This study aims to examine how older adults in Vietnam manage complex care needs where formal care is limited and how informal support, reciprocity and loneliness intersect within these arrangements.
This paper draws on 90 semi-structured interviews with older adults, family carers and local stakeholders at urban and rural sites in southern Vietnam, conducted in 2024. Older-adult interviews formed the primary analytic data set, while carer and local-stakeholder accounts were used to triangulate participants’ experiences and clarify how care and local provision were organised. Reflexive thematic analysis combined case-based comparison with attention to contrary cases.
Complex needs became difficult to manage when functional limitations interacted with low income, transport barriers and discontinuous assistance. Older adults maintained recognised roles through work, care, advice, income and community participation. As their capacity to contribute declined, some restricted requests for help or withdrew from interaction. Loneliness reflected whether relationships were accessible, responsive and able to provide practical support and recognition, rather than living arrangements alone.
Assessment should identify specific care tasks, who can perform them and whether support can continue. It should also consider needs that remain unspoken because older adults fear burdening relatives. Support with transport, medicine collection, carer needs and coordinated follow-up may strengthen informal care without treating family presence as sufficient.
This study offers a relational-institutional interpretation of care complexity. It demonstrates how the limitations of formal provision dictate informal care capacity and reciprocity shapes help-seeking and how loneliness may arise when relationships no longer provide usable support or recognition.
