Health Demography of the Elderly in Northeastern Thailand: Lessons for Sustainable Practice

Abstract

Background and Objectives: Perceptions of well-being among older adults must be understood within the context of rapidly changing social, cultural, and family structures. In response to these transformations, preparations have been undertaken in terms of financial planning and welfare provisions for the elderly in order to accommodate emerging social changes and to reduce potential inequalities in quality of life. This research aims to analyze the ontological meaning of elderly well-being, extract lessons from best practices in successful local contexts, and develop policy recommendations to guide the sustainable management of elderly well-being in Northeastern Thailand, a region that is rapidly transitioning into a fully aged society.

Methods: The research employed a qualitative design grounded in phenomenology to capture the lived experiences of older adults, families, communities, local administrative units, public-health personnel, civil-society actors, and policy makers. A total of 120 participants across four provinces Buriram, Surin, Sisaket, and Ubon Ratchathani were engaged through in-depth interviews, focus-group discussions, and non-participant observation. Secondary data related to the ontology of well-being, holistic health frameworks, health-service systems, and local wisdom were also reviewed. All data were systematically examined using content analysis and pattern analysis to identify shared meanings and systemic patterns affecting older adults’ well-being in the area.

Results: The findings reveal that elderly well-being in Northeastern Thailand constitutes a multi-layered state of being encompassing physical, psychological, social, and spiritual dimensions. Five interrelated themes emerged: 1) Family and kinship networks remain the primary caregiving structure. Despite outward labor migration, cross-locality care via remittances, phone communication, and ritualized homecoming during festivals preserves intergenerational bonds and the dignity of older adults. 2) Buddhist temples and religious institutions continue to serve as centers of emotional renewal. They function as spiritual anchors that mitigate loneliness and create new meaning in later life. 3) Elderly clubs and community-based social activities generate “social energy.” These collective spaces foster a sense of value, recognition, and participation, aligning with the World Health Organization’s framework on active aging. 4) Local healing traditions and herbal medicine constitute a culturally meaningful parallel health system. These practices help bridge structural gaps in access to modern healthcare. 5) Village health volunteers (VHVs) serve as “state intermediaries in caring for older adults’ everyday lives,” linking public health services with local contexts. They play a vital role in enabling close and continuous care for older adults.

Application of this study: From the findings, the older adults in Northeastern Thailand require supportive physical and social environments such as safe walkways, communal activity spaces, life-quality improvement centers and an integrated care system that connects families, communities, local authorities, and health care facilities. Strengthening social capital through VHVs, religious institutions, and community leaders can enhance both the meaningfulness and sustainability of elder care systems. The key policy recommendations include 1) establishing subdistrict-level life-quality development centers for older adults as integrated hubs for physical, mental, and social well-being, 2) implementing community-managed transport services for older adults, 3) developing short-course training programs for VHVs focused on holistic elderly care, 4) integrating local wisdom with modern medicine to build culturally appropriate health systems and 5) urban and community planning based on the age-friendly environment approach to support the long-term needs of an aging population structure.

Conclusions: This research studied the ontological meaning of well-being among the older adults in Northeastern Thailand through the perspectives of older persons, families, communities, and relevant stakeholders, employing a phenomenological approach to gain an in-depth understanding of their lived experiences. The findings revealed that elderly well-being is a complex and multidimensional phenomenon encompassing physical, psychological, social, and spiritual dimensions. Families, kinship networks, temples, elderly clubs, local wisdom, and village health volunteers play significant roles in fostering security, a sense of self-worth, and community participation among older adults. The findings indicate that promoting elderly well-being requires collaborative efforts among families, communities, and government agencies, together with the development of supportive environments and service systems that are responsive to local sociocultural contexts. These findings provide a foundation for policy formulation and the design of integrated elderly care systems to support a high-quality and sustainable ageing society in the future.