Home- and community-based service utilization and loneliness among older adults in China: the moderating role of elder abuse – a cross-sectional study

Introduction: Loneliness is a major public health concern among older adults. Home- and community-based services (HCBS) are increasingly promoted to support aging in place, yet evidence on their relationship with loneliness remains limited in China, particularly among vulnerable subgroups such as older adults with histories of elder abuse. Theory: Drawing on trauma theory, this study considers elder abuse as a contextual factor that may alter how HCBS utilization is associated with loneliness. Abuse may undermine trust, increase withdrawal, and reduce willingness to engage with available services. Method: Data were drawn from 8,940 participants in the 2018 China Longitudinal Aging Social Survey. HCBS utilization was operationalized as a binary indicator of self-reported use of at least one type of HCBS during the past 12 months. Loneliness was measured with the three-item UCLA Loneliness Scale. HCBS utilization (yes/no) was the primary exposure, and elder abuse history (yes/no) was examined as a moderator. Multivariable logistic regression models examined the associations among HCBS utilization, elder abuse, and loneliness. Results: HCBS utilization was associated with lower odds of loneliness, OR 0.61 (0.52, 0.71). A significant interaction between HCBS utilization and elder abuse was observed, OR 1.85 (1.03, 3.31). Among older adults without an abuse history, HCBS utilization was associated with lower odds of loneliness, OR 0.59 (0.50, 0.68), whereas no significant association was found among those with abuse histories, OR 1.08 (0.62, 1.90). Discussion: The HCBS-loneliness association may be attenuated among abuse survivors, supporting the need for trauma-informed HCBS models and further longitudinal research.