# The self-reinforcing cycle under dual constraints—a study of the behavioral logic of urban empty-nest older adults substituting self-medication for formal medical treatment

## TL;DR

This study explores how urban empty-nest older adults in China cope with health issues by substituting self-medication for formal treatment due to structural and social challenges.

## Contribution

The paper introduces a theoretical model explaining the self-reinforcing cycle of health behaviors in empty-nest older adults under dual constraints.

## Key findings

- Empty-nest older adults face dual constraints of inadequate support and health vulnerability, influencing their health behaviors.
- Self-medication is used as a survival strategy to maintain autonomy and achieve social adaptation through peer support.
- A self-reinforcing cycle of health behaviors is driven by illness experience and health anxiety, leading to recurring health issues.

## Abstract

Against the stark backdrop of China’s rapidly aging population and the high prevalence of chronic diseases among the older adults, urban empty-nesters face a dual challenge stemming from inadequate intergenerational support and heightened health vulnerability. A deeper understanding of their illness coping behavior is therefore critically needed.

This study employs grounded theory methodology, conducting in-depth interviews with 25 empty-nest older adults in H City. A total of 290,000 words of interview texts were collected to generate a theoretical model, systematically revealing the individual cognitive framework and dynamic mechanisms of health behaviors within this group.

The study reveals a “dual constraints–trigger mechanism–self-reinforcing cycle” logic underpinning the health coping strategies of empty-nest elders: (1) At the precondition level, insufficient intergenerational support and self-perceived burden constitute structural dual constraints; (2) The trigger mechanism is activated by illness experience and self-diagnosed health anxiety, which interact and amplify each other through lay explanatory models of illness, thereby directly driving behavioral decisions; (3) The behavioral pathway follows a self-reinforcing sequence of “self-medication → consulting community networks for medication advice → seeking medical treatment,” further exacerbated by structural contradictions within the healthcare system; (4) Outcomes form a closed loop, in which these health management practices not only conclude the current coping cycle but also often initiate new health issues, restarting the entire cycle.

The findings indicate that the behavior of “substituting self-medication for formal medical treatment” essentially functions as a survival strategy among the older adults under structural constraints. This strategy allows them to maintain autonomy through self-reliant narratives and achieve social adaptation via peer group-based mutual support. The study offers a theoretical pathway that integrates structural reflection with subjective care, contributing meaningfully to the development of healthy aging policies.