Community services, unmet needs, and health among older adults in China: Self-determination as a mediator

We used data for 1,748 people aged 70–116 years drawn from the 2018 Chinese Longitudinal Healthy Longevity Study to assess pathways among community services provided for daily care, medical services, spiritual recreation, legal aid, unmet needs in these services, self-determination, and self-rated health. Daily care services were positively associated with self-rated health but reduced self-determination, whereas medical and spiritual services were positively associated with self-determination. Unmet needs for daily care services were directly associated with poorer selfrated health, and unmet needs for medical/spiritual services were negatively associated with self-determination. There was a positive association between self-rated health and self-determination, and self-determination mediated the associations of daily care, medical services, and spiritual services with self-rated health, and the association between unmet needs for medical and spiritual services and self-rated health. Addressing unmet needs in community services and fostering self-determination are critical pathways to promoting good health for older adults.