Editorial: The costs of caring for older adults

Abstract

Many of the most consequential costs of caring for older adults remain less visible because they are absorbed by families. Across the collection, informal caregivers appear not as peripheral helpers but as central actors in the care economy. Studies on dementia care, caregiver resilience, health literacy, family functioning and behavioural symptoms illustrate how caregiving demands a ect psychological wellbeing, family relationships and time use (Alasqah et al.; Di Nolfi et al.; Liu, Li, Yao and Zhang; Liu, Luo, Zhou, Li, Liu and Hu). These pressures are intensified by frailty, disability, demographic change and constrained family structures. Peng et al. synthesise the lived experiences and care needs of frail older patients; Xiang et al. show how China's one-child generation faces structurally imbalanced care responsibilities; and Zhao and Zhao document heterogeneous care preferences among disabled older adults in an urban setting. These articles make clear that supporting caregivers is not only a matter of compassion, but a condition for sustainable health and social care systems.A further contribution of the Research Topic lies in its attention to the organisation of care. Rather than positioning treatment as the sole centre of later-life care, several articles call for models that integrate assessment, navigation, community support and social care. Fulceri et al. map comprehensive geriatric assessment and management in primary care, highlighting the need for multidisciplinary teams and coordinated instruments. Coyne et al. illustrate, through a senior care navigator programme, how older adults can be supported to address both health and social needs. Chen, Zhang, Han, Chen, Li and Wu examine rural demand for socialised older-adult care services, showing how care needs evolve across age, period and cohort influences. At the system level, Guo et al. and Liu, Zhao and Li show that aligning care-service supply with population ageing is a complex coordination problem, while Xin and Han caution that community-based integrated care reforms may have unintended consequences, including increased hospitalization expenses. These findings underscore that reform is not automatically beneficial; its e ects depend on design, implementation, financing and equity.Technology o ers opportunities to extend care, but the collection appropriately avoids treating digital innovation as a simple solution. Studies of community-based home care and smart home care, digital transformation among "new older adults," and digital health needs for long-term continuity care demonstrate the promise of technologyenabled support while also exposing persistent risks of exclusion (Chen, Li, Bai, Jiang, Tang, Huang et al.; Shao et al.; Sun et al.). Digital tools may improve monitoring, communication, self-management and continuity, but their benefits depend on a ordability, access, usability and digital literacy. This theme is complemented by Tang et al., whose work on ego depletion and hypertension self-management reminds us that e ective care also depends on behavioural resources, motivation and the everyday capacity of older adults to manage chronic illness. Technology, therefore, should be understood as one component of a wider care ecosystem rather than a substitute for human support, social protection or accessible services.The articles also demonstrate that ageing and care are shaped by social determinants and relational environments. Education, socioeconomic position, community context, living arrangements, intergenerational support and social participation influence both health outcomes and care needs. Alberio et al. highlight the role of education and socioeconomic context in health among ageing populations. A group of studies on intergenerational relationships and programmes shows that social connection is both a resource for wellbeing and a site where expectations, reciprocity and community environments matter (Cheng, Kwan, Yee, Sow, Lee et al.; Zhao and Zhu; Cheng, Loo, Kwan, Yee, Sow et al.). Zhang, Chen and Ochoa add to this discussion by examining mutual-aid care needs among older adults with multimorbidity. Taken together, these contributions caution against viewing older adults only as recipients of care. They also highlight older adults' agency as people who make preferences, sustain relationships, participate in communities and navigate constrained choices.Place and care environments are equally important. Gil-Lacruz et al. foreground older adults' own perspectives on residential care homes, while Yermukhanova et al. examine the characteristics of older people's needs in Kazakhstan. Zhang and Loukaitou-Sideris compare age-friendly city and community policies, illustrating how built, social and policy environments can either support or restrict healthy ageing. Bai et al. focus attention on sleep disorders among older adults in care institutions, reminding us that institutional environments influence everyday wellbeing as well as clinical outcomes. These studies collectively show that care is not delivered in a vacuum. It is embedded in homes, institutions, neighbourhoods, cities and policy systems that can either protect older adults' dignity and independence or deepen vulnerability.The geographical breadth of the collection is a major strength, but its significance lies not only in diversity of setting. Evidence from Georgia, Germany, Poland and China shows how di erent systems confront shared pressures around workforce capacity, long-term care, mortality risk, chronic illness and access to formal services. Macharadze identifies gaps in geriatric services, education and policy in Georgia; Hass et al. analyse excess mortality among German adults aged 60 years and older who needed long-term care during 2020-2024; Majchrowicz et al. examine the functioning of chronically ill patients receiving long-term care in Poland; and Wu et al. show how urban empty-nest older adults may substitute self-medication for formal medical treatment under dual constraints. These studies demonstrate that the costs of care often appear where formal systems are unavailable, insu icient, poorly coordinated or una ordable. They also create opportunities for cross-country learning without assuming that one model can be transferred wholesale from one context to another.Several implications follow from the collection. First, policies should measure and value unpaid caregiving time rather than treating family care as an inexhaustible resource. Second, health and social care should be integrated through comprehensive geriatric assessment, care navigation, community-based services and continuity mechanisms that respond to functional, social and economic needs. Third, reforms should be evaluated not only for intended outcomes but also for unintended consequences, including increased hospitalization, inequitable access or the shifting of costs onto households. Fourth, digital care must be designed around inclusion, a ordability, literacy and trust. Finally, ageing policy should treat social determinants, household vulnerability, community environments and older adults' preferences as central design concerns rather than background variables. This Research Topic therefore advances a wider conceptualisation of the costs of caring for older adults. The contributions show that these costs extend beyond expenditure to include caregiver strain, fragmented services, digital divides, institutional conditions, social inequalities and policy gaps. They also show that these costs are not inevitable consequences of ageing alone; they are shaped by how societies organise support across families, communities, markets and public systems. As populations continue to age, future research and policy should move towards equitable, sustainable and person-centred models of care that recognise the diverse experiences of older adults and the shared responsibility required to support healthy ageing.