Formal and Informal Long-Term Care Services for Older Adults in Lower-Middle and Low-Income Countries: A Systematic Review

Purpose: This systematic review examines current literature on formal and informal services addressing long-term care (LTC) needs of older adults in lower-middle and low-income countries (LMLICs).
Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, primary empirical studies were searched across PubMed, Embase, Scopus, EBSCOhost platforms, CINAHL, ProQuest, EconLit, and Social Science Research Network. Results were synthesised narratively.
Results: Of 2,442 records identified, 51 studies met inclusion criteria. LTC services in LMLICs encompass a continuum addressing physical, cognitive, and social needs. Formal LTC includes home-based care, community day-care centres, and institutional options, which improve patient function and relieve caregivers, though these services prioritise diagnosed conditions, leaving functionally impaired older adults underserved. Informal LTC primarily involves family caregiving. Access is influenced by socioeconomic status, demographics, health system infrastructure, cultural norms, and caregiver capacity. Both formal and informal care enhance functional ability and quality of life, yet significant unmet needs persist, especially for activities of daily living (ADLs) and instrumental ADLs (IADLs), due to limited coverage and financial barriers.
Conclusion: Integrated, culturally sensitive LTC models and supportive policies are needed in LMLICs to enhance formal and informal care, alleviate caregiver burden, and promote equitable access.