Objective To investigate the willingness to, demands of and factors associated with participation in mutual support elder care among the empty nest elderly in rural area of poverty-stricken county in Hunan province.Methods Totally, 807 empty nest elderly persons were selected from 50 administrative villages of 5 townships in Anren county of Hunan province using stratified random cluster sampling, then they were surveyed by employing a self-designed questionnaire aiming to willingness to and demands of mutual support elder care, the Social Support Rating Scale,and Health-promoting Lifestyle Profile.Results Among 807 respon-dents, 33.71% of them were willing to participate in mutual support elder care, and their needs of mutual support elder care scored 3.22±0.63. Logistic analysis revealed that age, education, self-care agency level, number of chronic diseases, and health promotion lifestyle were predictors of willingness to participate in mutual support elder care （P＜0.01 for all）.Conclusion The willingness to participate in mutual support elder care among the empty nest elderly in rural area of poverty-stricken county is relatively low, whereas their demands for healthcare service is high. Those who are aged, who have higher education background, poorer self-care ability, and more chronic diseases, and who report low level of health promotion lifestyle, have strong willingness. Awareness of mutual support elder care should be enhanced, thus to promote healthy development of elder care in rural villages.