Asia and the Pacific’s Rapidly Aging Population Needs Long-Term Care Solutions

By Silvia Garcia Mandico, Minhaj Mahmud, Aiko Kikkawa

These charts illustrate the rapid increases in the population aged 60 and older in Asia and the Pacific and the urgency of addressing long-term care needs in the region.

Over the past two decades, life expectancy at age 60 in the region has increased by more than 5 years. But the expected number of years lived in less than full health also increased in most economies. A new harmonized dataset on older persons in nine economies in developing Asia found that  on average, 57% Asians aged over 60 have at least one diagnosed noncommunicable disease (NCD). This share varies across the region, ranging from 35% in Bangladesh to 68% in the People’s Republic of China. Yet only 40% of older citizens reported they were having regular health check-ups. 

Mental health issues are also on the rise among older people in Asia and the Pacific.  Almost one-in-three older persons report depressive symptoms. In the People’s Republic of China the prevalence of reported depressive symptoms is higher, particularly for older women where they were experienced by 43% of women. An average 16% of older people say they feel lonely most of the time, which can only worsen depressive symptoms.

Meeting the increased demand for long-term care is a matter of urgency in some economies, and is a looming aspect that will occur in the near future in other economies.  The average share of older people reporting functional impairment in at least one primary activity of daily living (ADL) in the region stands at 20%. As shown in the figure below, the share of people reporting difficulty with dressing, bathing, and eating increases sharply after their mid-70s. As populations become older, and with it carry not only more NCD burden but also more daily activity care needs, healthcare and long-term care needs will be on the rise.

The current model of family-provided care will not withstand the increased needs that come with population aging.  On average, 43% of older Asians with a functional limitation experience care gaps. Women and the poor are disproportionately affected by care gaps. As family sizes shrink, and an increasing number of older people live alone, the current model of family care alone is unlikely to meet the increasing care demands. More importantly, it risks furthering existing inequalities that older women and older poor face in accessing care, jeopardizing their wellbeing.

Ensuring that Asian economies are prepared to face the increased care demands from demographic change requires designing comprehensive long-term care strategies, which address urgent matters and longer-term challenges.  Economies should be designing integrated care systems that tap into families, markets, and governments to provide seamless long-term care. It is essential that the region prepares for a market-driven care economy while upholding the value of family care.

Supporting informal family caregivers is essential to ensure continued care. Many economies in the region have implemented low-cost community-driven interventions that provide information, counseling, and training to community caregivers. Such support should be extended to family caregivers, including older caregivers who are often excluded from these programs. Further, governments should provide respite care, which has proven very effective at alleviating the burden on family caregivers and improving the quality of their care.

 Long-term-care systems should strongly encourage aging in place. Economies in the region need to consider how to make fiscal space for finance formal long-term care systems. Economies also need to increase the supply of formal caregivers, by formalizing informal caregivers and engaging youth and volunteers. Also critical is to integrate regional labor markets, thereby facilitating the migration of caregivers across borders. Regional coordination will be essential to optimize human resource allocation, uphold workers' rights, and prevent brain drain that can deplete the origin country's health system.

This blog is based on research undertaken for the Asian Development Policy Report 2024: Aging Well in Asia, which was released at ADB’s 57th Annual Meeting in Tbilisi, Georgia.

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