Well-Being of the Elderly in Thailand: A Scoping Systematic Review

Background and Context

Thailand is experiencing one of the most rapid demographic transitions in the ASEAN region. The country’s elderly population — defined as individuals aged 60 years and above — has been growing at an accelerating pace, driven by declining fertility rates and increasing life expectancy. Thailand is projected to rank among the top ten countries globally in terms of its older population proportion by 2030, with approximately 27% of the population aged 60 or above. This demographic shift presents profound challenges for the nation’s healthcare system, social welfare infrastructure, and economic development trajectory.

In this context, understanding the multidimensional well-being of elderly Thais becomes essential for evidence-based policy development. Well-being among the elderly encompasses physical health, mental and emotional wellness, social connectedness, financial security, living arrangements, and access to healthcare services. The interplay of these factors is further shaped by Thailand’s distinct cultural, religious, and social contexts — including the central role of Buddhist philosophy in Thai society, the traditional importance of extended family support structures, and the ongoing urbanisation that is reshaping intergenerational relationships.

Study Design and Methodology

This scoping systematic review was conducted to synthesise the available evidence on well-being among elderly individuals aged 50 years and above in Thailand. The review employed a comprehensive search strategy across three major biomedical databases: PubMed, Scopus, and ISI Web of Science. Studies published between 1994 and 2016 that addressed any aspect of elderly well-being in the Thai context were eligible for inclusion. The review framework organised findings around six predetermined outcome domains that collectively capture the multidimensional nature of elderly well-being.

The scoping review methodology was chosen because it allows for the systematic mapping of a broad and heterogeneous literature, identifying key concepts, evidence sources, and research gaps rather than seeking to answer a narrowly defined clinical question. This approach was particularly appropriate given the diversity of research designs, populations, and well-being domains covered in the Thai elderly literature.

Health and Well-Being Domain

Among the 72 included studies, a substantial proportion addressed physical health outcomes among elderly Thais. The prevalence of chronic non-communicable diseases — including hypertension, diabetes mellitus, dyslipidaemia, and musculoskeletal disorders — was consistently high across study populations. Physical inactivity emerged as a significant concern, with some studies reporting that nearly half of rural elderly Thais did not engage in regular physical activity. Gender differences were notable, with female elderly participants generally reporting lower levels of physical activity than their male counterparts, though income adequacy also played a moderating role.

Mental health and psychological well-being featured prominently in the reviewed literature. Loneliness, social isolation, depression, and anxiety were commonly reported among elderly Thais, particularly among those living alone, those with limited family support, and those experiencing chronic illness or functional limitations. The Buddhist cultural context emerged as both a protective and complicating factor — while Buddhist practices of mindfulness, community participation, and acceptance of ageing were associated with better psychological outcomes in some studies, others documented the stigma associated with mental health conditions and the reluctance of elderly individuals to seek formal mental health services.

Living Arrangements and Social Support

Traditional Thai family structures, in which elderly parents co-reside with adult children, have historically provided a primary source of material and emotional support for the ageing population. However, the reviewed studies documented significant changes in these arrangements driven by urbanisation, rural-to-urban migration of working-age adults, and changing family norms. An increasing proportion of elderly Thais were found to live alone or with only a spouse, particularly in rural communities from which younger family members had migrated for employment.

Social support networks — including family, community, religious institutions, and government welfare programmes — were consistently identified as important determinants of elderly well-being. Studies that examined the relationship between social support and health outcomes generally found that stronger social networks were associated with better physical functioning, lower rates of depression, higher life satisfaction, and more appropriate utilisation of healthcare services. Community-based health promotion programmes that leveraged existing social structures, including Buddhist temples and village health volunteer networks, showed promise as culturally appropriate interventions.

Healthcare Utilisation and Access

Thailand’s Universal Coverage Scheme (UCS), introduced in 2002, has significantly expanded healthcare access for elderly citizens. Several of the reviewed studies examined patterns of healthcare utilisation among the elderly, finding generally high rates of contact with primary care services but uneven access to specialist and rehabilitative care, particularly in rural and remote areas. Out-of-pocket healthcare expenditure, while reduced by the UCS, remained a concern for elderly individuals with multiple chronic conditions requiring ongoing medication and specialist follow-up.

The integration of traditional Thai medicine and Buddhist-based healing practices alongside modern biomedical care emerged as an important theme. Many elderly Thais were found to use complementary and traditional medicine, either as a first-line approach or in conjunction with conventional treatment. Understanding these health-seeking patterns is essential for designing healthcare delivery models that are responsive to the preferences and values of the elderly population.

Implications for Policy and Practice

The findings of this scoping review carry significant implications for public health policy in Thailand and across the ASEAN region. As Thailand’s elderly population continues to grow, the demand for age-friendly healthcare services, long-term care infrastructure, and social protection mechanisms will intensify. The review highlights the need for integrated approaches that address the physical, mental, social, and financial dimensions of elderly well-being simultaneously, rather than treating these domains in isolation.

Community-based interventions that build upon Thailand’s existing primary healthcare infrastructure and leverage cultural assets — including Buddhist institutions, village health volunteer networks, and intergenerational family support — offer a sustainable model for promoting active and healthy ageing. At the policy level, strengthening the social safety net for elderly individuals living alone, expanding access to geriatric mental health services, and investing in long-term care systems that can accommodate the projected increase in dependent elderly individuals are urgent priorities.

Limitations

This scoping review is subject to several limitations inherent in the methodology. The review was restricted to studies published in English, which may have excluded relevant Thai-language literature. The heterogeneity of study designs, outcome measures, and population definitions across the included studies precluded quantitative synthesis or meta-analysis. The operational definition of “elderly” varied across studies, with some using a threshold of 50 years and others using 60 or 65 years. Additionally, the review’s reliance on published literature may introduce publication bias, as studies with null or negative findings are less likely to reach publication.

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