Unmet community care needs and older adults’ well-being: the moderating role of childlessness in China

As China’s population ages rapidly amid declining traditional family support and rural–urban migration, community care services have emerged as a vital solution for eldercare. However, disparities between service demand and provision have created widespread unmet needs. This study investigates how unmet community care needs impact the health status and subjective well-being (SWB) of older adults, with attention to the moderator role of childlessness and variations across service types. The study analyzed four waves of data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008 to 2018, using two-way fixed-effects regression models (N = 8,301). Health status was assessed using self-rated, interviewer-rated, and comparative health, while SWB was measured by life satisfaction, positive affect, and negative affect. Unmet needs were associated with lower life satisfaction (β = -0.010, p < 0.01), reduced positive affect (β = -0.024, p < 0.01), and increased negative affect (β = 0.023, p < 0.01). Unmet needs also reduced self-rated health (β = -0.005, p < 0.05). These effects were weaker among childless older adults, while no significant effects were observed for interviewer-rated or comparative health—an important null finding indicating specificity to subjective perceptions. Service-specific analyses revealed that unmet needs in personal daily care and psychological support most strongly eroded SWB, while unmet needs in social/recreational activities and psychological support uniquely shaped health status. Unmet community care needs negatively affect health status and SWB, but their impact varies by service types and family structure. Childlessness appears to buffer against these adverse effects, reflecting adaptive coping and institutional support. Targeted expansion of psychological support, personal daily care, and social and recreational programs, together with culturally sensitive approaches that align with informal support norms, is essential to promote aging well in China.