The Demographic Shift Reshaping Asia and the Pacific
Asia and the Pacific now confront one of history’s most urgent demographic crises. Populations across the region age at a speed the world has never seen before. By 2050, more than one in four people will be 65 or older. Furthermore, this shift unfolds far faster than what advanced economies ever experienced.
Europe took 60 years to double its share of older persons. Asia will accomplish the same in just 25. Countries such as Thailand, Viet Nam, and Mongolia face changes that took European nations generations to absorb. Yet they must manage those same changes within one or two decades. Fertility rates have dropped below replacement levels. Life expectancy keeps climbing. Moreover, traditional family-based care networks weaken as urbanization, migration, and shifting social norms reshape daily life.
Governments must act now. The window to build scalable, equitable care systems is closing fast.
Why Traditional Care Systems Are Failing
For generations, families served as the backbone of elderly care across Asia. However, rapid urbanization and economic migration have broken that arrangement. Younger generations relocate to cities for work. Consequently, older relatives remain in rural areas with little or no formal support.
Around 60% of older people in the region skip regular health checks entirely. Additionally, 31% report depressive symptoms linked to illness, isolation, and economic insecurity. About 40% of people over 60 lack access to any pension, and women bear this gap disproportionately.
Chronic diseases add further pressure. Some 57% of older people carry at least one diagnosed noncommunicable disease. In addition, 16% feel lonely most of the time. Without a structured alternative to family care, millions of older adults face preventable suffering and unnecessary 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 treat community-based care as essential, not optional. Developing countries respond with innovative policies and pilot programs. They draw on global frameworks to shape system design.
The 2025 ADB–OECD Meeting on Healthy Ageing and Long-Term Care catalyzed important regional coordination. It established a Regional Policy Network on Healthy Ageing and Long-Term Care in Seoul. This network unites ADB, the OECD-Korea Policy Centre, WHO, and leading universities. As a result, countries now share evidence and build on each other’s experiences rather than working alone.
Country Innovations Leading the Way
Thailand’s Volunteer Care Network
Thailand stands as a clear regional leader in community care. The country built more than 1,000 care centers backed by 1.3 million volunteers. These volunteers deliver home visits, health checks, and referrals across communities. Notably, hospital admissions among frail older people fell by 15% in pilot areas. This result proves the power of community-level intervention — cost-effective, human-centered, and scalable.
Uzbekistan’s Social Protection Push
Uzbekistan moved decisively on institutional reform. In 2023, the country established a new national agency for social protection. Centers now offer more than 100 services, including home care, rehabilitation, personal assistants, and day centers. This comprehensive model ensures older adults receive support across their full range of needs, rather than through fragmented, reactive interventions.
Mongolia’s Digital Care Model
Mongolia launched long-term care pilot programs in its major cities. These programs introduced national case management protocols, caregiver training modules, and digital monitoring tools. This initiative marks the country’s first systematic effort to create a scalable, evidence-based care system. Combining digital technology with trained caregivers keeps quality consistent across locations and care types.
Sri Lanka and Indonesia
Sri Lanka operates day centers that deliver dementia support, fall prevention, and recreational activities. Early results show stronger elderly participation and fewer avoidable hospital admissions. In Indonesia, the government screens healthy, at-risk, and dependent older adults in targeted areas. A national digital platform then drives the broader scale-up effort.
Technology as a Force Multiplier
Digital tools make community care systems more efficient, equitable, and accountable. Indonesia’s SILANI platform illustrates this potential clearly. It identifies vulnerable households for targeted subsidies. It generates evidence to support financing reform. It also links health insurance with social services while reducing duplication.
Technology shifts governments from reactive to proactive care delivery. Systems can now identify at-risk individuals early and deploy the right support before a crisis develops. Furthermore, digital monitoring creates accountability across large, 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 direct resources where they matter most.
The Road Ahead for Policymakers
Asia and the Pacific must now move urgently from pilots to national scale. The evidence base keeps growing. Country-level models keep proving their value. However, time is short. Changes that took generations in Europe and Japan are now compressing into one or two decades for countries like Thailand, Viet Nam, and Mongolia.
Governments must prioritize three key actions. First, invest in community care infrastructure — centers, trained workers, and volunteer networks. Second, harness digital platforms to sharpen targeting, monitoring, and coordination. Third, design sustainable long-term financing mechanisms that keep care accessible as populations age and fiscal pressures intensify.
The region already 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 only a health issue — it is a development imperative.
