Understanding intergenerational dynamics and social support's impact on health and well-being of older adults in South Asia: a scoping review.

Abstract

Background: Traditionally, family members take care of older relatives in South Asian societies, and there is a strong reciprocal filial obligation through intergenerational family relations. The changing family structure, living arrangements, and out-migration have led to subsequent changes in reciprocal family support that influence the health and well-being of older adults. This scoping review aims to (1) map the evidence and prevailing motivations for family support including financial, instrumental, and emotional support that affect the health and well-being of older adults and (2) identify the research gaps in the academic scholarship available on motivation for family support to older adults given the changing demographic and societal dynamics in the South Asian societies.

Methods: We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR) guidelines. Electronic databases PubMed, Embase, Scopus, and ProQuest were searched, and Google Scholar was used to identify grey literature. The screening of titles, abstracts, and full texts included 22 studies for analysis.

Results: The included studies covered health indicators such as stress and/or depression, loneliness/isolation, loss of support/neglect, and level of satisfaction to illustrate well-being of older adults. The findings revealed that adult children recognised filial duties and responsibilities to provide care to older parents, whereas older parents provide cultural upbringing and care to grandchildren. Reciprocal care exchange, cultural expectations, and intergenerational transfers motivated adult children to be primary caregivers to their older parents. Intergenerational family care such as financial, instrumental, and emotional support is associated with a higher level of life satisfaction and lower level of depression and thus reported better health and well-being among older adults.

Conclusion: Although intergenerational support is still a significant factor in determining the well-being of older adults in South Asia, this study shows the complexity of intergenerational ambivalence, where caregiving responsibilities lead to both emotional stress and a sense of obligation. Additionally, out-migration of adult children and subsequent physical absence also increase psychological distress and loneliness of older adults. This emphasises the need for policies that address both the emotional and financial aspects of elder care. The Madrid International Plan of Action on Ageing (MIPAA) policies can be adopted to ensure friendly and supportive environments and emphasise the health and well-being of older adults in developing countries. MIPAA highlights the importance of policies that promote intergenerational solidarity, active ageing, and social protection for older individuals.