The research team examined twenty-two states across the MENA region, from the wealthy Gulf Cooperation Council monarchies to middle-income countries such as Egypt, Morocco and Tunisia, and to fragile or conflict-affected settings including Yemen, Syria and the West Bank and Gaza. Drawing on demographic, economic and labour indicators from global datasets compiled by the United Nations Department of Economic and Social Affairs and the World Bank, the authors synthesised this quantitative picture with the international literature on long-term care models and regional care dynamics. Their conclusion is blunt: population ageing is outpacing the development of formal care systems across the region, and the costs of that gap are being paid invisibly, mostly by women.

The demographic mechanics behind the warning are well established but often misread. Fertility rates across MENA have fallen sharply over recent decades while life expectancy has climbed, producing the classic stages of a demographic transition. For years, the region enjoyed a favourable age structure, with large working-age cohorts supporting relatively few dependents, a dividend that fuelled growth in labour-abundant economies. That window is now closing. As cohorts born during earlier high-fertility eras move into older age, the share of adults over sixty-five is rising rapidly, and the total age dependency ratio, which measures the balance between people typically outside the labour force and those of working age, is shifting in ways that will strain pensions, health systems and household budgets alike.

What makes the MENA case distinctive is the speed and heterogeneity of the transition. The Gulf states face a compressed version of the challenge, where rapid modernisation, large migrant workforces and citizenship-based welfare systems create peculiar fiscal and social geometry. Middle-income countries such as Egypt and Jordan are ageing before they have become rich, leaving little fiscal room for new social programmes. Conflict-affected states face the starkest picture of all; research cited in the study documents how armed conflict in Syria has directly reduced life expectancy, while humanitarian assessments in Yemen describe older populations with minimal formal support. Any regional strategy, the authors argue, must account for this diversity rather than impose a single template.

At the heart of the analysis is the informal care economy, the vast, unrecorded system in which family members, overwhelmingly women, provide daily care for frail older relatives. Cultural norms across the Arab region place strong expectations on families, and particularly on daughters and daughters-in-law, to care for ageing parents at home. This system has historically absorbed demand at zero fiscal cost, but the study shows it is eroding under its own contradictions. Urbanisation is dispersing extended families, smaller family sizes mean fewer adult children per ageing parent, and rising female education and employment aspirations collide with the assumption that women will provide unpaid care indefinitely.

The consequences ripple through the entire economy. Women across MENA already have among the lowest labour force participation rates in the world, and the burden of informal caregiving is a documented barrier to paid work. The study highlights that women also spend more years in ill-health during old age than men, compounding the inequity across the life course. Every hour a woman spends providing unpaid care is an hour not spent in formal employment, not generating taxable income and not building her own pension entitlements. The authors frame this as a hidden economic cost that never appears in national accounts but systematically suppresses productivity, female economic inclusion and the long-term solvency of social insurance systems.

The quality-of-life dimension is equally serious. Without structured services, older people with dementia, disability or chronic multimorbidity depend entirely on relatives who may lack training, respite or support. The literature the authors synthesise points to elevated risks of elder abuse, caregiver burnout and depression among informal carers, and notes that conditions such as dementia are rising in prevalence across the region as populations age. Respite care, home-based health services and day centres remain scarce or absent in most MENA countries, with a few notable experiments such as Oman’s home health care programmes and Saudi Arabia’s expansion of home care under its Vision 2030 reform agenda cited as early signals of change.

The study’s most provocative argument is that this gap is not merely a liability but an opportunity. Formal long-term care is labour-intensive work that cannot be automated away, making it a potent source of employment, particularly for women. International Labour Organization analyses cited in the paper estimate that expanding care services globally generates employment multipliers well above those of comparable investments. The authors propose that MENA governments build regulated care infrastructure through workforce development, dedicated insurance financing models and public-private partnerships, creating decent jobs for care workers while simultaneously freeing other women to enter the labour market. In their framing, care investment functions like roads or power grids: infrastructure that unlocks broader economic activity.

Financing such systems in a region with tight budgets and large informal economies is the obvious objection, and the authors address it directly. They advocate incremental financing mechanisms that expand coverage gradually, learning from international experience including Japan’s long-term care insurance scheme and cash-for-care experiments in Europe, while adapting to regional realities such as the widespread reliance on migrant domestic workers in Gulf households. Formalising caregiving roles, extending social protection to care workers, and aligning long-term care investment with the Sustainable Development Goals are presented as mutually reinforcing priorities. The paper also points to recent pension reform in Saudi Arabia as evidence that structural social protection change is politically achievable in the region.

The study’s bottom line is a reframing. Ageing in MENA has been treated as a distant problem, perpetually deferred by the region’s youth bulge legacy. Hussein and her colleagues argue that the window for proactive policy is closing now, and that governments which integrate long-term care into national development planning, rather than quarantining it in health or welfare ministries, can convert a looming fiscal burden into a driver of equitable growth. The alternative, they warn, is a future in which ageing households are impoverished by care costs, women remain locked out of the labour market by unpaid caring obligations, and governments confront the same demographic pressures a decade later with fewer options and higher price tags. The choice, on their reading of the data, is between building the care economy deliberately or paying for its absence involuntarily.

Subject of Research: Demographic ageing and long-term care policy in the Middle East and North Africa

Article Title: Ageing and Long-Term Care in the Middle East: Towards Inclusive Development Strategies

Article References: Hussein, S., Ismail, M., & Pallares-Miralles, M. (2026). Ageing and Long-Term Care in the Middle East: Towards Inclusive Development Strategies. Ageing International, 51(4), Article 38. https://doi.org/10.1007/s12126-026-09678-4

Image Credits: AI Generated

DOI: 10.1007/s12126-026-09678-4

Keywords: population ageing, long-term care, MENA, informal caregiving, gender inequality, care economy, demographic transition, labour force participation, social protection, economic development, Gulf Cooperation Council, sustainable development goals

The study drew on data from 319 participants aged 65 and older who were enrolled in a community-based health screening program in Japan. This population matters because the overwhelming majority of older people worldwide live at home rather than in institutional care, and their day-to-day well-being hinges on informal networks of relatives, neighbors, and friends. To capture the dynamics of these networks, the team used two validated instruments. Social support was assessed with the Social Support Giving and Receiving Scale for the Elderly at Home, which measures support as a bidirectional phenomenon, acknowledging that older adults are not merely passive recipients of care but active contributors to the people around them. Self-disclosure was evaluated with the Self-Disclosure Questionnaire, a self-assessment tool developed specifically for research with community-dwelling older adults in Japan.

Rather than treating social support as a single continuous score, the researchers employed cluster analysis, a statistical technique that groups individuals according to shared patterns across multiple variables. This approach revealed three distinct profiles of social support among the participants. The first cluster was characterized by low receiving combined with high giving—older adults who actively helped others but received comparatively little in return. The second cluster showed both low receiving and low giving, representing people whose support relationships had thinned out in both directions. The third and largest-profile category comprised participants with balanced or high receiving, whose networks delivered support that met or exceeded what they provided. The existence of these distinct patterns underscores that social support in later life is not a uniform resource but a set of different relational configurations with potentially different consequences for health.

The demographic and functional differences between these clusters proved telling. Participants in the giving-oriented cluster—younger within the study range and marked by higher functional capability and more extensive social networks—were, in effect, the helpers of their communities. Their capacity to provide support reflected physical and social resources that many of their peers no longer possessed. By contrast, individuals in the receiving-oriented cluster tended to be older, with lower functional capability, consistent with the intuitive picture that as physical capacity declines, the balance of support shifts from giving toward receiving. This gradient illustrates a fundamental asymmetry in aging: the same person may move across these clusters over time as health and social circumstances change, and the transition can be abrupt when illness or functional loss strikes.

The centerpiece of the analysis, however, was the relationship between self-disclosure and social support. Using regression models that adjusted for relevant covariates, the researchers found that greater self-disclosure to family members was significantly associated with higher levels of both giving and receiving social support, with the association reaching a p-value below .001—a threshold indicating an extremely low probability that the finding arose by chance. In practical terms, older adults who opened up to their families about their inner lives were embedded in richer, more reciprocal webs of mutual assistance. The finding aligns with long-standing social psychological theory, from Altman and Taylor’s social penetration model, which describes how relationships deepen through progressively more personal disclosure, to exchange-based accounts showing that disclosure tends to be reciprocated, drawing conversation partners into closer, more supportive bonds.

Intriguingly, the pattern changed when the researchers examined disclosure to friends and acquaintances. Here, the association was confined to giving support, reaching statistical significance at p = .023. Older adults who shared more of themselves with friends and broader acquaintances were more likely to give help to others, but this outward-facing openness did not translate into greater receipt of support in return. One interpretation is that friendships in later life, while valuable and often rich in emotional rewards, are structurally different from family bonds. Friends may be similarly aged and similarly capable, and therefore less positioned—or less obligated—to deliver instrumental care when needs arise. Families, by contrast, typically span generations and carry normative expectations of caregiving, so that disclosure within them activates both emotional closeness and practical assistance.

The study’s implications extend to public health and community care policy, particularly in rapidly aging societies such as Japan, which has built a community-based integrated care system premised on informal support networks surrounding each older resident. If self-disclosure within families functions as a gateway to reciprocal support, then interventions that encourage open communication—family conversations, counseling approaches, or even structured programs that teach and normalize the sharing of personal concerns—could strengthen the informal safety net that formal services increasingly depend upon. The finding that family disclosure predicts both directions of support also suggests a possible lever for addressing the low-receiving, low-giving cluster, the most isolated profile identified in the study, in which older adults neither contribute to nor draw from a support network.

As with any cross-sectional study, important caveats apply. The design captures a single moment in time, so it cannot establish whether self-disclosure causes richer support or whether supportive relationships simply create more opportunities for disclosure; most likely, the two reinforce each other in an ongoing loop. The sample comprised participants in a community health screening program, a group that may be more health-conscious and better connected than the general older population, raising questions about generalizability that the authors themselves acknowledge. Moreover, the data are not publicly available because they contain information that could compromise participant privacy, which limits independent reanalysis. The research was approved by the Sapporo Medical University Ethical Review Board, and all participants provided written informed consent after the procedure was explained. Funding came from the Health, Labour and Welfare Sciences Research Grants under grant number 23GB2001.

Future research, the authors suggest, should test these relationships longitudinally and, more ambitiously, develop interventions designed to promote self-disclosure among older adults. If the findings hold up under such scrutiny, the practical message is strikingly simple: encouraging older people to talk openly with their families about their feelings, worries, and daily experiences may do more than relieve loneliness in the moment. It may build and sustain the two-way currents of help—given and received—that keep people healthier, more connected, and more secure as they age. In an era when societies worldwide are scrambling to care for unprecedented numbers of older residents, one of the most powerful tools may not be a new service or technology, but a conversation at the kitchen table.

Subject of Research: The association between self-disclosure and the giving and receiving of social support among community-dwelling older adults

Article Title: Role of Self-Disclosure in Receiving and Giving Social Support Among Community-Dwelling Older Adults: A Cross-Sectional Study

Article References: Role of Self-Disclosure in Receiving and Giving Social Support Among Community-Dwelling Older Adults: A Cross-Sectional Study. (n.d.). https://doi.org/10.1007/s12126-026-09671-x

Image Credits: AI Generated

DOI: 10.1007/s12126-026-09671-x

Keywords: social support, self-disclosure, older adults, aging in place, family communication, community-dwelling seniors, cluster analysis, functional capability, social networks, well-being, cross-sectional study, gerontology