Older people care in the Kingdom of Saudi Arabia: Developing culturally appropriate and sustainable models of care

Abstract

Population ageing is increasing rapidly in the Kingdom of Saudi Arabia (KSA), accompanied by declining fertility rates, increasing life expectancy, and a high prevalence of chronic disease in older age. The proportion of the population aged 60 years or older is projected to reach 6.18% by 2030 and to double by 2050. Despite that, care for older people remains predominantly family-based, often supplemented by foreign live-in domestic workers, while formal long-term care services and geriatric expertise are limited and institutional care is culturally stigmatised. The aim of this PhD project was to examine options for developing culturally appropriate and sustainable models of care for older people in the KSA in the context of national health reforms and evolving family structures. This aim was addressed through one primary research question: what models of care for older people are appropriate and feasible in the KSA, given the emerging needs, national health reforms, and cultural expectations? The research was guided by three sub-questions concerning the gaps and challenges in the current care system, the barriers and enablers identified by stakeholders across system levels, and recommendations to improve care for older people in the KSA. Guided by an Islamic ethical lens and Ecological Systems Theory, this program of research is presented as a thesis-by-publication. The thesis consisted of an international literature overview, a regional scoping review, and two qualitative papers. Firstly, the international overview examined selected models of care for older people in countries with more developed care systems. This chapter identified system features relevant to the KSA, including governance, financing, service delivery, and family support. Secondly, a scoping review was conducted to map care services across the Arab Gulf countries. The review highlighted persistent gaps, including weak cross-sector coordination, a limited specialised workforce, and heavy reliance on informal care. The third study, reported across two manuscripts, was conducted using semi structured interviews with 16 stakeholders (academics, policymakers, health professionals, managers, and service providers) from the government, private and non-profit sectors in Riyadh, Qassim, Al-Baha, and Hafr Al-Batin between February and December 2024. The findings highlight significant barriers to enhancing care for older people at both the grassroots and system levels. At the grassroots level, these include workforce shortages and skills gaps, as well as infrastructure and accessibility challenges. At the system level, barriers include fragmented service arrangements and weak policy implementation. Key facilitators and recommendations for reform include workforce development, optimised infrastructure, the development of culturally appropriate care models, strengthened governance and integration across ministries and sectors, enhanced community engagement to support family caregiving, financial support for informal caregivers, and the integration of virtual health services. Overall, this PhD research suggests that sustainable care models in the KSA should prioritise integrated, community-focused services that support family caregiving while expanding formal system capacity. Furthermore, there is a need to increase the capacity of the geriatric workforce, reduce unnecessary hospital bed occupancy by long-term patients, and ensure that reform implementation aligns with culturally rooted expectations of dignity and family responsibility.