Population aging has presented an unprecedented challenge, with the proportion of individuals aged 65 years or above in the global population forecasted to grow from 10 % in 2022 to 16 % in 2050.1 The prevalence of physical, sensory, and cognitive impairments is on the rise among older populations,2 imposing considerable burdens on health and long-term care systems in many nations worldwide.3 As older individuals may face an array of health problems, they may receive treatment from diverse caregivers and take numerous prescribed pills, particularly in countries where healthcare providers are readily accessible.4 These individuals are at risk of being affected by breakdowns in the healthcare system, which can lead to fragmented and inadequately coordinated care provision, as well as costly and harmful medical errors.5 In this context, many high-income countries have implemented a person-centered strategy that focuses on self-management and aging in place (i.e. community-based care) to provide older people with integrated healthcare services that meet their specific needs.4,6 The key aspects of services for older people include primary care, specialty care, behavioral health services, chronic disease management, wellness and preventive services, care coordination, home health, and community-based services, as well as palliative care and hospice services.

In China, formal long-term care services for older adults have emerged and are rapidly expanding as demographic and socio-economic changes erode traditional home-based care.7 In response to the evolving needs of older adults, the Chinese government has piloted the Yi-yang-jie-he (Medical and Nursing Care Integrated Institution, MNCII) and prioritized it as a new component of the long-term care policy agenda since 2013.8 After nearly a decade of development, MNCII in China has taken four main forms: hospital care within nursing homes, nursing care within hospitals, contract cooperation between hospitals and nursing homes, and community-based adult services (CBAS) that integrate medical care.9 Since 2016, these patterns have been piloted in 90 cities driven by government promotion and support, replacing conventional forms of care in a more cost-effective, sustainable, and high-quality way.10,11

One of the primary objectives of promoting MNCII in China is to enhance the health-related quality of life (HRQol) for the old population. HRQoL can be defined as "the state of a person's functioning in life and his well-being in the domains of physical, mental, and social health".12 In this study, the European Quality of Life 5-Dimension Scale (EQ-5D) was used to measure the HRQoL of the oldest-old adults in China. Given the relative isolation of long-term care facilities,13,14 it is challenging to reach older adults within these facilities. As a result, while there is a large body of research on HRQoL in later life, there is little research specifically focused on older adults residing in long-term care facilities.14,15

Existing study reveals that older adults living in MNCII are a frail and vulnerable group,16 with older age and higher levels of disability. As they age, older people tend to have more complex health problems, characterized by multiple comorbidities and chronic conditions.4 In addition to their medical and health needs, older people often have needs for nutrition, safety, and social contact.17 Unmet care needs among older adults can result in the underutilization or misapplication of treatments, as well as the provision of inadequate or inappropriate long-term care services.18,19

Various studies have demonstrated the importance of assessing the comprehensive care needs of older adults.9 In this study, we used the Camberwell Assessment of Need for the Elderly (CANE) to measure the unmet care needs of older adults in MNCII. CANE provides a structured and standardized methodology for assessing the care needs of older adults, especially those in nursing homes, hospitals, or community settings.20 The World Health Organization (WHO) published the Integrated Caring for Older People (ICOPE) guidelines in 2017, which state that the care needs of older people should be well understood before offering integrated care services.21 Therefore, improving long-term care services around the care needs of older persons to enhance their quality of life has become an urgent public health priority.

Research on the HRQoL of older people in MNCII is essential in the context of population aging and expanding long-term care needs. However, current studies still present several gaps. Firstly, existing literature on unmet care needs in China primarily focuses on specific diseases or care barriers among particular populations, and often targets only one aspect of unmet healthcare demand.22,23 In this study, we utilized the CANE to capture older adults’ self-perceived unmet care needs within MNCII, encompassing multiple domains including environmental, physical, psychological, and social needs. Such a general and subjective perspective on unmet needs is particularly valuable for informing the sustainable development of MNCII services. Secondly, while previous research on MNCII in China has focused on the connotations of the model, existing systemic challenges, and implementation pathways,24,25 little attention has been paid to the actual service delivery and its impact on HRQoL. This assessment could not only highlight potential interventions targeting the prevention or alleviation of unmet needs, but also enable policymakers to allocate resources efficiently.26 Consequently, this study aimed to address this gap by employing the EQ-5D to assess HRQoL in Chinese older people, examining the potential association between unmet care needs and HRQoL among older adults in MNCII.