Over 7000 rare diseases have been identified worldwide, affecting approximately 6–8% of the global population. Patients with rare diseases often endure lengthy diagnostic journeys, consulting multiple physicians over several years before receiving an accurate diagnosis. These challenges stem from significant shortcomings in the current hierarchical medical system, which lacks an effective framework for rare diseases […]

As digital innovations rapidly penetrate aging populations, live-streaming e-commerce acts as a profound external disruption to the informal healthcare subsystem, fundamentally reshaping Health Shared Decision-Making in Elderly Households (HSDM-EH). This study investigates how the nested interplay of affective strategies and algorithmic mechanisms reconfigures this traditional socio-technical balance. Employing a directed content analysis, we conducted methodological triangulation with two complementary data sources: in-depth interviews and behavioral observations from a maximum-variation sample of 40 Chinese families. Our findings reveal a three-stage structural evolution: the de-bounding of the informal healthcare subsystem through the decentering of institutional and familial authority; the synergistic control of affect and algorithms that scales deprofessionalized trust; and the subsequent escalation of systemic friction, marking a failure of organizational resilience. Ultimately, we propose a Socio-Technical Nested Agency Model, demonstrating that algorithmic interventions effect a soft transfer of health authority away from familial oversight to commercial platforms. This socio-technical reconfiguration generates unintended policy feedback that undermines grassroots health initiatives, highlighting the urgent need for cross-sectoral regulatory frameworks to mitigate algorithmic risks and enhance the digital health inclusivity of aging populations.

This study adopts a systems perspective to examine the persistent effects of China’s One-Child Policy (OCP) on the subjective well-being of older adults, emphasizing structural persistence, reinforcing feedback, and path-dependent lock-in in complex socio-technical systems. Using nationally representative data from the China Longitudinal Aging Social Survey (CLASS-2014), we exploit the OCP’s formal rollout at the end of 1979—operationalized with a 1980 cutoff—as a quasi-natural experiment. A Fuzzy Regression Discontinuity (FRD) design identifies the Local Average Treatment Effect of being an only-child parent on late-life well-being, mitigating endogeneity from selection and omitted variables. Theoretically, we integrate three lenses—policy durability and lock-in, intergenerational support, and life course dynamics—to construct a cross-level transmission framework: macro-institutional environments shape substitution capacity and constraint sets; meso-level family restructuring reconfigures support network topology and intergenerational resource flows; micro-level life-course processes accumulate policy-induced adaptations through education, savings, occupation, and residence choices, with effects materializing in old age. Empirically, we find that the OCP significantly reduces subjective well-being among the first generation of affected parents decades later (2SLS estimate ≈ −0.23 on a 1–5 scale). The effects are heterogeneous: rural residents experience large negative impacts, urban effects are muted; men are more adversely affected than women; and individuals without spouses exhibit greater declines than those with spouses. Design validity is supported by a discontinuous shift in fertility at the threshold, smooth density and covariate balance around the cutoff, bandwidth insensitivity, “donut” RD robustness, and a placebo test among ethnic minorities exempt from strict enforcement. These results demonstrate how demographic policies generate lasting impacts on elderly well-being through transforming intergenerational support systems. Policy implications include strengthening rural pension and healthcare systems, expanding community-based eldercare services for spouseless elderly, and developing complementary support programs.