How Social Connections Can Strengthen Care Systems in Aging Societies

Population aging raises a fundamental development question. How can societies meet growing care needs while enabling older people to remain healthy, connected, and supported?

A broad understanding of well-being recognizes health, productive work, economic security, and social engagement as interconnected dimensions of aging well. At the same time, existing arrangements for care face significant pressures.

The share of older people living in one-person households has risen by 40%–90% over roughly two decades in several developing Asian economies. More than 16% of older Asians report feeling lonely most of the time. Formal care infrastructure remains nascent in many economies even as demand increases.

Strengthening formal long-term care and supporting families is therefore essential. But meeting the growing need for care is not only a matter of expanding services. It also means maintaining the relationships through which older people remain part of everyday social life.

Social networks are already recognized as important for social engagement and well-being. But what happens within these relationships that might itself be understood as care?

The article, “Beyond Directional Care: Theorising Mutuality in the Geographies of Care Through the Lens of Friendship,” examines friendship as a neglected dimension of the geographies of care and provides a different way of understanding how care is produced.

Care is often easiest to recognize when it moves in one direction. A family caregiver assists an older relative. A care worker provides personal support. A befriender visits someone at risk of isolation. These relationships remain indispensable.

Friendship complicates this model. Between friends and peers, the roles of caregiver and recipient may change continually or disappear altogether. Care may arise through walking or eating together, pursuing shared interests, sharing routines, keeping company, or simply being present. This is described as care-with, a non-directional form of care grounded in mutual co-presence.

Beyond friends, this perspective makes forms of everyday support more visible. Familiar strangers or neighbors who cross paths regularly may begin to recognize one another’s routines. Someone notices when a regular does not appear. Someone accompanies another person home, shares information, helps with a small task, or knows whom to contact when something goes wrong.

The significance of these relationships lies not only in closeness, but also in predictability. Repeated presence creates familiarity. Familiarity makes changes and absences visible.

A friend, neighbor, or regular acquaintance cannot replace a nurse, home-care worker, or family member providing practical assistance. Social networks contribute something different. They provide companionship, recognition, reciprocity, and help people look out for one another. They can help older people remain socially embedded, even when they live alone. These familiar encounters can offer assurance that one remains part of a web of care, with people to turn to now and in the future.

Older people also help sustain this web of care, challenging the view that they are primarily recipients of care. An older person may need assistance in one aspect of life while simultaneously providing company, knowledge, practical help, or reassurance to somebody else. Care-with treats older people as participants in networks of support, not only as people to whom support is delivered.

Recognizing care as something that can emerge through everyday relationships has implications for how communities support older people. Programs need to do more than bring people together; they can create opportunities for relationships to develop and continue. Planners also need to recognize the places that make repeated encounters possible.

Design for connection, not just participation
Programs addressing social isolation often need to demonstrate reach through outreach, referrals, and attendance. These measures are important, but contact is not the same as connection. A community activity can fill every seat while participants remain separate beneficiaries whose principal relationship is with the service provider.

If social connection is an intended outcome, programs can also create conditions for relationships to develop among participants. Repeated encounters with the same people, informal time before and after activities, and opportunities for participants to initiate their own gatherings can help relationships continue beyond a scheduled program. The objective is not to manufacture friendship. It is to make reciprocity more possible.

Look at changes in networks alongside reach
Programs do not need to turn friendship into another performance indicator. They can explore whether participants have become familiar with one another, maintain contact independently, exchange small forms of support, or notice when somebody stops attending. Social network questions, participant feedback, and qualitative observation can complement conventional measures of participation.

Recognize social infrastructure beyond care facilities
Networks are sustained through places. Coffeeshops, parks, libraries, markets, residential common areas, and walking routes can become socially important because they allow the same people to encounter one another repeatedly. This matters for both service delivery and the built environment.

Community providers can work with networks and gathering places that already exist rather than assuming that social connection must begin within a formal program. Planners can consider the relational consequences of changing common spaces that may appear ordinary but sustain everyday patterns of contact.

Social networks should not be treated as a low-cost substitute for long-term care. Treating friendship in this way would simply shift responsibility from formal systems onto individuals.

Rather, social networks are one component of a wider care ecosystem. Formal services provide professional and intensive support. Families remain important sources of care. Community programs connect people to services and activities. Friends, neighbors, and familiar others can add another layer through recognition, companionship, and mutual support.

As care needs grow, aging systems should ask not only how much care can be provided, but also how older people can remain embedded in networks through which care circulates.

Friendship cannot be delivered as a service. Policy can, however, create and preserve the conditions in which older people become known, missed, and able to show up for one another.

Asian Development Bank. 2024. Aging Well in Asia: Asian Development Policy Report 2024.

G.E.Y. Chan and E.L-E. Ho. 2026. Beyond Directional Care: Theorising Mutuality in the Geographies of Care Through the Lens of Friendship. Dialogues in Human Geography.