Challenges Of Ageing Population Research Articles

Semmelweis University’s innovative Center of Preventive Services in support of healthy ageing

Abstract Issue/problem Europe’s aging population presents substantial hurdles for healthcare sustainability. To alleviate the social and economic impacts of age-related diseases, promoting healthy aging is imperative. However, motivating individuals to adopt a healthier lifestyle proves challenging. Description of the problem Semmelweis University, a leading institution in medicine, health sciences, and health care in Hungary and Central Eastern Europe, has addressed this challenge by establishing the Center of Preventive Services (CPS), serving 12,500 Semmelweis University employees. The CPS conducts comprehensive health risk assessments and offers consultations with specialists in preventive medicine, public health, dietetics, physiotherapy, and health psychology. Motivational interviewing is used to enhance patient engagement and commitment to healthy lifestyle changes. Results The CPS has effectively integrated preventive services into the university’s healthcare system, reaching a significant number of employees. Early results show improvements in participants’ lifestyle and health behaviors due to the effective use of motivational interviewing. According to the first preliminary result, a study on step count conducted within the CPS found that those taking part in motivational interviewing session were able to increase their average daily step count by 1074 (95% Confidence Interval: 116-2033) steps more than controls. Lessons The Semmelweis University’s CPS provides valuable lessons for integrating healthy aging-focused preventive care into healthcare systems: 1. Effective preventive care requires targeted interventions based on detailed risk assessment and motivational interviewing; 2. Embedding preventive services within existing health infrastructure improves accessibility and utilization; 3. Collaborative and multidisciplinary approaches are essential to comprehensively address the needs of ageing populations. Key messages • Motivational interviewing boosts the effectiveness and engagement of preventive health services, which is essential to meet the challenges of ageing populations. • The Semmelweis University’s model program shows that embedding preventive services into the infrastructure of existing institutions like universities is scalable for better public health.

Systematic scoping review of ageing in place strategies in Japan, Singapore and Thailand: A comparative analysis.

Given the differing cultural contexts and service needs of older persons in the west and the east, programs or policies should be thoughtfully redesigned to accommodate these diverse societies. This paper presents a systematic scoping review of ageing in place (AIP) strategies in Japan, Singapore and Thailand, emphasising how they are tailored to address the unique challenges of ageing populations in Asia. A systematic literature search was conducted through seven databases. Empirical, peer-reviewed studies in English that discussed AIP-related programs or policies involving aged populations in the target countries were included. Themes were identified using the policy triangle framework, allowing for a comprehensive comparison of AIP across the countries. Three key components of AIP, place, support network and workforce, were identified from 44 included studies. Each country exhibits distinctive approaches to implementing these components. Japan has extensive AIP systems with comprehensive services and strong community and family support. Singapore offers innovative aged care with significant government involvement, though on a smaller scale. Thailand's localised initiatives focus on community health care and age-friendly city assessments, with a less developed AIP infrastructure. The study proposes a comprehensive framework for developing ageing policies in Asia, emphasising the need for a person-centred approach in developing AIP strategies that cater to the diverse needs of ageing populations, and underscores the importance of integrating health-care services, community support and home environment modifications. The three AIP elements advocate for a person-centred approach, providing valuable insights for policymakers to effectively manage challenges of rapidly ageing populations.

Elderly care in an aging population: The impact of parental care needs on adult children

Abstract One of the challenges of population aging is the rising demand of elder care. Adult children fill a substantial portion of this care need. To understand its implication on their labor market choices and welfare outcomes, we build a simple static model where households can spend time and money producing care. We calibrate the model using data from the American Community Survey, the Health and Retirement Study, and National Health and Aging Trends Study/National Study of Caregiving to match moments in the labor market and caregiving patterns. With the calibrated model, we consider a few government programs under a projected aging population structure. Our results show that care subsidy and Medicaid expansion both cause a shift from informal care to formal care, relieving adult children from care burdens and thus improving their welfare. Caregiver allowance appears to have little effects on caregiving behaviors, which leads to minimal welfare improvement.

Mechanism of the impacts of older adults social participation on their health.

Against the background of population aging challenges in China, focusing on health, security, and social participation as core elements of positive aging, this study aims to formulate strategies for promoting the health of the older adults and reveal the pathways and trends of social participation in promoting health. The study analyzed 1,015 randomly selected older adults individuals living at home in Beijing using household survey questionnaires. Drawing on group dynamics theory and structural equation modeling, the study proposed hypotheses regarding the relationships between social participation, group cohesion, and health status. First, the triangular path model of social participation, group cohesion, and health status among the older adults was established. The direct path coefficient of social participation on health status was 0.15, that of social participation on group cohesion was 0.56, and that of group cohesion on health status was 0.32. The indirect path coefficient of social participation on health status through group cohesion was calculated at 0.56 × 0.32 = 0.18. Second, of the older adults age groups-younger, middle, and older-social participation's direct path effects on health status were present only in the older age group. Social participation's indirect path effects on health status through group cohesion were relatively high in all three groups, with a slight increase in the older age group. First, just the older adults participation in social activities serves as a benign stimulus to physical and mental health. Additionally, group cohesion formed through interaction with others during social activities encourages self-improvement behaviors, indirectly promoting health. In fact, indirect pathways of health promotion through group cohesion are stronger than direct pathways, highlighting the importance of group cohesion during social participation. Second, participation in activities alone can provide only sufficient benign stimuli for the older adults aged 80 and above, with the direct path effect of social participation on health beginning to appear only with increasing age. With age, selectivity of interaction with others decreases, and dependence increases; social participation's indirect path effect on health through group cohesion continues to grow slightly.

Determinants and inequities in healthy working life expectancy in China.

Many countries are raising the pension age to mitigate the challenges of population aging, but such a solution may ignore the disparities in health and working conditions across populations. Using large-scale longitudinal data from China, this study provides estimates of healthy working life expectancy (HWLE), defined as the average number of years expected to be spent healthy and in work from age 50 years, and highlights substantial inequities in HWLE by gender, socioeconomic status and geographical region. The HWLE from age 50 years was, on average, 6.87 (95% confidence interval: 6.70 to 7.04) years in China. Hypertension was the leading chronic condition for people working unhealthily (5.67 years for men and 4.85 years for women), and arthritis contributed the largest differences in unhealthy working years across people by occupation (agricultural laborer versus enterprise employee, 3.28 years). Moreover, adopting healthy lifestyles was associated with gains in HWLE (2.13 years for men and 1.61 years for women). Our findings suggest that increasing the pension age through a 'one-size-fits-all' approach may not effectively meet the goal of extending working lives. Inclusive initiatives aimed at targeted populations to promote health or work conditions and to facilitate the pension system will be essential to improve HWLE by reducing inequities.

Research on the Interaction Mechanism between Land System Reform and Rural Population Flow: Europe (Taking Spain as an Example) and China

This paper examines the interaction between land policies and rural labor migration in China and Europe, highlighting how land reforms guide labor mobility and their impacts on land and social structures. In China, the Household Contract Responsibility System and land transfer policies have facilitated agricultural scale expansion and the urbanization of the rural labor force. Homestead reforms have further enhanced farmers’ asset liquidity. In Europe, using Spain as a case study, EU agricultural policies have spurred agricultural modernization, economic diversification, and intensive land use. These advancements benefitted from a mature land transfer market and increased non-agricultural employment opportunities. Both China and Europe face challenges of population aging and rural depopulation, necessitating improvements in land use efficiency, the balance of the scale, and the protection of farmers’ rights and interests. Europe addresses labor shortages through technology, mechanization, and cooperatives, while China employs land trusteeship, transfer platforms, and the “three rights separation” system to combat land abandonment and labor shortages. Future research should strengthen comparative studies between China and Europe, quantify interactive relationships, consider the impact of transnational labor mobility under globalization, explore policy innovations, and foster international cooperation to address demographic changes and agricultural labor shortages. Additionally, promoting sustainable land use and farmers’ rights, equalizing urban–rural public services, enhancing education and training, and improving the social security system are crucial for integrated urban–rural development.

Combined effects of loneliness and diabetes mellitus on disability incidence among older Japanese adults

BackgroundDeveloped countries worldwide face the challenge of aging populations in which loneliness is problematic, leading to mental and physical health issues. Diabetes mellitus (DM) can cause decreased physical activity, reduced functioning, and depressive symptoms. However, how interactions between loneliness and DM influence health outcomes remains unclear. We aimed to determine the effects of loneliness and DM-related complications on the incidence of disability among older individuals. MethodsWe analyzed data from the Japanese National Center for Geriatrics and Gerontology Study of Geriatric Syndromes for community-dwelling adults aged ≥65 years without initial long-term care needs. Loneliness was assessed using the University of California Los Angeles Loneliness Scale, and DM status was determined based on medical history obtained through face-to-face interviews. Disability incidence was identified by monthly tracking of certifications under the Japanese long-term care insurance system. The combined effect of DM and loneliness on care needs was examined using Cox proportional hazard regression models. ResultsAmong 5,160 participants, 298 (5.8 %) developed incident disabilities within 24 months. Cox models adjusted for potential confounders revealed a significantly increased disability risk among persons with DM and loneliness. Having DM without loneliness and vice versa were not significant risk factors for disability incidence compared with having neither. ConclusionsThe combination of loneliness with DM was a risk factor for disability development among community-dwelling older adults. Loneliness and DM might be interrelated and associated with disability development, suggesting that support along with assessments of mental health and illness might help to avoid disability in this population.

Reframing policy responses to population aging in Iran

Iran is aging rapidly and is expected to see negative population growth rates later this century. This change is generating significant concern for policymakers, whose response is to seek ‘demographic solutions’ to these issues: raise the fertility rate, decrease the divorce rate, and promote marriage among young people. Part of these policies has entailed curtailing access to free family planning services. This ‘call and response’ approach is unlikely to succeed in its stated aim, as it over-simplifies the real challenges of population aging as well as the multiple dimensions of population change. Such policies derive from simple representations of demographic change, most notably using the old-age dependency ratio. Using a microsimulation model, this paper suggests that increasing Iran’s currently low female labor force participation and translating educational gains into rising productivity is a more effective means of responding to the challenges of population aging, even under low fertility conditions. The advancement on previous such microsimulation exercises lies in the fact that this study explicitly considers the comparison between raising fertility and increasing female economic empowerment to offset population aging in a setting characterized by an overt pronatalist policy system. In tandem with reforming stressed institutional systems (such as the pension system), releasing the full potential of Iran’s existing (and future) human capital—especially of its women—is a far more effective policy direction than fertility-promoting policies.

Aging Population Challenges and the Role of Thai Adolescents in Caring for the Elderly: A Cross-Sectional Study.

This cross-sectional study aimed to investigate the perspective and caregiving practices of Thai adolescents towards the elderly in the Northeastern region of Thailand. The study was carried out during July 1st to September 30th, 2023 among 1,551 participants in grades 4-6 from eight randomly selected schools. The analyzing using descriptive statistics. The results found that the average age was 15.30±1.66 years old, 62.4% were female, and most lived with their parents and relatives. About 36.4% of parents have experienced either widowhood or separation, 69.4% of families had a monthly income less than 15,000 THB. While 33.7% had an elderly person in the family, 1.6% lived with bedridden patients, and 40.3% required assistance in daily activities such as cooking, mobility, while 58.7% had diabetes and high blood pressure. 59.3% did not have a primary caregiver in the family, only parents or relatives usually taking on this role. Adolescent grandchildren spent the majority of their time on education. Almost one of three rarely took care of the elderly, even though their parents and teachers taught about moral responsibility. Regarding the belief in the merit that would arise from taking care of the elderly, one of five was indifferent or did not believe, while half of them believed to some extent. From self-assessment of their ability to take care of the elderly, most were in the moderate and low levels, despite receiving information from family, teachers, or various media. The predominant perspective is that caregiving is perceived as the responsibility of parents or health professionals, and the belief that the elderly is captious and irksome. Therefore, it is advisable to present policy-oriented information across education, health, and societal dimensions to support children and young people to learn about elderly individuals and instilling their responsibility within families and societies, fostering a sustainable and well-being-oriented community.

Urban–Rural heterogeneity in the effect of population ageing on the savings rate of urban and rural households in China

As the second populous country in the world, China is confronted with the significant and rapid challenge of population ageing. The household savings rate is inevitably impacted by population ageing. Most existing research has been conducted using macro data from 31 provinces in China. However, most of them lacks consideration of urban-rural differences. Furthermore, there are concerns regarding the applicability of using macro data to study household-level microeconomic issues. Against this backdrop, the objectives of this paper are twofold: first, to investigate the effect of population ageing on the savings rates of urban and rural households in China. Second, this work examines whether urban–rural heterogeneity is evident in the impact of population ageing on household savings in China. This paper conducts a regression analysis on pseudo-panel data from 2010 to 2018 in China using micro-level household data from China Family Panel Studies and employing a Feasible Generalized Least Squares model. The key contribution of this paper is converting cross-sectional microdata into pseudo-panel data, enabling regression analysis within a logical and rigorous theoretical framework. It addresses limitations on existing literature, which predominantly relies on macro data. Additionally, the study takes into account heterogeneity, individual differences, and multicollinearity in regression model selection, thereby remedying the shortcomings of model selection in the majority of the existing literature based on pseudo-panel data. The findings reveal the heterogeneity of household savings rates in urban and rural China, as well as the heterogeneity of the impact of population ageing on the savings rates of urban and rural households in China. Specifically, population ageing significantly reduces household savings rates in both China and rural areas, but significantly increases the savings rates of urban households. Moreover, in the context of population ageing, urban household savings rates are significantly lower than those in rural areas. Policymakers should strengthen urbanization efforts to reduce the urban-rural disparity. In addition, to mitigate the impact of population ageing on savings rates, policymakers should encourage fertility in order to improve household demographics. They should also strengthen investment in education to reduce the burden of household expenditure on education. In addition, policymakers should promote entrepreneurship, provide job training in order to increase household incomes.

Analysis of the Impact of Population Aging on the Economy and Countermeasures —— Take China as an Example

Since the reform and opening up, China's population aging has gradually deepened, and nowadays, population aging has become one of the most concerned issues for China's economic development. Therefore, the research theme of this paper is the current situation and development trend of population aging in China and specifically analyzes the impact of population aging on economic development in terms of labor supply, employment, and investment. The research methods of this paper are literature analysis and data analysis. It is found that the proportion of China's aging population in the total population is already greater than 16.7%, and it will accelerate in the future. And the rise of the aging population has different degrees of negative impacts on labor supply, employment, and investment, and has an inhibitory effect on economic development. Therefore, this paper suggests that in the face of the challenge of population aging, the state can increase the investment in human capital, encourage enterprises to innovate, and improve production performance through new technologies. Rational use of the demand generated by aging, and the development of the service industry to increase employment.

Study on the Development Strategy of China’s Health Care Industry from the Perspective of Active Ageing: Based on Public Cognition Survey

With an aging population currently posing a challenge, China must accelerate the construction of a health development model with "prevention as the main focus" from the perspective of active aging. This development requirement is exactly met by the growth of health care industry, which is highly significant strategically to cope with the dual challenges of aging populations and public health issues. The study construct an evaluation index system of influencing factors for the development of health care industry, and further empirically analyse the influencing factors of China’s health care industry by using Analytic Hierarchy Process (AHP) and Entropy Weight Method (EWM), and calculate the relative importance weights of 18 influencing factors of perceptual indicators under the four levels of economy, environment, products and individuals. Lastly, countermeasures are made for the superior growth of China’s health care industry based on the results of the weighing analysis.

Measuring the impacts of the two-child policy on industrial structure and economic growth in china using a CGE model

Facing the challenge of population aging and labor force shrinking, the Chinese government has been trying to reform its family planning policy since 2015. This paper analyzes the impacts of China’s Two-child policy on economic growth and industrial structure from 2020 to 2060 using a dynamic Computable general equilibrium (CGE) model. This paper constructs an effective labor input index accounting for changes in educational attainment and labor force participation rates by age and sex to simulate the effects of the demographic changes on labor supply and economic growth, rather than using simple working-age measures. This paper sets two policy scenarios, the One-child policy and the Two-child policy, to simulate the changes in the employment structure, industrial structure, and main macroeconomic indicators under different population policies. The main finding is that under the Two-child policy, the average GDP growth rate is expected to be 0.3% and 1.0% points higher than the One-child policy in the period of 2015–2030, and 2045–2060; the employment growth rates of the manufacturing and service industries are higher than that under the One-child policy; the shift of industrial structure from manufacturing to service industry will be slightly slower than the One-child policy. The positive impacts of the Two-child policy on China’s economic growth are not significant in the short run. From the perspective of the quantity, structure and quality of labor supply, this paper reveals how a more relaxed family planning policy will affect labor supply, and ultimately affect economic structure and growth in a long run.

Artificial Intelligence in Stroke Imaging: A Comprehensive Review.

The aging population challenges the health-care system with chronic diseases. Cerebrovascular diseases are important components of these chronic conditions. Stroke is the acute cessation of blood in the brain, which can lead to rapid tissue loss. Therefore, fast, accurate, and reliable automatic methods are required to facilitate stroke management. The performance of artificial intelligence (AI) methods is increasing in all domains. Vision tasks, including natural images and medical images, are particularly benefiting from the skills of AI models. The AI methods that can be applied to stroke imaging have a broad range, including classical machine learning tools such as support vector machines, random forests, logistic regression, and linear discriminant analysis, as well as deep learning models, such as convolutional neural networks, recurrent neural networks, autoencoders, and U-Net. Both tools can be applied to various aspects of stroke management, including time-to-event onset determination, stroke confirmation, large vessel occlusion detection, difusion restriction, perfusion deficit, core and penumbra identification, afected region segmentation, and functional outcome prediction. While building these AI models, maximum care should be exercised in order to reduce bias and build generalizable models. One of the most important prerequisites for building unbiased models is collecting large, diverse, and quality data that reflects the underlying population well and splitting the training and testing parts in a way that both represent a similar distribution. Explainability and trustworthiness are other important properties of machine learning models that could be widely adopted in clinical practices.

How to explain social innovation in elderly care services: The role of for-profit and non-profit social enterprises

Social innovation and social enterprise are two major factors in addressing the challenges of population ageing since both are aimed at solving social problems. One of these challenges involves providing quality care services for the elderly. However, few studies have analysed how social enterprises can promote or manage social innovations in this sector. This research therefore studies said relationship, paying particular attention to the for-profit and non-profit nature of social enterprises. Specifically, to test the hypotheses, we use data from a survey of nursing homes in southern Spain, where care services are expanding with the support of welfare state social policies. The results show that non-profit social enterprises tend to develop more social innovations in care services, and that the social mission and participative governance positively influence the implementation of social innovations in this activity sector. Consequently, implications for social policies are suggested to better meet the needs of the elderly.

Study on the development characteristics and spatial and temporal patterns of population ageing in 31 central cities in China.

Population ageing is inseparable from technological innovation, social progress and the development of human civilization, and constitutes a new element in the development of contemporary human history. To dynamically analyses the developmental, structural and growth characteristics of population ageing in 31 provincial capitals and municipalities in China, using the data of the fifth national census in 2000 and the seventh national census in 2020. The development characteristics and spatial and temporal patterns of population aging in the 31 cities were measured using the population aging index growth model, Theil's index, coefficient of variation, population aging index and other analytical methods. (1) From 2000 to 2020, the population aging rate of the 31 central cities generally increased, and the population aging level of the cities showed the characteristics of "East-Central-Northeast-West" to "Northeast-East-Central-West" decreasing. (2) Regional differences in the ratio of old to young are relatively high, while regional differences in the level of population ageing are relatively small. The level of population ageing is classified with the indicators of size structure, family structure and age structure in the first and third quadrants, and with the geographic concentration rate in the second and fourth quadrants. (3) China's population ageing has a T-shaped spatial distribution characteristic pointing along the coast - along the Yangtze Rivers. The 31 central cities are the center of gravity of China's economy and have strong economic power in dealing with the challenges of population ageing, but how to make population ageing compatible with the economy and society, and then promote sustainable population development, is a topic that needs further attention in the study.

The Relationship Between Aging, Economic Development and Healthcare Expenditure in Japan: An Empirical Analysis

This paper investigates the relationship between ageing, economic development, and healthcare expenditure in Japan, considering the challenges posed by an ageing population. The study utilizes a VAR and ARMAX modelling approach to analyse the complex dynamics among these variables. The empirical results reveal interesting findings that contrast with previous literature. While population ageing is often assumed to lead to increased healthcare spending, this study finds no significant correlation between population ageing and healthcare expenditure as a percentage of GDP. The analysis suggests that factors such as advancements in medical technology, healthcare system efficiency, and cultural variations in healthcare utilization patterns may have mitigated the expected rise in healthcare expenditure associated with an ageing population. These findings have implications for policymakers and investors. Policymakers should consider a broader range of factors beyond population ageing when projecting future healthcare expenditures and developing strategies for managing healthcare costs. Investors can benefit from a nuanced understanding of the healthcare sector, focusing on areas such as medical technology, innovation, and healthcare delivery models that are likely to be influenced by population ageing and changing healthcare needs. Overall, this research contributes to the existing knowledge base, offering insights for addressing the challenges of population ageing and healthcare sustainability.

Identifying Accessibility and Equity Defects of Elderly Care Services in Developing Countries: Insights From Xiamen City

Background: The global aging population has raised concerns about the fair distribution of elderly care resources. China, as the largest developing country, has made efforts to address population aging challenges. However, equitable distribution of elderly care resources remains a concern. This study analyzed the spatial layout and accessibility of elderly care service facilities (ECSFs) in Xiamen City to improve resource allocation and enhance the elderly care system in China. The findings provide valuable insights for other developing countries and regions seeking to improve their own elderly care resource allocation.Methods: Xiamen City was chosen as the research area due to its unique geographical location and advanced information technology infrastructure. The study examined the spatial distribution, accessibility, and equity of ECSFs. Using Python, point of interest (POI) data were collected and evaluated using the kernel density method and two‐step floating catchment area method. Spatial autocorrelation analysis identified areas of aggregation and dispersion in ECSF accessibility.Results: Xiamen currently has 660 ECSFs, including nursing homes, adult day care centers, home care agencies, and rural elderly care homes. The analysis revealed spatial disparities, with ECSFs clustering primarily in the central area of Xiamen Island. Significant differences in accessibility were found among the four types of ECSFs. Spatial autocorrelation analysis identified cold and hot spot areas, indicating variations in accessibility across regions.Conclusion: Xiamen City has made progress in allocating elderly care resources and constructing service facilities. However, equity in resource allocation remains a concern. Areas with limited accessibility were identified, leading to unequal access to elderly care resources and timely physical care. To address these challenges, decision‐making departments should consider increasing facilities, improving transportation, enhancing macro planning, and improving facility service quality and accessibility. These measures will optimize ECSF accessibility and promote equitable distribution of elderly care resources.

USING TRANSDISCIPLINARY CO-PRODUCTION TO GAIN INSIGHTS INTO SPATIAL JUSTICE AND AGE-FRIENDLY CITIES

Abstract Globally, a popular policy approach to address the two interrelated challenges of population ageing and urbanisation has been to adopt the World Health Organization’s Age-Friendly City framework, a model that can help to identify and address barriers to the well-being and participation of older people. This paper reports early findings from the ‘Ageing in Place in Cities’ project. The research was conducted from a critical gerontology perspective and embedded a spatial justice perspective by centring the concepts of equity, diversity and co-production in our underpinning theoretical framework. Discussing findings from seven case study cities (all who were early adopters of the Age-Friendly Cities framework), this paper discusses how a transdisciplinary co-production approach has been used to gain greater understanding of age-friendly initiatives in each city. Using mixed methods, we first developed descriptive profiles for each city using both census and other local demographic data to explore how the populations have changed over time, and narratives and policy documents detailing the initiatives used to support ageing in place. Second, we conducted semi-structured interviews with a variety of actors in each city to examine how the cities delivered age-friendly change. We integrated the data using a comparative case study approach to draw out insights across the cities. Our findings reveal the role of key leaders and stakeholders in age-friendly cities and will be of interest to policy makers and academics interested in population ageing and urban change. Further, our transdisciplinary co-production methods present a novel approach to conducting age-friendly research.

Urban Resilience and Its Links to City Size: Evidence from the Yangtze River Economic Belt in China

Understanding the relationship between city size and resilience is crucial for informed decisions on preparedness and interventions in building resilient cities. This study addresses this issue by dividing urban resilience into four components: stability, redundancy, resourcefulness, and connectivity. Using the above evaluation framework, we assessed the spatial–temporal variations in the relationship between city size and resilience in the Yangtze River Economic Belt from 2005 to 2020. The findings shows that, overall, resilience increased in the cities, with larger populations and spatial scales showing greater resilience, but both megacities and small cities experienced a decline in resilience. In terms of the four components of resilience, most of the region’s cities have roughly equal connectivity and stability, but redundancy and resourcefulness vary by city size and location. Specifically, downstream and larger cities demonstrated better crisis resolution and innovation. The dominant coupling coordination states showed antagonism between population and resilience. Upstream areas experienced a mismatch between “low resilience” and “large population”, while a moderate coordination existed between spatial scale and resilience. Further, it was found that factors hindering urban resilience varied according to city size. Cities with a population of <3 million faced low connectivity and limited transformation capacity. Those with a population of 3–5 million had moderate connectivity limitations, while cities with a population >5 million faced energy and aging population challenges. This study contributes to urban resilience discourse by providing a conceptual understanding and empirical analysis of the impact of city size on resilience.