{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T09:38:02Z","timestamp":1777887482862,"version":"3.51.4"},"reference-count":54,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Social Science Fund of China","award":["22AZD082"],"award-info":[{"award-number":["22AZD082"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Systems"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/systems14050480","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T09:46:11Z","timestamp":1777455971000},"page":"480","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Algorithmic and Affective Interventions in Elderly Household Health Decision-Making: A Socio-Technical Analysis of the Informal Healthcare Subsystem Evolution"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-1807-7754","authenticated-orcid":false,"given":"Haoxuan","family":"Cheng","sequence":"first","affiliation":[{"name":"School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai 200240, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lufa","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai 200240, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haoju","family":"Xie","sequence":"additional","affiliation":[{"name":"School of Marxism, Shanghai University of Sport, Shanghai 200438, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Soon, G.C., Bodeker, G., and Kariippanon, K. 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