Promoting endogenous mutual-aid older adults care in rural areas for healthy aging: an evolutionary game-based analytical framework

Introduction: Against the backdrop of rapid population aging and widening health vulnerabilities among older adults in rural China, the erosion of traditional family-based care has posed significant challenges to achieving healthy aging and equitable older adults care. Promoting an endogenous mutual-aid older adults care model has therefore become a critical issue in public health and governance. Methods: This paper utilizes an evolutionary game model to analyze dynamic interactions among local governments, social organizations, and the rural older adults. Results: MATLAB simulations identify four critical drivers: willingness to participate, reward intensity, punishment severity, and reputation loss. Results reveal a paradox where high willingness from social actors accelerates local governments' tendency toward negative support. This paradox arises because the proactive engagement of social organizations and older adults may alleviate perceived pressure on local governments, thereby diminishing their motivation to provide active support. However, stricter penalties imposed by higher-level governments consistently promote positive choices across all parties. Furthermore, while reputation risks motivate government support, they may simultaneously deter older adults participation. Discussion: This study proposes strategic recommendations: implementing stricter penalties for government non-compliance, optimizing incentives for social organizations, and offering targeted guidance to the rural older adults to foster their active engagement in mutual care activities. These measures aim to facilitate the sustainable development of an effective rural mutual aid care ecosystem.