Editorial: Clinical, health services and legal dimensions in older adult care: a focus on the Middle Eastern and Northern African region
Year: 2026
Type: editorial
Abstract: The Middle East and North Africa (MENA) region is undergoing a rapid demographic transition, placing new demands on health care and its regulatory and policy systems. Globally, the population aged 60 and over is projected to nearly double, from 12% in 2015 to 22% by 2050 (World Health Organization, 2025), and the Eastern Mediterranean Region is ageing from a younger base and at a faster relative pace (World Health Organization Regional Office for the Eastern Mediterranean, 2006). Saudi Arabia's older population is projected to more than triple as a share of the total by 2050 (Alsaeed et al., 2026), and Morocco's cancer burden is rising in step with its own transition (Sabri et al., 2026). Health systems, workforces, and financing models built around a younger population profile are being asked to meet the needs of a rapidly growing older population. This Research Topic gathered clinical, health services, management, and regulatory and policy scholarship addressing that shift. Its eight published items (seven original studies and one correction), drawn largely from Saudi Arabia with contributions from Qatar and Morocco, provide insight into the current state of evidence on older-adult care in parts of the MENA region and point to important directions for future research, policy, and practice.The collection clusters around five questions any aged-care system must eventually answer: can disease be detected early enough to intervene; can people access and afford the care they need; is care delivered where and how older patients can use it; does the informal, family-based system that carries much of the load continue to hold as cohorts grow; and is policy governance capable of steering the response rather than simply reacting to it. Each article speaks most directly to one or two of these questions, and together they begin to build a fuller picture across all five. Table 1 summarises the seven studies. Alnuaimi et al. (2026) screened 249 adults aged 65 and over in Qatari primary care and found an atrial fibrillation prevalence of 5.4%, with 2% newly diagnosed; family physicians matched cardiologists on 75% of diagnoses, suggesting stroke prevention can advance through task-shifting rather than new infrastructure; scaled nationally, the authors estimate roughly 747 undiagnosed cases could be found among those aged 65 and over. On affordability, Al-Hanawi and Keetile (2024), analysing 10,785 respondents, showed that outof-pocket medicine expenditure in Saudi Arabia (mean SAR 279.69) rises with age, income, and chronic illness, so financial exposure persists under free public care and concentrates on those least able to absorb it, a catastrophic-expenditure risk calling for targeted insurance and subsidy design. On delivery, Alanazi et al. (2026) found that 78.7% of Saudi neurologists intended to use telehealth, with far greater confidence for follow-up (82.7%) than for new patients (24.0%) and familiarity the strongest predictor of intent (odds ratio 32.0), a sequencing lesson for digital-health rollouts in conditions such as dementia and stroke. On the informal system, Moubarak et al. (2026) documented strong family-centred social support among older Saudis (high social-support and social-adjustment scores, attributed to family-centred, culturally rooted care norms) while cautioning that it will be tested as cohorts grow and recommending formal community-based capacity now; shared-responsibility community care models suggest formal and informal care can reinforce rather than compete with each other (Kaderani et al., 2026). On governance, Hariri et al. (2026) traced a shift toward more collaborative, evidence-informed policymaking in Saudi Arabia, alongside weak evaluation structures and reliance on external expertise, and recommended a centralised policy repository with investment in local policy capacity; given the study's exploratory design and small qualitative sample, these findings warrant validation in future research.Two contributions provide scaffolding for the field. Alsaeed et al. (2026) conclude in their systematic review that Saudi Arabia's elderly-care system is "evolving but under strain", with progress under Vision 2030 set against workforce shortages and reliance on migrant caregivers. Sabri et al. (2026) propose a Four-Phase Oncogeriatric Transition framework for Morocco, where over 80% of some cohorts screened abnormal on the G8 vulnerability tool and geriatric assessment is not yet routine in oncology care. Both suggest that studies in the region are accumulating faster than the frameworks needed to interpret and act on them.Taken together, these studies give the region a working foundation of methods and findings that can be extended across MENA health systems, given similarities in cultural, regulatory, and policy contexts. Opportunities include carrying the primary-care screening model of Alnuaimi et al. (2026) to other Gulf and MENA systems, and testing the emerging frameworks of Alsaeed et al. (2026) and Sabri et al. (2026) against data from other North African and Levant countries. The Research Topic invited clinical, health services, and legal perspectives together; this collection has built strongly on the first two, and now offers a starting point from which the third, along with business, social work, and industry voices, can be drawn in as the field's next chapter.The comparatively limited representation of legal and regulatory scholarship in the present collection also identifies an important gap. Future work should examine regulatory frameworks for long-term care, rights and protection of older persons, consent and decision-making capacity, governance of digital technologies, regulation of formal and informal caregiving, and accountability for quality and safety in aged-care services. Ageing systems research more broadly benefits from treating workforce, models of care, technology, governance, financing, and place-based environments as elements of a single system (Balasubramanian et al., 2026a).Bringing these additional disciplines into the conversation is also the kind of work that regional capacity-building initiatives are beginning to take on, in parallel with this Research Topic rather than produced by it (Figure 1). One example connected to members of the editorial team is the MENA Hub for Business, Law, Regulation, Health and Aged Care, now forming through the Australian-Arab Collaborative at Flinders University with support from a DFAT Council for Australian-Arab Relations grant. It seeks to bring legal and regulatory scholars, business specialists, and health and aged-care researchers into closer contact with government, university, and industry partners, beginning with a two-part symposium series held across Adelaide, Cairo, and Jeddah and a partnership between Flinders University and King Abdulaziz University. It sits alongside the Flinders Ageing Alliance, which connects research teams in Adelaide and Jeddah with collaborators across more than ten countries, including Egypt, Qatar, the United Arab Emirates, India, Nepal, Bangladesh, Malaysia, Indonesia, China, Singapore, and the Philippines (Flinders University, 2026). An earlier DFAT-funded fellowship that brought 15 aged-care leaders from six Asia-Pacific nations to Australia in 2023 produced its own special issue in this journal (Balasubramanian et al., 2024), showing how a fellowship network can convert into published regional research within a single funding cycle; the progress of the MENA Hub will be a matter for future evaluation.Taken together, the articles in this Research Topic make an important, though necessarily partial, contribution to the emerging evidence base on older-adult care in the MENA region.We hope this collection marks the beginning of an ongoing series of contributions. The next phase will require comparative, interdisciplinary and policy-oriented research capable of translating demographic change into evidence-informed approaches to prevention, financing, service delivery, workforce development, regulation, and protection of older adults across diverse MENA health systems. (published 07 Apr 2026), which does not alter the reported findings and is treated here as part of the same study rather than a separate row.The seven studies are summarised above.Note: This Research Topic and regional capacity-building efforts (the MENA Hub, the Flinders Ageing Alliance, and the APACH Asia-Pacific fellowship network) are independent, parallel responses to the same regional ageing challenge. Both feed into a broader interdisciplinary dialogue that shapes how the region continues to respond.
Source: Frontiers in Public Health
Language: English
Subfield: Life-span and Life-course Studies
Field: Social Sciences
Domain: Social Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7224111036