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Ageing and Elderly Care in the Arab Region: Policy Challenges and Opportunities

Demographic Trends

Almost 1/2 of the population younger than the age of 25 in 2009

↓ fertility rates and ↓ mortality rates has ↑ the process of population aging

By 2050, the proportion of older persons (60 years or more) is predicted to climb to 19 % compared to an average of around 7 % in 2010.

In nine countries in the region - Algeria, Bahrain, Kuwait, Lebanon, Libya, Morocco, Oman, Qatar and Tunisia - there will be more older persons than children (under 15 years old)

Economic and Social Implications

Wealth distribution across the population is far from uniform, with significant pockets of poverty.

It is estimated that social security coverage extends to less than 25 % of the population (Economic and Social Commission For Western Asia [ESCWA] 2006)

Majority of older people rely excessively on savings and informal support, including financial, from family and charities.

The continued availability or indeed willingness of family members to care for elderly relatives is uncertain, due to a number of interacting demographic and socioeconomic trends.

Healthcare Challenges

↑ hospital stay and the admission of frail, older people to care facilities have occurred in many Arab countries for at least the past two to three decades, these were usually attributed to combined effects of longevity and lack of other suitable formal care provisions that is home or community-based.

Countries in the Arab region are also experiencing epidemiological and health transitions, with non-communicable diseases replacing communicable diseases as the leading causes of morbidity and mortality (Abyad 2006).

Policy Responses

Most pension programs in the region consider additional benefits if the pensioner has surviving parents.

The eligibility of elderly care activities to receive tax incentives in Jordan

Expanding welfare provision to cover old age disability in Kuwait

Cultural Attitudes

Changes in family structure and youth migration, combined with increases in women’s participation in the labour force, may negatively affect the availability and willingness of family members to provide care for their older relatives.

Long-term care in the majority of cases is family-based, mainly because of deeply-rooted religious and cultural norms that emphasis the duties of younger generations towards their elders, but also due to critical lack of formal care alternatives.

According to the United Nations (2008) most countries in the Arab region view population ageing to be a ‘minor’ concern.

Most of the countries in the region have young traditional social insurance programmes that offer old-age statutory pensions, with a typically higher uptake in urban areas.

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Ageing and elderly care in the Arab region

Demographic Trends

As in many other parts of the world, most Arab countries are experiencing demographic transitions including lower fertility, lower mortality and longer life expectancy.

In nine countries in the region - Algeria, Bahrain, Kuwait, Lebanon, Libya, Morocco, Oman, Qatar and Tunisia - there will be more older persons than children (under 15 years old) by 2050 (UN 2013).

Economic and Social Implications

Increased need for support and care as the people move to end of life

Impact on intergenerational linkages and living arrangements among older women

Creation of long term care rooted in religious and cultural norms

Indications of increased use of formal care, especially among urban older people are emerging (employment of formal or paid care workers).

Healthcare Challenges

There is a need for health professionals specialised in geriatrics and gerontology in the region.

There is a growing need for home-based care that requires a larger and more adapted healthcare system

Major gaps exist in aging research in the Arab region, limiting the evidence base to inform policies and interventions.

Longevity is often accompanied by many years of ill health and disability in the region.

Most Arab countries continue to rely on the family, particularly women, as the primary source of elder care. However, socio-demographic changes may hinder the ability of families to provide such care.

Many Arab countries are not paying attention to the rapid aging of their populations, despite populations expected to age rapidly in the coming decades

Policy responses

Suggested Policies:

State support for women who provide long-term care for family members (Supporting informal caregivers)

Create policy legislations that address the needs and wellbeing of family in long term care (ex. having additional benefits for individuals with surviving parents

Increasing access to care facilities and availability of community based care

Expand and encourage volunteers or students in providing basic health and care through financial incentives in the form of tax relief or other benefits

Promote work-life balance through legislation and initiatives. Can be done through flexible and supportive work environment)

Offering financial assistance to informal carers through tax relief and allowances

Current Policies:

Eligibility of elderly care activities to receive tax incentives

Expand welfare provision to cover old age disability

Initiate long term care insurance provisions

New pension laws

Establishment of LTC day centres and community provision

Establishment of mobile unit that provide health and care services

Cultural attitudes toward elderly

In majority, long term care is family based mainly because of deeply-rooted religious and cultural norms that emphasize the duties of younger generations towards their elders.

Women are expected to be the main source of emotional and care support meanwhile, male sons have the duty particularly on financial support (El-Ashi 2007).

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Ageing and elderly care in the Arab region: policy challenges and opportunities

Demographic Trends

The Arab region is experiencing significant demographic changes with an increasing elderly population due to declining fertility rates and increasing life expectancy. By 2050, it is projected that the proportion of people aged 60 and above will significantly increase, posing challenges for social and healthcare systems.

Economic and Social Implications

Economic growth is impacted due to the shrinking working population and rising elderly population. There will also be an increased demand for pensions, social security, and healthcare services will strain public finances.

Healthcare Challenges

The healthcare system may face obstacles such as less professionals for geriatric care and inadequate infrastructure to support the needs of elderly. Other challenges faced are the chronic diseases common among elderly that need to have a specific plan of care, and lastly there should be healthcare services that are specifically for the elderly population.

Policy Responses

There is a need to develop policies on comprehensive aging that address economic, social, and healthcare needs of the elderly. Currently, there is a push for the development of social protections like pensions and insurance to support the aging population. Healthcare systems can also be enhanced by training and infrastructure development. Furthermore, policies that promote active aging and the integration of the elderly into society can mitigate challenges.

Cultural Attitudes Toward Elderly

Cultural attitudes in the Arab region traditionally emphasize respect and care for the elderly, often within the family. However, modernization and changing family structures are impacting traditional caregiving models. Therefore, there is a growing need to balance traditional values with modern support systems to ensure the well-being of the elderly.

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Ageing and Elderly Care in the Arab Region: Policy Challenges and Opportunities

Demographic Trends

By 2050, the proportion of older persons (60 years or more) is expected to reach 19%, up from around 7% in 2010.

The number of older persons is predicted to more than quadruple, from 22 million in 2010 to 103 million by 2050.

This increase is attributed to historically high fertility rates.

In nine countries—Algeria, Bahrain, Kuwait, Lebanon, Libya, Morocco, Oman, Qatar, and Tunisia—there will be more older persons than children (under 15 years old) by 2050.

Economic and Social Implications

Increased life expectancy in Arab countries is a success but also a public policy challenge.

The speed of aging varies, with the UAE, Tunisia, Bahrain, Kuwait, Morocco, Algeria, Libya, and Lebanon aging rapidly.

Non-communicable diseases are becoming the main health issues - leading cause of morbidity and mortality.

More elderly, especially women, are living alone due to migration and modernization. Traditionally, older people in the region lived with or near their offspring

Traditional family-based care is threatened by modernization and migration.

Ex. Younger men migrating and leaving their wives and parents with multiple caregiving responsibilities.

Healthcare Challenges

1. Extended Hospitalizations and Admission of Frail: due to the longevity and lack of other suitable formal care provisions that is home or community-based.

2. Changes in Family Structure:  increases in women’s participation in the labor force, may negatively affect the availability and willingness of family members to provide care for their older relatives

3. Indication of Increased Use of Formal Care: various factors (demographic and socioeconomic trends) prompt family caregivers to employ formal or paid care workers to look after older relatives, despite the longstanding norms of family care.

4. These challenges increase the burden on healthcare facilities to adapt to the growing needs of an ageing population by expanding and improving their services.

Policy Responses

These responses combine support measures, legislative changes, financial incentives, and initiatives to improve elderly care infrastructure in the Arab region.

1. Support for Women with Care Responsibilities

Paid maternity leave indirectly aids women caring for older parents.

Lack of specific support for women's long-term care responsibilities.

2. Legislation and Practical Measures

Includes tax incentives, welfare provisions, long-term care insurance, new pension laws, and care centers.

Mobile health units in Saudi Arabia, Bahrain, and Oman.

3. Encouraging Informal Care and Work-Life Balance

Work-life balance campaigns in the UK, New Zealand, and Australia.

Broad support in the Netherlands, Sweden, and Denmark.

Legislative support in France, Belgium, the US, and Ireland.

4. Financial Assistance for Informal Carers

Cash benefits or allowances in the UK, Australia, Germany, Norway, and Sweden.

5. Enhancing Access to Care Facilities

Increasing community-based care and university/voluntary sector initiatives, especially in Egypt and Tunisia.

6. Balancing Informal and Formal Care

Supporting informal care while developing formal care systems to avoid an unmanaged market.

Cultural Attitudes Toward Elderly

1. Elderly care is traditionally provided by families, with cultural and religious norms emphasizing the duty of younger generations.

2. There are few formal care options available, and using private nursing homes carries social stigma.

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Demographic trend : many other parts of the world, most Arab countries are experiencing demo graphic transitions including lower fertility, lower mortality and longer life expectancy.many of the Arab countries are not currently experiencing population ageing at the same level as most developed countries, the majority of the countries are in the cusp of predicted significant demographic changes particularly in relation to the pace of population ageing.

Economic and Social Implications : most pension programs in the region consider additional benefits if the pensioner has surviving parents. Nevertheless, some countries in the region have attempted to upgrade, or consider, legislation and practical measures that address the growing long term care needs of their elderly populations. Social stigma on elderly living in nursing homes.

Healthcare challeges : longevity is often accompanied by many years of ill health and disability and most of the countries in the region continue to rely on the family as the primary source of elder care. While not all longevity is associated with ill health and increased need for care provision, the proportion of the population that is living longer means that more people will need support and care as they move to end of life these countries are also experiencing epidemiological and health transitions, with non-commun eases replacing communicable diseases as the leading causes of morbidity and mortality.

Policy responses: While there are several social policy legislations in the region that address the needs and wellbeing of the family institution within the society, there are very few that are specific to long term care.

Cultural attitudes toward elderly: male sons needs to take care of old parents, traditionally in finance. Although older people in the region have traditionally tended to live with or near their offspring, larger proportions of the, notably older women, are increasingly living alone. traditional forms of long-term care in the family unit are threatened due to various factors such as modernization, urbanization and youth migration.

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Aging and Elderly Care in the Arab Region: Policy Challenges and Opportunities

DEMOGRAPHIC TRENDS

- Life expectancy is rising amidst socio-economic changes, reduced fertility rates, and evolving family structures.

- In countries like Lebanon and Tunisia, older adults make up at least 10% of the population.

- Studies show much of the increased life expectancy in the Arab region involves years lived in poor health.

- Long-term care is predominantly family-based due to cultural, religious, and social stigmas.

POLICY RESPONSES

Limited formal long-term care: There's a lack of established systems for providing long-term care for the elderly, with most relying on informal family support.

Burden on working women: While men are assumed to have the “breadwinner” role, women traditionally take on caregiving responsibilities for elderly relatives, creating a conflict with their work lives.

Emphasized that elderly care needs can be unpredictable, making it difficult for women to plan and manage work schedules.

ECONOMIC AND SOCIAL IMPLICATIONS

Increase in the need for social security, pensions, and healthcare, which will put a pressure on government fundings.

HEALTHCARE CHALLENGES

The region faces challenges in providing adequate healthcare to the elderly, including a lack of specialized geriatric services and long-term care facilities.

Chronic diseases and disabilities are prevalent among the elderly, increasing the need for comprehensive and continuous healthcare services.

CULTURAL ATTITUDES TOWARD ELDERLY

Traditional norms emphasize family, particularly women ( as daughters/daughters-in-law), as the primary caregivers for the elderly.

Religious beliefs promote family support for elders, with sons having a financial responsibility, and they are assumed to be the “breadwinners”

Increasing female labor participation and changes in family structure (later marriage, smaller families) challenge traditional caregiving models.

Women struggle to manage caregiving alongside work and other duties.