Informal care gaps, associated factors and support pathways among older adults with chronic diseases: a cross-sectional survey in China

With population aging in China, informal care from family, relatives, and friends is the cornerstone of long-term care for older adults with chronic diseases, yet how far their needs are actually met remains understudied. Guided by the Andersen Behavioral Model, we examined the prevalence of informal care gaps and their predisposing, enabling, and need factors, and explored support pathways. A cross-sectional convenience-sample survey was conducted from March to June 2026 among residents aged 60 years and above with physician-diagnosed chronic diseases in urban and rural Wenzhou, Zhejiang Province. The questionnaire covered individual and family characteristics, activities of daily living (ADL; 14 items), depressive symptoms (PHQ-9), current informal care receipt, and need fulfillment in seven care dimensions. An informal care gap was any dimension rated “needed but only partially met” or “needed but completely unmet.” Chi-square tests and hierarchical logistic regression (Andersen Model) were used. Among 795 valid responses, 56.86% (452/795; 95% CI: 53.4–60.3) had at least one informal care gap, and 13.58% of the total sample had gaps in three or more dimensions. As a share of the total sample, gaps were most common in daily living assistance (20.50%) and emotional support (18.49%); among those reporting a need in a dimension, the unmet share was highest for daily living assistance (43.12%, 163/378) and lowest for emotional support (30.88%, 147/476). Only 49.94% were receiving informal care, and 73.87% (294/398) of those not receiving care had at least one gap. In the final model, greater geographic distance of the nearest caregiving child (OR = 1.23, 95% CI: 1.09–1.38) and more severe ADL impairment (OR = 1.83, 95% CI: 1.38–2.43) were independently associated with higher odds of gaps; explanatory power was modest (Nagelkerke R² = 0.089). Informal care gaps were common in this Wenzhou convenience sample and were associated with the distance of the nearest caregiving child and with functional impairment. These cross-sectional findings suggest that caregiver training and respite, community-based formal care, and wider long-term care insurance awareness merit testing as support pathways; they derive from Wenzhou’s context and require validation elsewhere in China.