Dynamic trends of family-based eldercare vulnerability among older adults in agro-pastoral areas of Xinjiang, China: a longitudinal study

Background: Population ageing in the context of China’s economic transition exposes older adults to accumulating health risks, shrinking family structures, inadequate economic security and weakening social-support networks. These challenges are further magnified in agro-pastoral regions, where harsh geographical settings, underdeveloped social-security systems, and shortages of both pension and medical services render family-based eldercare increasingly fragile and complex, thereby constraining healthy ageing and sustainable regional development. We therefore examined the dynamic characteristics of family-based eldercare vulnerability among rural older adults in Xinjiang’s agro-pastoral areas and identified its key obstructive factors, aiming to provide an evidence base for targeted policy making in underdeveloped pastoral-agricultural regions. Methods: Using a multistage stratified random sampling design, we recruited 1 400 rural residents aged ≥ 60 years across agro-pastoral counties of Xinjiang, China. Baseline data were collected in 2019, with follow-up waves conducted every two years in 2021 and 2023. Family-based eldercare vulnerability was quantified with an entropy-weighted TOPSIS model. Latent class growth model was employed to delineate distinct trajectories of vulnerability over time, while an obstacle-degree model was applied to identify the principal determinants impeding effective support. Results: The family-based eldercare vulnerability index exhibited an overall increasing trend among the study population. Based on vulnerability trajectories, three distinct subgroups were identified: (1)High-level ascending group (14.09%) – Key barriers: major illness, hospitalization due to illness, depression, widowhood, body mass index, and indebtedness. (2)Medium-level gradual increase group (45.95%) – Key barriers: hospitalization due to illness, grandchild-care, body mass index, unemployment, and lack of daily life care.(3)Low-level stable group (39.97%). Conclusion： Family-based eldercare vulnerability among rural older adults in Xinjiang’s agro-pastoral regions intensified continuously over the study period, and distinct latent trajectory subgroups emerged. Older adults in the medium-level gradual increase group exhibited suboptimal health status and a tenuous family-support network, whereas those in the high-level ascending groupconfronted severe health deterioration and substantial economic strain. Despite shared barriers, subgroup-specific obstacles were also evident, underscoring the need for precisely targeted interventions to strengthen eldercare services. For the Medium-level gradual increase group, priority should be given to promoting health-protective behaviours through tailored health-literacy initiatives, alleviating family caregiving burden, and systematically rebuilding social-support networks. For households in the high-level ascending group, policy efforts should focus on comprehensive medical-security coverage, psychological-crisis interventions, and targeted economic assistance to resolve the family-care predicament.