Introduction
Ageing-in-place has been widely studied in gerontology, sociology and social policy since the concept emerged in the 1980s (Bigonnesse and Chaudhury, Reference Bigonnesse and Chaudhury2020). It is based on the expectation that ‘[older adults] remain living in the community, with some level of independence, rather than in residential care’ (Wiles et al., Reference Wiles, Leibing, Guberman, Reeve and Allen2012: 357) and is viewed as a desirable means of ‘prevent[ing] or delay[ing] traumatic moves to a dependent facility’ for older adults (World Health Organization, 2004: 9). Research also suggests that ageing-in-place is not only desirable for older adults, but can benefit society at large. For instance, given the rapid population ageing taking place worldwide, ageing-in-place represents a more economically feasible means for policy makers to respond to growing needs for long-term care and shortages in care-giving workforces than does nursing home care (Iecovich, Reference Iecovich2014). The literature generally emphasises that ageing-in-place is an ideal care-giving arrangement preferred by most older adults (Alley et al., Reference Alley, Liebig, Pynoos, Banerjee and Choi2007; Vasunilashorn et al., Reference Vasunilashorn, Steinman, Liebig and Pynoos2012). However, how older adults understand ageing-in-place can vary across settings and contexts (Tang and Lee, Reference Tang and Lee2011; Vasunilashorn et al., Reference Vasunilashorn, Steinman, Liebig and Pynoos2012). Evidence about how rural older adults understand and experience ageing-in-place in different contexts can provide particularly useful insights for tailoring strategies that promote ageing-in-place in different rural settings. The purpose of this study is thus to explore how older adults in rural China conceptualise ageing-in-place based on their experiences in order to provide more nuanced understandings of this concept that can inform future initiatives to support ageing-in-place in rural China and in other developing countries.
Since the 2000s, researchers have paid increasing attention to rural gerontology and taken critical approaches to understanding older adults' ageing processes in rural contexts, especially by examining their active role in constructing their self-identity, interacting with their environments and shaping their ageing processes in rural contexts (Keating and Phillips, Reference Keating, Phillips and Keating2008; Milbourne, Reference Milbourne2012; Skinner and Winterton, Reference Skinner and Winterton2018; Poulin et al., Reference Poulin, Skinner and Hanlon2020). Such critical perspectives also emphasise that rural gerontology should avoid taking the meaning of ‘rural’ for granted (Phillipson and Scharf, Reference Phillipson and Scharf2005; Skinner and Winterton, Reference Skinner and Winterton2018) and instead foreground the diversity and dynamics of ageing experiences constructed in rural contexts (Cutchin, Reference Cutchin2009). Yet even as research brings more attention to rural ageing, Skinner and Winterton (Reference Skinner and Winterton2018) have critiqued these studies for continuing to overlook rural older adults' desire and rights to age in place. A contextually sensitive and nuanced perspective is needed to explore how rural older adults conceptualise ageing-in-place.
Recently, ageing-in-place among rural older adults worldwide has received increasing research and policy attention. In some developed countries (e.g. Britain and Australia), rural older adults reported having strived to age-in-place by staying self-reliant, resilient and persistent in the face of advanced age, poverty and a lack of support (Scharf and Bartlam, Reference Scharf, Bartlam and Keating2008; Milbourne and Doheny, Reference Milbourne and Doheny2012; Walker et al., Reference Walker, Orpin, Baynes, Stratford, Boyer, Mahjouri, Patterson, Robinson and Carty2013). Rural older adults in developing countries (e.g. Jamaica and Malaysia) have also begun to prioritise ageing-in-place to support their living preferences (James et al., Reference James, Holder-Nevins, Morris, Eldemire-Shearer, Powell and Laws2012; Tobi et al., Reference Tobi, Fathi and Amaratunga2017). However, promoting ageing-in-place in developing countries remains challenging due to a high prevalence of chronic diseases, low levels of support from children due to migration, low health-care accessibility and low public subsidies for eldercare (James et al., Reference James, Holder-Nevins, Morris, Eldemire-Shearer, Powell and Laws2012; Tobi et al., Reference Tobi, Fathi and Amaratunga2017). Given the lack of ageing-in-place infrastructure in developing countries, understanding how rural older adults consider ageing-in-place requires further investigation to better inform the timely and tailored supports needed to fulfil their desire to age in place in a specific sociocultural context.
In China, a developing country, rural older adults also suffer from poverty and limited access to formal supports. Compared to their urban counterparts, they also tend to be more dependent on their family members to achieve ageing-in-place (Hu et al., Reference Hu, Cao, Shi, Lin, Jiang and Hou2018; Tang et al., Reference Tang, Lin and Chen2020). A body of studies has consequently highlighted the key role of filial piety (Jiang et al., Reference Jiang, Lou and Lu2018; Chen and Lou, Reference Chen and Lou2023) – which refers to an unconditional obedience of children to fulfil the older parents' instrumental, emotional and financial needs for care (Cheung and Kwan, Reference Cheung and Kwan2009) – to understand the ageing-in-place process in rural China. These studies suggest that although adult children's practices of filial piety are still desired in rural China, older parents' have changed their expectations regarding their children's performance of filial piety in practice (Luo and Zhan, Reference Luo and Zhan2012; Mai, Reference Mai2015). For example, one study found that Chinese older parents did not regard children who lived far away or were unavailable to provide personal care as less filial or unfilial (Luo and Zhan, Reference Luo and Zhan2012). However, the focus on filial piety has resulted in the researchers' assumption that these older adults tend to be more dependent on their family members to achieve ageing-in-place than their counterparts in Western rural contexts (Luo and Zhan, Reference Luo and Zhan2012). In fact, studies of the meanings of ageing-in-place in rural China have loosely equated ageing-in-place with reliance on children's support in later life (e.g. Guo et al., Reference Guo, Gao, Sun and Feng2020), thus rendering the concept of ageing-in-place as a study background or a presumed context for their analyses. As a result, studies of ageing-in-place in rural China remain hampered by a preconceived concept of ageing-in-place drawn from experts' views rather than emerging from the perspectives of the older adults themselves (e.g. Chen and Lou, Reference Chen and Lou2023). More evidence is needed to understand ageing-in-place through older adults' conceptualisation and experiences.
Understanding ageing-in-place through experts' and older adults' perspectives
Numerous studies suggest that ageing-in-place is an essential means for older adults to have a high-quality later life because living in a familiar environment can facilitate the preservation of their autonomy and social relationships, and delay their relocation to nursing homes (e.g. Alley et al., Reference Alley, Liebig, Pynoos, Banerjee and Choi2007; Wiles et al., Reference Wiles, Leibing, Guberman, Reeve and Allen2012; Iecovich, Reference Iecovich2014; Vanleerberghe et al., Reference Vanleerberghe, De Witte, Claes, Schalock and Verté2017; Ahn et al., Reference Ahn, Kang and Kwon2020; Bigonnesse and Chaudhury, Reference Bigonnesse and Chaudhury2020). Experts and policy makers have reached a consensus that ageing-in-place is a policy ideal that is optimal for older adults to remain safely, independently and comfortably in their familiar environments for as long as possible (Centers for Disease Control and Prevention, 2013). Such familiarity supports older adults' competency in and control over their environment, unlike ‘cared for’ environments including nursing homes and retirement communities (Alley et al., Reference Alley, Liebig, Pynoos, Banerjee and Choi2007; Iecovich, Reference Iecovich2014).
At the same time, scholars have debated the proper meanings of place in the term ageing-in-place (e.g. Gilleard et al., Reference Gilleard, Hyde and Higgs2007; Buffel et al., Reference Buffel, Verté, De Donder, De Witte, Dury, Vanwing and Bolsenbroek2012; Wiles et al., Reference Wiles, Leibing, Guberman, Reeve and Allen2012). Iecovich (Reference Iecovich2014) suggests that there are at least three dimensions of place, including physical, social and cultural dimensions. In order to capture the dynamic of place, some scholars have proposed changing the term ageing-in-place to ageing-in-community (e.g. Pani-Harreman et al., Reference Pani-Harreman, Bours, Zander, Kempen and van Duren2021; Choi, Reference Choi2022) to foreground the need for age-friendly facilities in older adults' communities. Scharlach (Reference Scharlach2017) has proposed further expanding the term to ageing-in-context, highlighting the dynamic and evolving intersections between individual ageing processes and environments. What these alternative terminologies suggest is that experts' definitions of ageing-in-place draw on various underlying theoretical underpinnings while lacking consensus on the salient factors constructing the concept (Bigonnesse and Chaudhury, Reference Bigonnesse and Chaudhury2020). Understanding how older adults themselves view ageing-in-place can illuminate the meanings of ageing-in-place from these laypersons' perspectives and their decisions about care-giving arrangements that matter for their entire ageing process.
Existing evidence shows that older adults report mixed feelings towards their experiences of ageing-in-place. For some older adults, ageing-in-place cultivated their sense of attachment and belonging to their homes and communities, provided them with control over their lives and spaces, and sustained their self-identity and wellbeing (Gilleard et al., Reference Gilleard, Hyde and Higgs2007; Wiles et al., Reference Wiles, Leibing, Guberman, Reeve and Allen2012; Iecovich, Reference Iecovich2014; Stones and Gullifer, Reference Stones and Gullifer2016; Ahn et al., Reference Ahn, Kang and Kwon2020). By contrast, other older adults reported negative effects of ageing-in-place, including injuries at home, stresses of living independently, difficulties maintaining their homes and daily activities, insufficient support resources and burdens on their family care-givers (e.g. Hrybyk et al., Reference Hrybyk, Rubinstein, Eckert, Frankowski, Keimig, Nemec, Peeples, Roth and Doyle2012), which are particularly challenging for rural older adults (Milbourne and Doheny, Reference Milbourne and Doheny2012). These mixed findings point to older adults' diverse experiences and understandings of ageing-in-place, in relation to their various health, financial and functioning statuses, their interactions with built and interpersonal environments, and policy and service contexts (Lewis and Buffel, Reference Lewis and Buffel2020; Choi, Reference Choi2022). Thus, ageing-in-place is not a one-size-fits-all concept across the entire ageing process for all older adults (Grimmer et al., Reference Grimmer, Kay, Foot and Pastakia2015). The nature of older adults' ageing-in-place is dynamic in terms of both their ongoing ageing process as well as the possible changing environments of the place where they age (Lewis and Buffel, Reference Lewis and Buffel2020).
Ageing-in-place in rural China
Compared with their urban counterparts, older adults in rural China face greater socioeconomic disadvantages and much more limited access to social support resources (e.g. welfare benefits, health care; Mao and Han, Reference Mao and Han2018; Tang et al., Reference Tang, Lin and Chen2020). Despite the fact that population ageing has been more rapid in rural China than in urban areas, the number of hospital beds and health professionals per 1,000 persons in rural China was about half of those in urban areas (National Bureau of Statistics of China, 2021a). Urbanisation has further exacerbated care-giving shortfalls in rural China as young adults move to urban areas to seek better livelihoods. An additional 250 million rural Chinese young adults are projected to move to urban areas by 2026 (Weller, Reference Weller2015). These vast population shifts have prompted researchers to raise questions about adult children's commitment to supporting older parents in rural areas in the future (e.g. Luo and Zhan, Reference Luo and Zhan2012; Silverstein et al., Reference Silverstein, Gong and Kendig2020), further emphasising the prominent position that the concept of filial piety continues to occupy in this body of literature.
As noted, studies of Chinese rural older adults' care-giving arrangements have primarily focused on the traditional but evolving notions and practices of filial piety. Although Chinese people in general continue to report high levels of filial piety (He et al., Reference He, van Heugten, Perez-Y-Perez and Zheng2021), a series of sociocultural changes in China in recent decades (e.g. mass migration and urbanisation) have fundamentally altered notions and actual practices of filial piety and transformed rural older parents' filial expectations (Shi, Reference Shi2009; Mai, Reference Mai2015). Traditional co-residence with and caretaking for older parents on a daily basis is no longer the norm in rural China today (Mai, Reference Mai2015). For example, rural older parents in middle-west China did not lower their appraisals of their children's filial piety due to their absence or regard children's care-giving as necessary (Luo and Zhan, Reference Luo and Zhan2012). Further, older parents in rural China no longer follow the patrilineal tradition that obliged sons (i.e. the oldest son, in particular) to shoulder the care-giving responsibilities, with daughters also expected to contribute (Shi, Reference Shi2009; Mai, Reference Mai2015). These studies highlight how rural older parents have reinterpreted filial piety and their expectations regarding it in response to changes in contemporary China (Shi, Reference Shi2009). Yet these analyses centre on sociocultural changes in filial piety rather than the meanings of ageing-in-place among older adults in rural China, leaving unexplored the issue of how these rural older adults' views and experiences of ageing are changing in tandem with evolving practices of filial piety.
Indeed, evolving notions and practices of filial piety may have varying implications for ageing-in-place in rural China. On the one hand, older parents' reinterpretation and modified standards of filial piety will potentially decrease the support they receive from their children, which may discourage them from ageing-in-place (Silverstein et al., Reference Silverstein, Cong and Li2006; Lin and Tang, Reference Lin and Tang2021). On the other hand, studies have repeatedly identified positive linkages between the evolving practices of filial piety and older adults' wellbeing in rural China (e.g. Silverstein et al., Reference Silverstein, Cong and Li2006; Cong and Silverstein, Reference Cong and Silverstein2008; Lin and Chen, Reference Lin and Chen2018). These studies suggest that older adults in rural China may continue to consider ageing-in-place as beneficial and preferable, regardless of where their children live. These seemingly contradictory findings highlight the need for more qualitative evidence of how older adults in rural China understand ageing-in-place within this changing sociocultural context in order to better support these older adults' desires for and ideas of ageing-in-place.
Conceptualising ageing-in-place
Many theoretical perspectives frame ageing as an ongoing process co-constructed by older adults and their environment. Lawton and Simon (Reference Lawton and Simon1968) and Lawton (Reference Lawton1990) have proposed two classic environmental hypotheses: (a) the environmental docility hypothesis: when individuals grow old and their functions decline, they may feel pressured from the increasing environmental barriers and their declining ability to live independently would be negatively influenced; and (b) the environmental proactivity hypothesis: older adults may continue to strive to change their environment proactively to meet their needs and live independently, despite increasing functional limitations. Building on this foundation, scholars in gerontology have come to recognise the fundamental implications of person–environment (P-E) transactions (Wahl and Weisman, Reference Wahl and Weisman2003), leading to the development of models such as the congruence model of P-E fit, which places older adults' needs at the centre of environmental improvement to achieve their environmental satisfaction and psychological wellbeing (Kahana, Reference Kahana, Lawton, Windley and Byerts1982). These theoretical perspectives suggest that older adults' conceptualisations of ageing-in-place are intertwined with their personal and environmental characteristics as well as their experiences of the ageing process.
In recent decades, building upon previous theoretical developments in the P-E relationship, evidence has continued to show increasing proactivity in older adults' P-E transactions. Specifically, these studies have recognised the importance of older adults' conceptualisation of P-E fit and their changing agency to alter the environment by means of proactive and intentional behaviours (e.g. Kahana et al., Reference Kahana, Lovegreen, Kahana and Kahana2003; Wahl and Weisman, Reference Wahl and Weisman2003; Wahl et al., Reference Wahl, Iwarsson and Oswald2012). Integrating P-E transactions and older adults' proactivity, in this study we chose to employ the Preventive and Corrective Proactivity (PCP) model to understand Chinese rural older adults' conceptualisation of ageing-in-place within the evolving sociocultural changes in rural China. The PCP model emphasises older adults' potential to meet challenges posed by the ageing process through proactive adaptation (Kahana et al., Reference Kahana, Lovegreen, Kahana and Kahana2003). This model also posits that older adults conceptualise ageing-in-place in an evolving manner based on their changing personal needs and environmental conditions, and they use their agency to prepare proactively for the potentially increasing stresses in later years, using future-oriented thinking to continue to develop their resources and problem-solving strategies (Kahana et al., Reference Kahana, Kahana and Lee2014). Thus, drawing on the PCP model, this study examines rural Chinese older adults' conceptualisation of ageing-in-place, particularly how they use future-oriented motivations and exert efforts to prevent or reduce potential adversities imposed by the ageing process.
Methods
Study design
We employed a qualitative approach to understand the experiences and perceptions of ageing-in-place among older adults in rural China. As qualitative approaches posit that a phenomenon can best be understood as viewed by those who experience it (Patton, Reference Patton2002), our study gathered qualitative data directly from these older adults. This approach enabled us to explore how rural older adults define ageing-in-place and how they experience it.
Study setting
This study took place in a rural village in south-western Shandong Province on the east coast of China. Shandong has the largest rural ageing population in China. As of 2020, approximately 10.4 million older adults (i.e. 60 years old and over) lived in rural Shandong, accounting for 27.8 per cent of the total rural population in the province (National Bureau of Statistics of China, 2021b). This percentage is 4 per cent higher than the proportion of the rural population that is ageing nationally (i.e. 23.8%; National Bureau of Statistics of China, 2021b). During the time of our interview, 118 older adults (i.e. 60 years old and over) lived in the village, accounting for 27.7 per cent of the village's total population. In addition to farming, there was one cement factory and one textile factory in the area, which attracts older residents in the village to work part-time.
The village in this study is located about 40 kilometres to the east of Jining, one of the largest cities in Shandong Province. Jining is a railway hub for eastern China. By high-speed railway, it is 2 hours from Beijing (i.e. the national capital of China) and 3 hours from Shanghai (i.e. the largest metropolis in China). Jining is famous for being the birthplace of the renowned philosopher Confucius, and key tenets of his philosophy persist in the city's culture and municipal priorities – including ongoing eldercare efforts (e.g. the award of most filial villagers) and poverty relief initiatives (e.g. People's Confucianism Project) – with a particular emphasis on filial piety (Xing, Reference Xing2010). As such, filial piety not only acts as a powerful cultural force shaping parent–child relationships in the region (Chang and Kalmanson, Reference Chang, Kalmanson, Chang and Kalmanson2010), but also serves versatile functions in promoting social, cultural and economic development in Jining. Notably, there was no nursing home or official community-based eldercare service available in the village at the time of this study.
Recruitment and sampling
The study took place from December 2020 to March 2022. After receiving ethical approval from LC and WZ's university, WZ began the sampling procedure. She had one relative living in the village. Her relative provided background information about the village but did not participate in recruitment or interviews. WZ employed a snowball sampling strategy to recruit potentially eligible participants. The inclusion criteria were: (a) being age 60 years old or older, (b) living in the village, and (c) having no evident cognitive impairment.
As a trained graduate student, WZ held one information briefing session for those who were interested in the study to introduce the study purpose, answer their questions and address their concerns. She emphasised that participants' confidentiality and anonymity would be protected during and after the study. She also underscored participants' right and opportunity to refuse to answer any question or withdraw from the study with no consequences. After WZ conducted two rounds of recruitment in the village, a total of 30 older adults agreed to participate in the study.
Participants
Table 1 shows the participants' demographic characteristics. All participants were natives of the village and lived in their own homes. Half of them were female. Participants' average age was 73.9 years old, with ages ranging from 62 to 92 years old. Three participants had only one child (one had a daughter and two had a son). Most participants had two or more adult children, among whom five participants only had sons and the remainder had female and male children. Thirteen participants lived alone and the rest lived with their spouse. A majority of participants (87%) reported being able to take care of themselves, and the rest relied on care-giving from spouses and children. Ten participants had children living in Jining, 21 had children living in other major cities in Shandong (e.g. Jinan and Qingdao), 16 had children living in municipalities (e.g. Beijing and Shanghai) and major cities in other provinces on the east coast (e.g. Nanjing, Suzhou and Shenzhen), and two participants had children living abroad. About 40 per cent of participants still worked part-time, 37 per cent lived on their own savings, one participant received a pension and the rest relied on their adult children's financial support. All participants had lived most of their lives in the village. They all owned their own houses. Most of them continued to grow produce in their family's household plots, such as vegetables and grains. Approximately 80 per cent of participants had intermittent experiences of co-residence with their adult children, mainly due to illness, accidents and doctor visits, and all periods of co-residence lasted less than 3 months.
Table 1. Demographic characteristics of participants
Note: N = 30.
Data collection and analysis
WZ collected written informed consent from each participant before each interview. She conducted all the face-to-face, in-depth interviews at each participant's home. Each interview began with a general question about what the participant's typical day looked like. Informed by the PCP model, the interview guide then explored participants' experiences of ageing, including ageing in the village, their perceptions of ageing in the village, their adaptive strategies, their adult children's care-giving and their plans for future care. Finally, the interviewer inquired about participants' thoughts of their present and future living arrangements. WZ used the local dialect and Mandarin during the interview to ensure that all participants understood all interview questions. All interviews were audio-recorded with participants' permission. Each interview lasted for 30–60 minutes.
WZ transcribed each interview verbatim into Chinese immediately after the interview. LC and XM independently analysed each transcript. We open-coded all transcripts using line-by-line coding techniques detailed by Corbin and Strauss (Reference Corbin and Strauss2008). Codes were grouped together as categories when they described similar expressions, events and feelings pertaining to participants' perceptions of ageing-in-place (Corbin and Strauss, Reference Corbin and Strauss2008). To form themes, LC and XM extensively discussed these categories and their connections to participants' understanding and experience of ageing-in-place, self-reliance, autonomy, children's care-giving and the evolving meaning of filial piety (Guest et al., Reference Guest, MacQueen and Namey2011). Informed by the PCP model, we also paid attention to categories about participants' dynamic interactions with their environments as well as their agency to adapt to those environments in order to further elicit the theoretical interpretations of themes and data analysis in general. The whole research team then reviewed and extensively discussed each theme. We began interpreting themes only when the entire team reached consensus on the definition of each theme (Creswell and Poth, Reference Creswell and Poth2017). Because LC and XM are proficient in both Chinese and English, we translated all the themes and salient quotations into English for the purpose of writing up the results. EK provided peer scrutiny to strengthen the trustworthiness of the data analysis (Shenton, Reference Shenton2004). We kept all memos and discussion notes as an audit trail.
Findings
Living independently in the village was essential to participants' conceptualisation of ageing-in-place, preserving their self-reliance and autonomy, as well as sustaining their self-identity. Participants sought contentment in their independent living and adapted proactively to the forms of support offered by their children. As such, their conceptualisation of ageing-in-place evolved along with their capacity to live independently, and in a specific order: self-reliance first, children's care-giving second.
Living independently to protect autonomy
All participants affirmed that independent living was essential to their ageing-in-place and their desire to stay self-reliant and preserve their autonomy, and thus all of them proactively chose independent living. As the 88-year-old Mr Liu (all participants used pseudonyms), who lived alone, put it:
I prefer to live in my house in the village, taking charge of my own life. When you are capable of taking care of yourself, you earn the ability to choose and decide what you want.
One of the most mentioned reasons for living independently was to reduce disruptions to their own lives. For example, 80-year-old Mrs Qian, who had lived alone since her husband passed away 14 years ago, refused to live with her son because she did not want to change her routine. She said:
I live on my own terms, not others’. I like my routines: getting up around 6 am, breakfast, walk around for exercises, chat with neighbours, lunch, do some housework, dinner and go to bed around 9 pm.
Participants underscored that their ability to make decisions about their own life and living arrangements was essential to achieving ageing-in-place.
Choosing to live independently also helped participants avoid straining their relationships with their children. For example, 65-year-old Mr Zhao, who lived with his wife, said with relief:
[Living separately] would not require us to put up with my son and his family as we have our own living space and they have theirs.
Given their prior co-residence experiences, several participants reported that intergenerational disagreements or even conflicts were inevitable when living with their children. Mr Zhao continued:
As we [my wife and I] become old, we enjoy peace and quietness in the household. We don't understand our children's life.
Consequently, participants exercised their autonomy to choose the life they wanted given the resources available to them.
Even when they had lived with their children in cities for a period of time, participants insisted on maintaining autonomy and preferred to live independently in the village. For example, 75-year-old Mr Hu, who lived alone, recalled his experience of living at his son's residence in Jining:
I lived at my son's for a month after a small medical procedure. My son and daughter-in-law took good care of me and arranged everything for me. Yes, they are good, filial children, [but] I am used to my own pace of living and a place of my own. So I moved back as soon as I was recovered.
Given their strong sense of self-reliance, participants who temporarily lived with their children felt overwhelmed despite the fact that their children provided for them. As they were capable of exercising their autonomy, participants preferred to have control over their lives and routines, which motivated them to continue to live independently in the village.
The village as a source of belonging and identity
As their independent living was deeply embedded in the village, the village became an anchor of participants' vision of ageing-in-place. The village was not only a physical location that they would inhabit, but also a haven for sustaining their self-identity. Participants stayed closely connected in the village. For example, 73-year-old Mrs Chen, who lived alone and had not had co-residence experiences with her children in urban areas, relished living among her peers. Mrs Chen shared her own experience:
This spring I fell down the stairs at home. Upon hearing me calling for ‘Help! Help!’, my neighbour, also an old lady, who was 5 years older, hurried to check on me and ran to another neighbour to call the ambulance. Indeed, distant relatives are not as good as close neighbours.
A close-knit social network was critical for participants' independent living in the village. Meanwhile, although some participants had intermittent co-residence experiences with their children in cities, all of them positively appraised their decision to move back to the village and live independently. For example, 79-year-old Mr Zhou, who lived alone, compared the two living situations:
I didn't say much at my son's [in Beijing]. There's nothing to say, really. I only spent a month living there. [For older adults], it's crucial to know the place where your life belongs. So I insisted on moving back [to the village]. It feels right to be back.
Feeling out of place at their children's residences, participants missed the mutual support and connectedness they had in the village, and determined to move back. Participants sought to preserve the senses of security, familiarity and belonging that characterised their relationship with the village.
The deeply rooted sense of belonging to the village shared by all participants also came from farming and working. Twelve participants (40%) worked part-time in the village, mostly in various forms of craftsmanship and seasonal jobs in the factories, and about two-thirds of participants still farmed and produced their own food. Most participants grew vegetables and grains in their own household plots. Several continued to fish when the weather permitted. For participants, the land and the village were not simply a means of and space for living, but key to sustaining their self-identity and achieving self-value. As such, working and farming continued to be an integral part of their independent life in the village.
Compared with their urban counterparts, older adults in rural China typically do not have a mandatory retirement age or financially rely on a pension (Wang, Reference Wang2006). Our rural participants viewed themselves as very capable of ‘working until old age [huo dao lao gan dao lao 活到老干到老]’. In fact, all participants reported their current life was much less physically challenging and more leisurely than their youth, which made it possible for them continue to work and farm. Gaining produce from the land and their own labour indicated their persistent effort to be a productive member in the community. For example, 83-year-old, Mr Feng, who had lived with his wife in the village for his entire life, said:
Compared with [when I was young], we now have sufficient food supply, all kinds of vegetables and meat. So I'm still fairly healthy, considering this advanced age [83 years old]. I won't leave the land until my body says the opposite.
Participants' commitment to work provided a means of avoiding overdependence on their adult children and the shame they anticipated they would feel from becoming a burden. For example, 73-year-old Mrs Sun, who lived alone, stressed, ‘If I don't work, it feels that I am totally dependent on my children. It doesn't feel right.’ Like Mrs Sun, most participants preserved their self-value through continual farming and working, which formed the cornerstone of their independent living. Thus, participants' conceptualisation of ageing-in-place was grounded not only in the village as a physical environment, but as an interplay between the physical and social environment, encompassing senses of belonging and self-value that sustained their self-identity.
Seeking contentment and adapting accordingly
When describing their feelings of living independently in the village, all participants emphasised the word ‘contentment [zhi zu 知足]’. All participants expressed their satisfaction with and gratitude for the significant economic improvement in the village, and they believed that living independently in the village was optimal for their current circumstances. They particularly appreciated that the village had sufficient material and financial resources to enable them to live independently. For example, 77-year-old Mrs Tian, who lived alone, remarked:
I still have the land whose harvests are enough for an entire year. I have my house. This, for us [rural farmers], should be contentment. The current life has already been very much blessed. So I declined to move to my son's place in Jining.
With their well-supported life, participants chose to pursue what was realistic and suitable for them: living independently in the village. Some participants also found contentment in their independent living by comparing it to their co-residence experiences with their adult children in urban areas. For example, 71-year-old Mrs Bai, who lived with her husband, commented on their one-month stay at their eldest son's residence in Beijing:
Everything is of course very convenient and luxurious in the national capital. However, it was always congested and crowded. It was too easy to get lost and disoriented. We [my husband and I] were unable to go out by ourselves. Relying on my son for everything is not doable. We'd better be independent when we are still able.
Navigating life in cities, metropolises in particular, was challenging for participants. Although participants praised their children's filial gestures of inviting them to co-reside, they still preferred living in the village.
While they insisted on independent living, participants also acknowledged that practices of filial piety were evolving in and beyond their village. Participants accepted the fact that their children who had left the village would not be able to take care of them in accordance with traditional notions of filial piety, and they found contentment in their children's evolving practices of filial piety (e.g. regular visits and calls) and valued every opportunity of being with their children when they returned to the village. For instance, participants with children who lived in Jining reported receiving frequent visits over weekends and holidays and their appreciation of these visits. For participants whose children had migrated beyond the Shandong Province, they enjoyed children's regular phone or video calls and visits during long holidays (e.g. national day and Lunar New Year). For example, Mrs Bai appreciated her sons' in-person company during the holidays:
We keep in regular and close contact with our sons. Since our unsuccessful stay in Beijing at my eldest son's, they [both sons and their families] have spent every Lunar New Year with us in the village, which is very considerate of them.
Thus, participants found contentment in recognising non-traditional forms of closeness with their children – necessitated by the realities of urbanising China – as evolving practices of filial piety.
At the same time, participants subscribed to traditional aspects of filial piety, asserting that it would be natural for their children to provide care-giving for them when they could not sustain their independent living. Approximately 80 per cent of participants had already had intermittent co-residence experiences due to illness or accidents, and viewed it as inevitable that they would eventually require their children's care-giving. For example, 77-year-old Mrs Shen, who lived alone, said:
It [children's care-giving] has been essential since I was diagnosed with diabetes and hypertension. I live at my son's in Jinan [i.e. the provincial capital of Shandong] every once in a while for check-ups at big hospitals.
Children's care-giving had consistently remained crucial to participants' conceptualisation of ageing-in-place, particularly given their awareness that they faced further health issues. As such, participants accepted their children's evolving practices of filial piety while they were still capable of living independently in the village, and expected children's care-giving in the face of future health declines.
Conceptualising ageing-in-place: ‘self-reliance first, children's care-giving second’
Given their current independent living in the village and evolving notions of filial piety, all participants conceptualised ageing-in-place as occurring in two phases: ‘Self-reliance first, children's care-giving second’, as the 88-year-old Mr Liu concisely put it. In the first phase, participants steadfastly believed in independent living. When asked how they felt about their life, all participants rejected the common expression of eldercare, ‘yang lao [养老; i.e. provided-for older adults]’, which, in Chinese, literally means older adults should be taken care of by their spouse, adult children or relatives. For example, Mrs Li, who was 62 years old and lived alone, said, ‘I'm still young and don't need to be taken care of.’ Most participants, even participants in their eighties, similarly expressed a strong willingness to stay self-reliant for as long as possible. These oldest participants (i.e. 80 years old and over) believed their capability of self-reliance related to how much longer they would live. For example, 92-year-old Mrs Hu insisted:
As long as I can cook for myself, I will live on my own. If I cannot continue [to cook for myself], I think it's time to move to my son's place and wait for [death] coming.
In fact, all participants shared Mrs Hu's opinion that losing the capability of self-reliance was an ominous sign of the end of life that would prompt them to seek their children's help.
Because participants were all in phase one (i.e. independent living) during the time of the interviews, they could only describe the anticipated prospect of receiving their children's care-giving after their self-reliance declined: the second phase of ageing-in-place that would involve their children's care-giving. Specifically, of the 27 participants who had more than one child (three participants had one child), 13 reported that they would live with a son, in particular their eldest son, for care-giving. This decision may have derived from a Confucian notion of filial piety, which emphasises that sons represent the family lineage and are parents' designated care-givers. As 73-old-year Mrs Chen put it, ‘Being taken care of by the eldest son is the natural way to obey filial piety for Chinese families.’ These participants both modified and subscribed to the traditional concept of filial piety by framing their children's care-giving as a secondary rather than primary stage of ageing-in-place, but nonetheless expecting this care-giving when it became necessary.
Another 14 participants thought both sons and daughters should take turns providing care-giving, regardless of where children resided. For example, Mr Liu felt it would be too much care burden to only depend on his eldest son, saying:
Children should come back [to the village] and live with us or we move in with them, doesn't matter, but more importantly, [children] should take turns. My three children should all contribute.
Like Mr Liu, these 14 participants' belief that care-giving responsibilities should be shouldered by all adult children also highlights their flexible and evolving understandings of how their children should practice filial piety. This flexibility is what enabled all participants to perceive their ageing-in-place as a progression, in which self-reliance and independent living were consistently prioritised over receiving care from children for as long as possible.
Discussion
This study took a qualitative approach to exploring 30 older adults' conceptualisation and experience of ageing-in-place in a village in Shandong Province, China. Participants chose to live independently in the village for as long as possible to protect their self-reliance and autonomy. The village offered both a physical and social environment that allowed participants to sustain their self-identity. While consistently prioritising their self-reliance and autonomy, participants also anticipated that should their capabilities decline, they would expect to live with and receive care-giving from their children. As such, participants tended to view ageing-in-place as consisting of two consecutive phases: a first phase when participants were self-reliant and lived independently; and a second phase during which they were cared for by their children when their capabilities declined to the point that independent living was no longer possible.
Dynamic meanings of ageing-in-place in rural China
As long as they were capable of taking care of themselves, participants chose to live independently in their village – what they considered to be the first phase of ageing-in-place. Self-reliance was the cornerstone of participants' conceptualisation of ageing-in-place. This finding aligns with findings of previous studies from rural Britain and Australia suggesting that older adults made sense of their ageing processes with limited resources by maintaining self-reliance (Winterton and Warburton, Reference Winterton and Warburton2011; Milbourne and Doheny, Reference Milbourne and Doheny2012). Our participants' prioritisation of self-reliance, however, was different from that of older adults living in rural areas in migrant-exporting provinces in China (i.e. provinces where children are most likely to seek opportunity in urban areas), who preferred co-residence with their adult children (Luo and Zhan, Reference Luo and Zhan2012). This may be because about two-thirds of our participants had children who lived in Shandong Province, meaning that they lived within a relatively close proximity to participants. The difference between our findings and those of Luo and Zhan's (Reference Luo and Zhan2012) study may also indicate that Chinese rural older adults' expectations for care-giving arrangements based on filial piety have evolved in the past decade. Yet participants also recognised that their self-reliance was inherently valuable. Staying self-reliant and living in their own homes further buffered participants' autonomy and their ability to make decisions for themselves. Being able to maintain self-determination and make choices about their own lives, such as maintaining a preferred life routine and continuing to work, helped participants foster a sense of control and their confidence in their ability to age in place (Duay and Bryan, Reference Duay and Bryan2006; Coleman and Wiles, Reference Coleman and Wiles2020).
As they had lived in their own homes in the village for their entire life, to some extent participants believed the first phase of ageing-in-place was equivalent to ‘ageing-in-village’, highlighting the importance of the locality and living space for them. This pattern corroborates other findings that rural older adults tend to be geographically bound and emotionally attached to their villages (Milbourne and Doheny, Reference Milbourne and Doheny2012; Walker et al., Reference Walker, Orpin, Baynes, Stratford, Boyer, Mahjouri, Patterson, Robinson and Carty2013). Indeed, studies suggest that older adults' social spaces tend to be constricted, relying on geographically proximate social ties (Gilleard et al., Reference Gilleard, Hyde and Higgs2007; Scharlach, Reference Scharlach2017). Peer support in the village was a crucial means by which participants coped with age-related declines (Milbourne and Doheny, Reference Milbourne and Doheny2012). Ageing-in-village further preserved their self-value by allowing them continual working opportunities, in particular, farming. This is consistent with existing findings that working constitutes lifetime commitment for rural older adults, and forms a foundation of their self-identity (Rogers et al., Reference Rogers, Barr, O'Callaghan, Brumby and Warburton2013). The village – as a familiar space, a cornerstone of their identity and an established social network – remained a key care-giving resource for participants that they believed would facilitate their ageing-in-place (Wahl et al., Reference Wahl, Iwarsson and Oswald2012).
Notably, our participants expected that the location where they would age-in-place would change (i.e. from their own homes to their children's homes, as opposed to nursing homes). This perception counters previous findings that older adults typically understand the ‘place’ in ageing-in-place as a fixed location (Gilleard et al., Reference Gilleard, Hyde and Higgs2007). Rather, our findings highlight how the social, psychological and emotional aspects of ‘place’ can influence older adults' views of the desirability of different sites for their ageing-in-place (Wiles et al., Reference Wiles, Leibing, Guberman, Reeve and Allen2012; Scharlach, Reference Scharlach2017).
Facing age-related declines, participants considered it inevitable that they would need to seek children's care-giving when they could no longer support themselves: the second phase of ageing-in-place. They recognised the physical and cognitive constraints posed by increasing age while accepting the ageing process as natural and seeking to achieve what was possible within their capacities, an attitude shared by rural Australian older adults (Walker et al., Reference Walker, Orpin, Baynes, Stratford, Boyer, Mahjouri, Patterson, Robinson and Carty2013). This two-phase understanding of ageing-in-place suggests that our participants, like their Chinese urban counterparts, realistically appraised both the opportunities for and constraints on autonomy presented by advanced age (Chen et al., Reference Chen, Ye and Kahana2020), and proactively chose the most suitable arrangement for their current capabilities.
Participants' children's evolving practice of filial piety may also have critically influenced participants' conceptualisation of ageing-in-place. Participants understood that recent sociocultural changes in China had changed the ways that their children could provide care-giving and adapted accordingly (Luo and Zhan, Reference Luo and Zhan2012; Guo et al., Reference Guo, Gao, Sun and Feng2020). They delayed their children's fulfilment of filial responsibilities (i.e. care-giving for and sharing their home with them) and expected both sons and daughters to contribute to their care when necessary. These findings suggest that older adults adapted their expectations regarding filial piety to the present sociodemographic realities of rural China, such as young generations' mass migration to urban areas (Luo and Zhan, Reference Luo and Zhan2012; Mai, Reference Mai2015). Nonetheless, despite their recognition of this reality and their informal support network in the village, participants prioritised their children's care-giving as the most reliable choice when they could not live independently, emphasising that core tenets of the filial piety tradition may still be intact among older adults in rural China (He et al., Reference He, van Heugten, Perez-Y-Perez and Zheng2021). Participants' preference for their children's care-giving when independent living was no longer available may also relate to the limited formal support resources available in rural China (Shi, Reference Shi2009), indicating that culture and infrastructure may both be reinforcing older adults' plans regarding ageing-in-place. Thus, participants' conceptualisation of ageing-in-place was not a fixed but a flexible and dynamic concept that evolved in relation to their ageing process, living environments and understandings of filial piety. They were open to – indeed, they planned for – changes in care-giving arrangements from living independently to receiving their children's care-giving.
Participants' conceptualisation of ageing-in-place aligns with key tenets of the PCP model. Participants were motivated to seek contentment by balancing their capabilities, physical and social environment, and care-giving arrangements. The process of planning their ageing-in-place thus underscored their ability to exercise their agency to make choices about their lives, concurrently and prospectively (Duay and Bryan, Reference Duay and Bryan2006; Kahana et al., Reference Kahana, Kelley-Moore and Kahana2012). Planning ahead, participants viewed their children's care-giving as a means of mitigating ageing-related insecurities in the future (e.g. functional declines). This future-directed orientation was the foundation of participants' preventive proactivity (Kahana et al., Reference Kahana, Kahana and Lee2014). Thus, participants' planned sequence of ageing-in-place – a self-reliant, independent living and then co-habitation with and care-giving from their children – reflected their proactive decision-making regarding care-giving arrangements directed by their own living capacities and agency (Kahana et al., Reference Kahana, Kelley-Moore and Kahana2012).
Policy and practice implications
The findings of this study provide valuable insights for developing policies and practices that better support older adults in rural China as they age in place. As urbanisation in China continues to intensify and draw young adults from rural to urban settings, the number of left-behind rural-dwelling older parents will likely continue to grow. More policy efforts should aim to improve welfare infrastructure for these rural older adults to facilitate their ageing-in-place. In particular, policy makers need to prioritise enhancements to rural older adults' health-care services, including providing care policies and benefits with long-term coverage (e.g. long-term care insurance plans). As rural older adults consider their adult children as their primary alternative care-givers, policies that expand the amount of and eligibility for family leave can help adult children take care of their older parents when needed. Because being able to work is fundamental to rural older adults' ability to realise their values and sustain their identity, employment policies also should increase opportunities for older adults to continue working.
In terms of practice, community-based long-term care options for older adults should receive extensive development in rural China to better facilitate their ageing-in-place. For instance, gerontology professionals can collaborate with local services to develop community- and family-based programmes to improve older adults' social participation. Meanwhile, as the notion of filial piety is changing significantly in rural China (Silverstein et al., Reference Silverstein, Cong and Li2006), more long-term care options should be introduced to provide other care-giving options for older adults who may not be able to turn to children for care.
Study limitations
This study's findings should be interpreted in light of several limitations. First, this study's findings may be subject to selection bias due to its snowball sampling strategy. The fact that all of our participants had strong autonomy, agency to adapt to ageing and functional capability at the time of the interviews may have influenced their willingness to participate and share their thoughts, meaning that our findings may not be representative of all older adults in the village. Also, we did not interview older adults who had previously aged in place in the village and were now living with their children. These older adults would likely have had different perceptions of ageing-in-place given the transition they experienced. Second, all study participants came from only one village in Shandong Province, which may limit the generalisability of our findings. Indeed, older adults living in other parts of rural China may have different definitions and experiences of ageing-in-place. Older adults' experiences of ageing could be as diverse as the many distinct rural contexts in China. Third, this study is cross-sectional, as we were only able to capture how participants conceptualised ageing-in-place during the time of interview. Notably, the second phase of participants' ageing-in-place had not yet occurred. Thus, how their ageing-in-place evolved over the ageing process was not explored. Future longitudinal investigations are thus warranted to trace older adults' evolving conceptualisations and experiences of ageing-in-place in rural China.
Conclusion
This study explored how older adults in rural China conceptualised ageing-in-place. Their definition of ageing-in-place consisted of two phases: self-reliance first and children's care-giving second. Self-reliance was the foundation of their ageing-in-place and their village offered physical and social environments that sustained their senses of belonging and self-value that bolstered their identity. Were their health to decline, participants anticipated turning to their children for care-giving as a ‘second phase’ of ageing-in-place. These findings highlight sociocultural nuances in rural China that can allow researchers and policy makers to better understand ageing-in-place from these older adults' perspectives. This study advances the existing literature on rural gerontology by illuminating how rural older adults in China conceptualised ageing-in-place, further emphasising the diverse views of ageing experiences among older adults in rural communities. As such, our findings can inform the development of policies and practices that better support ageing-in-place for older adults in rural China.
Acknowledgements
We thank all the older adults for sharing their stories with us.
Author contributions
LC planned the study, analysed data and wrote the paper. XM analysed the data and revised the manuscript. EK revised the manuscript. WZ collected data and transcribed data.
Financial support
This work was supported by 2023 Shanghai Planning Office of Philosophy and Social Science (number 2023BSH004); and the Youth Fund, The National Social Science Fund of China (number 22CSH004).
Competing interests
The authors declare no competing interests with respect to the research, authorship and/or publication of this article.
Ethical standards
This study was approved by the research ethics committee of Fudan University (approval number 2020PJC024).
