Exploring the Lived Experiences of Caregiving for Older Family Members by Young Caregivers in Singapore: Transition, Trials, and Tribulations

Greater longevity and a declining fertility rate are causing the global population to age rapidly, with an estimated 101 million older adults aged 60 and above dependent on family members for their care [1]. The Eastern and Southeastern regions of Asia will witness the largest increase in the proportion of older persons, with Singapore being one of the fastest-aging nations globally and in the region [2]. By 2030, 1 in 4 citizens in Singapore will be aged 65 and above [3]. By 2050, 1 in 2 of the total population will be aged 65 and above [4]. Such a profound demographic transition is accompanied by a growing proportion of seniors with multimorbidity [5], with 1 in 2 healthy residents aged 65 and above potentially becoming severely disabled in their lifetime, which will prolong for ten years or more for 3 in 10 seniors [6]. These would intensify the demand for long-term care from family members of older adults.

Yet, with shrinking family sizes, the old-age support ratio will decline from 3.8 in 2022 to 2.7 by 2030. This is against the backdrop of socio-demographic undercurrents such as plummeting fertility rates and later parenthood, alongside a significant rise in the old-age population amidst extended life expectancy [3,7,8]. These induce verticalisation and horizontal narrowing of family structures, resulting in “longer years of shared lives between generations”, with prolonged caregiving relationships [9]. This increases the potential for caregiving by younger generations for older parents and surviving grandparents.

Consequently, Singapore has observed a rising number of young caregivers for older family members [10]. According to the Agency for Integrated Care (AIC), which coordinates aged care services in Singapore, the number of caregivers under 35 who tapped into the Caregivers Training Grant grew from 287 in 2013 to 465 in 2017. Some social service agencies (SSAs) report witnessing significant numbers of young caregivers, attributed partly to the earlier onset of diseases, which were once construed to be prevalent in old age. Dementia Singapore (formerly Alzheimer’s Disease Association) reported that annually, up to 200 young individuals are thrust into the role of caregiving amidst the rising trend of adults contracting dementia earlier, with caregivers being as young as 12 years old [11,12]. However, there is currently no nationally representative research on the prevalence of young caregivers among older adults or dedicated exploratory local studies on their experiences and impact of caregiving. Thus, practitioners and policymakers have limited data to draw upon to inform the formulation of targeted support.

While young caregivers in the Western world are increasingly being studied and recognised as a distinct social group alongside varying levels of policies [13], there remains a notable gap, especially in Asia, in exploring the experiences of children and young adults in family caregiving roles, despite them existing in every country [14,15]. This is complexified by the lack of self-awareness among young caregivers as being family caregivers amidst cultural expectations around care, alongside caregiving being typified as a mid-life or old-age phenomenon by societal norms [16,17]. Therefore, young caregivers remain an overlooked, invisible population, falling through the gaps of public policy and practice amid the discrete boundaries of health, social care, and education services and within the wider caregiving literature [18,19].

Notably, young adult caregivers are experiencing critical developmental tasks and life transitions such as identity formation, growing autonomy, navigating intimate relationships, tertiary education, career development, leaving the parental home, and starting a family [20,21]. The demands of caregiving may challenge the negotiation of these milestones, with resultant implications for overall well-being [22,23]. Becker and Becker [24] (p. 6) defined “young adult carers” in the United Kingdom (UK) as individuals aged 18–24 “who provide or intend to provide care, assistance, or support to another family member on an unpaid basis.” However, extant literature addressing young adult caregivers utilises competing age-based definitions of young adulthood, ranging from 24–25 years old [25,26], to 29 years of age [27,28], or to a more expansive age threshold of 40 years old [29].

These expanded age bands are attributable to the prolonged life course period of young adulthood over the last decades, due to later average ages of life-stage transitions (e.g., transition to a stable career, marriage, parenthood), especially within developed nations [30]. These trends are consistent within Singapore, with the age definition of youths being 15–35 [7,31]. Hence, developmental theorists assert that young adults reside at a qualitatively unique life stage, which impacts the nature of caregiving experiences, outcomes, and needed support services [32].

Young caregivers assume varied responsibilities, from provisioning emotional support and companionship to assisting with basic and instrumental activities of daily living (ADL) for older family members. To this end, the widely documented effects of caregiving on well-being among adult family caregivers may even be more pertinent to young caregivers yet distinctively experienced owing to their life stage [33,34].

Caregiver burden is one of the primarily investigated outcome indicators for the multifaceted strains and responses associated with physical, psychological, social, and financial demands and challenges arising from caregiving, including impaired family relationships [35,36,37]. In this regard, caregiver burden is related to the well-being of the care recipient, caregiver, and the wider family system. While caregiver burden is not confined to any specific culture and has been well-established in the adult caregiver literature, there are distinctive elements that bear an influence on the Asian caregiving experience. Given that family assumes precedence in Asian societies like Singapore, buttressed by values and expectations of filial piety and responsibility [38,39,40], it is imperative to study how caregiver burden is experienced among Asian young caregivers as well. Among the dimensions of caregiver burden, psychological dysfunctions such as depression and anxiety remain the most enduring and widely studied forms among adult caregivers [41,42,43].

In Singapore, based on the 2018 Quality of Life (QOL) of caregivers study by the National Council of Social Service (NCSS) [44], caregivers of both older and younger individuals with disabilities, chronic illnesses, mental health conditions, or frailty reported lower quality of life, especially in the domains of personal belief and social relationships. Amongst other predictors, caregivers co-residing with care recipients, caring for more than one individual, and engaging in higher duration and intensity of care reported significantly lower quality of life. Further, according to the 2013 Well-being of the Singapore Elderly (WiSE) population-based cross-sectional survey, a sizeable 24.5% of all caregivers experienced burden, whereas 46% encountered distress from care recipients’ behavioural and psychological symptoms of dementia and 8.8% underwent psychiatric morbidity [45,46]. Similarly, based on the Singapore Survey on Informal Caregiving (2010–2011), the leading predictor of caregivers’ depressive symptomatology was their negative reaction to caregiving. This arose from weak family support, apart from the care recipient’s health and functional and cognitive limitations, which intensified caregivers’ negative reactions [47].

Although these local studies provide valuable indications of the multifaceted strains associated with caregiver burden, they failed to report disaggregated findings on the youngest age band owing to methodological constraints (e.g., small sample size) and excluded caregivers aged 18 and below. As the samples were heterogeneous in age, amalgamating young adult caregivers with older cohorts, it was beyond the scope of these studies to investigate young caregivers’ specific experiences. Hence, they provide limited contextual and targeted insights to design and implement services attuned to the needs of young caregivers. Bastawrous [36] further contends that quantitative measures of caregiver burden fail to capture critical contextual elements of the caregiving experience. They preclude the nuanced subjectivity and sophistication inherent to human experiences within sociocultural and familial contexts, which instead warrant qualitative explorations.

This is pertinent given Singapore’s socio-political stance, which maintains that families remain the first line of support. Fostering intergenerational support constitutes a core component of the city-state’s ageing policies in areas across legislation, housing, taxation, health care, and financial subsidies [48], while promoting aging in place that is commensurate with the preferences of older adults [49]. This reflects the wider socio-cultural norms within Asian families, which buttress expectations for intergenerational interdependence across the life course [50].

Familial obligations are reinforced by the presiding culture of filial piety in Singapore [51], which is also evident among the youths. According to the National Youth Council [52], youths have consistently ranked maintaining strong family ties as a top life goal over the past decade. In 2019, 8 in 10 youths reported they would care for parents in old age irrespective of circumstances, reflecting the propensity for caregiving underpinned by the pertinence of family values among young individuals. Hence, although it is posited that nations with underdeveloped long-term care systems may have a larger incidence of young caregivers [53], the duty of primary caregiving still chiefly rests upon informal family caregivers in Singapore, despite its developed eldercare infrastructure and services. This is due to the “underlying social policy framework, cultural values, and social expectations of filial duties in Singapore” [54] (p. 4).

Therefore, the sustainment of salubrious intergenerational relationships is necessary for caregiving, given that members of older generations become the primary responsibility of subsequent generations [55]. Intergenerational caregiving refers to caregiving activities that transpire between generations, which sometimes skip a generation [56]. Roles and responsibilities among family caregivers of older adults are often shared [57,58], although the intensity of care engagement differs across each family member [59].

Primary caregivers are perceived by themselves and others as the foremost source of assistance in most aspects of daily care for care recipients. They tend to be the primary point of contact for formal and informal networks [60]. Some are supported by other relatives or friends recognised as secondary caregivers, who execute tasks at a level akin to primary caregivers yet without the same level of responsibility, attributable to their comparatively less intensive and/or frequent assistance [61,62,63]. This includes hands-on help, personal care, assisting with instrumental ADLs, emotional support, health-related care [64,65], and respite care. This helps mitigate distress and burden among primary caregivers, thereby delaying and preventing the institutionalisation of care recipients [66].

However, scholars contend that secondary caregivers, typically younger with higher education and income, remain underexplored and overlooked in research and practice. Secondary caregivers experience comparable psychological distress and burden alongside physical strain, about whom researchers argue for inclusion in future research [62,67,68]. Yet, while there are avenues for information and services targeting primary caregivers, secondary caregivers face inadequate guidance on how best to support primary caregivers alongside themselves [61]. As caregiving roles develop with time amidst the vicissitudes of familial and labour market contexts (e.g., dual-income families, single-parent, or skipped-generation families), young individuals are also becoming an emerging population of primary caregivers [33,69,70].