Against the dual strategic background of healthy aging and high-quality development of the Yellow River Basin, care for the elderly with chronic diseases has become a key field of regional people’s livelihood services. At present, the services for elderly chronic diseases in the Shandong section of the Yellow River are plagued by the separation of medical treatment, pension, and nursing, uneven resource allocation, and insufficient collaboration among stakeholders. The traditional single-service model can hardly meet the long-term care demands of the elderly with advanced age and chronic diseases. Supported by holistic governance, collaborative governance, and integrated nursing theories, this paper sorts out the current situation and practical dilemmas of medical-nursing-pension services for the elderly with chronic diseases in the Shandong section of the Yellow River and analyzes the underlying causes through field surveys, questionnaires, interviews, and case studies. An integrated service system is constructed from four dimensions: service subjects, service contents, service procedures, and supporting carriers, with differentiated implementation paths and a four-dimensional long-term guarantee mechanism designed. The research results can provide practical references for cities along the Yellow River to optimize elderly health services and advance the in-depth integration of medical, nursing, and pension services, and help implement the Healthy China strategy as well as the upgrading of regional elderly care services.
The Central Committee of the Communist Party of China and the State Council, 2019, Outline of the Healthy China 2030 Plan. China Oncology, 28(10): 724.
The Central Committee of the Communist Party of China and the State Council, 2021, The Central Committee of the Communist Party of China and the State Council Issued the Outline of the Plan for Ecological Protection and High-quality Development of the Yellow River Basin. Gazette of the State Council of the People’s Republic of China, 2021(30): 15–35.
General Office of Shandong Provincial People’s Government, 2021, Notice on Issuing the 14th Five-Year Plan for Elderly Care Services in Shandong Province. Gazette of Shandong Provincial People’s Government, 2021(25): 27–37.
Wang ZY, 2021, Boost High-Quality Development of Elderly Care Services Under the Guidance of Planning — Interpretation of the 14th Five-Year Plan for Elderly Care Services in Shandong Province. Social Welfare, 2021(8): 19–20.
Zhang XL, Pan T, 2024, Accurate Identification and Characteristic Analysis of Town Population Shrinkage from the Dual Boundary Perspective — A Case Study of the Yellow River Basin. Economic Geography, 44(3): 1–10.
Sun BK, Dong XY, Zeng XL, 2026, Ethical Dilemmas and Governance Strategies of the Integrated Medical and Elderly Care Model. Chinese Medical Ethics, 39(1): 113–120.
Zhou Z, Hu CP, 2021, Research on Collaborative Governance System of Health Data Under the Strategy of Healthy China 2030. Library and Information Service, 65(1): 102–109.
Gao S, Yang L, Peng T, 2021, Research Progress of Foreign Integrated Medical and Elderly Care Models. Journal of Nursing, 36(3): 17–20.
Liu ZY, Chen YL, 2022, Difficulties and Countermeasures in Promoting the Integration of Medical and Elderly Care. Chinese Public Administration, 2022(4): 152–154.
Qin S, Zhou M, Cheng Y, et al., 2024, Choice Preference of Middle-Aged and Elderly People on Integrated Medical Services and Elderly Care Model: A Cross-Sectional Study. Inquiry, 2024(61): 469580231224345.
Jiao YX, He XF, Li J, et al., 2025, Research Progress on Activation and Nursing of Patients with Chronic Diseases. Journal of Nursing, 40(21): 116–120.
Xie ZW, Sun XN, Liu CE, 2025, Research Progress on the Application of Smart Nursing in Chronic Disease Care. Chinese Journal of Prevention and Control of Chronic Diseases, 33(2): 145–148 + 152.
Xu C, Zhang WX, Xiao LY, 2021, Qualitative Research on Community Home-Based Integrated Medical-Nursing-Pension Health Service Demands of the Elderly in Jinan. Journal of Nursing, 28(11): 74–78.
Yang M, Zhu XJ, Zhang CY, 2022, Research on Influencing Factors of Integrated Medical-Nursing-Pension Services Based on Implementation Research. Chinese General Practice, 25(4): 505–509.
Zhu XJ, Yang M, 2022, Research on Influencing Factors of Elderly Patients’ Experience of Community Integrated Medical-Nursing-Pension Services. Chinese General Practice, 25(13): 1618–1623.