Abstract
BACKGROUND: Sports services constitute an important non-medical intervention for promoting healthy aging. China has the world's largest older population with growing demand for institutional care; however, systematic research on supply-demand matching of sports services in residential care facilities remains scarce. METHODS: This cross-sectional study surveyed 278 older adults across 15 residential care facilities in Zhengzhou, China, between March and June 2025. Based on the SERVQUAL gap model, supply-demand status was assessed across five dimensions: facilities, fitness guidance, activity organization, information consultation, and physical monitoring. The dependent variable was constructed using a project counting method: the supply side was measured by service accessibility (SA1-SA5, binary items assessing "whether the institution provides the service"), and the demand side by the number of dimensions with urgent needs (demand mean > 4.0); a difference ≤ 0 was coded as supply deficit. Binary logistic regression was employed with overall satisfaction (Z-standardized) as the core independent variable to examine predictors of supply-demand matching. Cronbach's α coefficients ranged from 0.767 to 0.845 across dimensions. RESULTS: A pronounced structural imbalance in supply and demand was identified. Facilities (gap = 1.03, shortage rate 25.6%) and fitness guidance (gap = 1.02, shortage rate 25.2%) exhibited the strongest demand yet poorest supply, whereas activity organization was relatively well-supplied but ranked lower in demand priority. Significant demographic differences existed across institution types: residents of public institutions had significantly lower self-care ability than those in private institutions (M = 1.65 vs. 1.93, p = 0.027) and lower monthly income (M = 2.17 vs. 2.62, p = 0.005); however, overall satisfaction (p = 0.695) and supply-demand gap rates (p = 0.705) did not differ significantly across institution types. Logistic regression (Nagelkerke R (2) = 0.223, LLR χ(2) = 49.06, p < 0.001) revealed that overall satisfaction (OR = 0.484, p < 0.001), education level (OR = 0.612, p = 0.002), and monthly income (OR = 0.604, p < 0.001) significantly predicted supply-demand matching. After controlling for demographic variables, institution type was non-significant (private OR = 0.801, p = 0.500; public-private partnership OR = 0.922, p = 0.813), suggesting that inter-institutional differences were primarily attributable to a compositional effect. Among 278 respondents, 97 (34.9%) were classified in the supply-deficit group and 181 (65.1%) in the supply-demand balance group. CONCLUSION: Sports services in residential care facilities exhibited a structural contradiction characterized by the coexistence of "high demand-low supply" and "low demand-high supply." Satisfaction, education level, and monthly income were identified as three key predictors of supply-demand imbalance: older adults with higher satisfaction (i.e., better perceived service quality) had lower odds of supply deficit, while those with higher education and income were associated with less supply-demand mismatch, potentially owing to superior information access and resource utilization capabilities. The non-significant effect of institution type, combined with demographic comparisons, suggested a compositional effect-public institutions bore greater responsibility for functionally impaired and economically vulnerable older adults, yet this structural difference in resident composition was not associated with significant differences in sports service supply-demand matching. However, given the cross-sectional design, these associations should not be interpreted as causal relationships.