [4], culture [51], and education [28]. However, few studies have explored its impact on aged care policies. This study finds that the Party Congress exerts a notable influence on aged care governance through periodic agenda-setting mechanisms. Specifically, the 19th National Congress marked a critical inflection point, triggering a realignment of the aged care policy agenda. Policy priorities shifted toward epidemic prevention, smart aged care, and the enhancement of social security systems—strategic responses to new challenges such as the COVID-19 pandemic, rapid technological transformation, and the deepening of demographic aging.

The observed interaction between the Party Congress cycle and aged care policy agendas suggests that future research should also investigate the potential effects of other political rhythms—such as Central Committee plenums and Five-Year Plans—on the development and reform of aged care policies in China.

For a visual representation of the thematic evolution of aged care policy agendas across the 18th and 19th Party Congress periods, based on the integration of the MSF and political cycle theory, see Fig. 4.

Fig. 4.

Transformation of Aged Care Policy Themes in China (2013–2022) Based on the Multiple Streams Framework and Political Cycle Theory

Policy implications

In addition to the theoretical contributions mentioned above, this study aims to provide practical recommendations for decision-makers and practitioners in the field of aged care. Based on the four thematic categories identified through text mining, China’s aged care policies have shown a focus on responding to public health emergencies, improving social security for older adults, promoting integrated care, and advancing smart aged care. However, the policy measures within these themes remain underdeveloped, necessitating stronger top-level design by the central government, broader coverage of aged care policies, and an enriched focus on aged care themes. For instance, to address the impact of pandemics on older adults’ health, emergency response plans and guidelines should be improved, and ongoing public health risk management policies for older adults should be established. In the area of social security for older adults, it is essential to continue expanding the coverage of basic pension insurance and promote the development of the third-pillar pension insurance. Integrated care policies require the support of a long-term care insurance system, while addressing the widespread “information gap” among older adults calls for the development of age-friendly policies in the field of smart aged care, such as the adaptation of smart products for older adults. Specifically, institutional innovations can be undertaken in the following four areas:

• First, enhancing emergency preparedness for older adults during public health crises through the development of targeted response plans and operational guidelines across home-based, community-based, and institutional care settings. The first cluster of core feature words—such as “epidemic”, “quality”, and “door-to-door service”—demonstrates the policy system’s increased focus on rapid response mechanisms for vulnerable populations during emergencies. The emergence of COVID-19 as a major public health crisis, and the frequent co-occurrence of terms like “epidemic” and “prevention and control”, underscore structural weaknesses in China’s public health system when addressing large-scale infectious disease outbreaks.

This sentinel event catalyzed the formation of multi-tiered policy response mechanisms specifically tailored to older adults. It is essential to establish systems for disease prevention, early warning, information sharing, and inter-agency coordination. During emergencies, grassroots Party organizations, community-based self-governance bodies, aged care institutions, and healthcare professionals should play a central role in delivering medical care, daily support, and psychosocial services to older adults. Furthermore, policy efforts should support the development and operation of community-based aged care service institutions and extend service provision into family settings to ensure comprehensive and equitable emergency coverage for aging populations.

• Second, establishing an age-friendly, multi-level smart aged care service system is vital to address the challenges of population aging and align with broader societal trends. The second cluster of core feature words—such as “health”, “care”, and “rehabilitation”—reflects a policy emphasis on integrating health and social care to promote healthy aging. In response to this policy direction, greater efforts should be made to advance smart aged care development. Smart aged care plays a pivotal role in addressing demographic shifts, easing care burdens, and embracing the digital transformation of services. While local governments have initiated pilot programs for smart aged care, new challenges continue to emerge.

When developing smart products and services for older adults, it is crucial to consider their specific needs and cognitive capacities. Smart service interfaces should be simplified and accessible, and continued efforts are needed to enhance internet age-friendliness to prevent the marginalization of older adults into a “digital refugee” population. Comprehensive digital literacy programs should be provided, along with volunteer support teams dedicated to helping older adults navigate smart technologies, thereby addressing the persistent digital divide. Furthermore, ensuring the safe use of digital services is essential—measures should include strong regulatory oversight to combat telecom fraud and protect the legal rights and interests of older adults. These initiatives can foster a greater sense of security, empowerment, and well-being within an inclusive smart aged care system.

• Third, improve the foundational pension and medical insurance systems by continuously expanding the coverage of basic pension insurance and advancing the development of third-pillar pension schemes. The third cluster of core feature words—such as “pension insurance”, “supervision and management”, and “pilot programs”—highlights a policy shift toward diversifying pension structures through market-driven mechanisms. The emphasis on “pilots” further underscores an experimental approach to social security innovation. This transition reflects not only the increasing policy attention to leveraging market forces but also growing concerns about the sustainability and equity of the social security system amid accelerated population aging.

Policymakers should prioritize the development of commercial pension and health insurance products tailored to the needs of older adults, foster a society-wide awareness of life-cycle insurance planning, and promote the expansion of inclusive financial services for aging populations. Additionally, a comprehensive long-term care security system should be established that integrates insurance, welfare, and assistance programs, ensuring a seamless connection between long-term care insurance and care service systems to better support diverse and evolving care needs.

• Fourth, strengthen health education and preventive care for older adults, develop medical, rehabilitative, and palliative care services, and further promote the integration of health care and social care systems. The fourth cluster of core feature words—such as “smartification”. “informatization”, and “demonstration”—provides strong evidence of China’s policy evolution toward smart aged care. This reflects an increasing emphasis on the application of digital technologies to enhance service quality, efficiency, and accessibility.

At the same time, greater recognition must be given to the cultural and spiritual needs of older adults. Policies should support innovation in lifelong education for older adults, increase the supply of age-appropriate cultural products and recreational facilities, and diversify opportunities for cultural and leisure engagement. Moreover, encouraging the social participation of older adults is essential. Those who are willing and able should be actively involved in public service, volunteer work, and community governance, thereby ensuring they can continue to contribute to society and experience a sense of purpose and inclusion.

In summary, future efforts should be directed towards expanding the focus and scope of aged care services in response to the growing needs of the aging population in China. This approach aims to elevate the development of China’s aging services and create a more comprehensive and well-rounded policy system for aged care.

Limitations and future research directions

This study is limited by its focus on national-level policies, potentially overlooking local variations. Additionally, the TF-IDF algorithm has its drawbacks, such as not accounting for the position and semantic meaning of words within documents, which may lead to inaccuracies in contextual understanding. Moreover, the selected policy period was influenced by the three-year COVID-19 pandemic, resulting in a significant number of pandemic-related policy feature words. However, this also reflects the genuine impact of public health emergencies on the evolution of aged care policies during 2018–2022.

Future research could broaden the scope to include local and regional policies to gain a more comprehensive understanding of policy impacts. Methodologically, integrating the TF-IDF algorithm with word embedding techniques like Word2Vec and GloVe could enhance the accuracy of capturing relationships between words. Additionally, longer longitudinal studies are recommended to evaluate whether the policy trends identified in this study have lasting effects on the lives of older adults and their caregivers.

Conclusions

This study’s exploration of China’s aged care policies from 2018 to 2022 through a TF-IDF lens reveals significant shifts towards blending health care and social care to improve the life quality of older adults. It also highlights China’s proactive and adaptive policy strategies in response to aging challenges, emphasizing smart care solutions and financial sustainability. This work enriches aged care policy analysis and offers a blueprint for other nations navigating similar demographic transitions or with similar cultural and resource settings, advocating for a more resilient, holistic, inclusive, and intelligent aged care system. The study suggests future researchers and practitioners should focus on the significant impact of cyclical political events like CPC National Congresses on aged care policies and validate these effects through quantitative studies.

Authors’ contributions

ZL and HL contributed to the design of the study. HL led the data collection, performed the data analysis, and wrote the first draft. ZL secured the funding and supervised the entire research process. ZL, ZZ, LP, WG, and YY revised the manuscript. All authors approved the final version of the manuscript for submission. All authors carefully reviewed subsequent versions of the manuscript. All authors had final responsibility for the decision to submit the manuscript for publication.

Funding

This study was supported by the National Natural Science Foundation of China under Grant [72474233]; the General Research Program of Humanities and Social Sciences of the Ministry of Education under Grant [24YJAZH096]; the Changsha Philosophy and Social Sciences Planning Program (Grant No. 2025CSSKKT116); the Natural Science Foundation of Hunan Province under Grant [2022JJ30055]; the Changsha Science and Technology Bureau under Grant [kh2302039]; and the Postgraduate Innovative Project of Central South University under Grant [2023ZZTS0811].

Data availability

The datasets generated and/or analyzed during the current study are derived from central-level policy documents available on the official websites of the State Council and various central ministries of China. These documents are publicly accessible through these websites. Requests for the data may be made to the corresponding author upon reasonable request after the manuscript is published.

Declarations

Ethics approval and consent to participate

Not applicable.

Competing Interests

The authors declare that they have no competing interests.