Common‐Sense Model Applied to Self‐Perception of Aging Among Chinese Community‐Dwelling Older Adults: A Qualitative Study

ABSTRACT

Objective

Self‐perception of aging (SPA) involves individuals’ subjective experiences and beliefs concerning their health and aging process. This study aims to explore the experiences of SPA and coping strategies among Chinese community‐dwelling older adults based on the common‐sense model (CSM).

Methods

The semi‐structured interviews were conducted with 15 community‐dwelling older adults in Chongqing. A hybrid inductive‐deductive thematic analysis approach was employed for data analysis.

Results:

Five main themes were identified: (a) health decline and identity in aging, (b) navigating the aging timeline with personal paces, (c) negative impacts with silver linings in later life, (d) individualized emotional spectrum of aging, and (e) multiple coping strategies. These themes align with the domains of the CSM.

Conclusion

In this study, the researchers gained valuable insights into the SPA among Chinese community‐dwelling older adults and demonstrated the applicability of the CSM in understanding SPA. Findings also provide a theoretical basis for future research on SPA and developing culturally sensitive interventions for older adults.

1. Background

Aging is a global phenomenon, with the proportion of the population aged 60 and over increasing steadily worldwide (World Health Organization ²⁰²⁴). In China, the demographic structure is shifting rapidly as the older adult population grows at an unprecedented rate. In 2023, 21.1% of the Chinese population was aged 60 or older (The State Council the People's Republic of China ²⁰²⁴). Evidence also indicates that the average life expectancy has increased significantly worldwide in recent decades (Collaborators 2024), and China is no exception. By 2035, the average life expectancy in mainland China will be 81.3 years (Bai et al. 2023). As individuals live longer, their subjective views and experiences of old age and the aging process are also undergoing changes.

Self‐perception of aging (SPA) refers to individuals’ subjective experiences, beliefs, and emotional responses concerning their own aging process (Barker et al. 2007). Researchers in previous studies have found that positive SPA is associated with greater engagement in health‐promoting behaviors, such as adopting a balanced diet, participating in regular physical exercise, and maintaining good medication adherence (Levy and Myers 2004; Menkin et al. ²⁰¹⁷; Qing et al. ²⁰²¹). Moreover, SPA has been identified as a significant predictor of many health outcomes in older adults, including cognitive function (Tovel et al. 2019), mental health (Westerhof and Barrett 2005), social relationships and engagement (Schwartz et al. 2021), and longevity (Westerhof et al. 2014).

As research has progressed, researchers have increasingly recognized that SPA varies across different cultural contexts (Löckenhoff et al. 2009). To capture the complexity of aging experiences, qualitative studies on SPA have been conducted in several Asian countries. For instance, Shiraz et al. (2020) highlighted how cultural beliefs and social norms influence individual differences in aging perceptions. A qualitative study from an Indian culture context found that older adults’ aging experience was influenced by factors such as family roles, social expectations, and religious beliefs (Bandyopadhyay & Singh ²⁰²³). In a study conducted in South Korea, 20 community‐dwelling older adults aged 65 years and above were interviewed based on the stereotype theory. The findings suggested that negative age stereotypes and disrespect for older adults, prevalent in certain cultural/social contexts, may act as trigger factors for negative SPA, manifesting as feelings of being a burden and experiencing intergenerational conflicts (Choi et al. 2021).

Previous studies have provided valuable insights into older adults’ aging experience but lack a structured theoretical framework to explore the multidimensional of SPA. Barker et al. (2007) innovatively proposed that common‐sense model (CSM), originally developed by Leventhal and colleagues (Leventhal et al. 1980) and later elaborated (Leventhal et al. 2016), to explain how individuals perceive and manage illness, could be effectively adapted to the study of aging perceptions (Figure 1). The CSM is a self‐regulatory model in which individuals form parallel cognitive and emotional representations of a health threat. These representations, influenced by both personal and sociocultural factors (Hagger et al. 2017), guide subsequent coping strategies (Moosa et al. 2021). Barker et al. (2007) argued that, although aging is a normative physiological process rather than a discrete illness, it nonetheless entails significant changes that require adaptive self‐regulation, making the CSM a suitable framework for examining the multidimensionality of SPA.

FIGURE 1.

The common‐sense model.

Existing research has yet to systematically examine how Chinese older adults perceive and experience aging amid the tension between deeply rooted traditional values and the rapid influence of modernization. Traditional Chinese cultural values, such as filial piety and respect for older adults, have historically played a central role in shaping older adults’ views of aging (Yu and Wang 2022). However, processes of modernization and urbanization are rapidly transforming family structures, social support networks, and individuals’ expectations regarding later life (Chow and Xue 2011). The CSM provides a comprehensive framework for exploring older adults’ cognitive and emotional representations related to aging, which is particularly important in the Chinese context. Given that the perception of aging varies according to the cultural context, the present study aims to explore SPA among community‐dwelling older adults in the Chinese cultural context based on the CSM through a qualitative study.

2. Theoretical Framework

The CSM posits that when individuals encounter health‐related stimuli, cognitive, and emotional representations are activated in parallel to process the information and form a personal conceptualization of their health status (Hagger et al. 2017). The cognitive representation consists of five dimensions: identity (labels of diseases or health threat), causes (belief in factors that contribute to disease or symptoms), timeline (perceptions of the duration and progression of the disease), consequences (the impact of the disease on the individual), and control (beliefs about the ability to manage or cure the disease). Emotional representation encompasses the affective responses triggered by the health threat. These factors form an individual's overall perception and response to their health status. The CSM also includes coping procedures, ranging from approach‐oriented (e.g., problem‐focused) to avoidance‐oriented strategies.

When applying the CSM to SPA, aging is conceptualized as a normative and inevitable life process rather than a pathological condition with identifiable external triggers. The present study did not explore the cause dimension of the CSM (Barker et al. 2007). Instead, the framework focused on the remaining four cognitive dimensions, emotional representation, and coping strategies to explore Chinese older adults’ experiences of aging. In this study, identity refers to the labels older adults use to describe aging and the beliefs linking specific symptoms or functional declines to the aging process. Timeline involves beliefs about the duration and progression of aging and its symptoms, which may be perceived as chronic, acute, or cyclical/periodic. Consequences dimension relates to the individual's evaluation of the impacts of aging on their physical health and social life. Control reflects beliefs about whether the aging process or its symptoms can be managed or influenced through interventions. Emotional representation captures the emotional responses triggered by the perception of aging.

3. Methods

3.1. Study Design

A qualitative descriptive study was conducted to understand older adults’ aging experiences and coping strategies. This approach allows for capturing rich, in‐depth details from the participants’ perspective while enabling participants to express their views without being constrained by predetermined hypotheses or frameworks. This study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines (Tong et al. 2007; see File S1).

3.2. Settings and Participants

The maximum variation sampling method in purposive sampling was used to recruit participants from urban communities in Chongqing. This method is equivalent to determining the characteristics or criteria for constructing the sample (Willis et al. 2016). Based on existing literature, age, gender, and marital status have been identified as influencing factors of older adults’ SPA (Gao et al. 2022; Zhu et al. ²⁰²³). Therefore, maximum variation was sought across these demographic characteristics. Therefore, these demographic characteristics need to be covered. The inclusion criteria were as follows: (a) aged 60 years or older, (b) residing in an urban community of Chongqing, (c) able to communicate effectively with the researchers, (d) willing and able to provide informed consent and voluntarily participate in the study.

Recruitment was conducted with the assistance of staff at community healthcare centers (CHCs) in urban Chongqing. Researchers first provided CHC staff with a detailed description of the study's inclusion and exclusion criteria and emphasized that the study involved semi‐structured interviews lasting approximately 30–60 min, during which participants would be invited to share their personal experiences and perceptions of aging. CHC staff then introduced the study to potentially eligible older adults in accessible language and inquired about their initial interest in participating. Staff subsequently supplied the researchers with contact details of older adults who had verbally expressed willingness to take part. The researchers then contacted these individuals by telephone to verify that they met all inclusion criteria. During this contact, the researchers once again confirmed the individual's willingness to participate, provided a full explanation of the study procedures, risks, benefits, confidentiality measures, and obtained verbal agreement to proceed.

The sample size was determined using the “10+3” rule for theory‐based interview research (Francis et al. 2010). This rule stipulates an initial minimum of 10 interviews followed by additional interviews until no new theory‐relevant information emerges in three consecutive interviews. The interview process of the study was conducted in two stages. An initial phase comprising at least 10 in‐depth interviews was designed to cover the predefined theoretical concepts related to SPA based on the CSM. Subsequently, additional interviews continued until the stopping criterion was met. This criterion required three consecutive interviews to yield no new theory‐relevant information, indicating that data saturation had been achieved.

3.3. Data Collection

One‐on‐one, face‐to‐face, semi‐structured, in‐depth interviews were conducted between July and August 2023. This method was used because it facilitates in‐depth exploration of participants’ subjective experiences and perspectives on aging, while offering sufficient flexibility for them to elaborate freely and introduce emergent topics or meanings not predefined by the researchers. An initial interview guide was developed by the research team based on the CSM and literature review. The final version was formed after consulting two geriatric nursing experts and conducting preinterviews with two older adults (see Table 1). Consistent with the conceptualization of aging as an inevitable normative process, the interview guide did not cover the cause dimension but focused on the remaining cognitive dimensions (identity, timeline, consequences, and control), emotional representations, and coping strategies. During each interview, the researcher asked detailed questions at appropriate times to obtain more information. Each interview concluded with the open‐ended question: “Is there anything else you think is important that we have not covered?”

TABLE 1.

Interview guidelines.

Questions	CSM domains
Do you think the changes in your health (illness) are related to your aging? In what ways?	Cognitive representation (identity)
What do you think aging is? How do you understand and feel about your own aging?
Do you think aging is a natural process? Why?	Cognitive representation (timeline)
Do you believe the aging process is controllable? Why?	Cognitive representation (control)
What impact do you think aging has on you?	Cognitive representation (consequences)
What emotional responses has aging brought you?	Emotional representation
How do you cope with the impacts of aging?	Coping strategies

According to the participant's preferences, the researcher selected a suitable time and location for each interview, typically in a conference room of the CHCs or the participant's home. After obtaining written informed consent, interviews were conducted in accordance with the interview guide, with questions adjusted flexibly based on the flow of the conversation. The researcher employed various communication techniques, including active listening, timely questions, and clarifications. All interviews were audio‐recorded with participants’ permission. Each participant received a small token of appreciation (a pack of tissues valued at approximately 15 yuan) for their time and contribution.

3.4. Data Analysis

After the interview, the recordings were transcribed into text. A hybrid approach of inductive and deductive thematic analysis was employed (Fereday and Muir‐Cochrane ²⁰⁰⁶), identifying themes using preset categories from the CSM (deductive) and allowing unique themes to emerge from participants’ narratives (inductive). The stages of data analysis and detailed description were shown in Table 2. Data analysis was conducted iteratively and collaboratively by multiple members of the research team. Initial coding was performed independently, followed by regular team discussions to compare findings, resolve discrepancies, and achieve consensus. All data were analyzed in their original language (Chinese) to preserve contextual nuance and cultural meaning. Quotations selected for presentation were translated into English independently by two doctoral students specializing in geriatric nursing with advanced English proficiency. The research team subsequently reviewed and refined these translations through multiple iterations to ensure accuracy and fidelity to the original meaning.

TABLE 2.

The process of inductive/deductive hybrid thematic analysis.

Stage	Description
Stage 1	Using a deductive approach, two authors categorized the interview data into three a priori domains based on the CSM: (a) cognitive representations of SPA, (b) emotional representations of SPA, and (c) coping strategies for SPA.
Stage 2	Using an inductive approach, themes and sub‐themes were extracted iteratively and collaboratively: Two authors independently matched statements from the interview data with existing themes and sub‐themes, creating new ones as necessary. Inconsistencies and ambiguities in the inductive analysis process were discussed with other authors to reach a consensus, ensuring accuracy and applicability of the themes. Two authors verified that each quotations appropriately fit the corresponding theme and sub‐theme.
Stage 3	Connections between inductive and deductive codes were established by two authors, leading to the merging and reorganization of codes. The research team reached a consensus through joint discussions.

3.5. Trustworthiness

Maximum variation sampling was used to purposefully recruit participants differing in characteristics, thereby capturing a broad range of perspectives on aging. All interviews were conducted by the first author, a PhD candidate with systematic training in qualitative research methods and extensive clinical and research experience in geriatric nursing. This study provides detailed data collection and analysis methods, enabling other researchers to replicate the work conceptually. During data analysis, the research team employed reflexive practices to minimize the potential influence of assumptions or biases on the results (e.g., Timmins ²⁰¹³).

3.6. Ethics Consideration

The study was approved by the XX (Number: XX). Permission to conduct data collection was also obtained from the managers of the CHCs. Participants were fully informed of the purpose and methods of the study and voluntarily decided whether to participate. In addition, participants’ privacy and anonymity were strictly protected, and their personal information and interview content will not be disclosed to any unauthorized third parties.

4. Results

4.1. Participant Characteristics

According to a list provided by the manager of the CHC, the researchers contacted 18 older adults. Three individuals declined to participate due to physical discomfort or family disapproval, resulting in a final sample of 15 participants. The mean age was 75.2 years. The sample comprised ten women and five men. The demographic characteristics are detailed in Table 3. Interviews lasted between 32 and 68 min. Five themes were identified and mapped to the CSM (see Table 4). The following sections describe each theme.

TABLE 3.

Demographic characteristics of the participants.

No.	Age	Gender	Marital status	Education level	Number of kids	Living situation	Self‐assessed economic pressure	Self‐reported diseases	Self‐assessed health status
1	93	Male	Married	High school	2	Living with spouse	High pressure	Hypertension, diabetes, vascular cell cancer, heart disease	Fair
2	75	Female	Married	Junior high	2	Living with spouse	High pressure	Hypertension, diabetes	Poor
3	67	Male	Married	Junior high	1	Living with family	No pressure	Hypertension, heart disease, stroke	Good
4	63	Female	Married	High school	1	Living with spouse	High pressure	Heart disease	Fair
5	83	Female	Married	High school	2	Living with spouse	No pressure	Diabetes, heart disease, hypertension, lumbar disc herniation	Good
6	63	Female	Married	College	1	Living with children	High pressure	Bronchial asthma	Fair
7	76	Female	Married	Junior high	2	Living with children	Some pressure	Heart disease	Good
8	71	Female	Widowed	High school	1	Living alone	No pressure	Chronic gastritis	Fair
9	77	Female	Widowed	Junior high	3	Living alone	High pressure	Hypertension, heart disease, hyperlipidemia	Poor
10	77	Female	Widowed	High school	1	Living with children	High pressure	Urinary incontinence, subcutaneous cyst	Poor
11	72	Male	Divorced	Junior high	0	Living alone	High pressure	Cervical spondylosis	Poor
12	78	Female	Widowed	Junior high	2	Living alone	Some pressure	Diabetes, heart disease, hypertension, osteoporosis	Poor
13	82	Male	Married	College	4	Living with spouse	High pressure	Hypertension, chronic obstructive pulmonary disease	Fair
14	85	Female	Married	High school	3	Living with spouse	Some pressure	Gastritis, pain	Poor
15	66	Female	Married	High school	1	Living with family	High pressure	Heart disease	Poor

TABLE 4.

Themes and their mapping to domains in CSM.

Themes	CSM domains
	Cognitive representations				Emotional representations	Coping strategies
	Identity	Timeline	Control	Consequences
Theme 1 Health decline and identity in aging	√
Theme 2 Navigating the aging timeline with personal paces		√	√
Theme 3 Negative impacts with silver linings in the later life			√	√
Theme 4 Individualized emotional spectrum of aging					√
Theme 5 Multiple coping strategies						√

4.2. Theme 1: Health Decline and Identity in Aging

Participants generally perceived the decline in physical function with age as inevitable:

As we age, various organs and functions start to decline. It's kind of like a machine; if you use it every day, it's bound to wear out. When you're young, your body is like a brand‐new piece of equipment—you can use it however you want. But as you get older, even if you take good care of it, it's bound to have some little issues. (N7)

When asked about changes in health, participants mentioned several perceived functional declines and symptoms. The commonly mentioned changes included impaired vision and hearing, lower back and joint pain, sleep problems, slowed movement, decreased muscle strength, and cardiovascular diseases or related symptoms. In addition to physical and functional changes, three participants reported mental health problems; they were diagnosed with depression. Less frequently mentioned changes include swollen feet, cramps, respiratory‐related illnesses or symptoms, and dizziness. When queried about their perceptions of functional decline and health changes, some participants directly linked aging to certain chronic diseases:

A lot of people think that as we get older, we start facing different problems. As we age, our bodies aren't as good at fighting off issues anymore, which can lead to problems like heart disease, and high blood pressure. (N9)

Even without talking about chronic diseases, participants assumed that once people reach a certain age, their health will change accordingly:

Before I turned 70, I was perfectly fine and even drove all the way to Xishuangbanna, which is over 1500 kilometers from where I live. But after hitting 70, I've started noticing some symptoms. (N11)

Conversely, some participants felt that specific diseases were caused by a combination of factors, not necessarily attributable solely to old age:

When I was younger, I always had to do tough work. After retiring, I found another job and would climb the mountain every day to deliver goods. My body feels too heavy, which makes my heart uncomfortable. (N15)

Notably, participants attributed the worsening of symptoms to aging:

I guess that I'm getting older, and my symptoms are getting worse. Even though I've been treating it and trying to keep it under control, the symptoms have just gotten worse as I age. It's not just about the disease itself. (N6)

Participants overwhelmingly identified physical and functional declines, along with specific chronic conditions, as integral to their experience of aging. These health changes often served as concrete markers of older age, shaping their perceived identity as an older adult.

4.3. Theme 2: Navigating the Aging Timeline With Personal Paces

Most participants viewed aging as a continuous process:

I think when you start getting older, the first thing you notice is your feet. You know, at first, walking does not feel as smooth as it used to, and it's easy to get tired after a long walk. Then slowly, even my hands started feeling weak. (N1)

Furthermore, participants described the cyclical changes inherent in the aging process, noting that daily events often served as reminders of their aging bodies:

Now, I know I cannot walk as much as I used to when I was younger. I have to take it easy because I am older and my body is not as strong anymore. It is tough on my knees, so I really need to slow down. (N5)

Alterations in physical appearance, such as the emergence of wrinkles, also reinforced their awareness of the passage of time:

Sometimes when I look in the mirror, I notice that my skin is not as good as it used to be, and it's starting to get wrinkled. These visible changes really make me realize that I am getting older. Time and tide wait for no man. (N6)

During pivotal life events, such as the formation of a family or the bereavement of a spouse, participants may suddenly become acutely aware of their aging process:

Sometimes when I see my kids all grown up and settled down, it hits me that I am getting old. I used to be so busy worrying about them, but now they have their own lives. (N10)

When my husband was diagnosed with cancer and left me, I suddenly felt old. Like I had lost my sense of dependence—everything just felt different. (N8)

Participants expressed differing beliefs about control over aging. Some viewed aging as an uncontrollable natural process:

Of course, you cannot stop getting older. We just have to roll with it and go with the flow. (N3)

However, other participants believed that individual efforts could influence aging. They believed they could age at their own pace:

I mean, getting older is something we can't fully control, but we can definitely try to slow it down. For instance, watching what we eat, and keeping a positive attitude can really help us age more slowly. (N8)

Older adults generally viewed aging as a continuous, dynamic process marked by significant life events and daily reminders of bodily changes. While recognizing aging as largely uncontrollable, many expressed a belief in their ability to influence the pace or experience of aging through individual efforts and adaptations.

4.4. Theme 3: Negative Impacts With Silver Linings in Later Life

While aging is frequently associated with decline, participants identified new meanings and positive turning points within these transitions. Participants described a range of negative effects and outcomes of aging that they felt impacted all aspects of their lives, including physical functioning, exercise capacity, social skills, and relationships. Regarding cognitive changes, some participants lamented their perceived decline:

Sometimes I really feel like I am getting older and more confused. My memory isn't as sharp as it used to be, and I keep forgetting things left and right. I used to pick up new stuff really quickly, but now it takes me a long time to learn it. (N10)

Participants generally reported a significant decline in physical ability, noting that activities they once enjoyed had become increasingly difficult due to physical limitations:

I am older now and not as active. I used to go dancing when I was younger, but I can't do that anymore—I just don't have the energy. (N8)

This contraction was particularly evident in social engagement, as participants often preferred leisure activities at home or nearby rather than long‐distance travel:

I mostly spend my time at home these days and really enjoy the peace and quiet. If I do go out, it is just around the neighborhood or maybe to the park once in a while. (N6)

However, perceptions of the impacts of aging were not exclusively negative. Participants regarded their accumulated life experience and wisdom as valuable familial assets:

As the saying goes, “Having an older person in the family is like having a precious gem in the house.” I really believe that is even more true now. The experience and wisdom that older folks have can truly be a treasure for the family, offering great ideas and advice when needed. (N12)

At the same time, this wisdom allowed participants to reflect on their lives and recognize personal growth and improvement:

Sometimes when I take a moment to calm down, I find myself reflecting on my life. While most things seem clear now, there are still some areas that I just do not quite understand and have some regrets about. But hey, that's part of life—I have just got to accept it. (N14)

Regarding social relationships, participants placed a higher value on connections with close friends and family, cherishing intimate bonds and investing effort into maintaining them:

These days, I really cherish my old friends even more. It feels so great to just chat and catch up together. That kind of friendship is priceless—there's no amount of money that can buy it. (N8)

Aging was associated with various negative consequences, including cognitive and physical limitations, and reduced social engagement. However, participants also highlighted positive aspects such as accumulated wisdom, a deeper appreciation for close relationships, and newfound leisure time, revealing a nuanced perception of later life.

4.5. Theme 4: Individualized Emotional Spectrum of Aging

The emotional experiences of aging were individualized and not solely attributable to the aging process itself. Participants reported a range of emotions, including worries and sadness about aging itself:

Honestly, I've been worried because I feel like I'm getting older every day. I'm afraid my health is just going to keep declining and that there are so many things I won't be able to do anymore. (N3)

However, not all participants experienced negative emotions. Some participants, having reached an age they had expected and accepted, felt better prepared for old age and thus expressed fewer worries:

I'm not too worried about it. I'll be 80 in a few years, after all. Both my parents lived long lives—especially my dad, who's even older. Most of the older folks I know are also quite advanced in age, so I'm pretty prepared for getting older myself, and honestly, I don't think there's anything to be afraid of. (N9)

Participants’ deep understanding of aging's impact on daily life and relationships often manifested as specific emotional experiences. Loneliness emerged as a common emotion, especially when participants lost contact with friends and colleagues:

Sometimes I worry that if I end up living alone and don't talk to anyone for a long time, my heart will just feel lonelier and lonelier. As you get older, it might get even worse—having no one to chat with can really amplify that feeling of loneliness, and honestly, thinking about it is pretty sad. (N10)

This loneliness can be exacerbated by the death or relocation of old friends or colleagues:

A lot of my old colleagues and friends are gone now. There's only one or two left, but they've all moved so far away. Because of that, I usually don't have any activities to keep me entertained, and I often feel pretty lonely—like something's missing. (N12)

Concerns about physical health represented a prominent emotional challenge for participants. The potential for age‐related physical problems frequently evoked additional worries:

I'm really worried about my health. As I get older, there's always something uncomfortable here and there, and I'm afraid it might get more serious later on. (N1)

Emotional responses to aging were diverse and highly personal, ranging from worries about declining health and loneliness to feelings of acceptance and contentment, often influenced by personal expectations and social connections. Concerns about physical health and social isolation were particularly prominent emotional challenges.

4.6. Theme 5: Multiple Coping Strategies

To cope with the complexities of aging, participants employed various strategies, encompassing problem‐focused and emotion‐focused approaches. In the face of the physical changes brought by aging, participants adopted a series of problem‐focused coping strategies, such as “adapt to the environment if you cannot change it.” In terms of activity, participants modified their favored activities to align with their current physical condition. They persisted in exercise but reduced the intensity and duration as needed:

Now I just dance at home, taking it slow. The movements and tempo are much slower than when I was younger. You can't go all out like you used to. (N2)

Participants also prioritized diet and health management, maintaining their well‐being through self‐care practices, including traditional Chinese health maintenance methods such as acupuncture and moxibustion:

You really have to be careful about what you eat. We need to keep an eye on all our health indicators and make sure they don't spike. Try to cut back on fat, but you can eat more lean meat, as well as good stuff like yams and tomatoes. (N1)

I really enjoy acupressure and moxibustion these days, so I bought a bunch of moxibustion boxes and strips to keep at home. I've also self‐studied a lot about massage techniques, and I usually try them out on my own at home. (N8)

Participants also adopted emotion‐focused coping strategies. They countered the emotional impacts of aging by cultivating a positive outlook, emphasizing the importance of self‐belief, and focusing on the present moment rather than dwelling on future worries:

Honestly, aging does affect my mood a bit—after all, who doesn't want to stay young forever? But I'm okay with it. I always aim to live to be 100. Since life is long, I'll try to keep myself happy. (N1)

When experiencing negative emotions, participants sought the companionship and support of close relationships:

I usually spend most of my free time with Zhou, who's a really close friend of mine. When I'm feeling down, I drag her to the park or we go square dancing together. Being with her helps me forget everything else. (N8)

However, some participants chose not to share their struggles, preferring to bear them alone:

Look, everyone's busy, and I don't want to stress them out about me. Just focus on your own stuff and don't bother anyone else. (N11)

Participants employed a range of adaptive strategies to navigate the complexities of aging. These included practical, problem‐focused approaches (e.g., adjusting activities and prioritizing health management) as well as emotion‐focused strategies (e.g., maintaining a positive outlook and seeking social support), though some also adopted avoidance‐oriented strategies.

4.7. Overall Summary of Findings

This study explored the SPA among Chinese community‐dwelling older adults through five themes. Participants largely perceived aging through the lens of health decline, which shaped their identity in later life. They navigated aging as a personal timeline, acknowledging both its inevitability and their capacity for control. While experiencing significant negative impacts, they also found silver linings and wisdom in later life. Their emotional responses to aging were highly individualized, spanning a spectrum from worry to acceptance, and they adopted diverse problem‐focused and emotion‐focused coping strategies to adapt to these changes.

5. Discussion

This study utilized the CSM as a theoretical framework to explore the SPA among Chinese community‐dwelling older adults through a qualitative approach. The CSM offers a valuable lens for understanding how older adults cognitively and emotionally represented aging and how these representations shaped their coping strategies. These findings indicated that older adults viewed aging as an inevitable natural process, one that unfolds at varying paces and may change periodically. They managed and controlled this process at their own pace. They believe that aging has both negative and positive effects on their lives. In terms of coping strategies, problem‐focused, and emotion‐focused approaches were essential for older adults in adapting to aging.

Participants in the present study perceived physical and functional decline as an inevitable hallmark of aging and often used this decline as a primary marker of their identity as older adults. These perceptions align with prior evidence that aging is characterized by progressive declines in physiological function (Preston & Biddell ²⁰²⁴) and that older adults frequently attribute both new symptoms and the worsening of existing conditions to the natural aging process (Stewart et al. 2012). This tendency to link health problems primarily to old age, rather than to modifiable factors such as lifestyle (Oster and Chaves 2023) or socioeconomic conditions (Li et al. 2020), may be reinforced by prevalent societal views that equate later life with frailty, decline, and dependence (Yao 2020). Furthermore, ageist attitudes within healthcare systems can exacerbate this attribution pattern. Older patients often receive differential treatment based solely on their age. For example, older adults experiencing acute myocardial infarction face longer delays to hospitalization than their younger counterparts (Ouellet et al. 2017). Nearly half of medical students reported observing ageism in clinical settings (Dobrowolska et al. 2019). These experiences suggest that healthcare providers’ perspectives may inadvertently encourage older adults to normalize symptoms as simply part of getting old. Although such normalization provides a coherent explanation for complex health changes, it carries potential risks. Evidence indicates that attributing health issues primarily to unavoidable aging can reduce engagement in preventive behaviors and adversely affect long‐term health outcomes and longevity (Stewart et al. 2012).

Aging and the passage of time are inextricably linked, as aging fundamentally represents lived time, particularly after individuals have accumulated a substantial lifespan (Baars 2016). Traditional chronological classifications divide older adulthood into categories such as “young‐old,” “old,” “old‐old,” and “oldest old” (Neugarten 1996). However, individuals’ awareness of aging is inherently dynamic, and their SPA remains heterogeneous.

Specifically, older adults may periodically become aware of their age when health challenges or social roles shift, while understanding of aging may also develop in daily life. This pattern aligns with previous research. For instance, older participants in Kok and Yap (2014) expressed amazement at how long they had lived and how little time had passed. They thought old age crept in, describing this feeling as “time just goes by.” These accounts parallel the perception of aging as a natural, ongoing process observed in the current findings. This is consistent with the perception of aging as a “natural process” in the present study. On the other hand, even though aging is a gradual process, this perception could be influenced by events such as being labeled an “old lady,” the sudden death of a friend, or a disease diagnosis (Settersten and Hagestad 2015). The timeline perception variability highlights the aging experience's individualized nature and may be shaped by personal and situational factors.

The control belief dimension within the CSM reflects individuals’ perceptions of their ability to influence or manage the aging process. Some participants regarded aging as uncontrollable and accepted it as a natural progression, whereas others believed that personal efforts could meaningfully slow or improve the quality of their aging experience. These findings resonate with lifespan developmental psychology research distinguishing between essentialist and anti‐essentialist views of aging. Essentialists tend to view aging as a fixed, biologically inevitable trajectory with limited controllability (Weiss et al. 2016), whereas anti‐essentialists regard it as flexible and substantially shaped by lifestyle choices (Weiss et al. 2019). As individuals encounter increasing external constraints with advancing age, the direct link between their actions and outcomes may weaken. However, this external limitation does not necessarily diminish their belief in personal agency. The core of control beliefs is individuals’ belief that they can influence aging outcomes, rather than whether the aging process itself is fundamentally changeable. Notably, some older adults may acknowledge the potential plasticity of aging yet feel unable to enact relevant changes due to practical barriers. The variability in control beliefs observed in the current study highlights the personal nature of this dimension and underscores its critical role in motivating adaptive coping among Chinese community‐dwelling older adults.

This study revealed the consequences of SPA in older adults and the corresponding coping strategies based on the CSM. Participants frequently described negative physical consequences, including increased susceptibility to illness and reduced mobility. Cognitive consequences included reduced memory and slower cognitive processing speed. Social consequences included loss of purpose due to retirement and increased loneliness. Some participants mentioned positive effects such as increased wisdom and the ability to enjoy retirement and leisure activities. These findings align with existing research on age‐related changes and their impact (Ge et al. 2022; Zhang and Wood ²⁰²²). Understanding these perceived consequences from the perspective of older adults themselves has important implications for community‐based practice. It enables healthcare providers and community workers to identify potential barriers to physical and psychological well‐being and to develop targeted interventions. For example, Tai Ji Quan: Moving for Better Balance (TJQMBB) is a 24‐week, community‐based fall prevention program for older adults. It consists of eight forms of tai chi, ranging from simple to complex, which can be adjusted to suit older adults’ physical condition. Li et al. (2019) demonstrated the positive effects of TJQMBB in reducing the number of falls and improving balance and physical performance in older adults.

Emotional representation is a key component of the CSM, which involves an individual's emotional experience of the aging process. This study revealed various emotional responses of older adults to the aging process and its associated changes. Some older adults expressed worry and sadness about aging. In contrast, others set personal age goals by referring to the life expectancy of family members (e.g., parents) and felt satisfied upon meeting or exceeding this goal, resulting in fewer worries about aging. However, concerns about isolation and disconnection frequently accompany extended longevity (Fang et al. 2023). Physical deterioration, bereavement, and shifts in social roles emerged as key triggers for negative emotions, with health‐related worries representing a particularly prominent challenge (Bandyopadhyay & Singh ²⁰²³). Additionally, older adults worry about becoming dependent on others and becoming a burden. Loneliness is the emotional impact of changes in the social life of older adults. These findings suggest that cognitive representation of SPA in older adults may influence emotional representations, consistent with previous findings on disease perception based on the CSM. According to the transactional model of stress and coping proposed by Lazarus and Folkman (1987), coping strategies can be broadly categorized into problem‐focused and emotion‐focused approaches. Drawing on previous research on older adults’ coping strategies (Reyes et al. 2021), this study employed this framework to examine how participants managed the cognitive and emotional representations of their SPA. Problem‐focused coping strategies emphasize dealing directly with a problem or threat. In this study, the strategies adopted by older adults included engaging in moderate physical exercise, maintaining a healthy diet, acquiring new skills, participating in social activities, and practicing self‐care. Due to age‐related reductions in physical energy and recovery capacity, older adults often cannot respond to crises as rapidly as younger individuals. Consequently, many participants favored anticipatory coping styles, which involved proactive planning and preventive arrangements to address potential future challenges (Marcus‐Varwijk et al. ²⁰¹⁹).

Emotion‐focused coping strategies aim to minimize the distress and negative emotions caused by threats. Older adults tend to prioritize immediate emotional and relational goals over long‐term problem resolution (Westerhof et al. 2014). Positive thinking and optimistic attitudes are frequently regarded as valuable internal resources for mitigating the adverse effects of aging. In this study, participants mentioned that emotion‐focused coping strategies included acceptance, identifying positive aspects, and focusing on the present. Additionally, many participants sought emotional support from close relationships to obtain understanding and comfort, which is consistent with previous findings (Akhter‐Khan et al. ²⁰²²). They were more inclined to turn to friends than family members for such support, noting that conversations with family often remained superficial and centered on health concerns (Moult et al. 2020).

However, some participants mentioned avoidance‐oriented strategies. When perceiving a threat, their responses often included withdrawing, feeling helpless, and fearing they might become a burden to others. This lack of self‐expression is common in Asian cultures, where disclosing personal problem or seeking help is considered “losing face” (Mojaverian and Kim 2013). Although avoidance may offer short‐term emotional relief, prolonged use of this strategy has been linked to accumulated stress responses, including elevated cortisol levels (O'Donnell et al. 2008), and heightened risk of depressive symptoms (Murayama et al. 2020). Therefore, it is essential to understand the characteristics of older adults who use avoidance strategies and pay attention to them in future research.

Lazarus and Folkman (1987) proposed that the nature of stressors and available resources changes across the lifespan, which is reflected in their coping strategies. Evidence indicates that age is negatively associated with the use of problem‐focused coping and positively associated with emotion‐focused approaches (Cohrdes et al. 2023). This may be because with age comes an increased risk of chronic diseases. Additionally, older adults may have the advantage of experience and wisdom and are generally superior to younger people in emotional regulation (Charles 2010).

Despite analysis of older adults’ strategies for coping with SPA, previous research pointed out that relying solely on these two broad categories of strategies may overlook that they do not exist independently (Folkman and Moskowitz 2004). Problem‐focused coping reduces threats and the emotional responses they provoke, while effective emotional regulation helps to deal with problems more calmly. Therefore, it is more effective to view these two types of coping strategies as complementary functions rather than separate patterns. Within the CSM applied to the aging process, older adults’ cognitive representations can be improved through problem‐focused strategies, while emotional representations can be modulated by emotion‐focused strategies; importantly, these two types of strategies often function complementarily.

This study has several limitations. First, participants were limited to community‐dwelling older adults, so caution is needed when generalizing the findings to other older populations, such as those residing in assisted living or nursing homes. Second, this study was conducted in the specific context of Chinese culture, which may limit its applicability to different cultural contexts. Finally, the status of SPA among older adults with varying demographic characteristics and the relationship between cognitive and emotional representations and coping strategies require further exploration through quantitative studies.

6. Conclusion

Valuable insights into the SPA among Chinese community‐dwelling older adults are gained through this qualitative study. By applying the CSM, the researchers demonstrated its effectiveness as a framework for capturing the multidimensional cognitive and emotional representations of aging, as well as the diverse coping strategies employed in a non‐Western cultural context. The findings extend current understanding of aging by elucidating its dynamic and often paradoxical nature. Older adults’ perceptions are not limited to decline but also incorporate individualized timelines, positive adaptations, and the integration of accumulated life wisdom. These culturally nuanced insights highlight the importance of adapting existing aging perception instruments and designing interventions that are closely aligned with older adults’ specific lived experiences, cultural backgrounds, and preferred coping approaches.

Author Contributions

Study conception and design: Yu Luo and Xinyi Liu. Data collection: Xinyi Liu, Dan Wang, and Chunyan Gu. Data analysis: Xinyi Liu, Xiaochong He, and Wanhong Xiong. Drafting of the article: Xinyi Liu. Critical revision of the article: Yu Luo. The authors read and approved the final manuscript.

Funding

This work was supported by the Natural Science Foundation of Chongqing Municipality (General Program) [No. CSTB2023NSCQ‐MSX0489].

Ethics Statement

The Ethics Committee of Shuangbei Community Healthcare Center approved our interviews (approval: SB202305‐02) on June 20, 2023.

Consent

All participants provided written informed consent prior to participating.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Supporting Information: phn70155‐supp‐0001‐SuppMat.docx

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.