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Objective: With China's rapid aging and urbanization concentrating older adults in cities, urban elder care has become an urgent challenge. Smart home technologies offer support for aging in place but remain underused. This study examines the factors influencing urban elderly individuals' willingness to use and pay for smart home services in China. It fills a critical research gap in understanding technology adoption for elderly care in the context of large-scale demographic and urban transitions. Methods: Data was collected from 639 elderly individuals across 12 communities in China through questionnaires in 2021. The study distinguishes between willingness to use, measuring technology acceptability, and willingness to pay, reflecting cost-value perceptions. Given the ordinal nature of the five-point Likert scale responses, ordered logistic regression was employed to analyze factors from three dimensions: predisposing factors (age, gender, marital status), enabling factors (income, insurance), and demand factors (life satisfaction, hospitalization history, health conditions), with appropriate controls for sample characteristics. Results: The empirical analysis revealed that factors such as age, life satisfaction, income, and health issues (including multiple chronic conditions such as insomnia, memory decline, and mobility problems) significantly impact older adults' willingness to use smart home services. In this model, age showed a negative effect, with older cohorts being more conservative. In contrast, for willingness to pay, age, hospitalization history, and income were found to be significant factors, with age again associated with increased resistance among the older groups. Conclusion: The study reveals that income capacity, health transitions, and age barriers critically determine smart home adoption among older adults. Policy implications include tailored digital literacy for older cohorts, subsidies to improve affordability, and integrating smart home consultations into hospital discharge planning. These targeted interventions can bridge the adoption gap and enable aging populations to access smart home health monitoring benefits.
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