From family support to smart health devices: addressing subjective community healthcare gaps in aging China.

Background and Objectives: Population aging is increasing pressure on community health services in China, while family support remains central to later-life care. It remains unclear whether smart health devices can help reduce subjective gaps between older adults' service needs and actual service use, and whether such effects depend on family support. Research Design and Methods: We analyzed pooled person-wave observations from the 2018, 2020, and 2023 waves of the China Longitudinal Aging Social Survey, including 34,482 observations from 18,292 respondents in 1,277 village or urban neighborhood community clusters. Subjective service gaps were measured as a binary indicator of severe unmet need, defined as unmet need for three or more community health services, and as a count of unmet services from 0 to 7. Mixed-effects logistic and negative binomial models examined the associations of intergenerational support, smart health device ownership, and comprehensive community care capacity with these outcomes. Interaction terms, predicted probabilities, and subgroup analyses were used to aid interpretation. Results: Intergenerational support alone did not show a stable gap-reducing association. Smart health devices moderated the association between intergenerational support and subjective service gaps, such that device ownership was more beneficial when family support was stronger. This pattern was more evident among urban residents, women, and adults aged 60-69 years. Discussion and Implications: Smart health devices are unlikely to reduce subjective service gaps on their own. Their value depends on whether older adults can use them within supportive family and community contexts.