Identifying core community care demands and influencing factors among pre-frail and frail older adults in China: a cross-sectional network analysis

BACKGROUND: With population aging accelerating in China, frail older adults living in the community face complex care demands. However, limited research has focused on identifying the core demands and its influencing factors in this population. This study aimed to (1) construct the network structure of community care services needs and identify the core demands among frail older adults; (2) compare the network structures of community care needs and core demands between pre-frail and frail groups; and (3) explore the key factors influencing the core demands based on Andersen’s Behavioral Model. METHODS: A cross-sectional survey was conducted among 340 pre-frail and frail community-dwelling older adults in Zhejiang province, China. Data were collected through face-to-face interviews using structured electronic questionnaires, covering sociodemographic characteristics, health status, and 20 items on community care service needs. Network analysis was used to identify core demands, compare subgroups, and examine influencing factors using R (v4.4.0) with the EBICglasso method and the “bootnet”, “qgraph”, and “NetworkComparisonTest” packages. RESULTS: “Regular mental comfort by volunteers or social workers” played a central role in the community care needs among pre-frail older adults, whereas “Household management services” played a central role in the community care needs among frail older adults. “Marital Status” and “Living arrangement” emerged as the most influential determinants of core needs in both subgroups. However, the stability of the determinant network was relatively low among frail older adults, therefore findings should be interpreted cautiously. CONCLUSIONS: Household management was the core demand among frail older adults, emphasizing the need for daily life support. In contrast, the core demand for pre-frail adults was emotional comfort, suggesting the value of early psychosocial care. These findings highlight the need for community care to differentiate service priorities according to frailty stages. Interventions should be tailored to marital status and living arrangement to ensure that community care align with individual contexts.