Renewal Strategies for Older Hospital-Adjacent Communities Based on Residential Satisfaction: A Case Study of Xiangya Hospital

Abstract

Since 2019, China has been promoting the renovation of old urban residential areas built in 2000 or earlier. However, older communities surrounding large urban hospitals face unique challenges, including deteriorating infrastructure, complex social dynamics, and conflicts between tenants and residents. This study focuses on old communities near Xiangya Hospital in Changsha, Hunan Province, employing questionnaire surveys to analyze residential satisfaction and demands across three dimensions: housing spaces, community public spaces, and social relations. Using multilevel linear regression, structural equation modeling, and moderation effect analysis, this research systematically investigates influencing factors and group heterogeneity. The findings reveal that community greening, recreational facilities, and property management are core drivers of residential satisfaction, while social relationships and public spaces play critical mediating roles. Distinct group-specific needs emerged: elderly residents prioritized greening, security, and property management responsiveness; medical students emphasized sound insulation and tenant management; and patients and their families heavily emphasized ventilation and lighting, hygienic conditions, and infrastructure. To address these issues, the study proposes an integrated renewal strategy emphasizing the integration of physical upgrades and soft governance. The findings provide theoretical and practical insights for the systematic renewal of similar older hospital-adjacent communities.

1. Introduction

Since 2019, China has initiated urban renewal programs targeting residential communities constructed in 2000 or earlier. Official reports indicate that by 2023, approximately 220,000 older urban neighborhoods had undergone renovation, benefiting over 38 million households and nearly 100 million residents. The national plan for 2024 aims to commence renewal projects in 54,000 additional communities [1]. According to the Guiding Opinions on Comprehensive Urban Renewal of older communities issued by the General Office of the State Council, this large-scale renewal initiative follows a three-tiered approach managed by local governments: basic renovations, improvement upgrades, and enhanced transformations [2]. These progressive categories aim to first ensure residential safety and essential living requirements, optimize convenience provisions, and ultimately enrich community services to elevate quality of life. However, challenges persist in China’s urban renewal efforts. Current renovation strategies predominantly focus on aging-friendly adaptations, exhibiting limited diversity in target populations and implementation methods [3]. The top-down governance model led by municipal authorities frequently fails to adequately address residents’ specific concerns, particularly when dealing with unique community conflicts [4]. Standardized renovation templates often prove insufficient when applied to neighborhoods with distinctive spatial configurations or complex social dynamics [5].

Compared to other older neighborhoods, communities surrounding large urban hospitals face more pronounced challenges. From a spatial perspective, these areas grapple with deteriorating infrastructure, insufficient community services, and substandard environmental conditions. Socially, hospital proximity cultivates a transient population dominated by low-income groups, including medical trainees, pre-admission patients, and patient caregivers. Meanwhile, long-term residents predominantly comprise elderly homeowners. This demographic dichotomy, compounded by inadequate community governance, has fostered a lack of mutual recognition and sense of security between tenants and original residents. Despite these complexities, such communities have received limited scholarly attention. This study investigates neighborhoods adjacent to Xiangya Hospital in Changsha City, Hunan Province, through resident interviews and questionnaires. The research evaluates living satisfaction and demands across three dimensions: housing conditions, communal spaces, and daily life experiences. Findings inform targeted renewal strategies addressing the unique spatial and social challenges of hospital-adjacent communities.

The subsequent chapters of this study are structured as follows. Section 2 conducts a literature review on urban renewal practices for older communities and identifies key factors influencing residential satisfaction, providing the theoretical foundation for research design and questionnaire development. Section 3 details the methodological framework employed in this study. Section 4 analyzes the current conditions of communities surrounding Xiangya Hospital in Changsha, synthesizing their most pressing challenges. Section 5 performs a statistical analysis of the questionnaire data, summarizes findings. Finally, Section 6 formulates evidence-based renewal strategies for older communities near urban hospitals, grounded in the empirical conclusions derived from this study.

2. Literature Review

2.1. Urban Renewal of Older Communities

Older urban residential communities refer to neighborhoods characterized by early construction dates, inadequate maintenance and management, incomplete municipal infrastructure, and insufficient community service facilities. The renewal initiatives aim to enhance residents’ quality of life while addressing their most pressing needs [3], primarily through public facility upgrades, environmental quality enhancement, and community safety improvements. Current research on urban community renewal predominantly focuses on two aspects: implementing aging-friendly adaptations and promoting resident participation in decision-making processes.

Current research on spatial renewal of older communities shows limited specialized investigation into hospital-adjacent neighborhoods, with existing efforts predominantly centered on aging-friendly architectural adaptations. The substandard living conditions in these communities have driven out most middle-aged and younger residents, resulting in older populations [6]. Existing studies emphasize enhancing safety, accessibility, and social interaction in public and residential spaces to align with elderly lifestyles. Recommendations also include creating flexible spatial configurations and implementing sustainable, multifunctional facilities [7]. While vulnerable groups like the elderly remain a priority in inclusive community design, the actual demographic profiles are rarely homogeneous [8]. The coexistence of diverse groups necessitates attention to heterogeneous needs. Current renewal strategies often remain overly generalized, offering limited actionable guidance for evidence-based policymaking. Hospital-adjacent older communities face compounded challenges beyond typical infrastructure decay. Their unique resident composition—blending permanent elderly homeowners with transient medical populations—creates acute conflicts between housing demands and functional requirements. These tensions not only compromise residents’ quality of life but also pose systemic challenges to urban spatial optimization and resource utilization [9].

2.2. Determinants of Residential Satisfaction

Residential satisfaction constitutes a critical focus in urban studies [10], reflecting the alignment between current housing/community conditions and resident expectations [11,12]. Higher satisfaction emerges when environmental realities match anticipated standards, whereas discrepancies often indicate unmet expectations and highlight areas needing improvement through renewal initiatives. Existing research categorizes determinants of residential satisfaction into three primary dimensions.

Firstly, numerous studies have investigated the socio-demographic characteristics of residents. Attributes such as age, income, length of residence, and homeownership significantly influence residential satisfaction [13]. For instance, homeowners exhibit higher community satisfaction compared to renters [14], while longer residency demonstrates a positive correlation with satisfaction levels [15]. Recent years have seen growing scholarly attention to vulnerable populations in urban contexts. Yung and Conejos emphasize the critical role of recreational spaces in supporting elderly social interactions [16]. Regarding low-income and migrant populations, Li and Wu’s research in informal settlements (chengzhongcun) identifies community belongingness as the most significant factor influencing residential satisfaction among urban newcomers [17].

Second, substantial empirical research has examined factors influencing residents’ satisfaction with built environments, primarily encompassing two dimensions: housing conditions and communal spaces. Beyond housing safety [18], enhanced residential quality—including sufficient indoor space, functional facilities [19], adequate daylighting, ventilation [20], sufficient bedrooms and bathrooms, and functional kitchen and living areas—positively correlates with satisfaction [21]. Communal spaces serve as vital platforms for social interaction [22]. A study reveals that features such as shared open spaces and communal areas serve as critical determinants of residential satisfaction [23]. Residents’ perceptions of internal road conditions, infrastructure quality, and the structural integrity of buildings exert significant influence on their overall satisfaction with older neighborhoods [24]. Notably, deficiencies in green infrastructure—particularly the absence of public green areas—were found to substantially diminish satisfaction levels [25]. Furthermore, community amenities, physical environmental quality, and service accessibility are also critical determinants of satisfaction with built environments [26].

Finally, beyond the physical attributes of built environments, the capacity to foster social networks proves crucial to residential satisfaction [27]. A supportive social environment constitutes a decisive factor in residential choices [28]. The sense of community belonging enables individuals to perceive improved relationships with fellow residents and heightens their awareness of renewal outcomes [29], with stronger neighborly relations correlating to elevated satisfaction levels [30]. Simultaneously, enhanced property management efficacy directly contributes to superior residential experiences, reinforcing overall satisfaction [31].

In summary, current research on older community renewal predominantly focuses on elderly populations, with limited attention to the diverse needs of coexisting demographic groups. Moreover, existing research on urban community renewal exhibits critical gaps in addressing the acute challenges of hospital-adjacent older neighborhoods, which face compounded pressures from older infrastructure, transient populations, and conflicting spatial demands. Without targeted interventions, hospital-adjacent communities risk becoming bottlenecks in urban development, undermining both resident welfare and healthcare efficiency. Yet, the paucity of empirical studies addressing these intersections leaves policymakers ill-equipped to balance competing priorities—preserving community identity while accommodating medical service needs. This study therefore investigates neighborhoods surrounding Xiangya Hospital in Changsha, using this case to demonstrate methodologies for identifying localized needs and core conflicts during renewal processes. By systematically analyzing spatial configurations, resident demographics, and service demands, this research proposes a framework for developing context-sensitive strategies that balance universal renewal principles with community-specific realities, ultimately aiming to enhance intervention efficiency and resident satisfaction.

3. Methods

To gain deeper insights into the practical needs of local residents, this study employed a questionnaire survey method. The specific procedures are outlined as follows.

3.1. Item Development

During the questionnaire development phase, the research objectives were first defined to assess residential satisfaction and needs among residents of older communities near urban hospitals. Core constructs included dimensions such as housing quality, community facilities, and social relationships. An initial item pool was generated by integrating existing theoretical frameworks and literature, covering Likert-scale items and demographic questions. Subsequently, experts in urban planning, sociology, and public health conducted multiple rounds of review to optimize question clarity, logical coherence, and cultural adaptability. Abstract concepts were operationalized into measurable indicators. The finalized questionnaire underwent linguistic simplification to ensure comprehensibility across respondents of varying educational backgrounds.

3.2. Pilot Testing

Multiple methods were applied during the pilot testing phase to validate the questionnaire’s effectiveness. Cognitive interviews were first conducted with 15 residents from target communities through one-on-one sessions, focusing on identifying misunderstandings of terminology (e.g., “sense of belonging”) and cognitive load associated with scale items. Ambiguous expressions were revised, and missing response options (e.g., adding “Patients and their caregivers” under “Reasons for residency”) were supplemented. A small-scale pilot survey (n = 80) was then administered. Quantitative analysis identified abnormal response patterns (e.g., overuse of the neutral option “3”) and optimized scale balance. The average completion time (approximately 15 min) was monitored to ensure adherence to length requirements. Internal consistency was confirmed via Cronbach’s alpha coefficients for Likert-scale items, and exploratory factor analysis (EFA) validated the hypothesized dimensional structure. The questionnaire was finalized and approved for formal distribution.

3.3. Questionnaire Distribution

The study focused on older communities within a 1 km radius of Xiangya Hospital, with target areas identified using urban planning maps. Non-residential buildings were excluded, and sampling prioritized purely residential or mixed-use buildings. A quota sampling strategy aligned with community demographics was implemented. Geographically random intercept sampling was adopted: the area was divided into 50 m × 50 m grids, with 25 grids randomly selected as survey sites (See Supplementary Material Figures S1–S3). Trained interviewers intercepted eligible residents (aged 18+) passing through these grids during three time windows (8:00–10:00, 12:00–14:00, 19:00–21:00) at 10 min intervals. Data collection spanned three weeks to maximize sample randomness and representativeness. Respondents accessed the questionnaire online via QR code scanning, with mandatory completion of all items required for submission. Most participants completed the survey independently, while interviewers assisted a minority with physical or literacy limitations.

3.4. Data Preparation

Strict quality control protocols were applied after the questionnaire survey. Among 283 returned questionnaires, 3 duplicates were removed based on IP addresses and submission timestamps. A total of 14 low-quality responses were excluded using completion time thresholds (<5 min or >60 min). For Likert-scale items, 6 questionnaires exhibiting extreme response bias (exclusive selection of “1” or “5”) and 4 with contradictory responses (e.g., high overall satisfaction but extremely low scores across all subdimensions) were identified and removed after manual verification. The final valid sample comprised 256 questionnaires (90.5% retention rate).

4. Study Area Analysis

4.1. Study Area

Changsha, the capital of Hunan Province, had a permanent resident population of 10.51 million by 2023 [32]. Since 2016, the city has implemented numerous urban renewal initiatives targeting older communities [33], with plans to renovate 15 urban villages, 300 older residential communities, and 300 dilapidated housing units in 2024 [34].

Located in Changsha, Xiangya Hospital is a modern, large-scale medical complex integrating healthcare, education, and research [35]. As a pivotal national hub for medical services, education, and scientific innovation, it hosts over 3000 graduate students, undergraduates, and trainees annually [36], while serving approximately 15,000 daily patients [37]. Consequently, older communities near Xiangya Hospital have become critical residential hubs for medical students, patients, caregivers, and healthcare workers. These neighborhoods now face dual demands, namely accommodating elderly long-term residents while addressing the needs of transient medical populations, which poses unique challenges to their built environments.

Xiangya Hospital operates multiple campuses in Changsha, with its First and Second Affiliated Hospitals situated in older urban areas. Surrounding residential communities exhibit distinct governance models: a minority are community-managed, while most smaller complexes rely on resident self-governance. These areas are characterized by older buildings, inadequate public spaces, and subpar community services, aligning with the State Council-designated criteria for older communities. The environmental typologies around the hospital are illustrated in Figure 1 and Figure 2.

4.2. Descriptive Findings

4.2.1. Resident Demographic Characteristics

The communities surrounding Xiangya Hospital exhibit unique demographic patterns: long-term elderly residents coexist with a large transient population of medical trainees, patients, and caregivers. These groups rarely interact with local homeowners, creating distinct social divisions.

• Elderly Homeowners

Field surveys reveal that most property owners are elderly or empty-nest seniors, many having resided in the community for over a decade. Their primary concerns center on structural safety and maintenance issues in older buildings.

2.

Medical Trainees

Medical students, distinct from higher-income physicians, prioritize affordable housing near the hospital. To minimize costs, they typically share subdivided units where landlords retrofit properties to maximize rental income—often converting single apartments into cramped multi-bedroom spaces with shared bathrooms and kitchens. Interviews highlight their focus on basic amenities (e.g., private bathrooms, air conditioning) and community safety. Notably, physicians with established incomes tend to relocate to newer, higher-quality neighborhoods.

3.

Patients and Caregivers

This under-served group, frequently overlooked in urban renewal discourse, consists primarily of low-income individuals traveling for specialized medical care. Overburdened hospital capacities—chronic bed shortages and delayed specialist appointments—force many to seek temporary lodging nearby. Informal accommodations (see Figure 3), created by retrofitting residential units or ground-floor storage areas into partitioned bunk spaces, charge approximately CNY 50 daily, far below hotel rates (CNY 200–400/day). These makeshift lodgings, though substandard, serve as critical shelters for patients requiring short-term stays (7–10 days), particularly post-IVF monitoring periods when hospital housing is unavailable.

This tripartite demographic structure creates overlapping demands: elderly residents prioritize safety retrofits, medical trainees need affordable yet functional housing, and patients require temporary low-cost shelters. These competing needs exacerbate existing spatial tensions and governance challenges in hospital-adjacent communities.

4.2.2. Community Physical Environment Characteristics

The older communities around Xiangya Hospital face intensified challenges in their physical environments during urban renewal.

• Structural Safety Risks

Residents reported critical building safety issues, particularly structural cracks in walls caused by adjacent high-rise construction projects affecting foundation stability. Although affected residents have been evacuated, these incidents have heightened lingering safety concerns among remaining occupants.

2.

Dissatisfaction with Prior Renovations

Observations confirm that most communities underwent basic-level renovations in recent years, including road resurfacing, wall repainting, and parking space reallocation (see Figure 4). However, residents criticized these efforts as superficial, citing subpar construction quality and lack of post-renovation maintenance accountability.

3.

Spatial Limitations

Urban planning analysis reveals that most hospital-adjacent communities are gated neighborhoods enclosed by perimeter walls. These areas suffer from limited communal areas and low vegetation coverage (see Figure 5), with minimal provisions for social interaction or recreational activities. The constrained public spaces fail to accommodate the diverse needs of elderly homeowners, transient medical trainees, and temporary patients, exacerbating social segregation and functional conflicts.

4.2.3. Community Social Environment Characteristics

The complex demographic composition in communities surrounding Xiangya Hospital has eroded residents’ sense of security and mutual trust.

• Social Fragmentation

Elderly interviewees noted minimal social interaction among permanent residents, who originate from diverse professional and socioeconomic backgrounds, despite sharing the same neighborhood. High tenant turnover further destabilizes community cohesion, with long-term homeowners expressing insecurity about transient occupants. This alienation is exacerbated by frequent conflicts, such as noise disturbances from transient tenants disrupting elderly residents’ rest.

Medical students and patients/caregivers view their housing as purely functional overnight shelters, further limiting community engagement. Consequently, most residents coexist as strangers, lacking shared identity or collective responsibility.

2.

Governance Deficits

Residents reported governance apathy, with community management agencies routinely ignoring service requests and displaying dismissive attitudes toward resident concerns. This institutional neglect has fostered widespread disillusionment, as evidenced by low participation in surveys and interviews. Many residents declined to voice opinions, believing their input would be disregarded—a stark contradiction to participatory renewal principles.

5. Empirical Research

5.1. Research Variables

Building on the literature review and preliminary findings, this study operationalizes independent variables into two categories: demographic variables and subjective perception variables. Independent variables were structured across three dimensions—housing conditions, communal spaces, and social relations—with subjective variables measured using a five-point Likert scale (1 = “strongly disagree” to 5 = “strongly agree”). The specific details are provided in

Table 1. Indicators of independent variables.

Category		Variables
Demographic variables		Gender (X1), Marital status (X2), Age (X3), Occupation (X4), Duration of residence (X5), House ownership (X6), Cohabitation status (X7), Monthly income (X8) [14,15]
Subjective variables	Housing space	Space size (Z1), Building quality (Z2), Sound insulation (Z3), Ventilation and lighting (Z4), Facilities and equipment (Z5) [18,19,20,21]
	Community public space	Greenery (Z6), Sanitation conditions (Z7), Security (Z8), Activity spaces (Z9), Recreational facilities (Z10), Basic infrastructure (Z11) [16,23,24,25,26]
	Social relations	Property management (Z12), Interaction frequency(Z13), Sense of community belonging (Z14), Neighborly relations (Z15), Tenant management (Z16) [17,27,28,29,30,31]

.

5.2. Statistical Results

This study systematically investigates the influencing mechanisms of residential satisfaction in older communities surrounding urban hospitals through quantitative methods, employing SPSS 26 software for data analysis. The research framework proceeded as follows:

First, a two-stage hierarchical linear regression model was applied to control for potential confounding effects of demographic variables while analyzing the roles of built environment and social environment factors. In the initial stage (Model 1), relationships between control variables and residential satisfaction were examined. Subsequently, in the second stage (Model 2), independent variables were introduced to assess their unique contributions to satisfaction.

Next, a structural equation model (SEM) was constructed based on regression results to dissect mediating pathways through which key independent variables influence satisfaction via three dimensions: housing space, community public space, and social relations.

Finally, moderation analyses were conducted to identify population heterogeneity by incorporating interaction terms between built environment variables and moderators. Significant interaction effects were interpreted through simple slope analysis, revealing subgroup-specific variations in satisfaction determinants.

The specific findings from the data analysis are presented as follows.

5.2.1. Respondent Demographics

The demographic profile of respondents revealed a relatively balanced age distribution, with approximately one quarter being under 30 years old and another quarter over 55 years old. A majority (58.6%) had resided in the community for more than three years, while 40.3% identified as renters. Nearly half (47.1%) shared their housing units with others. In terms of residential experience, 60.2% of participants reported satisfaction with their current living conditions, contrasting with 24.6% who expressed negative perceptions. Detailed demographic characteristics are summarized in

Table 2. Characteristics of respondents.

Characteristic	Categories	Frequency	% of Respondents
Gender (X1)	Male = 1	144	56.3
	Female = 2	112	43.8
Marital status (X2)	Married = 1	194	75.8
	Unmarried = 2	62	24.2
Age (X3)	≤30 years old = 1	65	25.4
	31~40 years old = 2	57	22.3
	41~54 years old = 3	71	27.7
	≥55 years old = 4	63	24.6
Occupation (X4)	Students = 1	65	25.4
	Medical workers = 2	30	11.7
	Others = 3	25	9.8
	Retired = 4	136	53.2
Duration of residence (X5)	Less than 1 year = 1	28	10.9
	1~3 years (including 3 years) = 2	84	32.8
	3~5 years (including 5 years) = 3	66	25.8
	5~10 years (including 10 years) = 4	44	17.2
	More than 10 years = 5	34	13.3
House ownership (X6)	Owner = 1	160	62.5
	Tenant = 2	96	37.5
Cohabitation status (X7)	Living alone = 1	146	57
	Sharing a flat = 2	110	43
Monthly income (X8)	Less than 1000 RMB = 1	36	14.1
	1001~2000 RMB = 2	28	10.9
	2001~3000 RMB = 3	60	23.4
	3001~5000 RMB = 4	53	20.7
	5001~8000 RMB = 5	34	13.3
	8001 RMB or more = 6	45	17.6
Residence satisfaction (Y)	Very unsatisfied = 1	33	12.9
	Unsatisfied = 2	30	11.7
	Neutral = 3	39	15.2
	Satisfied = 4	97	37.9
	Very satisfied = 5	57	22.3

.

5.2.2. Reliability and Validity Analysis

Reliability analysis was conducted to assess the internal consistency of measurement items and evaluate questionnaire design appropriateness. The overall reliability (Cronbach’s α) of subjective variables Z1–Z16 reached 0.923, indicating excellent internal consistency.

Validity analysis evaluated the extent to which questionnaire items effectively captured their intended constructs. The validity assessment for both demographic and subjective variables produced a coefficient of 0.959 (see

Table 3. Validity analysis results.

KMO and Bartlett’s Test
KMO Measure of Sampling Adequacy		0.959
Bartlett’s Test of Sphericity	Approx. Chi-Square	2968.035
	Degrees of Freedom	120
	Significance	0.000

), indicating robust reliability. This result confirms significant intrinsic relationships between the independent and dependent variables in the questionnaire.

5.2.3. Correlation Analysis

Prior to regression analysis, Pearson’s correlation analysis was conducted to examine correlations between independent variables (demographic variables X1–X8 and subjective variables Z1–Z16) and the dependent variable (Y). The results of these correlations are presented in

Table 4. Correlation analysis of subjective variables with the dependent variable.

Variable	Correlation	Variable	Correlation
Gender (X1)	−0.062	Satisfaction with indoor equipment and facilities (Z5)	0.689 **
Marital status (X2)	−0.201 **	Satisfaction with community greenery (Z6)	0.608 **
Age (X3)	0.685 **	Satisfaction with community sanitation conditions (Z7)	0.672 **
Occupation (X4)	0.757 **	Satisfaction with community public security (Z8)	0.713 **
Duration of residence (X5)	0.381 **	Satisfaction with size of community activity spaces (Z9)	0.724 **
House ownership (X6)	−0.087	Satisfaction with community recreational facilities (Z10)	0.773 **
Cohabitation status (X7)	−0.117	Satisfaction with community basic service facilities (Z11)	0.755 **
Monthly income (X8)	0.681 **	Satisfaction with community property management level (Z12)	0.171 **
Satisfaction with indoor space size (Z1)	0.733 **	Satisfaction with interaction with other community residents (Z13)	0.630 **
Satisfaction with building quality (Z2)	0.379 **	Satisfaction with community sense of belonging (Z14)	0.312 **
Satisfaction with building sound insulation performance (Z3)	0.543 **	Satisfaction with overall community resident relationships (Z15)	0.735 **
Satisfaction with indoor ventilation and lighting (Z4)	0.712 **	Satisfaction with community tenant management (Z16)	0.220 **

Notes: ** significant correlation at the 0.01 level (two-tailed).

.

The correlation analysis revealed statistically significant relationships between the dependent variable (Y) and all independent variables except Gender (X1), House ownership (X6), and Cohabitation status (X7). Linear regression analysis can thus be appropriately applied to the remaining variables exhibiting significant correlations.

In this study, a hierarchical linear regression model was constructed:

Model 1 incorporated demographic variables (X2, X3, X4, X5) exhibiting significant correlations with the dependent variable (Y) as control variables.

Model 2 introduced subjective variables (Z1–Z16) alongside these controls to assess their combined explanatory power.

Both models underwent multicollinearity and residual independence diagnostics, with variance inflation factors (VIF) for all variables below 10, confirming no severe collinearity issues. Regression outcomes, including standardized coefficients and significance levels, are detailed in

Table 5. Regression model of residential satisfaction.

	Unstandardized Coefficients		Standardized Coefficients	t	p	95.0% Confidence Interval for B		VIF
	B	Std. Error	Beta			Lower-Bound	Upper-Bound
Model 1
Constant	0.35	0.198		1.77	0.078	−0.039	0.74
Marital status (X2)	0.01	0.061	0.006	0.163	0.871	−0.11	0.13	1.074
Age (X3)	0.281	0.062	0.241	4.53	0.000 **	0.159	0.403	2.123
Occupation (X4)	0.501	0.08	0.375	6.279	0.000 **	0.344	0.659	2.687
Duration of residence (X5)	0.143	0.042	0.133	3.437	0.001 **	0.061	0.226	1.123
Monthly income (X8)	0.201	0.041	0.249	4.887	0.000 **	0.12	0.281	1.954
R2	0.668
Adjusted R2	0.661
F value	100.518, p = 0.000 **
ΔR2	0.668
ΔF	100.518, p = 0.000 **
Model 2
Constant	−1.036	0.235		−4.409	0.000	−1.499	−0.573
Marital status (X2)	0.074	0.054	0.046	1.358	0.176	−0.033	0.18	1.185
Age (X3)	0.258	0.07	0.221	3.701	0.000 **	0.121	0.396	3.74
Occupation (X4)	0.122	0.083	0.091	1.46	0.146	−0.043	0.286	4.08
Duration of residence (X5)	0.099	0.037	0.091	2.679	0.008 **	0.026	0.171	1.214
Monthly income (X8)	0.08	0.04	0.1	2.003	0.046 *	0.001	0.159	2.59
Satisfaction with indoor space size (Z1)	0.135	0.057	0.135	2.38	0.018 **	0.023	0.247	3.381
Satisfaction with building quality (Z2)	0.086	0.043	0.072	2.028	0.044 *	0.002	0.17	1.314
Satisfaction with building sound insulation performance (Z3)	0.028	0.054	0.028	0.525	0.600	−0.078	0.134	3.039
Satisfaction with indoor ventilation and lighting (Z4)	0.076	0.058	0.074	1.316	0.189	−0.038	0.191	3.336
Satisfaction with indoor equipment and facilities (Z5)	−0.023	0.058	−0.023	−0.393	0.695	−0.138	0.092	3.526
Satisfaction with community greenery (Z6)	0.143	0.051	0.137	2.807	0.005 **	0.043	0.243	2.48
Satisfaction with community sanitation conditions (Z7)	−0.068	0.054	−0.069	−1.263	0.208	−0.174	0.038	3.133
Satisfaction with community public security (Z8)	−0.041	0.062	−0.041	−0.661	0.509	−0.164	0.082	3.976
Satisfaction with size of community activity spaces (Z9)	0.049	0.064	0.045	0.76	0.448	−0.078	0.175	3.678
Satisfaction with community recreational facilities (Z10)	0.181	0.062	0.184	2.921	0.004 **	0.059	0.303	4.133
Satisfaction with community basic service facilities (Z11)	0.079	0.062	0.081	1.277	0.203	−0.043	0.201	4.242
Satisfaction with community property management level (Z12)	0.059	0.029	0.076	2.056	0.041 *	0.002	0.115	1.431
Satisfaction with interaction with other community residents (Z13)	−0.138	0.053	−0.135	−2.598	0.010 *	−0.243	−0.033	2.829
Satisfaction with community sense of belonging (Z14)	0.101	0.034	0.1	2.965	0.003 **	0.034	0.168	1.179
Satisfaction with overall community resident relationships (Z15)	0.072	0.06	0.074	1.186	0.237	−0.047	0.19	4.032
Satisfaction with community tenant management (Z16)	0.07	0.029	0.092	2.401	0.017 *	0.013	0.128	1.522
R2	0.776
Adjusted R2	0.756
F value	38.651, p = 0.000 **
ΔR2	0.108
ΔF value	7.085, p = 0.000 **

Notes: * p < 0.05; ** p < 0.01.

.

Model 1 demonstrated statistical significance (p = 0.000 **) with a goodness-of-fit (R²) of 0.668. Among the demographic variables, Age (X3), Profession (X4), Duration of residence (X5), and Monthly income (X8) exhibited significant impacts on residential satisfaction. The beta coefficient ranking revealed the following order of contribution: Professions (X4) > Monthly Income (X8) > Age (X3) > Duration of Residence (X5). Based on this hierarchy, renewal strategies should prioritize addressing occupational disparities and income inequality, followed by mitigating the combined effects of age and residency duration on satisfaction outcomes.

In the second-level regression analysis (Model 2), the model achieved a goodness-of-fit of R² = 0.776 with a statistically significant p-value of 0.000, confirming its validity. After controlling for variables with substantial influence in prior analyses—Age (X3), Duration of Residence (X5), and Monthly Income (X8)—the following factors significantly affected the dependent variable: Space Size (Z1), Greenery (Z6), Recreational Facilities (Z10), Sense of Community Belonging (Z14), Building Quality (Z2), Property Management (Z12), Interaction Frequency (Z13), and Tenant Management (Z16). The beta coefficient ranking was ordered as follows: Recreational Facilities (Z10) > Greenery (Z6) > Space Size (Z1) > Sense of Community Belonging (Z14) > Tenant Management (Z16) > Property Management (Z12) > Building Quality (Z2) > Interaction Frequency (Z13). Consequently, renewal strategies should prioritize recreational facilities and greenery enhancement as central priorities, while addressing spatial equity and social integration to holistically improve community outcomes.

These findings, detailed in Table 5, highlight the interplay between physical environment enhancements and social governance improvements in shaping residential satisfaction.

5.2.4. Structural Equation Model Construction

To further explore differences in influencing pathways across resident subgroups, a structural equation model (SEM) was developed based on regression analysis results. The model specified causal pathways between independent variables (age, length of residence, income, occupation), mediating variables (housing space, community public space, social relations), and the dependent variable (residential satisfaction). Hypotheses included: (1) independent variables directly affect mediating variables; (2) mediating variables directly influence the dependent variable; and (3) all independent variables exert direct effects on the dependent variable.

Unstandardized and standardized regression coefficients were employed to quantify effect sizes between variables. Model parameters were estimated using maximum likelihood estimation, with standard errors (SEs), critical ratios (z-values/CR values), and significance levels (p-values) calculated. Model fit was evaluated through multiple indices, including the chi-square-to-degrees-of-freedom ratio (χ²/df), goodness-of-fit index (GFI), root mean square error of approximation (RMSEA), and comparative fit index (CFI). The results are presented in

Table 6. Analysis of path significance and effect strength.

Independent Variable		Mediating Variable	Unstandardized Coefficient	SE	z	p	Standardized Coefficient
Age (X3)	→	Housing space	1.267	0.088	14.406	0.000 **	0.966
	→	Community public space	1.017	0.087	11.673	0.000 **	1
	→	social relations	0.496	0.097	5.102	0.000 **	1
	→	Residential satisfaction	0.419	0.165	2.538	0.011 *	0.285
Occupation (X4)	→	Housing space	1.281	0.072	17.785	0.000 **	0.974
	→	Community public space	1.031	0.077	13.434	0.000 **	0.994
	→	social relations	0.509	0.095	5.33	0.000 **	1
	→	Residential satisfaction	0.54	1.944	0.278	0.781	0.378
Duration of residence (X5)	→	Housing space	2.322	0.367	6.321	0.000 **	0.971
	→	Community public space	1.894	0.313	6.054	0.000 **	0.999
	→	social relations	0.908	0.22	4.131	0.000 **	1
	→	Residential satisfaction	0.3	10.393	0.029	0.977	0.12
Monthly income (X8)	→	Housing space	0.861	0.059	14.671	0.000 **	0.969
	→	Community public space	0.707	0.058	12.123	0.000 **	1
	→	social relations	0.338	0.066	5.123	0.000 **	1
	→	Residential satisfaction	0.173	0.166	1.041	0.298	0.181
Mediating Variable → Residential satisfaction
Mediating Variable		Model	Unstandardized Coefficient	SE	z	p	Standardized Coefficient
Housing space	→	Age (X3)	0.199	0.283	0.704	0.482	0.178
	→	Occupation (X4)	0.04	0.439	0.091	0.927	0.037
	→	Duration of residence (X5)	0.188	0.412	0.457	0.648	0.18
	→	Monthly income (X8)	0.202	0.3	0.672	0.501	0.188
Community public space	→	Age (X3)	0.218	0.168	1.299	0.194	0.151
	→	Occupation (X4)	−0.047	2.024	−0.023	0.982	−0.034
	→	Duration of residence (X5)	0.703	9.665	0.073	0.942	0.534
	→	Monthly income (X8)	0.504	0.117	4.294	0.000 **	0.373
social relations	→	Age (X3)	0.84	0.082	10.262	0.000 **	0.283
	→	Occupation (X4)	1.531	0.989	1.547	0.122	0.545
	→	Duration of residence (X5)	0.355	9.435	0.038	0.97	0.129
	→	Monthly income (X8)	0.557	0.056	9.944	0.000 **	0.197

Notes: * p < 0.05; ** p < 0.01; “→” represents standardized path coefficients in the structural model.

and

Table 7. Comparison of model fit indices.

Fit Index	Threshold Criteria	Age (X3) Model	Duration of Residence (X5) Model	Monthly income (X8) Model	Occupation (X4)
χ2/df	<3	2.639	1.828	1.899	1.816
GFI	>0.9	0.872	0.912	0.906	0.911
RMSEA	<0.10	0.08	0.057	0.059	0.057
CFI	>0.9	0.941	0.968	0.967	0.971

.

The analysis of Table 6 and Table 7 reveals the following findings: Age (X3) and Income (X8) exhibit strongly significant effects on the mediating variables. Social relations and Community public space demonstrate significant mediating effects on residential satisfaction, whereas housing space shows no significant impact. Additionally, the direct effects of Occupation (X4) and Duration of residence (X5) on residential satisfaction are statistically non-significant. All models meet the established fit criteria, with χ²/df ratios below 3, RMSEA values under 0.1, and CFI scores exceeding 0.9, indicating robust overall model fit. Comprehensive analysis identifies social relationships and community public space as the core mediating variables influencing residential satisfaction, a finding consistent with the results obtained from on-site surveys.

5.2.5. Moderating Effect Testing

To avoid masking critical heterogeneous needs under generalized models, this study incorporated moderation analysis to examine whether a variable alters the strength or direction of another variable’s effect on the outcome. A significant moderating effect indicates subgroup heterogeneity in variable relationships, enabling data-driven strategy formulation.

Based on survey and analytical results, selected demographic variables were recoded. For instance, participants were categorized into an older adult group (X = 4) and non-older adult groups (X = 1, 2, 3). Continuous variables were centered to reduce multicollinearity between interaction terms and main effects. Models were constructed with age category (older vs. non-older adults) and resident type (long-term residents, medical students, patients and their caregivers) as moderators, built environment variables as independent variables, and residential satisfaction as the dependent variable. A significant interaction term coefficient confirmed the presence of moderating effects. Subsequently, the impact of built environment satisfaction on residential satisfaction was separately reported for each subgroup based on interaction term coefficients, revealing how these relationships vary across population segments.

The detailed results are presented in

Table 8. Moderating effect results 1 (moderator: age; 1 = non-elderly; 2 = elderly).

Independent Variable	B	p	t	ΔR2 (Model 3)
Satisfaction with indoor space size (Z1)	−0.172	0.000 **	−3.824	0.021
Satisfaction with building quality (Z2)	0.103	0.265	1.124	0.011
Satisfaction with building sound insulation performance (Z3)	−0.041	0.664	−0.436	0.002
Satisfaction with indoor ventilation and lighting (Z4)	−0.048	0.614	−0.507	0.003
Satisfaction with indoor equipment and facilities (Z5)	−0.261	0.000 **	−5.656	0.047
Satisfaction with community greenery (Z6)	0.180	0.030 *	2.209	0.038
Satisfaction with community sanitation conditions (Z7)	0.110	0.256	1.145	0.012
Satisfaction with community public security (Z8)	0.191	0.023 *	2.312	0.053
Satisfaction with size of community activity spaces (Z9)	0.207	0.018 *	2.428	0.053
Satisfaction with community recreational facilities (Z10)	0.022	0.830	0.216	0.000
Satisfaction with community basic service facilities (Z11)	−0.103	0.386	−0.872	0.007
Satisfaction with community property management level (Z12)	0.385	0.000 **	4.298	0.033
Satisfaction with interaction with other community residents (Z13)	0.043	0.666	0.433	0.002
Satisfaction with community sense of belonging (Z14)	−0.304	0.026 *	−2.236	0.016
Satisfaction with overall community resident relationships (Z15)	−0.024	0.818	−0.231	0.000
Satisfaction with community tenant management (Z16)	−0.349	0.005 **	−2.866	0.024

Notes: * p < 0.05; ** p < 0.01.

,

Table 9. Moderating effect results 2 (moderator: resident type; 1 = long-term residents; 2 = medical students).

Independent Variable	B	p	t	ΔR2 (Model 3)
Satisfaction with indoor space size (Z1)	0.132	0.002 **	3.134	0.018
Satisfaction with building quality (Z2)	0.11	0.273	1.099	0.003
Satisfaction with building sound insulation performance (Z3)	0.227	0.000 **	5.081	0.051
Satisfaction with indoor ventilation and lighting (Z4)	0.133	0.002 **	3.108	0.017
Satisfaction with indoor equipment and facilities (Z5)	0.156	0.001 **	3.340	0.022
Satisfaction with community greenery (Z6)	0.033	0.729	0.347	0.000
Satisfaction with community sanitation conditions (Z7)	0.137	0.129	1.525	0.004
Satisfaction with community public security (Z8)	0.211	0.000 **	4.885	0.042
Satisfaction with size of community activity spaces (Z9)	0.067	0.504	0.669	0.001
Satisfaction with community recreational facilities (Z10)	0.028	0.750	0.319	0.000
Satisfaction with community basic service facilities (Z11)	0.153	0.115	1.583	0.005
Satisfaction with community property management level (Z12)	0.035	0.714	0.367	0.000
Satisfaction with interaction with other community residents (Z13)	0.052	0.607	0.515	0.001
Satisfaction with community sense of belonging (Z14)	−0.036	0.720	−0.359	0.000
Satisfaction with overall community resident relationships (Z15)	0.219	0.000 **	4.41	0.04
Satisfaction with community tenant management (Z16)	0.137	0.001 **	3.259	0.018

Notes: ** p < 0.01.

and

Table 10. Moderating effect results 3 (moderator: resident type; 1 = long-term residents; 2 = patients and their caregivers).

Independent Variable	B	p	t	ΔR2 (Model 3)
Satisfaction with indoor space size (Z1)	−0.036	0.701	−0.384	0.000
Satisfaction with building quality (Z2)	0.008	0.936	0.081	0.000
Satisfaction with building sound insulation performance (Z3)	0.222	0.000 **	6.653	0.074
Satisfaction with indoor ventilation and lighting (Z4)	0.195	0.000 **	6.33	0.056
Satisfaction with indoor equipment and facilities (Z5)	−0.027	0.79	−0.266	0.000
Satisfaction with community greenery (Z6)	0.134	0.000 **	3.756	0.023
Satisfaction with community sanitation conditions (Z7)	0.188	0.000 **	5.696	0.049
Satisfaction with community public security (Z8)	0.064	0.519	0.646	0.001
Satisfaction with size of community activity spaces (Z9)	0.190	0.000 **	5.491	0.046
Satisfaction with community recreational facilities (Z10)	0.136	0.000 **	4.372	0.028
Satisfaction with community basic service facilities (Z11)	0.140	0.000 **	4.455	0.031
Satisfaction with community property management level (Z12)	0.064	0.533	0.625	0.001
Satisfaction with interaction with other community residents (Z13)	−0.062	0.549	−0.601	0.001
Satisfaction with community sense of belonging (Z14)	−0.064	0.528	−0.633	0.001
Satisfaction with overall community resident relationships (Z15)	−0.014	0.872	−0.161	0.000
Satisfaction with community tenant management (Z16)	0.140	0.000 **	3.869	0.025

Notes: ** p < 0.01.

.

The table above demonstrates distinct priorities between elderly and younger residents in community satisfaction drivers. Elderly individuals exhibit heightened sensitivity to community greenery, public security, activity spaces, and property management. The significant positive interaction coefficient for greenery (B = 0.180, p = 0.030) indicates that older adults’ satisfaction increases markedly with improved green environments. Similarly, robust moderating effects for public security (B = 0.191, p = 0.023) and activity spaces (B = 0.207, p = 0.018) underscore their reliance on safety and social infrastructure. Property management exerts the strongest moderating effect (B = 0.385, p = 0.000), highlighting older adults’ critical dependence on daily services.

In contrast, younger residents prioritize spatial adequacy, modernized facilities, and tenant management. The negative interaction coefficient for spatial size (B = −0.172, p = 0.000) reveals their significantly greater sensitivity to living space compared to older adults. Negative moderating effects for equipment modernization (B = −0.261, p = 0.000) and tenant management (B = −0.349, p = 0.005) suggest younger residents emphasize contemporary amenities and stricter control over transient populations. Notably, community belongingness (B = −0.304, p = 0.026) disproportionately impacts younger residents’ satisfaction, implying a need for enhanced social integration initiatives to foster their sense of belonging.

The moderating effect analysis reveals distinct priorities among student populations in shaping residential satisfaction. Students demonstrate heightened sensitivity to sound insulation, community security, resident relationships, and tenant management. The significant positive interaction coefficient for sound insulation (B = 0.227, p = 0.000) indicates that noise reduction measures substantially enhance their satisfaction, reflecting lower tolerance for auditory disturbances. Similarly, robust moderating effects for community security (B = 0.211, p = 0.000) and resident relationships (B = 0.219, p = 0.000) underscore their strong demand for safe environments and social support networks. The moderating effect of tenant management (B = 0.137, p = 0.001) further highlights students’ heightened awareness of transient population regulation. Additionally, the significant coefficient for spatial efficiency (B = 0.132, p = 0.002) suggests that students prioritize functional utilization of living spaces more intensely than long-term residents, emphasizing pragmatic spatial design in their residential evaluations.

The analysis of moderating effects highlights distinct priorities among patients and their families in shaping residential satisfaction. Patient populations exhibit heightened sensitivity to sound insulation, ventilation and lighting, sanitation conditions, activity spaces, and tenant management. The significant interaction coefficient for sound insulation (B = 0.222, p = 0.000) demonstrates that noise reduction measures substantially enhance their satisfaction. Similarly, robust moderating effects for ventilation and lighting (B = 0.195, p = 0.000) and sanitation conditions (B = 0.188, p = 0.000) underscore their elevated demands for air quality and cleanliness compared to long-term residents. The moderating effects of activity spaces (B = 0.190, p = 0.000) and infrastructure (B = 0.140, p = 0.000) reflect patients’ reliance on adequate space for rehabilitation exercises and dependable barrier-free facilities. Tenant management also shows a significant moderating effect (B = 0.140, p = 0.000), aligning with their need for controlled community environments. Additional indicators, such as community greenery (B = 0.134, p = 0.000) and activity facilities (B = 0.136, p = 0.000), further emphasize the critical role of green spaces and accessible amenities in promoting psychological well-being for patients and logistical convenience for their families.

5.3. Discussion

5.3.1. Heterogeneous Needs Across Subgroups

The data reveal pronounced heterogeneity in residential needs among different populations in older communities near Xiangya Hospital. Elderly residents exhibit heightened sensitivity to community greenery, public security, and property management (Z6, Z8, Z12), reflecting their reliance on safety, convenience, and environmental comfort. Field surveys indicate that older adults predominantly engage in daily activities within community boundaries, where the quality of green public spaces directly impacts their physical and psychological well-being—a finding consistent with Zaťovičová’s research [38]. Additionally, property service quality (e.g., timely maintenance, responsiveness to resident concerns) critically influences their daily convenience, aligning with Huang’s observations [39].

On the other hand, medical students demonstrated stronger statistical significance across most variables in housing space (Z1, Z3–Z5), while few variables in community public space reached significance, indicating their prioritization of indoor spatial quality over communal public spaces. The particularly stringent demands for sound insulation (β = 0.227) align closely with Rattapon’s findings [40]. This preference aligns with their heightened focus on community social safety (Z8, Z15) and tenant management (Z16), suggesting a desire to cultivate a harmonious and trust-based living environment with fellow residents.

Patient and caregiver populations, however, prioritize functional and health-supportive features. Strong correlations with sound insulation (Z3), ventilation and lighting (Z4), sanitation conditions (Z7), and facilities (Z11) highlight their acute sensitivity to health-oriented physical environments. For instance, poor ventilation may exacerbate respiratory risks, while inadequate sanitation impedes recovery. Furthermore, moderating effects for activity spaces (Z9) and infrastructure (Z11) suggest patients require public spaces that integrate rehabilitation functionality with accessibility. These findings resonate with the “environmental therapeutic” theory in medical sociology [41], emphasizing the supportive role of physical environments in psychological and physiological recovery.

To address these disparities, urban planning must transition from standardized static provision to precision-targeted dynamic adaptation. For elderly-dense areas, strategies include installing rest pavilions, enhancing nighttime lighting coverage, and establishing rapid property management response systems. For medical students, priority interventions should include retrofitting soundproof walls, integrating smart home technologies, and implementing tenant registration systems to enhance security. Concurrently, organizing community cultural activities can foster resident interaction and strengthen mutual trust, addressing their dual needs for private living environments and predictable social dynamics. For patients and caregivers, interventions should focus on consolidating community healthcare resources, designing therapeutic gardens, expanding barrier-free facilities, and conducting regular sanitation protocols. Such tailored approaches ensure equitable resource allocation while addressing the unique needs of each subgroup.

5.3.2. Built Environment Enhancement

The built environment, as the material foundation of residential satisfaction, directly shapes residents’ daily living experiences through its quality and functional configuration. In terms of building spatial quality, indoor space size (Z1) and structural safety (Z3) play foundational roles. Older communities commonly face challenges of cramped living spaces, which often fail to meet modern living requirements. Concurrently, prolonged building age raises significant concerns among residents regarding structural safety, reflecting anxieties about deteriorating construction standards and maintenance gaps.

Regarding community public space design, greenery and recreational facilities exhibit the highest contributions. Green spaces not only improve microclimates but also serve multifunctional roles in social interaction and health promotion [42,43]. However, field surveys reveal significant greenery deficits in older communities around Xiangya Hospital, necessitating urgent efforts to increase green coverage.

Additionally, supporting infrastructure (Z11) and property service levels (Z12) exert positive influences on residents’ residential satisfaction. Notably, the moderating effect of property service quality is particularly pronounced among the older adult population (Z12, B = 0.385), underscoring its critical role in addressing their daily convenience and safety concerns. Yet, older communities face systemic challenges such as low property fee collection rates and insufficient management funding, making market-driven service improvements unsustainable. A hybrid model combining government subsidies and resident co-governance is proposed to address these institutional barriers.

Optimizing the built environment requires prioritizing “micro-regeneration” strategies that balance efficiency and equity. For instance, “pocket greening” tactics can create dispersed green spaces to alleviate pressure on central areas, while low-cost retrofits like double-glazed windows and sound-absorbing materials can address noise issues in acoustically weak buildings. Expanding peripheral public amenities (e.g., community kitchens, gyms) can reduce indoor functional demands and enhance convenience for younger residents. Additionally, establishing “facility maintenance archives” enables regular inspections and preventive maintenance to avoid systemic failures. Spatial upgrades must extend beyond physical investments to incorporate resident feedback through participatory design, avoiding resource waste from uniform planning. Field surveys further advocate for a “lifetime accountability mechanism”, ensuring construction teams bear long-term responsibility for project outcomes. This guarantees accessible recourse for residents in case of quality issues, fostering trust between stakeholders and the community.

5.3.3. Social Relationship Restructuring

The role of social relationships in residential satisfaction is often oversimplified as “neighborhood harmony”, yet this study reveals its multi-layered and dynamic mechanisms. Structural equation modeling demonstrates that social relationships influence satisfaction through two pathways: community sense of belonging (Z14) and resident interaction (Z13), with differential moderating effects across subgroups. The moderating effect analysis revealed that the moderating role of community belongingness was non-significant among student populations. Field surveys suggest this phenomenon likely stems from their self-perception as “temporary dwellers”—medical students, constrained by academic cycles, tend to perceive the community as a transitional space rather than a locus of emotional attachment. Similarly, patients and their families exhibit low sensitivity to generalized social networks, reflecting a “utility-first” mindset under health-related stressors, where tangible support (e.g., caregiving, information sharing) outweighs broad social connections.

The moderating effect of tenant management (Z16, β = 0.092) underscores the institutional shaping of social dynamics. Younger residents’ demand for stringent regulation (β = −0.349) aligns with security concerns, while patients prioritize rights protection through management norms (β = 0.140). This paradox necessitates balancing safety and inclusivity in transient population governance.

Cultivating community capital requires transcending conventional “activity-intensive” approaches through institutional innovation and spatial empowerment. Digitally mediated solutions, such as community apps, could establish online deliberative platforms to foster intergenerational and cross-group dialog, particularly amplifying marginalized voices (e.g., caregivers). Public spaces should be reimagined as “relationship incubators”—for instance, integrating shared vegetable gardens into green areas to encourage collaborative cultivation, enhancing both interaction and environmental stewardship. Property management firms could evolve into “community service coordinators”, bridging generational gaps by organizing skill-sharing workshops that connect elderly residents’ expertise with younger populations’ technical needs. Crucially, relationship optimization must avoid over-intervention, respecting residents’ autonomy to prevent participation fatigue from ritualized activities.

6. Conclusions

In contrast to existing studies, the innovation of this strategy lies in its systematic identification and response to the complex needs of heterogeneous populations in older urban communities adjacent to hospitals. While prior research has predominantly focused on physical space optimization, this study introduces a holistic framework that integrates socio-relational dynamics into community renewal planning. By synergizing hardware upgrades with soft governance innovations, the approach addresses residents’ escalating and diversified demands while offering a scalable model for sustainable revitalization.

This empirical study reveals that current community renewal strategies predominantly targeting elderly populations may inadequately address the needs of heterogeneous communities surrounding Xiangya Hospital, where transient groups such as medical students, patients, and low-income caregivers constitute significant demographics. These groups demand greater policy attention, serving as a critical complement to the existing “long-term resident-centric” renewal framework.

This study systematically investigates the core determinants of residential satisfaction and the heterogeneous mechanisms across different demographic groups in the older communities surrounding Xiangya Hospital through multilevel linear regression, structural equation modeling (SEM), and moderating effect analysis, providing critical insights for targeted community renewal.

The findings reveal that key drivers of residential satisfaction include community greening, recreational facilities, and property management quality, while the foundational roles of indoor spatial adequacy and building safety remain significant. The SEM further highlights social relationships and community public spaces as pivotal mediating variables, whereas housing space exhibits no direct impact. Notably, distinct group-specific demands emerge: older adults demonstrate heightened sensitivity to greening, security, and property management efficiency, emphasizing their reliance on safety and service responsiveness; medical students prioritize sound insulation, security, and tenant management, reflecting their need for privacy and controlled environments; patients and their families focus on noise control, ventilation, hygiene, and accessible facilities, underscoring their dependence on health-supportive environments.

Three strategic approaches are proposed to optimize community renewal. First, precision-based environmental upgrades should be tailored to group-specific needs: enhancing greening coverage, installing nighttime lighting, and establishing rapid property service mechanisms for older adults; implementing low-cost soundproofing renovations, developing tenant registration systems, and fostering cultural activities to strengthen medical students’ sense of belonging; and optimizing ventilation, creating therapeutic gardens, improving accessible infrastructure, and intensifying sanitation protocols for patients. Second, social relationship empowerment should be prioritized through digital platforms to facilitate cross-group interactions, transforming public spaces into “relationship incubators”, while adopting hybrid governance models (e.g., “government subsidies + resident co-management”) to balance safety and inclusivity. Third, institutional innovations are essential, including establishing maintenance archives, implementing lifetime accountability for construction quality, and promoting participatory planning to integrate resident feedback and prevent resource mismatches.

This study also acknowledges limitations. While efforts were made to ensure random sampling, certain groups—such as night-shift healthcare workers and hospitalized patients—may have been underrepresented due to methodological constraints. Future research should refine sampling strategies to enhance representativeness. Additionally, as the community surveyed in this research has undergone minor urban renewal in recent years, and due to objective constraints during the study, it was not possible to clearly distinguish whether residential satisfaction was influenced by existing urban renewal measures. Therefore, the assertions regarding policy evaluation remain speculative. To address the limitations of the current research, we will refine the dimensions of questionnaire indicators in future studies and may adopt a comparative study approach.