The Demographic Shift Reshaping Asia
Asia and the Pacific face one of history’s most urgent demographic transitions. Populations across the region are aging at a speed that has no precedent. By 2050, more than one in four people in the region will be 65 or older. Moreover, this shift is unfolding far faster than what advanced economies experienced in earlier decades.
Europe took 60 years to double its share of older persons. Asia will do it in just 25. Countries such as Thailand, Viet Nam, and Mongolia face demographic changes that took European nations generations, but must manage them within one or two decades. Fertility rates have fallen below replacement levels. Life expectancy keeps rising. Traditional family-based care networks are weakening under urbanization, migration, and shifting social norms.
Consequently, governments across Asia and the Pacific must act now. The window to build scalable, equitable care systems is narrowing fast.
Why Traditional Care Systems Are Failing
For generations, families served as the primary caregivers for the elderly across Asia. However, rapid urbanization and economic migration have disrupted this arrangement. Younger generations move to cities for work, leaving older relatives behind in rural areas with little or no formal support.
Around 60% of older people in Asia and the Pacific do not attend or receive regular health checks, while 31% report depressive symptoms due to illness, social isolation, and economic insecurity. Additionally, 40% of people over age 60 in Asia and the Pacific lack access to any form of pension, with women disproportionately affected.
Furthermore, chronic diseases compound the burden. 57% of older people have at least one diagnosed noncommunicable disease, and 16% feel lonely most of the time. Without a structured alternative to family care, millions of older adults face preventable suffering and avoidable hospital admissions. Therefore, community-based long-term care has emerged as the most viable and scalable solution.
Community-Based Care: The Regional Response
Governments across Asia and the Pacific now recognize that community-based care is not just preferable — it is essential. Developing countries in the region are responding with innovative policies and pilot programs, drawing on global frameworks to guide system design.
The 2025 ADB–OECD Meeting on Healthy Ageing and Long-Term Care helped catalyze regional coordination. It established a Regional Policy Network on Healthy Ageing and Long-Term Care in Seoul, bringing together ADB, the OECD-Korea Policy Centre, WHO, and leading universities. This network now supports cross-country learning and evidence-sharing. As a result, countries across the region are no longer working in isolation — they are building from each other’s experiences.
Country Innovations Leading the Way
Thailand’s Volunteer Care Network
Thailand stands out as a regional leader. It has built one of the region’s largest community care networks, with more than 1,000 centers and 1.3 million volunteers providing home visits, health checks, and referrals. Notably, the results are measurable. In pilot areas, hospital admissions among frail older people fell by 15%. This demonstrates the power of community-level intervention as a first line of care — cost-effective, human-centered, and scalable.
Uzbekistan’s Social Protection Push
Uzbekistan has moved decisively on institutional reform. The country established a new national agency for social protection in 2023 and began opening centers across the country, offering more than 100 services — from home care and rehabilitation to personal assistants and day centers. This comprehensive approach ensures that older adults receive support across their full range of needs, rather than through fragmented, reactive interventions.
Mongolia’s Digital Care Model
Mongolia is building accountability into care from the start. The country launched long-term care pilot programs in major cities, introducing national case management protocols, caregiver training modules, and digital monitoring tools — the country’s first systematic effort to create a scalable, evidence-based model. By combining digital tools with trained caregivers, Mongolia ensures that quality remains consistent across locations and care types.
Sri Lanka and Indonesia
Sri Lanka and Indonesia are also making meaningful progress. Sri Lanka operates day centers that provide dementia support, fall prevention, and recreational activities. Early results show greater elderly participation and fewer avoidable hospital admissions.
In Indonesia, the approach is both local and national. In selected areas, Indonesia has started providing long-term care for screening healthy, at-risk, and dependent older adults. Additionally, a digital platform drives the national scale-up effort.
Technology as a Force Multiplier
Technology plays a growing role in making community care systems more efficient and equitable. Indonesia’s SILANI digital platform illustrates this potential clearly. The platform identifies vulnerable households for targeted subsidies, generates evidence for financing reform, and links health insurance with social services, while reducing duplication.
Digital tools help governments move from reactive to proactive care. Instead of waiting for elderly citizens to enter hospital wards, systems can identify at-risk individuals early and deploy the right support at the right time. Furthermore, digital monitoring creates accountability across distributed care networks — a critical feature when programs operate at national scale.
Across the region, technology bridges gaps in reach, consistency, and data. It enables policymakers to track outcomes, refine programs, and allocate resources where they matter most.
The Road Ahead for Policymakers
Asia and the Pacific must now move from pilots to scale. The evidence base is growing. Country-level models are proving their value. However, time is short. Changes that unfolded gradually in Europe and Japan are occurring within one or two decades in countries such as Thailand, Viet Nam, and Mongolia.
To respond effectively, governments must prioritize three key areas. First, they need to invest in community care infrastructure — centers, trained workers, and volunteer networks. Second, they must harness digital platforms to improve targeting, monitoring, and coordination. Third, they need to design long-term financing mechanisms that keep community care sustainable, even as populations grow older and fiscal pressures intensify.
The region has the knowledge. It has the models. What it needs now is the political will and funding to scale them rapidly. Healthy aging in Asia and the Pacific is not just a health issue — it is a development imperative.
