Intrinsic capacity decline and multilevel intervention needs of disabled older adults in nursing homes: a qualitative study based on the social-ecological systems theory

Abstract

Intrinsic capacity (IC) is a central pillar of healthy ageing. Diminished IC is closely associated with poorer health outcomes and a greater degree of care dependence among disabled older adults. This study used the social-ecological framework to examine lived experiences and intervention needs related to a decline in intrinsic capacity among disabled older adults in Chinese nursing homes, so as to inform personalized interventions and policy improvement. A descriptive qualitative study (single-site design, n = 16) adhering to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines was conducted. Using purposive sampling with attention to variation in age, sex, education, disability level, and length of stay, sixteen older adults with mild-to-moderate disability were recruited from one public nursing home between November and December 2025, with the sample size determined by data saturation. We conducted semi-structured in-depth interviews. A directed content analysis (hybrid deductive-inductive approach) was performed using NVivo 12.0: the micro/meso/macro levels of the social-ecological systems theory served as the a priori analytical framework, within which coding, categorization, and thematic development were conducted based on the interview data. The three overarching themes were theory-driven, whereas the sub-themes and specific intervention needs were inductively derived from participants’ narratives. Three core themes and nine sub-themes were identified: (1) Micro-level: limited awareness of intrinsic capacity and insufficient health empowerment; (2) Meso-level: multifaceted environmental barriers to health-promoting behaviors; (3) Macro-level: system-level support gaps and multidimensional intervention needs. The experiences of decline in intrinsic capacity and associated intervention needs among disabled older adults in nursing homes appear to exhibit distinct hierarchical characteristics consistent with the social-ecological systems theory within this single-center context. Key challenges include inadequate cognitive awareness of intrinsic capacity, low health empowerment, constrained health-promoting behaviors, and a lack of systematic support systems. These findings provide context-specific insights that may inform practice and policy development for nursing homes with predominantly oldest-old populations in rapidly aging regions and offer a theory-informed empirical basis for developing multilevel interventions. Further multi-site research is needed to confirm transferability.