Psychiatric standardized claim ratios by rurality and deprivation in Japan: A nationwide ecological study with contextual suicide mortality.

The World Health Organization (WHO) projects that one in five individuals in the world would be aged 60 years or above, which will double to two billion senior people from the year 2019 to 2050 (). Coupled with birth rates that consistently reach record lows year after year (), this means that the level of care-giving burden on the younger population to support the healthcare needs of the older population will escalate significantly due to increasing disease burden, straining healthcare systems globally. The rising burden of eldercare is similarly observed in Singapore, whose multi-ethnic Asian population has one of the highest average life expectancies in the world at 83 years, only trailing behind countries like Sweden and Japan (). More healthcare resources are thus required to support their well-being as ageing invariably results in multiple co-morbidities (). A suboptimal primary care response to cater to their healthcare needs will result in their adverse health outcomes and overload the local tertiary healthcare system. Majority of seniors in Singapore (97%) age in place at home (). Only a minority reside in nursing homes (2.5%) and even fewer live in assisted living facilities (0.1%) (). A 2024 study also showed that 82.8% of local seniors prefer to age at home (). In Asian communities like Singapore, children are traditionally expected to be the primary caregivers for their elderly parents who reside in the same households. However, such practice becomes difficult due to increasingly common dual-income earner work arrangements among the employed children. In addition, the shrinking family size due to declining fertility rate leads to fewer children taking direct care of their ageing parents. As a result, local working couples commonly hired contracted stay-in foreign domestic workers (FDWs) to look after the older and younger family members, aside from assisting with household chores. From 2015 to 2018, families which employed FDWs, largely from neighboring countries such as Indonesia, Myanmar and Philippines, increased from 12% to 14%, totaling about 90,000 households (). English is the common language in Singapore for communication. The FDWs are expected to be literate in basic English before they can be brought in by professional agencies.