Poor Countries Are Aging Fast but Can’t Keep Up With the Cost

The elderly population is exploding in developing nations like Thailand, where savings and government resources are scant.

NONG BUA HING, Thailand—Boonma Klahan starts her mornings by washing, changing and feeding her 85-year-old mother, who has dementia and spends her days on a mattress on the family home’s wooden floor.

Developing countries like Thailand are growing old before they are growing rich.

She makes breakfast for her 87-year-old father and then rides her motorbike to her job as a health aide to 22 other elderly people in this poor farming village west of Bangkok. Three of Boonma’s charges are bedridden like her mother. Most of the others can no longer leave their homes.

The three scrape by on the $90 Boonma receives each month for her work, her parents’ combined $50 old-age allowance from the government and money sent by her own adult son and daughter. Boonma’s brother, who lives nearby, drops off groceries most mornings.

“It’s getting more and more difficult to get by,” says Boonma, 57, whose own back and knees are starting to strain from lifting people without the help of hospital beds or other specialized medical equipment.

Developing countries like Thailand are growing old before they are growing rich. Their societies are aging quickly—but without the pension systems and personal savings that sustain older people in most developed countries.

One in six Thais is over the age of 65, the result of a baby bust that began in the 1970s. Within about a decade, the country’s fertility rate plunged from an average of nearly six children per woman to just over two.

Today, Thailand’s fertility rate is 0.9, compared with 1.6 in the U.S. and less than half that needed to keep the population stable. Average life expectancy, meanwhile, jumped from 51 years in 1960 to 77 years now—just two years below the U.S.

Key demographic markers in many developing countries, especially in Asia, are starting to look like those of much more developed economies. Their working-age populations are close to peaking or, like Thailand’s, already shrinking. They are staring at the prospect of far fewer young people supporting a growing cohort of aging adults.

But countries including Thailand, Vietnam, China and even India, whose fertility rate dropped to 1.9 babies per woman in 2024, are aging at much lower levels of wealth than the U.S. and European economies.

The U.S. became what the United Nations defines as an “aging society,” where at least 7% of the population is over 65, in the early 1940s. It then took more than 70 years to become an “aged society,” in which the size of that cohort has doubled to 14%.

Thailand, by contrast, became an aging society in 2004 and an aged society just 18 years later. Both countries are currently projected to become “super-aged societies,” where at least 20% of the population is over 65, around 2030.

But while U.S. per-capita gross domestic product was $55,264 in 2014, the year it became an aged society, Thailand’s stood at just $6,910 in 2022.

Filial piety

As recently as the 1990s, Thailand’s plunging birthrate was celebrated as a success by demographers worried about overpopulation and resource scarcity.

In contrast to China’s coercive one-child policy, Thailand’s “reproductive revolution” was the result of a voluntary rollout of contraceptives, including to married women.

Today, however, the Thai government, like others in the region, is trying to encourage women to have more babies. Vietnam’s Communist leadership last year scrapped a policy limiting families to two children as its manufacturing boom risks running out of workers. Thailand’s economy remains reliant on manpower-heavy industries such as tourism and farming.

“Our labor force is shrinking and output will decrease,” says Nikorn Soemklang, Thailand’s minister of Social Development and Human Security.

Meanwhile, that first generation of Thais who had fewer babies is now getting old.

Boonma’s mother was one of eight children, but only had two herself. So when her mother broke her hip five years ago, Boonma quit her local-government job to care for her.

A 2024 survey by Thailand’s statistics office found that 45% of Thais over 60 have no savings at all, while another 35% have less than $3,000. Nearly half of Thai seniors live with their children. Of those who don’t, 80% receive some financial support from them. Two-thirds of old people who need physical support depend on their offspring as caregivers.

“This is what we have been doing forever,” says Boonma. “My mother looked after my grandmother and then after my grandfather. Today I look after my parents.”

In Nong Bua Hing, around 80% of adults are over 60, says Yod Khlaisiri, 55, the village leader. Like Boonma’s two children, most younger adults have moved to Bangkok or other cities to earn money.

To combat loneliness and help older residents earn some money, Yod has started a traditional drumming circle that performs at weddings and other occasions. During a recent practice, two regulars, including the instructor, were in the hospital after suffering strokes. Of the 12 women who form the village’s Thai dance troupe—traditionally made up of young women or girls—five are over 60.

Breaking point

Nopphol Witvorapong, an economist at Chulalongkorn University in Bangkok who studies Thailand’s family structures, says social networks remain strong in rural communities, where neighbors will often step in and local health aides like Boonma pick up the slack.

Those bonds, however, are fraying in Thailand’s rapidly growing cities.

Malinee Sangkalak, 71, spent decades working as a cook in Bangkok restaurants until her 60s, when she could no longer handle the long hours standing up. Today she lives with her son, a factory worker, and a grandson.

On a recent Monday, she joined a crowd of some 200 people who lined up for free meals provided by a local charity. Many were homeless, and about two-thirds were seniors.

“I never had enough money to save. Whatever I had, I spent on my family,” says Malinee.

Successive Thai governments have debated raising a universal old-age allowance that currently amounts to between $18 and $35 a month, but eventually discarded the idea for cost reasons. Seniors can apply for additional means-based support of up to $90 a month.

Beyond that, elderly people without savings or family to sustain them have few options.

Homeless shelters usually don’t accept ailing seniors. A country of 71 million people, Thailand has only 25 government-run old-age homes where care is low-cost or free, according to the Ministry of Social Development and Human Security. The World Bank, meanwhile, forecasts that by the early 2040s, the number of Thais over 80 who need assistance will increase sixfold to around 2.5 million.

One model the government hopes to expand is paying families to “foster” seniors, similar to a foster-care system for children.

One of its first beneficiaries is Aran Inthakul, 71, a former car mechanic who struggles to move after a bad fall several years ago in front of his makeshift shack on the outskirts of Bangkok. His neighbor, Lucksana Tohtrakarn, 67, began checking in on Aran when she realized his family never stopped by.

She now receives $60 a month to help Aran with meals, bathing and other necessities. She says she spends most of that money on him, including on soy milk and a special meat broth she hopes will help him regain some strength. “I felt empathy for him,” says Lucksana, “because he was always alone.”

Write to Gabriele Steinhauser at Gabriele.Steinhauser@wsj.com