Exploring dementia care for community-dwelling older adults in Thailand: A qualitative descriptive study

Abstract

Background

Dementia is a growing public health concern in Thailand, placing significant demands on families, communities, and the healthcare system. Despite national policies supporting integrated care, community-based dementia services face challenges related to resource limitations, caregiver burden, and access to training.

Objective

This study aimed to explore the delivery of dementia care for community-dwelling older adults in Thailand, focusing on care processes, challenges, and support systems from the perspectives of community health nurses (CHNs), village health volunteers (VHVs), and family caregivers.

Methods

A qualitative descriptive approach was used. Twenty-two participants, including CHNs, VHVs, and family caregivers, were purposively selected from a metropolitan district in Thailand. Data were collected through semi-structured interviews and focus group discussions, supplemented by contextual health assessments. Thematic analysis was conducted using Sandelowski’s content analysis framework, with rigor ensured through member checking, audit trails, and peer debriefing.

Results

Six categories emerged: 1) Care processes involved integrated services across prevention, promotion, treatment, and rehabilitation, with family playing a central role; 2) Conditional factors included strong cultural values of filial responsibility and provider-community trust; 3) Care outcomes reflected partial independence in older adults, with caregivers experiencing varying levels of well-being and frequent stress due to lack of support and training; 4) Successes were attributed to supportive policies, family dedication, and healthcare providers’ intrinsic motivation; 5) Barriers included staff shortages, caregiver health issues, limited training, and insufficient confidence in VHVs; 6) Model development emphasized the need for policy backing, multidisciplinary collaboration, caregiver capacity-building, and dementia-specific community services.

Conclusion

Community-based dementia care in Thailand is driven by cultural commitment and dedicated local health workers but hindered by systemic constraints. Strengthening caregiver education, expanding service networks, and enhancing integrated support systems are critical for improving care quality and reducing caregiver burden. Equipping CHNs and VHVs with dementia-specific training and supporting their role in caregiver education and interdisciplinary coordination can further enhance the effectiveness and sustainability of dementia care in community settings.

Background

Dementia is a significant and growing global public health issue, affecting more than 55 million people worldwide, with nearly 60% of cases occurring in low- and middle-income countries. Each year, almost 10 million new cases are diagnosed, highlighting the need for coordinated global and local responses (WHO, 2025). The economic burden of dementia is equally alarming. Global costs related to the condition, including both direct medical expenses and indirect costs such as lost productivity and informal caregiving, are projected to rise from USD 1.3 trillion to USD 2.8 trillion by 2030 (WHO, 2021). These figures reflect the immense pressure placed not only on healthcare systems but also on families and informal caregivers who provide most of the long-term support.

In Thailand, dementia has become an increasingly prominent concern as the country undergoes rapid demographic aging. As of 2022, an estimated 770,000 older adults—approximately 6% of the elderly population—were living with dementia, and this number is expected to grow by approximately 100,000 new cases annually (Hfocus, 2023). The financial implications are significant, especially in rural households where the average annual cost of caring for an individual with dementia is about THB 90,644 (USD 2,683.97). A majority of these expenses—approximately 95%—are non-medical in nature, covering daily care needs, transportation, home modifications, and the opportunity costs associated with caregivers’ lost income. When considered on a monthly basis, the burden translates to an average of THB 7,554 (approximately USD 223.67) per person (Chuakhamfoo et al., 2020). This financial strain, coupled with emotional and physical demands, places a considerable burden on family caregivers, many of whom receive little or no formal support.

Dementia is an incurable, degenerative neurological condition that typically progresses through three stages: early, middle, and late. While no cure currently exists, treatment efforts focus on managing cognitive, behavioral, and psychological symptoms while promoting safety, autonomy, and quality of life (Alzheimer’s Association, 2023). The complexity of dementia care intensifies as patients gradually lose the ability to perform basic activities of daily living (ADLs), develop behavioral issues, and require constant supervision and assistance. As dementia progresses, individuals often face increased difficulty with memory, communication, mobility, and personal hygiene. These changes result in a growing dependence on caregivers, often family members, who must respond to unpredictable care needs while managing their own emotional and physical well-being (National Institute of Aging, 2023).

Caregivers, particularly those in low-resource settings, face substantial challenges. In addition to the physical demands of caregiving, many experience stress, fatigue, social isolation, and deterioration in their own health. The need for continuous, high-quality care creates a ripple effect, affecting not only the patient and caregiver but also local healthcare systems, which must allocate personnel and resources to support these households. As highlighted by Livingston et al. (2024), dementia care requires sustained, long-term engagement from individuals, families, communities, and formal health institutions. Without adequate support, caregivers risk burnout, and patients are more vulnerable to rapid health decline and complications.

In recognition of these challenges, Thailand’s public health system has introduced policies and initiatives aimed at integrating dementia care into existing healthcare services. The Ministry of Public Health has developed a comprehensive care framework that includes early screening, case management, and coordination among various providers at the community level (Department of Mental Health Ministry of Public Health, 2021). In theory, this model seeks to link health promotion, treatment, rehabilitation, and social support, enabling older adults to age in place with dignity. However, critical gaps persist in the actual implementation of this care model.

Despite policy-level advancements, local health systems—particularly Subdistrict Health Promoting Hospitals (SDHPHs) and community health networks—face serious limitations. These include a lack of trained personnel, minimal caregiver education and preparation, time constraints, and an insufficient allocation of financial and material resources (Chuakhamfoo et al., 2020). Village Health Volunteers (VHVs), who often serve as the first point of contact between the community and formal health services, may not have adequate dementia-specific training or support. Additionally, Thailand’s Universal Coverage Scheme does not currently include long-term institutional care, largely due to high costs. As a result, families must shoulder the majority of care responsibilities, frequently without the necessary means or professional guidance (World Bank Group, 2021).

Furthermore, societal awareness and acceptance of dementia remain uneven across regions, which can lead to stigmatization or delayed care-seeking behavior. Caregivers, particularly in rural and underserved areas, may be hesitant to disclose cognitive decline due to cultural perceptions or a lack of understanding, which further limits timely access to support services. The structural limitations in both the health and social protection systems contribute to fragmented care and a lack of continuity, further burdening caregivers and reducing the quality of life for people living with dementia.

Given these multifaceted challenges, there is an urgent need to examine how dementia care is currently being delivered at the community level in Thailand. Understanding the real-world experiences of caregivers, community health nurses (CHNs), and VHVs is essential for identifying care gaps and designing effective, sustainable solutions. Therefore, this study aims to explore dementia care practices in Thai communities, with a focus on the care process, challenges, and supports available to caregivers and healthcare workers. The findings are intended to inform improvements in nursing practice, service delivery, and policy development to enhance the quality of dementia care in community settings.

Methods

Study Design

This study employed a qualitative descriptive approach (Sandelowski, 2000, 2010), which is well-suited for capturing participants’ experiences in their own words through clear and direct summaries. It aimed to understand the care provided to community-dwelling older adults with dementia within real-world settings. It did not pre-select variables or align with a specific theoretical framework beforehand, allowing for a comprehensive exploration of diverse perspectives from key stakeholders in the community. This study does not aim to generate theory, interpret meaning deeply, or explore latent constructs, which would require grounded theory or phenomenology.

Participants and Setting

The study includes a total of 22 participants who have experience caring for older adults with dementia in the community. These participants consist of five CHNs, eight VHVs, and nine caregivers. The selection process began in Nonthaburi Province, a metropolitan area with the highest number of elderly residents, comprising 280,026 people aged 60 and over, accounting for 21.73% of the population (Office of Social Development and Human Security Nonthaburi Province, 2022). Nonthaburi Province consists of six districts. The researcher chose Mueang Nonthaburi District, which has the largest elderly population, as the study site. Within this district, the focus was on Nonthaburi Municipality due to its high number of elderly residents under its care. Nonthaburi Municipality has five SDHPHs. The study was conducted in three of these SDHPHs, which were selected because they have the highest number of dementia patients under their care.

The researcher employed purposive sampling with specific inclusion criteria: 1) CHNs: Selected based on at least one year of experience in caring for older people with dementia and their willingness to participate, 2) VHVs: Chosen if they had at least six months of experience in caring for older people with dementia and were willing to participate, 3) Family caregivers: Selected if they were the primary caregivers for at least six months, aged 18 years and above, and if over 60 years old, had no cognitive impairments (Chula Mental Test score > 15) (Jitapunkul et al., 1996) to ensure sufficient cognitive function to provide reliable data for this study. Participants with lower scores may have difficulties understanding or recalling information, which can lead to unreliable data. Additionally, they needed to understand and communicate in Thai.

Data Collection

The primary research instrument was the researcher, with supporting tools including semi-structured interviews, in-depth interview guidelines, and focus group discussion prompts. Data were collected from March to August 2019 through direct interviews, written notes, and audio recordings of interview sessions. A personal information questionnaire was used for CHNs, VHVs, family caregivers of older adults with dementia, and the older adults themselves. Additionally, the focus group and in-depth interview questions were reviewed by three experts to ensure content validity, assessing the appropriateness of language, clarity of statements, and comprehensiveness of the research topics.

Additionally, baseline health information is gathered for older adults with dementia to reflect the diverse caregiving contexts based on individual characteristics. To synthesize the caregiving situations involving CHNs, VHVs, and caregivers, the study explores various indicators, including Barthel Activities of Daily Living (ADL), blood pressure levels, blood glucose levels, depression, sleep disturbances, dementia status, psychiatric symptoms of older people with dementia, and the quality of life of caregivers. These quantitative tools were used as supportive, contextual background rather than for analytic weight. These instruments will provide a comprehensive understanding of the participants’ context and experiences.

The data collection process was conducted as follows: 1) After receiving approval from the Human Research Ethics Committee, the researcher coordinates with SDHPHs to explain the research objectives, ensure understanding among the involved CHNs, and request permission to collect research data in the community; 2) The researchers also requests the CHNs to select informants according to the specified criteria and introduce the researchers to VHVs and caregivers who have experience in caring for older adults with dementia; 3) The researchers enter the community, builds relationships with VHVs and caregivers, explains the research objectives, research procedures, rights protection, confidentiality, and voluntary consent. The researcher also schedules convenient dates and times for focus groups among CHNs and VHVs, as well as in-depth interviews with the caregivers. After that, the researcher transcribes the narrative text verbatim, phrase by phrase, sentence by sentence, and checks for completeness and clarity. Data collection was concluded when the information reached saturation.

Data Analysis

Qualitative data analysis was conducted using an inductive approach, allowing the researcher to collect and analyze data simultaneously. The study followed Sandelowski’s content analysis process, which began with repeated listening to the interview recordings and was followed by verbatim transcription of the content. The transcripts were read multiple times to fully understand the content and identify key themes. Relevant words and sentences were extracted and categorized, organizing data into codes, which were then grouped into sub-categories. Similar sub-categories were consolidated into broader categories to develop meaningful patterns. These categories were reviewed and refined by comparing different data sources to ensure the findings accurately reflect the caregiving situations under study (Sandelowski, 2000, 2010). This process facilitated a detailed description of dementia care in community settings, aligning with the research objectives.

Trustworthiness

To ensure the trustworthiness of the findings, the study followed the evaluative criteria of Lincoln and Guba (1985): 1) Credibility was enhanced through member checking, where selected participants reviewed and confirmed the accuracy of the interpretations; 2) Transferability was supported by providing rich, contextual descriptions of the study setting and participants, allowing readers to assess applicability to other contexts; 3) Dependability was addressed by maintaining a clear audit trail of the research process, including coding decisions and analytic memos; 4) Confirmability was ensured through peer debriefing and reflexive journaling, helping to minimize researcher bias and maintain neutrality.

Ethical Considerations

In this study, the researcher strictly adhered to the principles of research ethics. The data were collected after approval was granted by the Human Research Ethics Committee, Faculty of Medicine Ramathibodi Hospital, Mahidol University (Research ID: COA.NO.MURA2018/412). The researcher requested assistance in data collection from Nonthaburi Provincial Public Health Officers and Mueang Nonthaburi District Public Health Officers in the area where the research was conducted. Participants were informed about the research objectives and procedures. They could withdraw at any time (until data collection was concluded) without affecting their rights or services from the SDHPHs. All information was kept confidential, de-identified, and the data was presented in aggregate form. Participants signed an informed consent form, indicating they had been fully informed and participated voluntarily.

Results

Information about SDHPHs

In Mueang Nonthaburi District, Nonthaburi Province, Thailand, three large SDHPHs were selected for this study. Each of these facilities serves a population of at least 8,001 residents. Each SDHPH is typically staffed by a team that includes a director, 3 to 4 professional nurses, 1 to 2 public health officers, a dental public health officer, and a Thai traditional medicine practitioner. Some SDHPHs also have additional personnel, such as Thai traditional medicine assistants, administrative staff, and general workers, with total staffing ranging from 8 to 17 individuals. These SDHPHs offer a wide range of essential health services, including health promotion, disease prevention, medical treatment, rehabilitation, maternal and child healthcare, dental services, school health programs, and Thai traditional medicine.

The Basic Details of the Participants

CHNs in this study were all female, aged 45 to 55, with extensive nursing experience, averaging 24.8 years and 14 years at SDHPHs. They cared for 744 to 1,874 older adults, including 3 to 20 with dementia, with most receiving short-term dementia care training. VHVs were all female, aged 48 to 78 years, with an average of 13.5 years as VHVs and 10 years in elderly care. Each supported 1 to 15 older adults, including 2 to 8 with dementia, emphasizing their role in community-based care.

Nine family caregivers, predominantly female, also contributed to the study. Caregivers were typically spouses or children, aged between 21 and 79 years old. Many were married, with some having primary education and others holding bachelor’s degrees. Among caregivers, a few were unemployed, and many had chronic diseases. Most family caregivers had moderate quality of life scores in various areas, while some family caregivers had a poor quality of life, often associated with physical illnesses. Many caregivers experienced anxiety and sleep disturbances, particularly related to caring for older people with dementia.

Dementia Care for Community-Dwelling Older Adults

The analysis reveals six key categories focusing on: 1) Care process; 2) Conditional factors affecting care; 3) Care outcomes; 4) Successes in care; 5) The problem and barriers to care; and 6) Guidelines for developing a care model for community-dwelling older people with dementia.

Category 1: The Care Process, consisting of four subcategories as follows.

1.1. Perceived Problems: CHNs and VHVs have many methods of obtaining data about older people with dementia, including 1) from home visits by CHNs themselves and by VHVs in the area, 2) from relatives who come to inform directly, and 3) from data collection from research projects of some SDHPHs.

“We learned that the patient had more dementia symptoms from the CHNs’ home visits, from the previous case where the older person had previously had a chronic disease, and from the survey of the VHVs in the area who reported the news, and from relatives who came to inform us directly. The patient’s case we had followed up with before had symptoms.” (CHN 1.2)

1. 2. Perceived the Guidelines: CHNs receive information and guidance on caring for older adults with dementia through (1) academic training conferences involving relevant sectors, and (2) policy briefing meetings organized by the SDHPHs, provincial public health offices, and district health offices, as well as 3) studies from academic documents, books, the internet, and television. Most VHVs are informed of the problems, care methods, referrals, and coordination with various methods regarding discussions with CHNs, staff at SDHPHs, VHVs friends, and direct experience from having to care for the older people with dementia in their families, VHVs are aware of the guidelines for caring for the older people from attending meetings and trainings organized by the municipality and the Ministry of Public Health.

“From attending academic conferences and meetings on the care of elderly people with dementia, we saw figures that the number of elderly people with dementia increases every year. As the elderly population increases, the number of people with dementia, especially those aged 65 and over, will also increase” (CHN 1.1)

“Received from various meetings and policies that provide information on the situation, such as what problems the elderly have or what health problems they are likely to have.” (CHN 2.2)

1.3. Problems and Care Needs: Most older people with dementia suffer from chronic diseases and NCDs, including vision and hearing problems. Relatives who care for them must provide close care, attention, and preparation for caring for older people with dementia and chronic diseases. Some older people are unable to help themselves. Therefore, they must rely on relatives to care for them and do their daily routines. Some have behavioral and emotional problems.

“My wife has chronic diseases such as high blood pressure and high cholesterol… The doctor made an appointment for her in 5 months. I had to take her to take a taxi… I have regular medication for her because sometimes she can’t find the right medicine.” (Relative 2)

1.4. Care Dimensions: It consists of eight dimensions, which can be described as follows: 1) disease control and prevention: regularly screen the health of older people and organize a team to visit and survey older people in the community every month; 2) health promotion: organize monthly activities to promote the health of older people with dementia in collaboration with the Older People Quality of life Development Center; 3) medical treatment: provide advice on setting up a brain management group to slow down dementia. However, they will be referred to the hospital treatment system if the symptoms deteriorate; 4) health rehabilitation: promote exercise at home for the older people, with physical therapists providing advice, memory, and cognition: meet, socialize, talk, and count; 5) social welfare: access to nursing services from the primary level; 6) daily routine care: relatives play an essential role as the main caregiver for the older people with dementia; 7) arrange safety environment to prevent accidents; 8) promote social activities: CHNs will encourage this group of older people with dementia to join the activities of the older people clubs set up in the area; in the case of the bedridden group, relatives who care for them share their experiences in caring to strengthen the morale of the relatives.

“ There will be a team of staff from SDHPHs to visit and ask about symptoms, measure blood pressure, talk to and inquire about symptoms.” (Relative 6)

“ Volunteer health officers will teach patients to exercise their brains, such as counting, piecing, physical exercise of hands, arms, and legs.” (VHV 1.2)

Category 2: Conditional Factors Affecting Care, consisting of two subcategories as follows.

2.1. Views of Family Caregivers: The perspectives are that they will continue to provide care for older people in the family, even if they have dementia or illnesses, with love, value, and care in appreciation and gratitude to their elders as benefactors, thereby enabling community-dwelling older people with dementia to receive care.

“ There is no problem in terms of care. We are willing to do it anyway. It is a way to repay the kindness that our parents have taken good care of us since we were young. ” (caregiver3)

2.2. Views of CHNs and VHVs: CHNs and VHVs worked with pride, providing care as an expression of charitable deeds with love, understanding, and patience in addition to mutual reliance, trust, and faith from people in the community who have provided assistance and offering to counsel, thereby resulting in CHNs and VHVs working together happily to help care for older people with dementia and their family caregivers as attentive, interested relatives to build good interpersonal relationships.

“It is like making merit. If we can see the problem quickly and help them, they can live their daily lives normally. Moreover, partly, when they can live normally, we think it will not increase the burden of our work. We will be able to work in other areas because the context of nursing has a rather heavy burden. Furthermore, the impression is that the relatives are more open-minded and more willing to open their homes. In the past, they would keep the older people in the house and not dare to tell anyone that they had a mental illness or something like that. Later, when they understood that they had a disease, they were more open-minded about treatment and let the community, the village health volunteers, and the neighbors help and take care of them more… and accepted us more.” (CHN 2.1)

Category 3: C are Outcomes, consisting of three subcategories as follows.

3.1. Conditions of Older Adults with Dementia. According to the findings, most older people with dementia could perform activities of daily living with some dependence on others. Many had abnormal blood pressure but normal blood sugar levels. In terms of depression screening, most did not have depression. However, sleep disturbances were common, with many individuals experiencing severe insomnia, accompanied by daytime drowsiness and fatigue. Additionally, psychosis screening suggested that many older adults exhibited potential psychotic symptoms, while some had no psychotic symptoms.

3.2. Family Caregivers’ Quality of Life. From this finding, many caregivers manage to maintain a moderate quality of life, balancing their caregiving duties with other aspects of their lives. They find moments of joy and fulfilment in their caregiving roles, drawing strength from the bonds they share with the older adults they care for. However, the demands of caregiving can take a toll on their physical and emotional well-being. A few caregivers face more significant challenges, experiencing a poorer quality of life. These individuals often struggle with physical ailments such as headaches, abdominal pain, and general discomfort. Their vitality is often low, and they struggle to muster the energy required for daily tasks. Sleep disturbances are common, with many caregivers unable to rest through the night, leading to persistent fatigue.

Anxiety is another prevalent issue among caregivers, particularly concerning the care of older adults with dementia. The constant worry about their loved ones’ health and well-being can be overwhelming, affecting their mental health and overall quality of life.

3.3 Interpersonal Relationships of Family Caregivers and Older Adults with Dementia. According to the findings, caregivers were equally divided between spouses and children, followed by siblings or other relatives. The average length of care for older people with dementia was almost four years, with caregivers spending a significant amount of time each day, often more than 15 hours, providing care. Each dementia patient had one caregiver, and none of the family caregivers had received training on the care for older people.

Category 4: Success in Care, consisting of three subcategories as follows.

4.1. Operational Support Policies: Care for this group is complex and requires integrating health services in many ways. Therefore, government policies and the policies of local administrative organizations that focus on caring for community-dwelling older people support the provision of services covering disease control and disease prevention, as well as health promotion, health rehabilitation, recreation, social welfare, and environmental arrangements, thereby enabling CHNs and VHVs to find problems, provide care and referral treatment, including allocating operating budgets and organizing activities to develop the capacity of CHNs, VHVs and family caregivers.

4.2. Culture of Family Caregivers: The success of family caregivers is seen in older people maintaining a good quality of life, even when they are ill with dementia and experiencing pathological regression. Caring for older people with dementia is a way to express appreciation and gratitude to benefactors.

“Seeing you smile makes every effort worthwhile—your gratitude means everything to me.” (Relative 7)

4.3. Service Culture of CHNs and VHVs: The success of CHNs and VHVs in caring for older people with dementia is characterized by a sense of appreciation, pride, happiness, joy, and trust. Faith from older people with dementia, their families, and those in the community results in CHNs and VHVs being encouraged to work and perform tasks with happiness and efficiency.

“Caring for you brings me joy and fulfilment—your trust means everything to me.” (VHV 1.2)

Category 5: The Problems and Barriers, consisting of three subcategories as follows.

5.1. Views of Family Caregivers include the following: family caregivers’ physical health problems, illness with chronic diseases such as hyperlipidemia, diabetes mellitus, hypertension, arthritis, visual impairment, and mental health issues. In caring for older people with dementia for long periods, caregivers can easily become fatigued and stressed. Some family caregivers must also work while caring for older people with dementia. This reduces the time to care for older people and may result in inefficient care. In cases where a family caregiver must leave their job to care for older adults directly, there is a resulting loss of income from a full-time job.

“Of course I’m tired, I’m tired, auntie. And when I come back from my own work, it’s already hard… My blood pressure is up… I’m stressed; I’m stressed every day… I’m worried, I don’t know how my day is.” (Relative 8)

“I have diabetes, high blood pressure… The doctor said my knees were deteriorating. We didn’t know my knees were deteriorating… I’m overweight too… Now I have it too. I have it too. I forgot what I put down.” (Relative 2)

5.2. Views of CHNs: Barriers to care were related to the provision of health services as follows: 1) CHNs’ workloads at SDHPHs; 2) Shortages of personnel, budgets, and supplies, such as a shortage of physical therapists, occupational therapists, computer staff, and CHNs, all of which were insufficient in number at each SDHPHs.

“For example, in our health department, there are five people working, but we have to be responsible for 20 tasks. One person must take on five tasks. We can’t provide good care 100 percent of the time. It’s not thorough, and we can only do a little. It feels like it’s a haphazard thing. We can’t find the details or anything like that… The ministry should increase the number of personnel to ensure they are adequately equipped for the tasks. Nowadays, the tasks are more detailed. There aren’t just three tasks. There are 10 and 20. They should allocate enough people… We need to have more channels for communication.” (Nurse 2.2)

5.3. Views of VHVs: The care-related problems or barriers involved in the readiness and training of VHVs. The study found that some people in the community lacked confidence or did not believe in the work-related potential or knowledge of VHVs, and therefore did not cooperate with home visits.

“Sometimes when we go in, sometimes people don’t really trust us. We need to have an officer with us. If an officer goes in, that’s okay.” (VHV 2.2)

These barriers pose significant challenges to the adequate provision of care.

Category 6: Guidelines for Developing a Care Model

Based on the research findings, the developed care model for community-dwelling older adults with dementia includes: 1) policy and budget support for effective local implementation; 2) a proactive and reactive service system with a multidisciplinary team; 3) strengthening multidisciplinary collaboration in dementia care; 4) capacity-building for CHNs, VHVs, and family caregivers; 5) media and equipment to enhance caregiving skills and delay dementia progression; and 6) specialized health services, such as community-based daycare centers, integrated holistic care, counseling, treatment centers, and dementia support clubs.

Discussion

In this study, family caregivers for older adults with dementia are equally divided between spouses and children, with daughters more likely to assume caregiving roles due to traditional gender expectations (Netiparatanakul, 2020). Thai culture emphasizes family as the primary source of support, particularly in daily routines, reinforcing the perception of caregiving as a moral and social duty rather than a burden (WHO, 2024). Social and cultural norms contribute to women disproportionately undertaking caregiving responsibilities, viewing care as an extension of domestic roles (WHO, 2024). Despite challenges, many caregivers find fulfillment in providing care, motivated by love and gratitude (Netiparatanakul, 2020). Their commitment ensures that older adults with dementia receive dignified support within their families and communities.

Consistent with the study of Wang et al. (2022), positive aspects of caring for their parents with dementia include personal accomplishment and strengthened relationships, often driven by a sense of gratitude and love for their older adults. Cultural values usually profoundly influence caregiving, particularly in societies that emphasize respect and appreciation towards older adults. Many cultures, including those in Asia, Latin America, and indigenous communities, uphold traditions of filial piety and familial responsibility. These cultural values view caregiving as a duty and an honor, driven by respect for the wisdom and life experiences of older generations. In such societies, caregiving is not just a response to need, but also an expression of gratitude and a means to maintain strong family bonds (Knight et al., 2024).

The findings indicate that many older adults with dementia can perform daily activities with some dependence on others. Most do not show signs of depression, though sleep problems are common, with severe insomnia, drowsiness, and fatigue being prevalent. Additionally, a significant number are suspected of having psychotic symptoms, while a smaller portion do not exhibit these symptoms. The conditions of older people with dementia can depend on several factors, including the type and stage of dementia, overall health, lifestyle factors, and the support system available. Early stages may involve memory loss and confusion, while later stages can include significant cognitive decline and physical impairments (National Institute of Aging, 2022). Other health conditions, such as diabetes, heart disease, or hypertension, can impact the severity and progression of dementia (Livingston et al., 2024; Wu et al., 2025). Diet, physical activity, social engagement, and mental stimulation can influence the progression of dementia (Arora et al., 2023; Livingston et al., 2024). The availability of a robust support system, including family, friends, and professional caregivers, can significantly affect the quality of life and management of dementia symptoms (Lindeza et al., 2020).

This finding highlights the varied experiences of family caregivers. While some individuals maintain a moderate quality of life, others face emotional, financial, and social hardships that profoundly impact their well-being. These challenges emphasize the need for targeted support to address caregivers’ specific struggles. Consistent with the study by Hu et al. (2025) in rural China, family caregivers of older adults with dementia generally experience a moderate quality of life. However, caregiving burden has a negative correlation with quality of life, with social support playing a crucial mediating role. Similar results were found in the studies by Karg et al. (2018)) and Hazzan et al. (2022), both of which indicated that caregivers of older adults with dementia reported a lower quality of life and a greater sense of burden compared to those caring for older adults with non-dementia-related chronic illnesses. This is likely because individuals with dementia often have multiple comorbid chronic conditions, further compounding the caregiving burden.

The experiences of these caregivers highlight the need for additional support and resources to help them manage their responsibilities and improve their quality of life. Their stories reflect the resilience and dedication required to care for older adults with dementia, highlighting the importance of community and professional support in alleviating the burdens they face. As family caregivers’ quality of life is related to the quality of care provided to patients and the quality of life of patients, enhancing family caregivers’ quality of life is necessary (Pothiban et al., 2020). According to the findings, all dementia patients had one caregiver, and none of the family caregivers had received training in caring for older people. Caregivers’ lack of accurate knowledge and understanding about dementia, in addition to inconvenience in accessing health services, frequently results in caregivers becoming stressed, and the quality of care may be reduced (Griffiths & Bunrayong, 2016; Hazzan et al., 2022).

This highlighted that caregivers supporting older people with dementia need information, support, and help. Another issue involves the provision of health services for older adults, which should consider the issues of equality, quality, and performance. These issues will help improve the quality of care for older adults and impact care models for community-dwelling older adults with dementia, as well as organizations, agencies, and network partners involved in care for community-dwelling older adults with dementia (Murali et al., 2025).

Globally, dementia care practices often include structured support systems, such as dementia-friendly communities, specialized training for caregivers, and comprehensive national dementia plans (WHO, 2021). In contrast, Thai dementia care heavily relies on family members, with less formal support and training available. This reliance on family caregiving, while culturally significant, can lead to increased caregiver burden and stress due to a lack of resources and support, especially when they must make decisions alone, often without formal training or external support (Suriya, 2025). Although there are associations such as the Alzheimer’s and Related Disorders Association of Thailand and the Dementia Association of Thailand that provide support and assistance to caregivers of individuals with dementia, offering resources, support groups, and educational programs to help manage their responsibilities and improve the quality of care, these services are insufficient to meet the demand. Additionally, many people are unaware of their availability. Highlighting these disparities can offer unique insights into the challenges faced by Thai caregivers and underscore the potential benefits of integrating dementia-friendly communities and comprehensive national dementia plans into the Thai context.

Implications

The findings of this study carry significant implications for nursing practice, healthcare systems, and policy development, particularly in the context of community-based dementia care in Thailand. Nurses, especially CHNs, play a pivotal role in coordinating and delivering dementia care at the local level. As the primary link between families and formal health services, CHNs are often responsible not only for clinical care but also for providing education, emotional support, and navigation of resources for family caregivers.

For nursing practice, there is a clear need to strengthen the capacity of CHNs to deliver dementia-specific care through continuous education and skills development. Training should go beyond basic caregiving to include advanced communication strategies, behavioral symptom management, caregiver coaching, and coordination of community resources. Equipping nurses with comprehensive knowledge of dementia care will empower them to better support caregivers, detect early signs of caregiver burnout, and advocate for timely interventions. Furthermore, integrating structured caregiver education into routine nursing activities, such as home visits, health screenings, or village health meetings, could help bridge the current knowledge gap among family caregivers.

Additionally, the study emphasizes the importance of promoting interprofessional collaboration at the community level. Nurses must work closely with VHVs, social workers, local administrative organizations, and traditional medicine practitioners to provide holistic, culturally sensitive care. Nursing leadership should foster team-based care models that incorporate psychosocial support, rehabilitation, health promotion, and safety measures tailored to older adults with dementia.

The results also point to a pressing need to enhance nursing advocacy for caregivers. Nurses should take an active role in identifying families at risk, connecting them with social welfare programs, and advocating for more inclusive policies that expand caregiver support under Thailand’s Universal Coverage Scheme. Nurses can act as powerful voices in policymaking forums, using firsthand insights from their practice to advocate for the integration of long-term dementia care into public health priorities.

At a broader level, these findings can inform curriculum development in nursing education. Undergraduate and continuing education programs should incorporate modules focused on dementia care, caregiver support, and culturally competent community health nursing. Simulations, case-based learning, and fieldwork in community settings can enhance nurses’ confidence and competence in managing dementia in real-world conditions.

Policy and system-level implications also emerge from this study. By identifying common stressors among caregivers—such as lack of training, emotional exhaustion, and financial hardship—policymakers can develop targeted interventions, including respite care, caregiver stipends, and community-based dementia support centers. Creating dementia-friendly communities with nurse-led care coordination can ensure that care is both person-centered and sustainable.

Limitations and Recommendations

This study has some limitations that should be acknowledged. While purposive sampling ensured relevant perspectives, it may not fully capture the diversity of dementia caregivers and healthcare providers, potentially limiting the generalizability of findings. Additionally, recall bias may affect data reliability, as participants may struggle to accurately recall past caregiving experiences, which can influence the interpretation of results.

The findings are also context-dependent, reflecting the cultural and healthcare setting in Thailand, which may reduce their applicability to other regions with different caregiving practices and healthcare systems. Furthermore, the study lacks longitudinal data, providing only a snapshot of experiences rather than capturing long-term changes in dementia care.

To address these limitations, future research should expand participant diversity and research settings to enhance the understanding of dementia care across various populations and contexts. Longitudinal studies would be valuable for tracking changes in caregiver experiences and dementia progression over time, offering insights into evolving challenges and support strategies. Additionally, exploring the integration of technology in dementia care, such as telehealth, mobile applications, and assistive devices, could improve caregiving processes and enhance the quality of life for individuals with dementia. Addressing these gaps will contribute to a more comprehensive and adaptable approach to dementia care research.

Conclusion

This study highlights the need for structural improvements to enhance dementia care for older people in Thailand. The study also highlights the lack of skills development and training for CHNs, VHVs, and caregivers of older people with dementia. Therefore, ongoing education and training for CHNs, VHVs, and caregivers are essential, focusing on best practices in dementia care, stress management, and effective communication strategies to enhance the quality of care provided. Addressing these areas can significantly improve the quality of care for older people with dementia, benefiting both patients and caregivers’ quality of life.

Funding Statement

Funding No funding is associated with this work.

Declaration of Conflicting Interest

No conflict of interest to declare.

Authors’ Contributions

All authors contributed to conception and design, data collection, data analysis, data interpretation, writing, reviewing, and editing the manuscript. All authors have also read and approved the final version of the manuscript.

Authors’ Biographies

Parichat Mongklam, B.N.S., RN, is a Master’s degree student of the Nursing Science Program in Community Nurse Practitioner, Community Nurse Practitioner (Candidate) of Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Assoc. Prof. Phachongchit Kraithaworn, PhD., RN, is an Associate Professor at the Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Sangduen Piyatrakul, PhD., RN, is an Instructor at the Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Data Availability

The dataset generated during and analyzed during the current study is available from the corresponding author upon reasonable request.

Declaration of Use of AI in Scientific Writing

None to declare.