Culture and Caregiving for Older Adults in India: A Qualitative Study

Background: Family members have long provided care for aging and older adults at home, especially in low and middle-income countries.  India’s current increase in nuclear families, due to rapid-urbanization, is coupled with longer life expectancy.   Many of the cultural cornerstones of caregiving have not been explored in the context of India’s family structure, demographic and epidemiologic transitions. The goal of the current study is to assess the cultural beliefs, values and norms associated with elder care. It is important to systematically explore these norms, in order to develop culturally appropriate caregiver interventions and long-term care provisions, in the face of the changing demographic fabric of India.

Methods: Data was drawn from 30 semi-structured, in-depth qualitative interviews of caregivers of older adults (aged 60+) from Jodhpur, the 2^nd largest city in Rajasthan state. Caregivers were identified through key informants and sampled purposively, stratified by type of care needed: 1) cognitive impairment/dementia, 2) physical health condition, 3) healthy/”normal” aging). Respondents were selected both from nuclear as well as traditional ‘joint’ families, including two or more generations. First analysis stage was deductive, based on care demands, caregiving role and responsibilities, content areas in the interview guide. The second stage was inductive, based on new themes that emerged from the interview.

Results: Among caregivers, some of the common cultural explanations for taking on care roles included feeling compelled to care for one’s family, akin to but distinct from filial piety (respect for elders and parents). For caregivers to older adults, cultural gender norms remained important, but not sole motivators of care expectations. A key reward for care providers was the hope that providing their loved one care would result in this being their last re-birth, or offer them a better birth or life in the next life. Caregiving appeared distinct from seva, a Hindu concept of selfless service.

Implications: Cultural explanations for caregiving in this sample of Indian caregivers included concepts not typically seen in either Western or East Asian caregiving research. There may be different and greater subjective rewards of caregiving than typically included in Western caregiving stress models. Research on elder care and family caregiving in India is fairly new and there is much potential to critically look at the cultural factors that informs elder care, to shape elder care policies and programs. Current study expands research opportunities for shaping geriatric social work in India in culturally appropriate ways.