Algorithmic and Affective Interventions in Elderly Household Health Decision-Making: A Socio-Technical Analysis of the Informal Healthcare Subsystem Evolution

As digital innovations rapidly penetrate aging populations, live-streaming e-commerce acts as a profound external disruption to the informal healthcare subsystem, fundamentally reshaping Health Shared Decision-Making in Elderly Households (HSDM-EH). This study investigates how the nested interplay of affective strategies and algorithmic mechanisms reconfigures this traditional socio-technical balance. Employing a directed content analysis, we conducted methodological triangulation with two complementary data sources: in-depth interviews and behavioral observations from a maximum-variation sample of 40 Chinese families. Our findings reveal a three-stage structural evolution: the de-bounding of the informal healthcare subsystem through the decentering of institutional and familial authority; the synergistic control of affect and algorithms that scales deprofessionalized trust; and the subsequent escalation of systemic friction, marking a failure of organizational resilience. Ultimately, we propose a Socio-Technical Nested Agency Model, demonstrating that algorithmic interventions effect a soft transfer of health authority away from familial oversight to commercial platforms. This socio-technical reconfiguration generates unintended policy feedback that undermines grassroots health initiatives, highlighting the urgent need for cross-sectoral regulatory frameworks to mitigate algorithmic risks and enhance the digital health inclusivity of aging populations.