Elder Caregiving in Southeast Asia: A Systematic Review of Cultural Norms, Care Burdens, Carer Support and Policy Gaps

Abstract Background: Southeast Asia is undergoing one of the world’s fastest transitions toward population aging. Elder caregiving arrangements vary across the region, with stronger infrastructure in wealthier ASEAN countries. Nevertheless, care remains predominantly household-based, with women bearing primary responsibility. Although informal caregiving is supported by cultural norms such as filial piety, these also reinforce inequities. Limited long-term care infrastructure, weak policy integration, and insufficient caregiver support persist, particularly in poorer countries. Methods: Following PRISMA guidelines, a systematic search was conducted in PubMed, Scopus, Web of Science, and ScienceDirect for studies published between 2015 and 2025. Eligible studies included formal and informal caregivers of older adults in institutional, community, and household settings across Southeast Asia. Quality appraisal used the Joanna Briggs Institute (JBI) and CASP tools, with certainty of evidence assessed via GRADE and CERQual. Findings were synthesized thematically across structural, functional, health-related, sociocultural, and policy domains. Results: Forty-eight studies from ten Southeast Asian countries were reviewed. Findings differed markedly between richer and poorer countries, but across the region caregivers face high workloads, inadequate training, weak support systems, and poor working conditions, resulting in stress, burnout, and reduced quality of life. Dementia-related symptoms, care intensity, and family obligations were consistently linked to caregiver burden. When combined with limited institutional support, sociocultural values such as filial piety, religion, and gender norms functioned both as protective resources and as stressors. Policy gaps were evident in the areas of financial protection, LTC infrastructure, training, and integration between national and community systems. Conclusions: Elder caregiving in Southeast Asia is at a policy crossroads. Wealthier ASEAN countries are expanding formal long-term care, while poorer nations continue to depend on unpaid family caregivers, deepening inequalities. The evidence underscores the need for ring-fenced funding, minimum LTC standards, and stronger support and training for carers. Gender-sensitive, culturally adaptive strategies and ASEAN-level cooperation are vital to transform caregiving into a shared societal responsibility. Trial registration: PROSPERO ID - CRD420251138727