With the rapid changes in Chinese society and the intensification of population aging, the oldest old women are facing complex challenges. Based on data from the 1998, 2008, and 2018 Chinese Longevity and Healthy Living Survey (CLHLS), this study analyzed the multiple dilemmas encountered by the oldest old women at the individual, family, and social levels. At the individual level, this group of women often face, among other concerns, educational inequality and cognitive decline, sub-optimal health status, and limited self-care abilities, as well as feelings of loneliness and negativity. At the family level, they often encounter widowhood in later years, living alone in an empty nest, low economic autonomy, and insufficient care resources. At the societal level, issues such as inadequate medical security, imperfect elderly care systems, and the absence of long-term care insurance are even more prominent. China’s oldest old women are an important focus in the governance of aging societies. Countering these problems requires the construction of a comprehensive governance strategy framework that includes the micro, middle, and macro levels. The governance path must accurately identify, scientifically assesses, and actively address these issues to equitably modernize the governance system’s capabilities and to enhance the quality of life and well-being of China’s oldest old women.
