By 2050, the Asia-Pacific will be home to 1.3 billion people aged 60 and older – a staggering one in four of the population, according to United Nations projections. Southeast Asia is forecast to bear the brunt of this demographic shift, with over 170 million elderly accounting for 22 per cent of the region’s people.

They face a dual challenge: women may be living longer than men, but both are spending more of their years in poor health. Many are also cut off from well-funded healthcare and lack political or community representation.

Historically, families and traditional social structures have stepped in to support the elderly where governments fell short. But these cultural norms are now clashing with modern economic realities and shifting priorities, as younger generations pursue their own aspirations – overwhelming government planners with the sheer scale of the challenge.

Southeast Asia is undoubtedly growing old. The question now is: can it manage to do so gracefully?

The carer

When her 85-year-old father was hospitalised from a series of strokes in 2020, Lorraine’s time became consumed with caring for him and her mother, 74, leaving scant opportunity to focus on her studies.

“I was enrolled into a full-time Masters programme but had to switch to part-time and work at the same time to help with the family’s finances such as the costs of hiring a maid,” she told This Week in Asia, using a pseudonym.

For the next two years, she found herself constantly shuttling between university and the hospital to look after her father, a gruelling balance that took a toll on her own well-being.

“Having to watch him deteriorate, from being able to walk and talk to being completely bedridden and almost non-verbal and unable to remember any of us, wasn’t easy for us.”

An ageing population will totally change the way our society works

Lorraine, 28, does not have any siblings to help bear the burden and says she is still learning the ropes of being a carer.

“My mum is also growing older and she will be faced with more health issues and a part of me is afraid of how severe and complicated those issues might be.”

Singapore’s population is ageing rapidly. In 2010, about 10 per cent of its citizens were aged 65 and above. By 2022, that proportion had risen to 18.4 per cent.

In fewer than six years, the city state of less than 6 million is projected to have more than 900,000 people who fall into that age bracket.

With its small population, strong central planning and median gross monthly income of around S$5,100 (US$3,770), Singapore is among the best-placed nations in Asia to adjust to the demographic challenge.

The government plans to set aside some US$2.5 billion over the next decade under its “Age Well SG” programme to improve home-care arrangements and introduce elderly-friendly amenities in residential estates, among other measures.

The city state has already taken concrete steps to adapt its infrastructure and services. It has launched assisted-living public housing estates, featuring wheelchair-accessible designs and on-site healthcare and emergency monitoring. Bus stops across the country have also been revamped, with colourful way-finding graphics to aid those with dementia. And in 2017, it opened its first “retirement kampung” – a community designed to allow elderly residents to live independently, with amenities like community gardens and a medical centre.

Beyond physical infrastructure, Singapore is also bolstering its network of social and recreational hubs for older adults. More than 150 “Active Ageing Centres” offer a range of programming, from exercise classes to volunteer opportunities.

Spearheaded by the ministries of health, transport, and national development, the broader Age Well SG initiative was first announced by former prime minister Lee during last year’s National Day Rally.

Still, social isolation remains a challenge for Singapore’s ageing population. The number of residents aged 65 and above living alone has continued to climb, reaching 79,000 in 2022 – up from 58,000 just four years earlier, according to health ministry figures.

For many adult children like Lorraine, caring for ageing parents has upended the normal rhythms of daily life. She now finds her schedule dominated by a whirlwind of medical appointments, with frequent hospital visits disrupting the social calendar of a typical 20-something. She also grapples with the financial strain of providing care.

Yet she does not shirk her filial responsibilities, feeling a sense of duty that has been deeply ingrained in her since youth – overriding any friction that may arise from generational pressures.

“Every child should provide for their parents financially as much as they can when the need arises as they provided for us when we were younger,” she said.

“But there is also this aspect of time that parents usually value more than money, which I find difficult to give as I may not often see eye to eye with them on issues or feelings.”

The non-retiree

Despite being three years past the minimum retirement age, 63-year-old Kuala Lumpur beauty consultant Santokh Singh continues to work, aware that his pension and savings will not be sufficient to sustain him through his twilight years.

“If I’d saved enough for retirement, I would feel confident to ease back since I would be financially secure,” he told This Week in Asia.

While he is careful to “live within his means”, Singh says his primary focus as he grows older is the pursuit of happiness.

“I want to venture into farming with community members, ensure a good social environment, and plan activities to stay engaged,” he said.

Part of a growing cohort of ageing Asians who are prioritising their well-being, independence, and active lifestyles in their later years, Singh plans to settle in a retirement community alongside friends and family while still maintaining a degree of personal independence.

“As I grow older, I envision my living situation becoming simpler, with a smaller house, basic amenities, and healthier meals,” he said. “The most important factor in making these decisions is ensuring my happiness.”

Malaysia is undergoing a significant demographic shift as its population ages. Government data shows the proportion of residents aged 65 and older rose to 7.4 per cent last year, or around 2.5 million people in total.

As the elderly population expands, retirement communities have begun sprouting up across the country, with many older Malaysians seeking to alleviate the mounting pressures on their families, who find themselves increasingly squeezed by rising living costs and their own material ambitions.

John Chia, founder and chairman of Millenia Village in Malaysia’s Negeri Sembilan state, said the need for such assisted-living facilities “far exceeds what’s available presently and will grow exponentially in the years ahead.”

Singam, a 74-year-old former engineer, has lived in a retirement village in the state of Perak for over six years. He says his decision to move there was shaped by an evolving society and economy.

“Families these days are no longer nuclear like they used to be,” he said, requesting to be identified by only one name. “Children often have to move to a distant city in pursuit of a career … with both husband and wife needing to earn an income to keep up with the current cost of living, it is not practical nor is it fair to expect the children to be free to look after ageing parents.”

For Singam and many other older Malaysians, living independently within a community of their peers offers a sense of security and social engagement that traditional family-based care may not provide.

Retirement villages like GreenAcres in Ipoh and Pacific Senior Living in Klang cater to this demand, providing one- and two-bedroom units, 24-hour staffing, shared spaces for dining and socialising, access to healthcare services – including specialist therapy for dementia – and opportunities for physical activities.

While the concept is still relatively new to Malaysia, and faces some regulatory and funding challenges, retirement communities may ultimately provide a welcome solution to the country’s looming care crisis.

Experts like Dr S. Kantha Ruban Sivalingam, a general practitioner and council member of the Malaysian Healthy Ageing Society, are urging the government to play a part.

“The ageing society in Malaysia presents a compelling case for proactive government intervention,” he told This Week in Asia. “By prioritising healthcare, social support, and economic security for the elderly, Malaysia can pave the way for a more inclusive and compassionate society.”

The super-ager

While much of Southeast Asia is ageing, the challenge facing Thailand is especially daunting.

An estimated 2.5 million Thais will be aged 80 or above within the next 20 years and are likely to require care, according to the World Bank.

“It’s not enough to pay for utilities and buy rice and sugar and coconut every month,” she said.

“Nearly every elderly person in my village is facing the same situation, the only difference is that they’ve all got kids and I don’t. They’ve all got someone to take care of them, sending them money.”

Compounding Thailand’s ageing crisis is a plummeting fertility rate, sparking fears among health officials that the population could halve to just 33 million within the next 60 years.

Nearly 16 per cent of Thais are already aged 60 or above, a proportion that is forecast to surge to 38 per cent by 2050 – the highest among Southeast Asian nations with a comparably large population, according to a 2022 study by the UN’s Economic and Social Commission for Asia and the Pacific.

While improved diets and access to medicine have enabled Thais to live longer – super-aged society status is expected to arrive in a little over a decade – the quality of life in their later years often comes at a greater cost.

Poverty and household debt, which runs at 93 per cent of gross domestic product, continue to plague Thailand’s rural and working-class populations. The country’s economic growth, meanwhile, has sputtered over the past decade, projected to reach just 2.6 per cent this year – still lagging behind many regional rivals of similar size. To compensate, the government is now seeking ways to boost tax revenue.

The strain is also apparent in healthcare. Progressive universal healthcare policies implemented nearly two decades ago by then-prime minister Thaksin Shinawatra are starting to fray under the surge in demand.

While authorities are boosting care provision for those with long-term conditions such as dementia and other terminal illnesses, access to medications – especially those needed for complicated end-of-life conditions like cancer – remains limited and expensive, often forcing patients to pay out-of-pocket or seek care at better-funded private hospitals.

But it is an unfunded, uncosted, and unsupported civil society that props up the day-to-day lives of millions of older Thais, plugging the gaping holes in state provision. Over the past two decades, as the central government in Bangkok has been consumed by coups and power politics, the kingdom has quietly grown old.

Gaysorn, who relies on a close-knit network of relatives and friends in her village to get by, worries her time is running out. She now walks with a cane and can’t visit the local temple as often as she once did to engage in religious observances. Instead, her days are largely spent indoors, watching television and sheltering from the unforgiving tropical heat or monsoon rains.

“I try to live a simple life, not wanting much, not spending much,” she said.

“And I’m praying that I have a simple death, one that will not be a burden to anyone.