Feeling Good May Help China’s Elders Embrace Community Care, Study Finds

In the vast landscape of China’s aging society, one of the most pressing puzzles is why so many older adults fail to use the community- and home-based care services designed for them. A new study offers a striking answer that runs counter to purely economic or medical explanations: how elders feel about their lives—both in the moment and in terms of meaning and social connection—shapes whether they actually seek out care. The research, published in Current Psychology, suggests that well-being is not merely a pleasant byproduct of good aging, but an active gateway to care utilization that policymakers cannot afford to ignore.

The study was led by Paicheng Liu of Guangdong Medical University, together with Zili Xu of Zhejiang University’s School of Public Health, Yunying Zhu and Sisi Li of Zhejiang University School of Medicine, and colleagues. Drawing on data from 608 adults aged 60 and above in Qiantang District, Zhejiang Province, the team set out to test a deceptively simple hypothesis: that older people with higher well-being are more likely to engage with community- and home-based care, or CHBC, a service model that China has championed as a middle path between traditional family caregiving and institutional care.

What makes the study distinctive is its dual conception of well-being, rooted in decades of psychological theory. Hedonic well-being refers to pleasure, positive emotion, and life satisfaction—the classical philosophical pursuit of happiness—while eudaimonic well-being captures purpose, meaning, psychological functioning, and social contribution, tracing back to Aristotle’s notion of the good life. The researchers measured both dimensions using the Mental Health Continuum-Short Form, a validated instrument developed by Corey Keyes that assesses emotional, social, and psychological well-being along a continuum from languishing to flourishing. Rather than treating well-being as a single undifferentiated feeling, the analysis disentangled these strands and asked which of them actually predict care use.

The methodological design was equally careful. Participants were recruited through stratified random sampling, ensuring the sample reflected the older population of the district. CHBC utilization was measured along two axes: the frequency of service use and the variety of service types consumed, capturing both intensity and breadth of engagement. To analyze the data, the team employed descriptive statistics, linear regression, and—critically—propensity score matching, a statistical technique that helps control for confounding variables by comparing service users and non-users with otherwise similar characteristics. This allowed the authors to estimate the association of well-being with care utilization more rigorously than a naive correlation would permit.

The headline finding was clear: higher overall well-being scores were significantly associated with greater CHBC utilization, with a p-value of .019. When the researchers broke well-being into its components, two dimensions stood out. Emotional well-being, the hedonic component encompassing positive feelings and satisfaction with life, showed an even stronger association with service use (p = .007). Social well-being—encompassing a sense of belonging, social acceptance, and integration into one’s community—was also positively associated with utilization (p = .017). In other words, elders who feel good emotionally and feel connected socially are more likely to take advantage of the care services available to them.

Perhaps the most nuanced finding concerns the moderating role of social context. The associations between well-being dimensions and the use of specific service types differed according to marital status and living arrangements. Among married individuals and those who resided with others, higher well-being was linked to greater service utilization. This pattern suggests that well-being does not operate in a vacuum: its effect on care-seeking appears to be channeled through the social networks that surround an older adult. A spouse or co-residing family member may act as an information conduit, an encourager, or a logistical enabler, amplifying the tendency of a flourishing elder to engage with community services. Conversely, elders who are unmarried or living alone may face barriers that dampen even positive well-being into actual service use.

The implications of this finding ripple outward to a society undergoing one of the fastest demographic transitions in history. Research cited by the authors indicates that China’s population is aging at a faster pace than Japan’s over the coming decades, straining both family-based care traditions and the institutional care system. Confucian norms of filial piety have long made family caregiving the default expectation, yet shrinking family sizes, urban migration, and the rise of empty-nest households have eroded that foundation. CHBC has emerged as the policy response—an approach that delivers medical, personal, and social support while allowing elders to remain in their own homes and communities. Despite its demonstrated benefits, including reduced disability and promotion of aging in place documented in international studies, uptake in China has remained stubbornly low.

By identifying well-being as a significant correlate of utilization, the study reframes the problem. Previous frameworks, such as Andersen’s behavioral model of health services use, emphasized predisposing factors, enabling resources, and need. The new findings add psychological flourishing to that calculus: an elder’s emotional and social state influences whether services are sought even when they exist and are affordable. The mechanistic logic is plausible. Positive emotions broaden an individual’s thought-action repertoires and build personal resources, as psychologist Barbara Fredrickson’s work suggests, while purpose and social integration foster the self-efficacy needed to navigate service systems. Elders languishing emotionally or socially may lack the motivation, energy, or informational pathways to seek help, even when help is available.

The policy prescription that follows is both simple and profound. Rather than focusing solely on expanding service supply or lowering costs, the authors argue that policymakers should target older adults with low well-being and limited social networks—precisely the groups least likely to use services and most vulnerable to care gaps. Practical interventions could include integrating well-being screening into community health assessments, pairing isolated elders with peer navigators, and designing outreach programs that leverage spouse and co-resident networks to normalize and facilitate service uptake. In doing so, China’s care system would treat emotional and social flourishing not as a luxury for later, but as a precondition for the success of the entire care model.

The research also carries a caution about equity. If flourishing elders use services while languishing ones do not, existing disparities in care access could widen: those most in need may be the least likely to receive help. The study’s finding that the well-being effect operates differently across marital status and living arrangements offers a map of where such disparities concentrate. As aging societies worldwide grapple with sustainable long-term care, the Chinese evidence adds a new dimension to the global conversation: the psychology of happiness and meaning may be as consequential for elder care as economics or infrastructure. In the contest between hedonism and eudemonism, the victor appears to be older adults themselves—provided societies recognize that well-being is not the reward of good care, but, in part, the road to it.

Subject of Research: The role of hedonic and eudaimonic well-being in community- and home-based care utilization among older adults in China

Article Title: Hedonism and eudemonism: the role of well-being in community- and home-based care utilization among older adults in China

Article References: Liu, P., Xu, Z., Zhu, Y., & Li, S. (2026). Hedonism and eudemonism: the role of well-being in community- and home-based care utilization among older adults in China. Current Psychology, 45(17), Article 1483. https://doi.org/10.1007/s12144-026-10037-4

Image Credits: AI Generated

DOI: 10.1007/s12144-026-10037-4

Keywords: well-being, hedonism, eudaimonism, community-based care, home-based care, older adults, China, aging, social networks, care utilization, emotional well-being, Current Psychology