Confronting the Challenge of Dementia Care: Lessons from South Korea
Alzheimer’s disease and related dementias (ADRD) are putting a significant strain on families and healthcare systems worldwide, and with increasing life expectancies, they pose an escalating global challenge. As one of the world’s fastest aging economies, South Korea’s efforts to address the burden of care for people living with ADRD offer valuable lessons for other nations grappling with the social and economic pressures of the demographic transition.
A new comprehensive review of Korea’s programs and policies to promote healthy aging and diagnose, treat, and care for people living with ADRD sheds light on progress and ongoing challenges. Published in the May 2025 issue of Alzheimer's & Dementia: The Journal of the Alzheimer's Association, the review offers insights from Korea’s strategies that resonate far beyond its borders.
The co-authors – Stanford health economist Karen Eggleston, the director of APARC’s Asia Health Policy Program (AHPP), and Daejung Kim, an associate research fellow at the Korea Institute for Health and Social Affairs – focus on recent policies supporting “aging in place” for independent seniors and palliative care for those needing greater support.
Eggleston and Kim used a mixed-methods review of dementia care in Korea over the past 25 years, combining a critical analysis of peer-reviewed social science and health policy studies in both English and Korean, quantitative analysis of Korean statistical agency data compared with other OECD countries, and interviews with local policymakers and welfare administrators in a region with a high proportion of elderly population.
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Social and Policy Pressures in a Rapidly Aging Economy
Korea is aging fast, and the prevalence of ADRD among older adults is expected to surge, as is the projected social and economic toll of dementia care. Demographic and economic projections suggest that the annual cost of ADRD in Korea would increase from 0.9 percent to almost four percent of GDP from 2019 to 2050.
“Korea’s demographic transition, like its economic development, has been compressed into just a few generations,” Eggleston and Kim explain. “As a result, its triumph of longevity and current extra-low fertility engender social strains and policy pressures to address the burgeoning needs for long-term services and support – including prevention of ADRD, investing in early detection, and providing appropriate care for people with ADRD, which often involves addressing the broader social issue of financial support for older adults and detecting cognitive decline in those still engaged in the labor force.”
A Foundation for Dementia Care Service Delivery
Korea has taken decisive steps to build a comprehensive system for dementia care, leveraging its national health insurance and long-term care insurance (LTCI). This dual insurance framework aims to reduce unnecessary hospitalizations and shift social care away from medical settings.
Research shows that “the adoption of LTCI in 2008 helped to address regional disparities by providing nationwide risk pooling for long-term care services,” but the system still faces hurdles. Within Korea’s private-dominated service delivery system, the public-private balance varies significantly across different services, coordination between healthcare and long-term care services remains fragmented, and there is a need for better integration of community-based support.
Furthermore, “social insurance is no panacea for mitigating disparities and securing financial support for the most vulnerable citizens, such as people with ADRD and their families,” Eggleston and Kim note. Out-of-pocket payments for medical care still constitute a substantial portion of Korean household consumption.
Livelihood and Workforce Challenges
In light of Korea’s limited sources of financial support for its older citizens, the country has relatively high labor force participation, especially among older men. This high level of employment of older Koreans may bode ill in an economy where many of the “senior employment” positions – primarily low-paying roles in the service sector – are not age-friendly.
Giving elderly persons a reason to get up in the morning has its benefits, Eggleston and Kim note, but having them perform service jobs is not a sustainable way to support livelihoods and healthy aging. “How decision-making by cognitively impaired individuals affects health and financial well-being can be considered the defining feature of the economics perspective on ADRD and its social impacts,” the co-authors say.
The growing demand for professional dementia care strains Korea’s caregiving workforce in other ways. Amid the shortage and aging of caregivers, much of dementia care falls on unpaid family members, often women in their 50s, lowering their rates of labor force participation in prime age. The burden on these informal caregivers is profound.
The authors note that “Korea needs more strategies to recruit, retain, and empower a knowledgeable and resilient caregiving workforce.”
Prevention and Early Diagnosis: A Mixed Picture
Early detection is critical for planning care and support for people with ADRD, and Korea is taking steps to design programs and incentives for healthy aging habits and early ADRD detection. These efforts, however, require stronger staffing and funding to offer more personalized and coordinated care.
Another set of challenges stems from the underuse of existing long-term services and support programs and the need to diversify them. Currently, providers have weak incentives to offer palliative care, while families and patients often struggle to choose comfort care over ongoing medical treatments.
Policymakers must also expand the target group of beneficiaries and diversify long-term services and support for daily life, including promoting a reduction in risk factors associated with dementia, such as low educational attainment, smoking, physical inactivity, uncontrolled chronic diseases, and depression. Eggleston and Kim call for developing “additional care service types such as hospital companion and nutrition support services” and integrating new technologies as part of a diversified, long-term aging-in-place care system.
Expanding Care Options
The demographic transition has been accompanied by shifting social norms regarding responsibilities and caregiving, meaning significantly fewer Koreans believe care for older parents is the sole responsibility of family members. Accordingly, Korean policies aim to strengthen home- and community-based services (HCBS). Yet, the country’s share of at-home care recipients remains lower than in many peer economies.
“Making the vision of quality HCBS a reality involves multiple dimensions of financing and service delivery, tailored to local and individual circumstances while supporting equitable access nationally for those in need,” write Eggleston and Kim.
Institutional care in residential facilities remains a necessity for frail older people with ADRD and multiple comorbidities. While the supply of such service providers has greatly improved and long-term care insurance coverage has enhanced their affordability for families, wide disparities in quality of care for those in residential facilities persist. Meanwhile, hospice and palliative care remain largely an underdeveloped care option for people with ADRD in Korea.
Lessons for Aging Economies
South Korea’s dementia care journey illustrates the complex balancing act of addressing the multiple dimensions of a rapid demographic transition. The country’s efforts to promote healthy aging and diagnose, treat, and care for people with ADRD offer valuable insights for other economies that must prepare to provide long-term support for their aging populations.
One major imperative in Korea and elsewhere is ensuring that dementia care policies and programs are based on robust evidence. “To utilize limited resources most effectively, it will be critical to design and collect policy-relevant evidence about what works for people with ADRD and their care partners,” Eggleston and Kim write.
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A comprehensive review of rapidly aging South Korea’s efforts to mitigate the social and economic costs of Alzheimer’s disease and related dementias, co-authored by Stanford health economist Karen Eggleston, provides insights for nations facing policy pressures of the demographic transition.
