Caught in cultural lag: exploring health anxiety of China’s first-generation modern older adults

Health anxiety among older adults has attracted growing attention globally as the ageing population increases. In previous studies, health anxiety has largely been understood as a biomedical and psychological concern. This study conceptualizes health anxiety as a culturally mediated experience, embedded in socially shared ideals of what it means to age “well,” remain valuable, and feel morally adequate in later life.

From September 2022 to December 2023, the authors conducted life story interviews with 28 first-generation modern older adults in China who were socialized under collectivist moral frameworks yet have aged amid rapid modernization. These findings suggest a process in which participants initially seek to align themselves with dominant ideals of progress, autonomy, and successful ageing, but subsequently come to experience health anxiety when encountering bodily uncertainty, fragmented care arrangements, and weakening intergenerational and community support. Through this socialized shift, these external constraints and vulnerabilities are interpreted through moral expectations and internalized as personal inadequacies.

By foregrounding these cultural dynamics, the study challenges individualistic accounts of health anxiety and demonstrates how contemporary norms and policy discourses of ageing escalate emotional distress in later life. We thank all the older adults who participated in the interviews and three community schools for their support. We also thank the reviewers of the First Beijing Normal University Forum on Sociology of Health and the Eighth World Conference on Qualitative Research, for providing opportunities to present and discuss earlier versions of this paper.

We are grateful to the Academic Writing Group at the Jing Hengyi School of Education, Hangzhou Normal University, for their helpful comments and suggestions. This article was supported by the China Scholarship Council (CSC) under Grant No. 202508330329. Jing Hengyi School of Education, Chinese Education Modernization Research Institute, Hangzhou Normal University, Hangzhou, China AGORA for the Study of Social Justice and Equality in Education, University of Helsinki, Helsinki, Finland School of Education and psychology, Shaoxing University, Shaoxing, China University of California, Berkeley, Berkeley, CA, USA University of California, San Francisco, San Francisco, CA, USA The authors declare no competing interests.

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by East China Normal University Committee on Human Research Protection (protocol code HR 288-2022) at 5th May, 2022. All participants provided informed consent prior to their participation in this study. They were fully informed about the purpose of the research, their rights, and the use of their data.

Written consent was obtained for any images included in this manuscript. All personal and identifying information has been anonymized to protect participants’ privacy, ensuring that no individual can be identified from the data presented. Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.