ABSTRACT

Chinese elderly care services have recently received much attention because of the profound differences between urban and rural areas. These differences profoundly impact the caregiving standards of the world’s largest cohort of older persons in the affected country. Infrastructure is well developed, economic investment is high, and technologies are advanced in urban areas, and these factors play an essential role in maintaining sound elderly care services. Conversely, challenges persist due to resource scarcity and geographical limitations, with reliance on traditional family care systems. The present work employs bibliometric analysis to examine the developmental changes in the research theme, focusing on urban and rural elderly care services in China from 2024 to 2000. With the help of software like CiteSpace, the differences in resource deployment, service delivery, and policy support between the urban and rural areas are pointed out in the study. The conclusions emphasize the necessity of equitable resource allocation and recommend applying innovative technologies and localized policies to address rural challenges.

1.     Introduction

The challenges of elderly care services are not unique to China; they are shared globally, particularly in aging societies such as Japan, Sweden, and Norway. Countries like Japan and Sweden have adopted integrated care and decentralized governance systems to address aging populations. At the same time, China faces unique challenges stemming from rapid urbanization, significant urban-rural disparities, and the need for tailored elderly care solutions that address these complexities. China has the largest share of the aging population, with over 260 million people 60 years and above (Eggleston, 2020). The country is experiencing increasing pressure to provide care for the diverse needs of the growing population. This challenge works hand in hand with the higher disparities in the economic development, infrastructure, and cultural practices in the country’s rural areas compared to the urban areas (Sun et al., 2019). Urban regions often benefit from substantial government subsidies and advanced healthcare systems, enabling the provision of diverse elderly care services, including institutional, community-based, and innovative care (Han et al., 2020); these services are generally our cognate ones again. However, they can be intended to meet any requirements the elderly residents may have, from simple medical assistance to leisure and social.

This study focuses on institutional care in urban settings and family-based care in rural settings, where healthcare infrastructure remains underdeveloped. (Bao et al., 2022). This reliance is becoming increasingly unsustainable because younger people are now shifting to urban areas in search of employment, thus leaving behind the older group of people in rurally based societies who need help to support themselves adequately (Feng et al., 2020). One of the traditional cultures that have gradually deteriorated over the recent past is the caregiving model of older people. For the rural elderly individuals, this meant that most of them relied on family networks for care, but this is not the norm today due to various reasons, with the result that older people are stranded socially and some of their needs are not even met (Xing et al., 2018). These systemic challenges are compounded by modality implementation deficits, which appear as national policies that usually need to be revised to address the rural context’s peculiarities.

The traditional Chinese model of elderly care uses the family, especially among the rural populace, due to cultural beliefs such as filial deity. However, urban migration has relieved these caregiving traditions in the past decades (Bao et al., 2022). Young people look for jobs elsewhere, leaving their parents in rural areas, hence the “empty nest” syndrome where the parent is left alone with little support. The changing roles have socially isolated elderly persons in rural areas regarding their physical and emotional requirements (Liang et al., 2018). However, rural health systems are weak and hampered by a lack of connectivity to professional caregivers and medical services, which increases their risks.

In discussing these matters, previous research tends to overview urban-rural inequalities without adequately explaining how such distinctions are defined or managed. The present literature is heavily oriented on questions of access to services more than on system reinforcing of inequity (Zhang et al., 2020a). However, it is necessary to go deeper to examine the extent of these inequalities and understand how the normalization of cultural practices, the lack of adequate finance, and policymaking failures contribute to the gaps. For example, according to Jiang et al. (2022), while urban elderly care services heavily depend upon institutional and community-based care service sectors, rural sectors lack such institutional backup support where they are confined to ad hoc community-based care services at irregular and insufficient intakes.

Benchmarks against global practices seek to establish an increased understanding of current and best practices in comparison to China’s challenges in elderly care. Japan’s integrated care model combines public funding, private partnerships, and advanced technologies like remote health monitors to address rural aging challenges. This approach underscores the potential of leveraging technology and community-based interventions to enhance care access and quality in resource-constrained settings(Jiang et al., 2022). These models focus on the active participation of public and private partners and the involvement of the public in formulating and enacting policies. Similarly, Sweden and Norway, with competent policies and decentralized governance systems, ensure equal distribution of these resources to rural and urban dwellers (Saif‐Ur‐Rahman et al., 2021). Not only in rural areas but also in urban areas, the challenges of elderly care are worsening. Urban elderly individuals are increasingly affected by changes in traditional caregiving models. While rural areas historically relied on family-based care, urban areas also had strong traditions of intergenerational support within family networks. However, rapid urbanization and the pressures of modern life have led to significant shifts in these practices. In urban areas, smaller family sizes, rising costs of living, and career-oriented lifestyles often mean less availability of family members to provide care for elderly relatives. Consequently, elderly residents in cities face social isolation and emotional neglect, even when residing in proximity to family members. Moreover, urban caregiving institutions are often overwhelmed by demand, with limited capacity to offer individualized or culturally relevant care, further exacerbating the problem (Zhang et al., 2020a).

1.1 Research Questions

This study seeks to explore the following key research questions:

1. What are the primary factors contributing to the disparities in elderly care services between urban and rural areas in China?
2. How do cultural practices and urbanization influence the caregiving models adopted in urban and rural areas?
3. What lessons can be drawn from international models of elderly care to address the challenges faced by China in both urban and rural contexts?

 

1.2 Literature review

Over the past few years, big data analysis and meta-analysis have become important approaches for reviewing and advancing knowledge about elderly care and significant global and Chinese topics. These methodologies enable the investigator to extrapolate a conclusion on the relative effectiveness of elderly care systems in various countries worldwide. Big Data and Meta-Analysis of Elderly Care in Different Countries Across the globe, big data analytics has offered vivid statistics on the efficiency of different elderly care models, especially in developed societies. For example, the integrated care system in Japan requires the technology of remote health monitoring, predictive analysis, and an electronic health record to provide health risks, including continuity care for older adults, especially in rural areas where they have weak access to service (Jiang et al., 2022). These systems have enhanced positive health event ratios, decreased hospitalization risk, and optimality of expenditure (Takahashi et al., 2021). Additionally, a meta-analysis done in Northern countries such as Sweden and Norway has revealed the high effectiveness of the decentralized governance system and inclusive policies targeting issues of inequality between the urban and rural elderly in access to care services. These focus on the use of resources, which involve the participation of communities, and the use of the right policies which have benefited the elderly in both rural and urban areas (Saif‐Ur‐Rahman et al., 2021; Sundström et al., 2019).

In the United States, big data analysis has also been of immense help in explaining the effects of social factors on elderly care response. According to the evaluation of Medicare and Medicaid programs, disparities in hospital service provisions have been identified with a poor representation of both urban and rural areas. Frequently, urban environments provide better-funded services and improved availability of healthcare infrastructure compared to rural places with workforce deficits and constrained healthcare access (Smith et al., 2020). This, as we have seen, supports the call for specific policy interventions to reduce these gaps in service delivery.

In the Chinese setting, the big data in elderly care research studies has positively contributed to understanding the nation’s fast-growing demography and its struggles in meeting elderly needs. Big data imply that one of the factors highlighted in previous research is regional inequality in healthcare access and use. Urban older adults tend to receive institutional care services, whereas rural older adults depend on formal caregivers, for example, relatives, because there are few viable formal care options (Bao et al., 2022). As a result, there is a widening disparity in care quality and availability between the two environments, whereby rural areas are far more likely to experience poor care (Liang et al., 2018). In addition, Chinese elderly care practices meta-studies have analyzed the deformation process of family-based care models. In the past, the elderly had been cared for mainly by their families in villages across China, adhering to the Confucian culture of ‘respect of elders’. However, the above model has been derailed by urbanization, whereby young people flee farming lands in pursuit of employment in the cities. This has occasioned what has come to be referred to as the ‘empty-nest’ situation, whereby the old in rural areas are left stranded due to the lack of proper family care, leading to the high prevalence of social exclusion and unmet care needs (Xing et al., 2018; Zhang et al., 2020a).

2.     Research Methodology

2.1 Data Collection

The work adopted a bibliometric analysis to interrogate the literature on elderly care services in China. Data were collected from two prominent databases: the Web of Science, which gives the global perspective, and the China National Knowledge Infrastructure (CNKI), which offers information on China only. Thus, using two databases also allowed for obtaining an equal number of international and domestic articles, encompassing all the crucial scholarly contributions to the subject area. By employing the appropriate keywords such as “China elderly care services,” “urban and rural elderly care,” and “influencing factors of elderly care,” the study gathered 300 articles that were published between the years 2000 and 2024. All articles had to undergo screening to keep the dataset relevant and accurate. Selected articles were included if they specifically examined differences, influencing factors, or developmental themes in urban and rural elderly care services. Due to this systematic screening, we obtained samples that not only covered diverse topics concerning elderly care in China but also directly related to the study goals. This was done purposely to ascertain high-quality papers and peer-reviewed journals, forming the bibliometric analysis’s basis.

2.2 Bibliometric Analysis Tools

The primary bibliometric software tool, CiteSpace, was used in the following analysis to analyze the dataset and produce valuable visualizations. Some analyzed dimensions are outlined next: they were all selected to provide different insights into the research area. Co-citation analysis was used to determine foundational literature and influential documents, select key papers, and obtain a review of the field of elderly care services in China. Keyword co-occurrence analysis identified trends of practical interest and thematic groups of the identified literature in detail, indicating the most significant topics for scientific focus. Cluster analysis compared urban-rural divides in funding, services, and policies, while burst detection highlighted temporal changes in research output. These analytical modules were supported by such additional measures as modularity coefficients and silhouette measures showing the quality and continuity of the observed clusters. This work’s multi-dimensional approach made it possible to emphasize the development of research themes, to discover gaps, and to recognize trends in researching Elderly care services in China.

• Data Processing and Visualization

CiteSpace played an essential role in producing various types of maps, which gave us a clear and practical understanding of the thematic trends of elderly care research. Bibliographic coupling uses Keyword co-occurrence networks to show the connections between essential topics and Co-citation maps to highlight key works and persons. Burst detection charts singled out increasing trends, reflecting changes in scholarly interest in new and emerging areas. Besides improving the readability of the presented results, these visualizations also became a valuable means to effectively present the various patterns and associations to policymakers and practitioners.

2.4 Enhanced Methodological Features

To understand the disparities in elderly care services on a more nuanced level, the study employs both comparative and longitudinal analyses. The comparative analysis sought to identify the difference between urban and rural places because it should carefully discern the corresponding differences among different contexts. On the other hand, the longitudinal study tracked thematic evolution across three distinct periods: 2000–2010, 2010–2020, and 2020–2024. The temporal perspective enabled us to see how research priorities evolve through a dynamic view of how research priorities have changed as a function of the societal, technological, and policy changes that have occurred over time.

3. Results and Analysis

3.1 Publication Volume and Temporal Distribution

The bibliometric analysis showed that the number of research on elderly care services in China grew steadily, and the volume of publications soared after 2015. This coincides with the advent of ‘the 13th Five-Year Plan for the Development of the Elderly Care Service System,’ a watershed, highly nationalistic policy act that catapulted elderly care to the fore (Fang et al., 2020). The challenges of early healthcare research (2000 – 2010) were the modernization of basic healthcare infrastructure and the decline of traditional family care models (Guo & Wang, 2024). These studies helped us understand the systemic issues that create elderly care disparities. Research priorities changed from 2010 to 2020 in the direction of integrating care models involving the collaboration of medical and elderly care services (Zhou et al., 2020). During this period, a growing focus was also on community-based care, tracked by policy efforts to decentralize and diversify elderly care services (Zou et al., 2020). Since 2020, the focus has shifted towards technological solutions, emphasizing innovative elderly care systems. However, these findings reflect the changing nature of elderly care research in China, prompted by policy programs, demographic change, and technological progress.

3.2 Core Literature and Knowledge Base

Using the co-citation analysis of the selected articles, the knowledge base formed from research on elderly care services in China was rich. Fundamental studies frequently dealt with the socioeconomic basis of older individuals’ care, although family systems preparedness for rural locations and institutional care created in urban communities were mainly investigated. Many influential studies highlight that the growing urban-rural care divide stems from disparities in economic development and policymaking (Qin, Wang, & Hsieh, 2018). Among the cornerstones of the field were the ’13th Five-Year Plan for Elderly Care Services’ and academic text on the integrated care model. These works helped provide a theoretical and empirical foundation to follow up research on the disparities as a social and policy challenge that needs to be urgently addressed.

However, much of the influential literature in rural contexts stressed the critical role of family networks in providing care, notably where government services were lacking. It also studied the psychological impact of the older adults left behind in rural areas where their families had gone to find jobs in urban centers (Qin, Wang, & Hsieh, 2018). On the other hand, urban research focused on efficient institutional nursing care homes and community-based centers. Here, these studies explored what urban systems could accomplish when advanced technologies were combined with healthcare services to suit better the needs of elderly residents in their urban environments. This study analyzed co-citation networks to identify these two research streams’ integral role in shaping the field, indicating a requirement for a holistic approach that addresses urban and rural disparity. In addition, recurring themes of inequity in policy support and resource allocation were highlighted from the knowledge base. Implementation failures were often identified as having led rural elderly care studies to point to policies developed at the national level, which were challenged by localized situations, as failing to achieve outcomes. Meanwhile, urban studies focused on improving efficiency and accessibility in well-funded systems.

3.3 Keyword Co-occurrence and Hotspot Clusters

The keyword co-occurrence analysis has provided a detailed overview of the research hotspots in elderly care services across urban and rural settings. In rural areas, frequently occurring keywords such as ‘family support,’ ‘social security,’ and ‘elderly poverty’ underscore the critical reliance on familial networks and the pressing need for improved social safety nets. The language behind these terms captures the centrality of familial and community networks for delivering care in the face of resource scarcity. They also show the economic precariousness of rural elderly populations, often poorly financed by pensions or welfare. This research emphasizes the need for a better social security system and community-based interventions to overcome problems rural older adults face.

Instead, urban-oriented research had keywords such as “community care,” “institutional care,” and “smart elderly care.” Such terms reflect the wide variety of service models used in urban regions, where institutional and technology-driven solutions are responsible for a growing share of that demand. In that domain, studies often focused on integrating health care services with elderly care, piling it up with technology to increase efficiency and accessibility. As urban care challenges become increasingly important, the idea of “smart elderly care” using technology has become a hot spot of research, underscoring technology’s role in resolving urban care issues.

Cluster analysis was used to identify thematic clusters, such as ‘rural family support networks,’ ‘urban institutional efficiency,’ and ‘integrated medical and elderly care policies.’ Where does the research stand regarding elderly care, and what are the priorities and challenges in these different contexts? Simplistically, these clusters present a nuanced image of the landscape of research. Therefore, for example, urban clusters focused on service delivery and technology optimization, while rural clusters emphasized policy and community support. Such differences highlight the need for context-specific approaches to address elderly care disparities.

3.4 Thematic Evolution and Emerging Trends

Burst detection analysis revealed three-period shifts versus thematic shifts on different fronts, reflecting the dynamics of elderly care research in China. Between 2000 and 2010, infrastructure development and the changing role of family care were the main focus points. During this period, studies have shed light on the fact that the traditional family-based care models have declined in rural areas and need to be addressed immediately with better healthcare infrastructure. It also saw the dawn of discussions about the measures for elderly care, on which concrete subsequent policies will depend. This research landscape moved from 2010 to 2020 to integrated care models and community-based services. During this period, there were considerable policy advances, most importantly, the emergence of integrated medical and elderly care systems (Yuan et al., 2024). Researchers, especially in urban areas, increasingly emphasize the need for collaboration between healthcare providers and elderly care services. A key theme was the development of community care, which went some way toward decentralizing services and increasing their proximity to elderly audiences. For example, the last period (from 2020 to the present) has witnessed a rise in innovative elderly care technologies. Moreover, terms like “IoT,” “big data,” and “smart care systems” abound, reflecting the ballooning interest in technology-based solutions. As presented here, innovations have great potential for tackling the problems of elderly care in cities where infrastructure and resources are available easily (Fu et al., 2021). However, they present a critical gap that requires further attention, as adoption in rural contexts is limited.

3.5 Theoretical Framework: A Unified Approach to Understanding Urban-Rural Elderly Care Disparities

This study extends Resource Allocation Theory by integrating Policy Implementation Models, exploring how resource concentration and implementation barriers interact to exacerbate urban-rural disparities. Specifically, the framework highlights the bidirectional impact where inadequate policy adaptation amplifies resource inequalities, creating a feedback loop of systemic disparities. Specifically, the theory explains the concentration of resources in urban areas, while the implementation model highlights the challenges rural regions face in adapting centralized policies to local needs. Resource inequality is compounded by implementation barriers, particularly in rural settings, where centralized policies often fail to address local needs. For instance, while urban areas benefit from well-funded institutional care systems, rural areas lack the governance and financial resources to localize these policies effectively. This integrated framework not only explains disparities but also provides actionable insights for policy reform in aging societies (Warner, 2020). Where there is focusing economic development in cities and towns, enough resources are available for adequate investment in facilities, qualified human power, and technologies in health provision (Zhang, W., Zhang, X., & Wu, 2021). It covers various forms of developed institutional and community-based service models. On the one hand, rural areas experience underdevelopment, which results in chronic under-provision of facilities, inadequate skilled human resources and acute dependence on caregivers (Warner, 2020). This lack of balance in the distribution of resources only serves to enhance disparities; older people in rural areas continue to receive much attention; they are, in fact, in a worse-off position than before.

Policy Implementation Models reveal the disconnect between central policy design and local execution, identifying barriers such as inadequate stakeholder engagement, insufficient local governance structures, and the mismatch between national priorities and regional realities (Yip et al., 2019). It is understood that cities benefit from central policies backed by sound governance and infrastructure. On the other hand, regional issues are pointed out inappropriately due to a lack of effectiveness due to the misfit of the given policy with the regional framework (Liu et al., 2020). First, decision-makers at the center pay little attention to input from stakeholders in formulating rural policies, hence coming up with measures that do not effectively solve local problems (Yip et al., 2019). Lack of governance structures and ineffective scrutiny also negatively affect policy results in rural contexts, compared with better-organized environments and more structured and effective systems in the urban context.By integrating these models, this study demonstrates that urban regions benefit from robust governance frameworks and resource availability, allowing for effective policy enactment. In contrast, rural areas often experience policy misalignment due to limited administrative capacity and the absence of context-specific adaptations, exacerbating disparities in care quality and access.

The study demonstrates how resource distribution and policy implementation are closely linked in determining elderly care results by applying this framework. To eliminate these disparities, a more substantial investment in rural healthcare infrastructure accessibility of rural populations to policymaking processes is important (Li et al., 2018). Furthermore, increasing monitoring and evaluation capacities in distant regions minimizes policy failure due to inefficiency and ineffectiveness. This integrated framework elucidates how resource concentration and implementation barriers deepen the urban-rural divide. It advocates for targeted interventions, such as increasing rural healthcare investments, tailoring policies to regional needs, and strengthening local governance to ensure policy effectiveness.

Elderly Care Services: Types of Services Delivered

Elderly care services vary significantly between urban and rural areas, shaped by resource availability, infrastructure, and policy implementation. In urban regions, institutional care services such as nursing homes, rehabilitation centers, and long-term care facilities are well-funded and equipped with advanced medical technologies. These facilities are staffed with qualified medical professionals and offer specialized programs tailored to the diverse needs of the elderly. In contrast, rural areas face significant challenges, with limited institutional care facilities that often lack sufficient resources and qualified staff.

Community-based services in urban areas are more structured, providing daycare centers, home healthcare services, mental health support, and recreational activities to enhance social well-being. However, in rural areas, such services are less formalized and often depend on local NGOs or religious institutions. Informal care also plays a critical role, with urban areas supplementing family caregiving with paid caregivers or private agencies. In rural areas, caregiving relies almost entirely on family members, placing substantial burdens on informal caregivers, particularly women.

Technology-based services demonstrate another divide between urban and rural areas. Urban elderly benefit from telemedicine, health apps, and AI-driven health monitoring tools, while rural areas have limited access to such technologies due to poor internet connectivity and lack of awareness. These disparities highlight the need for tailored interventions to bridge the gap in elderly care services across urban and rural settings.

 

 

Comparative Table of Urban and Rural Elderly Services

Category	Urban Elderly Services	Rural Elderly Services
Institutional Care	Well-funded, technology-enhanced nursing homes and hospitals; specialized geriatric care.	Limited facilities, minimal technology, and fewer specialized caregivers.
Community-Based Care	Structured programs: daycare, recreational, mental health support.	Informal networks, sporadic NGO involvement; limited organized programs.
Accessibility	Close proximity to services, public transport availability.	Geographic isolation, lack of transport infrastructure.
Technology Utilization	Advanced tools: telemedicine, health tracking apps, AI diagnostics.	Low adoption due to poor internet connectivity and lack of awareness.
Caregiver Availability	Professional caregivers supported by family and private agencies.	Family-dependent care with minimal professional support.

 

Factors Influencing Elderly Care Services

Insights from CiteSpace’s bibliometric analysis reveal key factors influencing elderly care services. One critical factor is resource allocation. Urban areas benefit from higher resource prioritization due to stronger economic development, better governance frameworks, and superior infrastructure. In rural regions, chronic underinvestment, limited budgets, and poor resource utilization result in significant service gaps (Zhang et al., 2021).  Policy implementation barriers further exacerbate disparities. Centralized policies often fail to adapt to the unique needs of rural areas, resulting in a misalignment between national priorities and local realities. Rural policies are often developed without adequate stakeholder engagement, leading to ineffective solutions (Yip et al., 2019). Urban areas, on the other hand, benefit from robust governance and infrastructure, which support the effective enactment of policies.

Demographic trends also play a significant role. Urban areas experience a growing elderly population as younger generations migrate in search of better opportunities and healthcare access. In rural areas, migration creates “empty nest” households where elderly individuals are left without sufficient support (Liang et al., 2018). Furthermore, rural areas struggle to attract healthcare professionals, leading to staff shortages and inadequate specialized training programs (Warner, 2020). Technology adoption highlights another disparity. Urban centers leverage advanced health technologies such as telemedicine and AI-driven diagnostics, while rural areas lag due to limited internet penetration and technological infrastructure (Li et al., 2018). Cultural factors further contribute to the divide, as traditional caregiving models, such as filial piety, are eroding in rural areas due to urban migration and changing family structures (Xing et al., 2018).

 

4.     Discussion

4.1 Major Differences in Urban and Rural Elderly Care Services

The findings of this analysis showed appreciable differences in factors that influence the supply of elderly care services in urban and rural areas. Compared with other parts of the country, in terms of resource allocation, metropolitan areas have more abundant medical and elderly care facilities, with more economic investment and more developed infrastructure (Shi et al., 2023). Thus, these advantages allow urban regions to provide services from institutional care to community-based programs to advanced technological solutions (Feng et al., 2020). However, rural areas are characterized by resource shortages, mainly a lack of healthcare facilities and poor infrastructure. Rural elderly persons often depend on family support, a model that has become increasingly unsustainable as rural areas lose population to urban centers (Han et al., 2020). Also, service models greatly vary from place to place (rural or urban).

According to Zhao et al. (2020), economic development shows a concentrated distribution of resources for infrastructure investment and health sector development due to the density of urban areas. They usually provide the best clinical diagnostic centers, modern concept senior living homes, telemedicine, personal health care machines, etc. This availability means that urban consumers have choices from total dependency, which one may seek in a nursing home, to limited facility-dependent programs available on a community basis for fractional need types. On the other hand, rural centers are characterized by a chronic scarcity of resources that hinders the development of adequate protocols for elderly caregiving (Fang et al., 2020). As indicated earlier, most rural preparedness assessment indicators are poorly developed and lack adequate funding and human resources (Wang et al., 2021). This scarcity puts much pressure on older people in these regions, depending on family support, and gradually becomes a mirage due to rural depopulation. In most developing countries, the youth have been migrating to urban areas, which has resulted in an increasing number of old persons being left alone in rural areas; they can rarely afford even basic health facilities.

Urban areas leverage concentrated resources to develop specialized care services, supported by advanced technologies, validating the Resource Allocation Theory’s emphasis on systemic efficiencies. Conversely, the structural deficiencies in rural areas reveal a critical gap in adapting centralized policies to local contexts, highlighting the interplay between resource inequality and implementation challenges. Meanwhile, rural areas rely primarily on traditional family-based care bolstered by sporadic community efforts.

These challenges are not unique to China but resonate with patterns observed in other aging societies. For example, Japan has implemented integrated care systems in rural areas, combining government funding, community participation, and advanced technologies like telehealth to bridge the urban-rural gap. Similarly, Sweden and Norway have adopted decentralized governance models, allowing rural regions to tailor elderly care services based on local needs while ensuring equitable resource distribution. These international examples underscore the role of innovative technologies, local governance, and public-private partnerships in bridging urban-rural disparities. For instance, decentralized governance models could empower rural areas to allocate resources more equitably, while public-private partnerships may introduce sustainable funding mechanisms for community-based care programs.

Rural elderly populations are often neglected, relying on informal care networks that fail to meet their needs and increase vulnerability. Comprehensive policies and generous funding programs can pay considerable dividends in urban areas, but resource scarcity and governance deficiencies have frequently stymied rural implementation (Tang et al., 2021). Almost all national initiatives fail to address rural communities’ unique needs and ultimately end up with uneven policy coverage and low impact. The many differences highlight the rationale for targeted policy interventions focused on the unique problems associated with providing care to urban and rural elderly.

Service models also show the divide between urban and rural. Urban regions have adopted institutional and community care, and technologies are increasingly used. These models are extended with professional training for caregivers and combined health and social care work. These developments have allowed older adults in urban areas to receive specialized care to enhance their physical and mental health (Jia et al., 2021). On the other hand, most, if not all, of the rural nations continue to use the traditional family-based care system. – Unfortunately, this model based on cultural ideas of filial responsibility no longer suffices for families dealing with a lack of finances and a decreasing ability to care for older people. Substituting institutional care by attending relatives is less professional and less frequent than professional care agencies. This dependency poses a problem to the extent that the rights of rural elderly patients are vulnerable, and their needs are unrecognized.

4.2  Theoretical and Practical Implications

This study makes significant contributions to theory and practice. Theoretically, the study offers an integrated context to explain all the determinants of elderly care services in China. Taking co-citation analysis, keyword co-occurrence, and thematic evolution together, the study looks at the interplay of resources, service models, and policy support in elderly care outcomes. .The framework provides a platform for future research that guides scholars in advancing the concept of elderly care in broader terms, alongside the roles of technology and the generations affected. The study provides a set of practical insights for policymakers and practitioners. The findings reveal the critical need for equitable resource distribution, particularly in rural areas where resource shortages are most significant. In addition, they specify the importance of uniting healthcare and elderly care services, a way of working that has worked well in cities. Moreover, the study corroborates those innovative technologies can tackle system problems with proper training and infrastructure development. The implications of such insights for designing and implementing elderly care policies and programs can help improve elderly care services in China.

Also, the theoretical framework presented offers a comprehensive perspective on the disparities in elderly care between urban and rural China, emphasizing the critical roles of resource allocation and policy implementation. It clearly highlights how the unequal distribution of resources exacerbates the divide in care quality, particularly in rural areas where underdevelopment persists. A number of systematic issues in rural areas make it almost impossible to deliver adequate care; urban areas, however, have the resources and organized administration. This is the cycle that not only makes the elders in rural regions receive poor services but they are placed even worse off than they used to be.

Applying Resource Allocation Theory and Policy Implementation Models for the study explains how these factors are interdependent in influencing elderly care outcomes. This alone creates inequality in resources as areas in the countryside naturally get fewer resources to support them than urban regions do, which automatically leads to poor service delivery, but where policies are developed in centralized offices but implemented in rural areas, there is a disparity between the two. Hearths are born and nurtured well where policies are implemented; on the other hand, they falter in rural settings, where no concrete policies are implemented to meet the area’s needs. The gaps above are further deepened by the scarcity of adequate local government and policy, even though they are often stronger in urban settings.

Based on these gaps, the study recommends that the elaboration of recommendations for improving rural healthcare facilities coupled with the increased participation of the rural population in decision-making processes is required. This would help improve resources, facilities, and staff for the countryside so that the countryside has access to the same quality of carers as the city. Further, improving the monitoring and evaluation processes can eliminate policy breakdowns in these areas, implying that improvements in intervention can be made locally. Top of FormBottom of Form

4.3. Limitations

As much as the study is informative on the subject matter, it also contains some limitations. In this context, the work under analysis states that the author has significantly assessed the organization’s stability by identifying the key risks. First, this study primarily relies on English and Chinese databases, which may exclude relevant research published in other languages, particularly in non-English speaking countries with advanced elderly care systems. Additionally, the use of bibliometric methods limits the ability to capture nuanced qualitative insights, such as cultural factors influencing elderly care practices. Additionally, bibliometric methods rely on existing keywords, which may overlook emerging but less established themes in elderly care research. Future research should employ mixed methods, integrating qualitative interviews and quantitative modeling, to capture the nuanced experiences of caregivers and elderly individuals while quantifying the impact of policy interventions on care outcomes. This would provide a richer understanding of the socio-cultural and institutional dynamics influencing elderly care services. Longitudinal studies tracking the long-term effects of policies and interventions on elderly care outcomes are also essential. These could assess how demographic shifts, technological adoption, and policy adjustments influence the evolving urban-rural divide over time. Additionally, cross-cultural comparative studies could identify adaptable best practices from other aging societies, such as Japan or Sweden, to inform China’s elderly care strategies.This may lead to only getting part way to grasping trends and practices of elderly care in the global arena. Second, reliance on keyword-based clustering may overlook emerging themes or interdisciplinary perspectives not yet well-represented in existing literature, potentially narrowing the scope of identified research gaps. From this limitation, it is pretty clear that quantitative research should be accompanied by other qualitative techniques, including content analysis or expert interviews, to deepen the understanding of the key drivers of elderly care services. Finally, this study focuses on resource allocation and policy implementation at a macro level, without examining micro-level factors such as individual caregiver experiences or specific institutional practices. This limits the understanding of how systemic disparities manifest in everyday care delivery.However, these limitations should not be taken to mean that the study lacks sufficient evidence for tackling urban/rural differences in elderly care or that the framework presented here lacks clear directions for follow-up investigation and policymaking. Following the understanding of structural, cultural, and economic barriers, China could attempt to construct a fair and sustainable elderly care system for the society bearing the growing population of seniors.

5.     Conclusions and Recommendations

5.1 Key Findings

The bibliometric analysis shows a wide gap between elderly care in rural and urban China’s aged populations. Strong infrastructure, economic resources, and comprehensive policy support create urban areas conducive to various care models, including institutional and community-based programs leveraged with innovative technologies and data sources. In comparison, rural areas suffer from restricted finances, poor infrastructure, and the inability of the policy to be concreted successfully, especially with young people leaving for the cities. Urban areas quickly take up advanced technology-driven care models and personalized services. Rural areas heavily depend on the care and rely considerably on increasingly strained family-based care, which rarely can supply even basic needs, which makes it all the more striking to need a better distribution of resources and commitment to the more integral activities to balance this expanding divide between elderly care services and urban and rural areas.

The findings of this study also provide empirical evidence documenting the urban-rural division of elderly care services in China and the expansion of this gap in subsequent years; the finding suggests the imperative of solving the problem through system reform. A strong infrastructure, improved access to economic resources, and comprehensive policies enable the provision of enhanced models of care in urban sectors. These include programs such as institutional and community-based care programs; these programs are usually backed with newer technologies such as telemedicine and data health management systems. Together, the three aid in bringing distinction in care that, therefore, meets the different needs of the aging population within the urban setting. Also, the intensity of elderly care is high in urban areas, and the health workers in the area are well-trained to handle the situation.

On the other hand, the rural sector remains stagnant in development, with a poor cash base and poor health facilities. As such, the issue of policy implementation refers to the inability to actualize such policies, which in any case isn’t easy, and when harnessed to the challenges above, it makes the going even more challenging. This is because youths are moving en masse to urban centers in search of better job opportunities, leaving our rural counterparts with a scarcity of caregivers and health professionals. This has led to an overreliance on family care systems, which are now locked into the culture of the society but which offered little above basic care to older people. Hence, rural older adults have almost extremely restricted opportunities to get quality care, which has an adverse effect on the health status of elderly persons and makes them more vulnerable.

5.2  Policy Recommendations

A bibliometric analysis suggests key policy measures to narrow urban-rural disparities in elderly care services. To address disparities, substantial investments in rural healthcare infrastructure must be coupled with strategic capacity-building initiatives, such as developing regional training centers for caregivers and introducing subsidized telehealth services to enhance accessibility. By ensuring context-specific policy adjustments and robust local governance, rural areas can overcome systemic barriers to care. Specifically, the government should:

1. Allocate dedicated grants for rural healthcare facilities to purchase and implement smart care technologies like telemedicine devices and wearable health monitors.
2. Establish targeted training programs for family caregivers, focusing on basic medical care and the use of new technologies.
3. Develop partnerships with private sectors and NGOs to create sustainable community-based programs that supplement family care networks.
4. Introduce financial incentives, such as tax breaks, for companies investing in elderly care infrastructure in rural areas.

However, adopting such innovative technologies as IoT and wearable devices has the potential to boost care quality, and financial incentives and training programs should be implemented to encourage technology uptake into these areas, particularly in rural areas where technology uptake is lagging. To this end, we need strong monitoring mechanisms to ensure national policies are adjusted and executed for local contexts. Public-private partnerships can also scale successfully integrated models of care across rural and urban regions, and they can leverage ‘technological expertise’ to fill service gaps and work with NGOs and private sector stakeholders as part of partnerships.

Also, grants and subsidies should be introduced exclusively for rural clinics to use new technological devices. These funds could be used to purchase devices that will help deliver technologies, train healthcare professionals about these technologies and put up local technological work. Civil society support programs in rural areas imply the need for cooperation structures between local governments, NGOs, and businesspersons in firms. These platforms may also enable the setting up of volunteer-based caregiver organizations that would be especially useful in areas with few family caregivers. In addition, incentives and bargaining that focus on investment in necessary technologies within eldercare, such as tax exemptions or subsidies for families and businesses in rural areas, should be introduced. Lastly, this plan must be supported by strong monitoring and evaluation frameworks that would allow for the evaluation of the impact of interventions and feedback on the policymaking process.

5.3  Future Research Directions

The bibliometric analysis points to several key directions for future research in Chinese elderly care services. Interdisciplinary studies combining sociology, economics, technology, and public health could provide more comprehensive insights into developing sustainable care models that work across different contexts. Additionally, longitudinal research tracking the long-term effects of policies and service models on elderly care outcomes would help understand how demographic shifts and interventions impact care quality over time. Cross-cultural comparative studies examining how other aging societies address urban-rural disparities could identify adaptable best practices for China. More research is also needed on innovative technologies’ impact on care quality and accessibility, particularly in rural areas where adoption lags. Finally, studies focused on equity in policy implementation are crucial for ensuring effective care delivery across all geographic locations, including examining governance structures and community engagement approaches to address persistent urban-rural disparities in elderly care services.