Use of Home and Community-Based Services and Loneliness in Older People with Functional Limitations

Abstract

Background Loneliness is one of the major health problems among older adults. Home and community-based services (HCBS) have become increasingly popular. Despite their health benefits, little is known about the relationship between HCBS use and loneliness in older people with functional limitations. Here, we aim to explore the characteristics of loneliness among older people with functional limitations and examine the association between HCBS use and loneliness in China. Methods We used data from the 2018 Health and Retirement Longitudinal Study, which includes a nationally representative sample of Chinese residents aged 65 and older with functional limitations. Logistic regression models were used to examine the associations between HCBS use and loneliness, and we further used propensity score matching to account for the potential selection. Result In China, 46% of functionally limited older adults felt lonely and only 22% of functionally limited older adults reported using HCBS in 2018. Compared with participants who did not receive HCBS, those who received HCBS were less likely to report loneliness (OR = 0.81, 95% CI = 0.63, 0.99, p = 0.048), and the results remained significant after adjusting for confounding using propensity score matching. Conclusion Our results showed that loneliness was common among functionally impaired older people in China, and the proportion of HCBS use was low. There was robust evidence to support that among people with functional limitations, HCBS use was associated with less loneliness. Further policies should promote the development of broader HCBS use for older people with functional impairments to reduce their loneliness.