<p>From the perspective of healthy aging, assessing the multidimensional health status of older adults is crucial for identifying their specific health service needs, appropriate intervention strategies, and tailored health policies. This study aimed to examine the impact of adverse childhood experiences (ACEs) on multidimensional health patterns among older adults in China. Data were derived from the China Health and Retirement Longitudinal Study (CHARLS) 2020 survey. A total of 2,454 older adults (aged ≥ 60 years) were included as the analysis sample. Multidimensional health was assessed using measures of Activities of Daily Living (ADLs), Instrumental Activities of Daily Living (IADLs), chronic diseases, depressive symptoms, cognitive function, self-rated health, and social participation. Latent class analysis (LCA) was employed to analyze the potential classification of multidimensional health. LCA revealed three distinct multidimensional health classes: poor physical and depressive symptoms type (Class 1), isolated type (Class 2), and cognitive impairment and isolated type (Class 3). Individuals experiencing 2, 3, or ≥ 4 ACEs showed higher odds of belonging to Class 1 compared to Class 2, with the strongest association observed for ≥ 4 ACEs. Subgroup analyses showed the association between ≥ 4 ACEs and Class 1 was stronger in urban residents compared to those living in rural areas. For gender differences, females showed stronger associations between ≥ 4 ACEs and Class 1, while males showed significant associations with Class 3 but females did not. ACEs have a significant impact on multidimensional health in later life among Chinese older adults. The results provide empirical evidence to inform early-life interventions and personalized health promotion strategies for older adults, with effective health communication serving as a critical pathway for translating these findings into practice.</p>