Caregiving Across the Life Course in Rapidly Urbanising Sri Lanka: Structural Incompatibility, Eroding Networks, and the Limits of Filial Obligation

Caregiving Across the Life Course in Rapidly Urbanising Sri Lanka: Structural Incompatibility, Eroding Networks, and the Limits of Filial Obligation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Caregiving Across the Life Course in Rapidly Urbanising Sri Lanka: Structural Incompatibility, Eroding Networks, and the Limits of Filial Obligation Madudurage Nuwan Sampath Weerasingha This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9115626/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Sri Lanka is one of the most rapidly ageing societies in South Asia, experiencing concurrent demographic and urban transitions while formal long-term care infrastructure remains critically underdeveloped. Urbanisation is reshaping family structures, labour market demands, and community support networks, thereby straining families' capacity to sustain home-based elder care. However, these dynamics are insufficiently examined in the existing literature, which predominantly focuses on rural settings and cross-sectional measures of caregiver burden. This qualitative study addresses this gap by exploring the lived experiences of family caregivers providing home-based care for older adults in three urban and peri-urban districts of Sri Lanka: Colombo, Gampaha, and Kandy. In-depth, semi-structured interviews were conducted with 24 participants, comprising 12 older adults aged 70 years and above and 12 primary family caregivers. Data were analysed using Framework Analysis, informed by life course and social ecological perspectives. Four interrelated thematic domains emerged: (1) caregiving across life transitions; (2) time scarcity and employment–care tensions in urban settings; (3) shrinking family networks and the erosion of informal support; and (4) emotional strain, moral duty, and silent endurance. Collectively, these domains indicate that caregiving in urban Sri Lanka is a dynamic, cumulative process shaped by structural forces that current policy frameworks have yet to adequately recognise or address. The findings highlight the urgent need for urban-responsive elder care policy, including caregiver-inclusive employment reform, community-based respite and support services, and culturally sensitive implementation strategies that position help-seeking as consistent with filial responsibility. Family caregiving Urban ageing Life course perspective Social ecological theory Sri Lanka Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 1. Introduction Population ageing is a major challenge of this century. More older adults in both high- and low- to middle-income countries are straining care, health services, and family support. By 2050, the UN projects that over 1.6 billion people aged 65 or older—16% of the world—will be living, up from 761 million in 2021. Demographic change affects countries differently, depending on their social services, labour markets, households, and access to care. Addressing these gaps is central to managing the impact of ageing. In many high-income countries, ageing increases reliance on institutional and community care. Examples include residential facilities, home care, and social insurance. Japan, with one of the world’s oldest populations, takes this approach. National long-term care insurance [1](LTCI), introduced in 2000, allows older adults with limitations to access subsidised home and institutional services (Tsutsui & Muramatsu, 2007). Even well-funded systems face challenges: workforce shortages, rising costs, and dependence on informal caregivers reveal the limits of formal care (Campbell et al., 2010; Hashimoto et al., 2020). In many low- and middle-income countries, population ageing is advancing rapidly, but support systems lag behind. In sub-Saharan Africa, public health advances such as vaccination and lower early-life mortality have increased the number of older adults, but care systems have not kept pace (Aboderin, 2017). Families, particularly women, bear the majority of care responsibilities (Schatz & Ogunmefun, 2007). South Asia has similar trends, with demographic changes outstripping policy and services (Lloyd-Sherlock et al., 2018). Sri Lanka is one of the fastest-ageing countries in South Asia. Its population reached old age sooner than other countries in the region. In 1990, about 9% of people were aged 60 or older; this rose to 12.4% in 2012 and about 17% (almost 4 million) in 2024 (UNDESA, 2024; WHO, 2025). Projections suggest around 26% will be 60 or older by 2050, making Sri Lanka one of the fastest-ageing societies in Asia. This shift happens in a lower-middle-income setting with limited ability to expand formal income security and long-term care for older adults. A key trend is the growth of the 'oldest-old' group. In 2024, people aged 80 and above made up about 1.9% of the population, or 449,000 people. Most are women due to higher longevity (UNDESA, 2024; WHO, 2025). This group will grow by 2050, raising long-term care needs. Noncommunicable diseases cause most disability among older adults in Sri Lanka. Conditions like diabetes, joint problems, hearing loss, stroke, Alzheimer’s, and dementia are common in those over 75 (WHO, 2025). More falls, poor vision, and cognitive decline add to care needs in late old age. This is challenging because geriatric services are limited. Sri Lanka’s ageing population faces a key challenge. Weak geriatric and long-term care systems mean families give most elder care. National policy promotes healthy ageing, but resources for long-term care are limited (WHO, 2025). In 2021, only 31% of older adults had a pension. Many depend on family or must work longer (ILO, 2022). Older adults, especially women, are leaving the workforce, reducing income security. This increases reliance on female family caregivers, who often lack support. Urbanisation further strains families by weakening kin networks and threatening the sustainability of home-based care. Urbanisation is changing caregiving in Sri Lanka. Rapid urban growth and migration decrease the number of co-resident caregivers. More young family members are moving to cities or abroad for work, leaving older adults with a spouse, an adult child, or non-resident caregivers. These non-residents manage care from afar. In cities, caregiving must fit with jobs, childcare, and other duties, leading to time, emotional, and financial pressure. Women, who remain the main caregivers, bear the heaviest burden even as they join the workforce (Ruwanpura, 2016; Watt et al., 2014). Cities like Colombo, Gampaha, and Kandy show these changes. They have dense populations, rising living costs, more women in the workforce, and less extended family support. Cities may offer better healthcare but also present new challenges: time demands, transportation, housing issues, and more reliance on informal or paid care. These challenges increase family caregiver stress and reduce consistency of home care (Phillipson, 2013; Buffel et al., 2018). Nighttime light imagery proxies urban economic activity, infrastructure, and population density (Henderson et al., 2012; Elvidge et al., 2017). The above images show Sri Lanka’s light radiance in 2014 and 2024, highlighting rapid urbanisation in the Western and Central provinces. Colombo, Gampaha, and Kandy are key for this study. Most research on elder caregiving in Sri Lanka focuses on rural areas or demographic data, leaving the impacts in urban areas underexplored. This gap hinders development of policies for urban realities; formal care is limited in cities, so families remain main caregivers. This study explores family caregivers’ experiences of home-based care for older adults in selected urban and semi-urban areas of Sri Lanka. Using qualitative interviews and structured analysis, it presents detailed insights on caregivers’ challenges, stress, and coping as family systems and urban contexts change. By sharing caregivers' views and linking them to broader trends, it adds to Sri Lanka’s limited qualitative elder care literature. The findings aim to inform urban-responsive care policy, community support, and solutions for family caregivers amid rapid demographic change. 2. Literature Review 2.1 Global Perspectives on Family-Based Caregiving in Ageing Societies Population ageing is a major twenty-first-century transformation. It reshapes labour markets, family structures, and care systems worldwide. The World Health Organization (WHO, 2021) projects that the population aged 60 and older will reach 2 billion by 2050, with the fastest growth in low- and middle-income countries, where formal care infrastructure is underdeveloped. However, these numbers overlook the main source of care: families. Women in families bear the majority of caregiving duties. A growing body of international research documents the personal costs of family-based caregiving. In Canada, Australia, and much of Western Europe, studies show that family caregivers face time scarcity, social withdrawal, and exhaustion. These consequences worsen where formal services are limited or fragmented (Chappell & Funk, 2011; Funk et al., 2013). Research has shifted away from viewing these challenges solely as personal burdens. Longitudinal and life-course studies now view caregiving as a role that intensifies over time. It intersects with employment, gender expectations, and institutional conditions that affect caregivers’ vulnerability (Luo et al., 2019; Lilly et al., 2020). In the United States and Western Europe, this shift has influenced policy debates. Caregiving is increasingly seen as a public health issue rather than a private responsibility. Schulz and Eden’s (2016) review reinforced this view, showing that excluding family caregivers from policy is a structural failure rooted in outdated beliefs about family flexibility. In South and East Asian contexts, caregiving unfolds within distinct normative landscapes but faces comparable structural strains. Intergenerational norms of filial obligation remain culturally powerful, but they do not operate in a vacuum: in India and China, women increasingly manage caregiving demands alongside paid employment and childcare, often without any formal support (Sharma & Chakrabarti, 2020). In South Asia specifically, daughters, daughters-in-law, and spouses remain the primary providers of daily care for older relatives, their labour framed as a cultural duty and therefore rendered invisible to policy (Rathnayake & Siop, 2020). Rapid urbanisation, declining fertility, and rising female labour force participation are simultaneously reducing the pool of available caregivers and intensifying the demands placed on those who remain, a structural squeeze whose policy consequences have not been adequately addressed in any South Asian setting. 2.2 The Sri Lankan Caregiving Literature: Three Strands and Their Limits Research on family caregiving in Sri Lanka follows three main approaches. Each offers useful insights but leaves key issues unexplored. First, national demographic data show the rapid ageing of the population and a growing gap between care needs and formal provision. This demonstrates the urgency of the policy issue. Second, policy-oriented studies examine legal frameworks and welfare systems. They often highlight the gap between policy promises and actual service delivery, especially in long-term and community care (Herath & Wickramasinghe, 2018; Perera, 2022). Third, empirical studies use cross-sectional surveys to measure caregiver burden, psychological distress, and social factors. While this work reveals high strain, especially for women, it treats caregiving as a static condition. It rarely explores the lived experience, how caregiving begins and grows, or the structural factors that shape its sustainability. Recent qualitative research has begun to explore loneliness, dependency, and the emotional side of care from caregiver and older adult perspectives (Fernando et al., 2019; Wickrama & Wijesekara, 2023). Most of this research is rural or institutionally focused. Unique issues of urban living, labour-market inflexibility, commuting, weak neighbourhood networks, and housing constraints are rarely studied. As a result, Sri Lanka’s caregiving literature mostly reflects rural settings, missing the rising demographic pressures in cities. 2.3 Persistent Gaps: The Urban Dimension and the Need for Integrated Frameworks This review finds two connected gaps: one substantive and one methodological. The main substantive gap is the lack of qualitative research on family caregiving in Sri Lanka’s urban and peri-urban areas. These settings have the highest population density and the greatest shifts from multigenerational households. They also have the sharpest conflict between work and care. Urbanisation has reduced residential proximity of kin, neighbourhood support, and time for care. These changes make caregiving in Colombo, Gampaha, and Kandy very different from rural areas. Yet, urban caregiving remains largely unstudied. The methodological gap is also important. The field relies on demographic data, policy analysis, and surveys to examine outcomes such as caregiver burden, job withdrawal, and distress. However, this evidence lacks details on how these outcomes develop. Without life-course or social-ecological frameworks, we cannot see how caregiving builds over time or how household and neighbourhood factors influence support. These frameworks also help explain how policies and housing markets affect caregiving. The lack of integrated frameworks is the field’s biggest methodological limitation. 2.4.1 A Life Course and Social Ecological Conceptual Framework for Family Caregiving in Urban Sri Lanka The study’s framework, shown in Fig. 2.1 , draws from two key theoretical traditions. Life course theory, from Elder and others (Elder et al., 2003; Settersten & Angel, 2011), focuses on the timing of life events, relationships, and structural factors that influence life paths. Applied to caregiving, this approach shows how responsibilities build gradually—through a parent’s decline, a sibling’s migration, or household changes. These demands often peak when employment, parenting, and care needs overlap. Social ecological theory, elaborated by Bronfenbrenner (1979) and applied to health inequalities by Dahlgren and Whitehead (2007), situates individual experience within nested environmental systems: the immediate household, the extended family and neighbourhood, and the broader structural environment of policy, labour markets, and cultural norms. In urban caregiving contexts, this framework is analytically essential because it makes visible the ways in which structural forces, employment inflexibility, inadequate community services, and gendered policy assumptions determine the conditions under which caregivers operate, without reducing caregiving to purely structural determination or to individual choice. Together, these frameworks position caregiving as simultaneously a biographical process and a structurally embedded practice. This integration marks a substantive conceptual advance over existing Sri Lankan research, which has examined caregiving at either the individual or policy level without adequately connecting the two. The study contributes both empirically to the underdeveloped qualitative literature on urban caregiving in Sri Lanka and conceptually to broader scholarly debates on how to understand, support, and sustain family care in rapidly ageing and urbanising societies. 3. Methodology 3.1 Study Design and Analytical Orientation The methodology adopted in this study aligns with the research questions. Family caregiving in urban Sri Lanka is shaped by life histories, family dynamics, and broader forces such as urbanisation and labour-market demands. The availability of formal long-term care remains limited. To address these complexities, the research design was structured to assess the subjective dimensions of caregiving, including its meanings, tensions, and adaptive strategies, rather than solely measuring standard outcomes. Consequently, a qualitative design was selected, as it is widely recognized as the most suitable approach for these objectives. Qualitative research enables in-depth exploration of lived experiences and relationships, which quantitative surveys cannot fully capture, regardless of their design (Green & Thorogood, 2018; Pope & Mays, 2006). The study used two main theoretical approaches: the Life Course Perspective and Social Ecological Theory. These frameworks shaped the analysis but were not used as rigid templates. The Life Course Perspective shows how caregiving roles arise from personal experiences and transitions. These are shaped by personal history, family ties, and social context (Elder et al., 2003; Settersten & Angel, 2011). Social Ecological Theory, first developed by Bronfenbrenner (1979) and later expanded by Dahlgren and Whitehead (2007), places individual experiences within nested layers of environmental systems. These range from the home and neighbourhood to the community and larger structures such as policy and labour markets. Together, these theories explain how caregiving is both affected by and contributes to changes in urban society, linking individual pathways with social structures. This dual theoretical base connects individual caregiving experiences to wider urban and societal conditions by specifying that the Life Course Perspective traces caregiving as it unfolds across a person’s life, while the Social Ecological Theory situates these trajectories within layered social, community, and policy environments. By integrating these two frameworks, the study addresses a methodological gap identified in the literature review and clarifies how personal histories and external forces, such as urbanisation, shape and are shaped by family caregiving in these specific settings. 3.2 Study Setting Researchers conducted fieldwork in three Sri Lankan districts: Colombo, Gampaha, and Kandy. They chose these districts to represent varying urbanisation and demographic trends, each uniquely shaping caregiving. Colombo, the country’s main city, has a high population density and a busy economy. The city experiences higher costs, more nuclear families, and long commutes. Gampaha, just north of Colombo and part of Greater Colombo, is experiencing rapid industrial growth and new housing. This growth leads to increased commuter traffic and weaker community services. Kandy, the second-largest city and the cultural capital of the Central Province, is surrounded by mountains, with growth occurring along valleys, making it more challenging to access health and support services. Nighttime satellite images, discussed earlier, reveal rapid growth in these districts between 2014 and 2024. These images help contextualize caregiving conditions. Selecting multiple sites enables comparison between urban environments and avoids assumptions of urban uniformity. This approach follows established guidance for qualitative research on social change in diverse cities (Phillipson, 2013; Buffel et al., 2018). It underscores the importance of situating personal experiences within specific local contexts. 3.3 Participants and Recruitment The study included 12 older adults aged 70 or above and 12 primary family caregivers, selected to directly inform the research objectives. Including both groups provided insight from multiple perspectives, capturing not only caregiver challenges but also the feelings and concerns of older adults. Caregivers were recruited through local health and administrative networks, as is common in studies of older adults in South Asia. Local trust and relationships aided recruitment and research quality. Older adults were selected from the same households as caregivers to capture shared caregiving situations. Maximum variation sampling was employed, including caregivers of different genders, family roles, occupations, and household types (Patton, 2015). This approach reveals how diverse backgrounds shape caregiving experiences, rather than presenting a single narrative. Participation was voluntary and uncompensated. 3.4 Development and Piloting of Interview Guides Researchers tested the guides before fieldwork with two caregivers and one older adult in an urban area outside the study sites. This piloting clarified and improved the wording of the question and identified topics that needed more sensitive framing. Researchers checked the order of questions to ensure emotional appropriateness for older or vulnerable participants. These steps align with good qualitative interviewing practices (Turner, 2010; Braun & Clarke, 2013). After piloting, researchers slightly modified both guides. They did not include data from pilot interviews in the main analysis. Semi-structured interview guides were developed through a step-by-step process, informed by prior research and the study’s conceptual framework. Semi-structured interviews are commonly used in caregiving studies due to their flexibility and ability to support comparison. This approach allows exploration of issues important to each participant while maintaining consistency across interviews (Kallio et al., 2016; Charmaz, 2014). Separate guides were created for caregivers and older adults to reflect their distinct perspectives. 3.5 Data Collection Researchers collected data through in-depth, semi-structured interviews in Sinhala, the participants’ first language. They conducted interviews in participants’ homes. This setting provides richer, context-based descriptions of caregiving and family life as participants speak where care occurs (Opdenakker, 2006; Luff et al., 2000). Researchers observed the room layout, assistive devices, and proximity to neighbors—notes that added context to participants' stories. The first author conducted all interviews face-to-face. They have training and experience in qualitative research and in interviewing older adults and families in Sri Lanka. Interviews lasted 40 to 75 minutes. Duration depended on communication style and situation. With consent, all interviews were audio-recorded. Detailed field notes were written after each interview. These notes captured context, nonverbal cues, and thoughts not in the audio. Taking notes after interviews is a well-established practice in qualitative research (Emerson et al., 2011). 3.6 Transcription and Translation All interviews were transcribed verbatim in Sinhala. Then they translated it into English. Translating qualitative data goes beyond merely rendering words from one language to another. This process involves choices that shape meaning, especially in cross-cultural caregiving research. Many cultural phrases lack direct English equivalents (Temple & Young, 2004; Squires, 2009). To ensure translation quality, a bilingual researcher reviewed about 25% of English transcripts. The team discussed discrepancies to achieve the best resolution. This aligns with good practice for multilingual qualitative research. Full back-translation was not used. Careful attention was paid to preserving caregiving concepts in English. The focus was on meaning, not literal wording. 3.7 Ethical Considerations Ethical approval for the study was obtained from the relevant institutional body before fieldwork began. Written and verbal informed consent were obtained from all participants before each interview. The process was conducted in Sinhala to ensure full comprehension. Participants were clearly informed of their right to withdraw at any point without consequence. They were told about the voluntary nature of participation. They learned how their data would be stored, used, and reported. These procedures follow international ethical guidelines for research involving human participants, including older adults and caregivers who may be relatively vulnerable (World Medical Association, 2013). Additional ethical safeguards were applied when interviewing older adults who showed signs of frailty or cognitive limitation. In these cases, interviews were conducted at a slower pace, with more frequent pauses and opportunities for rest. The researcher remained attentive to signs of fatigue or distress. These practices follow ethical guidelines for gerontological qualitative research. They recognize the need for flexibility and responsiveness when working with older adults with varying cognitive and physical capacities (Dewing, 2007; Hellström et al., 2005). All identifying information was removed from transcripts and research outputs. Pseudonyms were assigned to all participants to ensure full anonymity. 3.8 Data Analysis Data were analysed using Framework Analysis. This is a rigorous, structured, and transparent qualitative analytic method. It was developed for applied social and health research. Framework Analysis is widely used in studies on complex social phenomena in policy-relevant contexts (Ritchie & Spencer, 1994; Gale et al., 2013). It was chosen here for its systematic, matrix-based approach. This lets researchers manage large volumes of qualitative data while keeping analytical transparency. It also helps compare data within and across cases. These qualities are important in a study involving multiple participant types across three geographically distinct sites. The analytic process followed five stages: familiarisation with the data through repeated reading of transcripts and field notes; development of an initial analytical framework based on emerging patterns and informed by the study’s theoretical orientation; indexing of data against the framework; charting data into thematic matrices; and interpretive mapping to identify patterns, associations, and explanations. The analytical framework was developed inductively from participants’ accounts and refined iteratively to ensure responsiveness to the data. The life course and social ecological perspectives introduced in Chap. 2 informed the interpretive stage, enabling the understanding of caregiving challenges across individual biographical, household relational, and structural levels. Data management was supported by QDA Miner [2]qualitative analysis software. 3.9 Methodological Limitations and Transferability As a qualitative study conducted in three selected urban districts, the findings are not intended to be statistically generalisable to all family caregivers in Sri Lanka or other national contexts. This is an inherent and accepted characteristic of qualitative research design rather than a limitation. The study’s aim was to generate theoretically grounded, contextually rich insights into how caregiving is experienced, organised, and sustained under conditions of urbanisation and population ageing, rather than to produce representative estimates of prevalence or distribution (Lincoln & Guba, 1985). The appropriate evaluative standard for qualitative research of this kind is analytical transferability: the extent to which the conceptual insights and interpretive frameworks generated by the study can illuminate caregiving dynamics in comparable settings and provide practically useful evidence for policy and practice development (Tracy, 2010). In both respects, this study makes a substantive contribution. The processes documented, including the gradual accumulation of caregiving responsibilities across life transitions, the structural incompatibility between urban employment demands and caregiving duties, the erosion of informal support networks, and the cultural framing of help-seeking as morally problematic, are not unique to the three districts studied. These findings reflect broader dynamics of urbanisation and demographic ageing that are reshaping family caregiving across South Asia and beyond, indicating that the study’s findings have analytical relevance beyond their immediate geographical context. 4. Results and Findings This chapter presents findings from in-depth, semi-structured interviews with family caregivers and older adults residing in urban and peri-urban districts of Sri Lanka. As described in Chap. 3, data were analysed using Framework Analysis. This method is rigorous and transparent. It enables systematic organisation and interpretation of complex narrative accounts, while preserving the depth and particularity of individual experiences (Ritchie & Spencer, 1994; Gale et al., 2013). The analytical process was informed throughout by the life-course and social-ecological perspectives introduced in Chap. 2. Together, these provided a conceptual vocabulary for understanding caregiving. They emphasise that caregiving is not a static role but a dynamic, socially embedded process, shaped simultaneously by individual biographical trajectories, household relational dynamics, and the broader structural conditions of urban life. Table 4.1 Participant Profile (n = 24) Category Sub-Category Frequency (n = 24) Percentage (%) Respondent Type Older Adults (70+) 12 50.0 Caregivers (family & paid) 12 50.0 Gender Male 9 37.5 Female 15 62.5 Age Group 30–39 3 12.5 40–49 4 16.7 50–59 3 12.5 60–69 2 8.3 70–74 4 16.7 75–79 4 16.7 80 and above 4 16.7 Marital Status Married 15 62.5 Widowed 7 29.2 Single / Other 2 8.3 Source: Primary data generated by the author. Table 4.1 shows that the sample included substantial variation across key sociodemographic characteristics. Women made up 62.5% of participants. This aligns with the gendered patterns of caregiving observed in South Asian contexts, as discussed in the literature review (Rathnayake & Siop, 2020; Sharma & Chakrabarti, 2020). Daughters were the largest group of caregivers, followed by spouses. This reflects the intersection of gender, kinship expectations, and life course position examined in this chapter. The age range of older adult participants, 70 to 80 years and older, corresponds to stages of increasing functional dependency and comorbidity. This is consistent with the morbidity profile of Sri Lanka’s older population (WHO, 2025). About 29% of participants were widowed. This highlights caregiving vulnerabilities associated with spousal loss, including increased care needs and reduced household caregiving capacity. Across interviews, caregivers did not describe challenges as discrete or isolated difficulties. Instead, they spoke of interconnected pressures that accumulated and intensified over time. Often, these pressures were unanticipated and difficult to address. Framework Analysis of the data yielded four interrelated thematic domains: (1) caregiving across life transitions; (2) time scarcity and employment–care tensions in urban settings; (3) shrinking family networks and the erosion of informal support; and (4) emotional strain, moral duty, and silent endurance. These domains are not mutually exclusive. Rather, they cut across and reinforce one another. They operate simultaneously at household, community, and structural levels in ways that reflect the multi-layered analytical framework developed in Chap. 2. 4.1 Caregiving Across Life Transitions: An Accumulation of Responsibilities A common and important pattern in the interviews was the gradual growth of caregiving jobs over time. Caregivers rarely said they chose this role clearly. Instead, their tasks built up slowly due to life events, like a parent struggling with daily chores, a sibling moving away for work, a spouse dying, or a child leaving home for school or work. Over time, caregiving became the main part of daily life, often happening without caregivers fully realizing it. A middle-aged daughter caring for her mother in Gampaha captured this process with particular clarity: “At first, it was just helping with hospital visits. Then, slowly, she couldn’t manage cooking or bathing. Now everuthing is with me “.(Caregiver, female, Gampaha) The gradual, often imperceptible nature of this transition has theoretical significance. Life course scholarship notes that major role transitions typically occur through incremental changes rather than sudden ruptures (Elder et al., 2003; Settersten & Angel, 2011). The data reveal that urban structural conditions accelerate and complicate these trajectories. As detailed in the introduction, internal and international labour migration has reduced the number of co-resident family members in all three study districts. As caregiving responsibilities intensify, fewer household members are available to share these duties. Some participants described being part of the 'sandwich generation', balancing care for aging parents and young children. This mix of duties placed significant stress on caregivers in their forties and fifties, who also held busy jobs (Lilly et al., 2020; Luo et al., 2019). There was little support from official bodies; caregivers handled these challenges on their own, seeing them as tiring but expected parts of family life. Older adults knew well the burden their growing needs put on their families. They did not just accept care passively. Many felt both grateful and uneasy about needing help and often worried they were disrupting their children’s lives. She has her job and her children. I never thought I would depend on her like this. (Older woman, 78 years, Kandy) This shared awareness caregivers feeling the weight of their role and older adults seeing how their needs affect their families shows a part of caregiving that surveys often miss. It points out that family care is about relationships and complex feelings, which, as found in Section 4.4 , lead to emotional strain and a sense of duty. 4.2 Time Scarcity and Employment–Care Tensions in Urban Settings The conditions of city life affected caregiving in many ways that were hard to solve. Most caregivers also had jobs, and the demands of work and care often clashed each day, with no formal help or adjustments from their employers. Long commute times to work, fixed job hours, and sudden care needs made it hard to do either job well. A male caregiver employed in Colombo articulated this structural dilemma with directness: If something happens during office hours, there is no option. I either take leave or ignore work calls.. (Caregiver, male, Colombo) The way this caregiver puts it ‘no option’ , ‘ both have consequences ’ points to a bigger problem: there is no policy that lets people care for family during work hours without risking their job. As noted earlier, this is common in city job markets across many growing countries. There, work rules usually prioritize job tasks over care needs when setting policies (Lloyd-Sherlock et al., 2018; Ruppanner et al., 2023). Women caregivers regularly spoke about handling the full load of both paid work and unpaid care, with neither side recognizing the other. The effects were serious and sometimes permanent. Some stopped working full-time, turned down job advancement, or left their jobs to care for their families. This hurt their future financial security, especially since pensions only reach about 31% of older people (ILO, 2022). While caregivers called these their personal choices, these decisions show how care work is divided by gender when there is no larger policy to share caregiving duties across society. It is important to situate these experiences within the specific urban geographies of the three study districts. Across all three settings, the daily rhythms of urban employment left caregivers with limited time, energy, and flexibility to respond to the unpredictable and often time-sensitive demands of care (Phillipson, 2013; Buffel et al., 2018). 4.3 Shrinking Family Networks and the Erosion of Informal Support A recurring theme across interviews was the contrast between participants’ experiences of caregiving in the present and their earlier expectations or their parents’ and grandparents’ experiences of care as a shared family responsibility distributed across a network of co-resident and nearby kin. The social ecology of care that many participants had grown up with, characterised by multi-generational households, proximate extended family, and active community reciprocity, had been substantially eroded by the time they assumed primary caregiving roles. The distribution of caregiver relationships within the sample is itself revealing. Daughters constituted the largest single group of caregivers (4 of 12), followed by spouses (3), with sons and daughters-in-law each accounting for 2 caregivers, and only 1 caregiver from other relatives. This concentration of caregiving responsibility within a narrow range of close relationships, and particularly among daughters, reflects the convergence of gendered cultural expectations, residential proximity, and the absence of alternative care options that the literature review identified as characteristic of South Asian urban caregiving contexts (Rathnayake & Siop, 2020). A caregiver in Kandy gave voice to this concentration directly: Earlier, there were many people in the house. Now it’s just me. Others help financially sometimes. (Caregiver, female, Kandy) The phrase ‘others help financially sometimes’ warrants particular attention, as it reflects a pattern observed across multiple interviews: absent family members such as siblings, adult children, or other relatives provided occasional financial support from a distance, while the practical, daily, and physically demanding aspects of care remained the sole responsibility of one individual. This asymmetric distribution of caregiving labour, where financial contributions substituted for but did not genuinely share the burden of direct care , resulted in primary caregivers experiencing substantial isolation in managing everyday care demands. The erosion of informal community support beyond the household was equally significant. Neighbours and extended kin occasionally provided emotional support or short-term practical assistance, but such help was described as irregular, unpredictable, and insufficient for sustained personal care. Formal community services were largely absent from participants’ accounts, or were perceived as inaccessible, inappropriate for ongoing personal care needs, or culturally misaligned with expectations of family-based provision. An older man in Colombo captured the changed texture of neighbourhood relations with an observation that resonated across multiple interviews: “ People are kind, but everyone is busy.no one has time like before“ (Older man, 82 years, Colombo) This observation is more than a nostalgic reflection on social change; it is a precise description of what social ecological theory terms the transformation of the mesosystem the layer of social relationships beyond the household that once provided a resource buffer for families managing care demands (Bronfenbrenner, 1979). Urban busyness, residential mobility, and the individualisation of household life have collectively weakened this buffer, leaving individual caregivers to absorb demands that were once distributed across a broader social network (Aboderin, 2017; Buffel et al., 2018). 4.4 Emotional Strain, Moral Duty, and Silent Endurance The fourth domain to emerge from the analysis concerned the emotional and moral dimensions of caregiving. Caregivers in this study did not simply describe the practical challenges of managing time, employment, and shrinking support networks; they also spoke, with considerable openness and often evident effort, about the emotional terrain of their caregiving lives, the fatigue, the guilt, the anxiety, and the sense of isolation that accompanied sustained care provision. What made these accounts analytically distinctive was that emotional strain and moral obligation were not experienced as separate or opposing forces. Rather, they were deeply intertwined: it was precisely because caregiving was understood as a moral imperative, rooted in cultural expectations of filial responsibility, that the emotional costs of caregiving were so difficult to acknowledge, articulate, or act upon. A daughter caring for her father in Colombo described this intertwining with candour: Some days I feel very tired, even angry. Then I feel guilty for thinking like that. He is my father. (Caregiver, female, Colombo) This account encapsulates a dynamic that was reproduced, in various forms, across the caregiver interviews: the experience of negative emotion exhaustion, frustration, even resentment, followed immediately by the experience of guilt at having had that feeling, rooted in the moral framework of filial duty. The emotional consequences of caregiving were thus compounded by the moral requirement to suppress or disavow them, producing, as the data consistently revealed, a pattern of silent endurance rather than active coping, help-seeking, or self-care. This pattern has been documented in qualitative caregiving research across South Asian contexts, where moral obligation both sustains care and intensifies the psychological strain of those who provide it (Sharma & Chakrabarti, 2020; Roy et al., 2020). The reluctance to seek help was a direct expression of this moral framing. Caregiving was understood as a private family matter, and the prospect of involving external services or sharing care responsibilities with non-family members was perceived as a failure of filial duty rather than a rational response to unsustainable demands. This reluctance was not confined to formal services; it extended to seeking support from neighbours, friends, or community organisations, all of which risked exposing a family’s private care arrangements to outside judgement. Women, in particular, described bearing this reticence alongside the practical and emotional burdens already documented, reinforcing the gendered dimension of silent endurance that runs through all four thematic domains. The emotional dimensions of the caregiving relationship, however, were not experienced only by caregivers. Older adults in the sample demonstrated a reciprocal and often quietly distressing awareness of the costs their care needs imposed on their families. Rather than experiencing their dependency as natural or uncomplicated, they expressed concern, guilt, and a sense of inadequacy about the disruption their care requirements created for their children’s lives: “I know they don’t complain, but I can see their tiredness “ (Older woman, 75 years, Gampaha) It indicates that interventions focusing solely on caregiver burden, without addressing the emotional experiences of older adults, are likely to offer only partial relief, as the relational dynamics generating and sustaining emotional strain operate at the level of the relationship rather than the individual. 5. Discussion The findings of this study challenge established understandings of family caregiving in rapidly ageing and urbanising societies. By examining caregivers and older adults across three Sri Lankan districts through life-course and social-ecological frameworks, the study demonstrates that caregiving is not adequately captured by burden metrics. Rather, it emerges as a biographical and structural process with notable and worsening consequences for health, household economies, and policy. This discussion situates the four thematic domains within the international literature, focusing on the mechanisms that generate caregiving strain rather than solely documenting its existence. 5.1 Caregiving as a Life Course Process: Accumulation, Transition, and Entrapment The most theoretically significant finding concerns the process by which caregiving roles are assumed. Participants did not describe a conscious decision; instead, they depicted an accumulation of minor, individually unremarkable acts of assistance that ultimately resulted in a full-time, largely irreversible role. This observation is consistent with life course scholarship, which suggests that major role transitions consolidate gradually (Elder et al., 2003; Settersten & Angel, 2011). The present study contributes additional evidence regarding the structural conditions that accelerate and limit the possibility of reversal. When labour migration disperses potential caregivers, the remaining family member is not gradually drawn into care but is instead left without alternatives. This structural dimension of role entrenchment remains underexplored in South Asian caregiving research, which has predominantly treated the assumption of care as a cultural norm rather than a structural necessity (Rathnayake & Siop, 2020). Integrating the life course caregiving framework of Schulz et al. (2020) reveals the intersection of work, family, and ageing trajectories. This convergence at mid-life often creates experiences that cross-sectional measures fail to capture. Existing Sri Lankan studies mostly rely on such measures, thereby missing crucial temporal implications for the design of preventive interventions. Identifying caregivers earlier, during the accumulation phase, is vital for effective support before role entrenchment sets in. 5.2 Urbanisation, Time Scarcity, and Employment–Care Conflict The employment–care conflict identified in this study highlights a structural incompatibility between urban labour markets and family care arrangements. These care arrangements have developed without policy intervention to manage their intersection. Caregivers in Colombo, Gampaha, and Kandy reported that employment requires a predictable presence. In contrast, caregiving demands availability at unpredictable times. No formal mechanisms, such as caregiver leave or flexible working arrangements, exist to ease this tension. This observation is consistent with comparative evidence: urban labour markets intensify caregiving strain by prioritizing productivity over care (Lloyd-Sherlock et al., 2018; Ruppanner et al., 2023). District-level specificity also emerges from the analysis. In Colombo, metropolitan density confines caregiving to the margins of the working day. In Gampaha, industrial growth has lengthened commutes but brought no supporting community infrastructure. In Kandy, mountainous geography creates time scarcity, shaped by both the landscape and labour-market demands (Jayaratne & Wickramasinghe, 2020). Policy responses that treat urban caregivers as a homogeneous group risk missing these distinct mechanisms. Women disproportionately experience the consequences of the employment–care conflict. These include reduced working hours, limited career advancement, and withdrawal from the labour market. This pattern reflects a structurally gendered care regime. The regime lacks employment accommodations. Limited pension coverage in Sri Lanka reaches only 31% of older adults (ILO, 2022). This worsens the issue. Women who leave the labour market to care for others forfeit pension contributions. This loss increases their financial vulnerability throughout life. The situation represents a policy failure at the intersection of ageing, gender, and social security. It highlights the need for coordinated reform. 5.3 Shrinking Informal Support Networks and the Paradox of Urban Proximity Living arrangement data show that 58.3% of older adults reside with a primary caregiver, 25% with extended family, and 16.7% alone with periodic visits. This distribution offers only a superficial view of family involvement. Qualitative evidence complicates the picture. Co-residence does not mean caregiving is shared. In many households, daily caregiving falls to one person. Non-resident family members contribute only occasionally. This does not redistribute care labor. This pattern has direct policy implications. Co-residence is the most common indicator in administrative assessments used to signal care adequacy. However, it is an unreliable proxy that masks the fact that care is concentrated on a single, often overburdened, individual. Actual task distribution must be assessed before making claims about household care capacity. The structural forces that concentrate caregiving responsibilities work as an interconnected system. Labor migration reduces the number of potential caregivers. Declining fertility means there are fewer siblings to help. High urban housing costs limit the likelihood of multigenerational co-residence (Aboderin, 2017; United Nations, 2023). More older adults now live alone. Though this trend remains limited, it likely signals the direction of future trends (Buffel et al., 2018; Phillipson, 2022). A central paradox emerges: living near urban services does not guarantee access to them. Caregivers often lack the time, flexibility, or cultural approval to use them. Unless employment constraints and moral frameworks discouraging help-seeking are addressed together, service expansion will not improve care sustainability. 5.4 Moral Responsibility, Emotional Strain, and the Limits of Individual Endurance The moral framing of caregiving as a filial obligation is well documented across South and East Asian contexts (Sharma & Chakrabarti, 2020; Roy et al., 2020). This study analyzes how such framing, combined with urban structural conditions, generates adverse outcomes. The stress-health process model, adapted from Schulz et al. (2020) and shown in Fig. 5 − 3, guides the analysis. Here, the key factor was how caregivers' moral appraisal of stressors transformed challenges into evidence of duty and coping into evidence of failure. This framing inhibited help-seeking, task redistribution, and service engagement—the model’s primary buffering mechanisms. The health consequences sleep deprivation, hypertension, musculoskeletal pain, depression, and social withdrawal align with findings from the stress process literature (Pearlin et al., 1990; Schulz & Eden, 2016). These effects reinforce each other; for example, sleep deprivation may exacerbate depression and pain, which in turn further diminish well-being. As deteriorating health reduces caregiving capacity, perceived demand rises, leading to greater emotional suppression and undermined self-care. Disrupting this cycle requires active interventions tailored to underlying value systems, since relying on information provision or passive service availability alone is insufficient. This study adds to the scholarship by identifying bidirectional suffering in caregiver-care recipient relationships. Older adults were acutely aware of the costs their dependency imposed. They felt ongoing distress about the burden they represented. This awareness influenced the caregiving dynamic. Caregivers, observing their relatives’ guilt, intensified efforts to seem uncomplaining. This deepened emotional suppression and reinforced patterns that perpetuated stress. In line with interdependent wellbeing frameworks (Martire et al., 2010; Monin & Schulz, 2009), these findings challenge models treating caregiver burden and older adult wellbeing as separate issues. The two are fundamentally interconnected. Effective relief of caregiving strain requires attention to both sides of the dyad. Across all four domains, the findings converge on one conclusion: the costs of demographic ageing and urbanisation are absorbed almost entirely by individual family caregivers disproportionately women without institutional recognition or structural support. The caregivers in this study were not failing; they were enduring under conditions that make sustained care progressively unsustainable. The study’s contribution is to specify the biographical, structural, cultural, and relational mechanisms by which unsustainability is produced the proper objects of the policy reform developed in the chapter that follows. . 6. Conclusion Sri Lanka’s demographic evolution is among the fastest in South Asia. Yet, the policy environment has not adapted. This study explored how family caregivers in urban and peri-urban Colombo, Gampaha, and Kandy manage care for older adults despite this policy lag. It used qualitative interviews analyzed using Framework Analysis, guided by life-course and social-ecological frameworks (UNDESA, 2024; WHO, 2025). The evidence indicates that in many households, caregiving has reached its structural limits. It is no longer just under pressure. 6.1 Principal Findings This study finds that caregiving in urban Sri Lanka is an accumulating biographical process. It is not a single, isolated role. The process intensifies gradually over the years before its impact becomes apparent. Its slow onset makes it hard to renegotiate once in place (Elder et al., 2003; Schulz et al., 2020). Earlier Sri Lankan caregiving research used cross-sectional measures. It has missed this temporal aspect. Policy interventions often arrive too late to be preventive. Two more findings clarify this context. First, living near services does not guarantee access. Employment structures limit caregivers’ availability during working hours. Cultural norms of filial obligation also discourage help-seeking. This paradox means expanding formal services is not enough without structural and cultural reforms (Roy et al., 2020; Sharma & Chakrabarti, 2020). Second, emotional suffering is bidirectional in these households. Older adults feel they are burdens, which increases caregiver strain. This reinforces the suppression and appraisal patterns that fuel the stress cycle (Martire et al., 2010; Monin & Schulz, 2009). Interventions that address only caregivers offer, at best, only partial relief. 6.2 Policy Implications The national policy framework’s continued reliance on the family as a self-sufficient care unit (Ministry of Social Welfare, 2018) is not only outdated but also actively harmful, as it legitimizes the structural neglect of caregivers whose capacity is already exhausted. Three reform priorities emerge directly from the evidence. First, community-based care infrastructure, including respite services, adult day centres, and formal home care, is essential but will remain underutilized unless accompanied by community engagement strategies that reframe help-seeking as consistent with filial responsibility. Second, employment reform is imperative. The women in this study who reduced their working hours, declined promotions, or exited the labour market entirely did so without any structural alternatives, and the financial consequences, compounded by Sri Lanka’s pension coverage reaching only 31% of older adults (ILO, 2022), will affect them throughout their lives. Flexible working arrangements, caregiver leave, and phased return-to-work provisions are not marginal adjustments; they are mechanisms through which the cost of demographic ageing is either distributed equitably or, as at present, concentrated on the least protected. With 26% of Sri Lanka’s population projected to be aged 60 or above by 2050 (UNDESA, 2024), the opportunity for proactive reform is diminishing. Future Directions The findings are not statistically generalisable, though the structural dynamics documented are analytically transferable across rapidly urbanising low- and middle-income contexts (Lincoln & Guba, 1985; Tracy, 2010). The exclusion of employers, policymakers, and service providers from the sample is a limitation that future multi-stakeholder research should address. Longitudinal designs tracking caregiving households over five to ten years would capture how responsibilities accumulate and health consequences compound in ways no cross-sectional design can, and comparative studies across rural, peri-urban, and metropolitan settings would produce the geographically differentiated evidence that calibrated policy reform requires. 6.4 Concluding Remarks The caregivers in this study were not exceptional. They were ordinary people doing what their families and society expected, under conditions that have become structurally untenable. What this study establishes is that their situation is not the inevitable cost of demographic ageing or the natural expression of cultural obligation it is the product of identifiable and addressable policy failures. The evidence is in place. 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The Qualitative Report , 15 (3), 754–760. https://doi.org/10.46743/2160-3715/2010.1178 United Nations Department of Economic and Social Affairs. (2024). World population prospects 2024: Summary of results . United Nations. https://population.un.org/wpp/ World Health Organization. (2025). Sri Lanka: Facts and figures — healthy ageing . WHO Regional Office for South-East Asia. https://www.who.int/srilanka Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9115626","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":624224141,"identity":"754baad4-3a8c-4aa7-a464-da05db3f8a08","order_by":0,"name":"Madudurage Nuwan Sampath Weerasingha","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBUlEQVRIiWNgGAWjYJADNjDJDyISCojSwQzRItkA0mJAihaDA2AStzpziRzDzwV/7KLN2c8fe8DYZiNvfH514ocHBgzy/GIHsGqxnJFjLD2zLTl3Z08yuwFjW5rhthtvN0sAHWY4c3YCVi0GN3I3SPM2MOduOJDMJsHYdjjB7MbZDSAtCQa3cWrZ/JvnT33uhvOPIVqMZ5zd/IOAlm3SPGyHczfcgNpiwN+7Db8tZ95/s+ZtO567c8ZjM4mEc2mGM27wbrNIMJDA7Zfjacm3ef5U527nT3wm8aHMRp6//+zmmz8qgAxp7FoQekEEWI0EhMSvHK4FDPgPEFY9CkbBKBgFIwoAAJyeX6FwW5b9AAAAAElFTkSuQmCC","orcid":"","institution":"Ministry of Public Administration , Provincial Councils and Local Government","correspondingAuthor":true,"prefix":"","firstName":"Madudurage","middleName":"Nuwan Sampath","lastName":"Weerasingha","suffix":""}],"badges":[],"createdAt":"2026-03-13 14:10:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9115626/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9115626/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107500637,"identity":"81cdbc30-1880-459c-a525-9f588d49a93c","added_by":"auto","created_at":"2026-04-22 05:48:56","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":78633,"visible":true,"origin":"","legend":"\u003cp\u003e1-1\u003cem\u003e- Demographic Shift in Sri Lanka\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Source\u003c/strong\u003e – \u003cem\u003eAdapted from World Health Organization (2025). Sri Lanka: Facts and Figures – Healthy Ageing\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.1.png","url":"https://assets-eu.researchsquare.com/files/rs-9115626/v1/506190eb2b13728ddac97c99.png"},{"id":107500638,"identity":"536dbeac-e3cc-4f1c-82d8-7a80cfbbd770","added_by":"auto","created_at":"2026-04-22 05:48:56","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":22325,"visible":true,"origin":"","legend":"\u003cp\u003e1-2 - \u003cem\u003eLabour force Participation\u003c/em\u003e \u003cem\u003eby older adults\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eData Source – \u003cem\u003eAdapted from World Health Organization (2025). Sri Lanka: Facts and Figures – Healthy Ageing\u003c/em\u003e.\u003c/p\u003e","description":"","filename":"1.2.png","url":"https://assets-eu.researchsquare.com/files/rs-9115626/v1/310ee81229093f69ee017450.png"},{"id":107705713,"identity":"f9304835-0788-4abe-94b5-241924e4534a","added_by":"auto","created_at":"2026-04-24 09:14:43","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":441039,"visible":true,"origin":"","legend":"\u003cp\u003e1-3 \u003cem\u003e1Nighttime Light Intensity in Sri Lanka, 2014 and 2024\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSource: \u003cem\u003eNASA Black Marble / VIIRS Nighttime Light Composite\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.3.png","url":"https://assets-eu.researchsquare.com/files/rs-9115626/v1/282c3e7b693f34b87a1c46b4.png"},{"id":107705908,"identity":"add99582-d51c-4692-9070-e4a83d319174","added_by":"auto","created_at":"2026-04-24 09:15:42","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":78847,"visible":true,"origin":"","legend":"\u003cp\u003e2.1 . \u003cem\u003eConceptual Framework\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSource\u003c/strong\u003e\u003cem\u003e - Developed by the author\u003c/em\u003e\u003c/p\u003e","description":"","filename":"2.1.png","url":"https://assets-eu.researchsquare.com/files/rs-9115626/v1/f98e65930662b4f276d9291e.png"},{"id":107705307,"identity":"2797060e-0015-4706-b7a5-360932c9f3ce","added_by":"auto","created_at":"2026-04-24 09:11:16","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":39840,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e4-1\u003c/strong\u003e \u003cem\u003eReationship of Caregiver to Older Adults\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSource\u003c/strong\u003e\u003cem\u003e - Developed by the author\u003c/em\u003e\u003c/p\u003e","description":"","filename":"4.1.png","url":"https://assets-eu.researchsquare.com/files/rs-9115626/v1/2281d8264b4d3e7b54a4f7ef.png"},{"id":107500642,"identity":"1b821e08-05e9-4fab-a319-219a3b0c7f16","added_by":"auto","created_at":"2026-04-22 05:48:56","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":118404,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e5-1\u003c/strong\u003e\u003cem\u003e. Life Course Framework of Family Caregiving.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSource: Adapted from Schulz et al. (2020), Family caregiving for older adults, Annual Review of Psychology, 71, 635–659.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"5.1.png","url":"https://assets-eu.researchsquare.com/files/rs-9115626/v1/db2da2f5e2c54a91b1038e92.png"},{"id":107705906,"identity":"86c52239-813c-4ca4-ac0d-38f1d5d74992","added_by":"auto","created_at":"2026-04-24 09:15:42","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":22874,"visible":true,"origin":"","legend":"\u003cp\u003e5-2 \u003cem\u003eLiving Arrangement of Older Adults\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSource – \u003cem\u003egenerated by the author\u003c/em\u003e\u003c/p\u003e","description":"","filename":"5.2.png","url":"https://assets-eu.researchsquare.com/files/rs-9115626/v1/328a28361b0b00705261d7ea.png"},{"id":107500644,"identity":"39a4f676-0cdf-429a-9e86-146b0b7ad2ea","added_by":"auto","created_at":"2026-04-22 05:48:56","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":242710,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e5-3\u003c/strong\u003e.\u003cem\u003e The Stress-Health Process Model.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSource: Adapted from Schulz et al. (2020), Family caregiving for older adults, Annual Review of Psychology, 71, 635–659; originally based on Pearlin et al. (1990) and Cohen et al. (1995).\u003c/em\u003e\u003c/p\u003e","description":"","filename":"5.3.png","url":"https://assets-eu.researchsquare.com/files/rs-9115626/v1/4cd15d4167d95d6b64bd00c0.png"},{"id":107711445,"identity":"54ceb077-d64d-4432-890a-a0bcfc7672b5","added_by":"auto","created_at":"2026-04-24 09:45:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1283320,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9115626/v1/c4ca9871-46a0-4ec4-a34b-f7da84831337.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Caregiving Across the Life Course in Rapidly Urbanising Sri Lanka: Structural Incompatibility, Eroding Networks, and the Limits of Filial Obligation","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003ePopulation ageing is a major challenge of this century. More older adults in both high- and low- to middle-income countries are straining care, health services, and family support. By 2050, the UN projects that over 1.6\u0026nbsp;billion people aged 65 or older\u0026mdash;16% of the world\u0026mdash;will be living, up from 761\u0026nbsp;million in 2021. Demographic change affects countries differently, depending on their social services, labour markets, households, and access to care. Addressing these gaps is central to managing the impact of ageing.\u003c/p\u003e\n\u003cp\u003eIn many high-income countries, ageing increases reliance on institutional and community care. Examples include residential facilities, home care, and social insurance. Japan, with one of the world\u0026rsquo;s oldest populations, takes this approach. National long-term care insurance [1](LTCI), introduced in 2000, allows older adults with limitations to access subsidised home and institutional services (Tsutsui \u0026amp; Muramatsu, 2007). Even well-funded systems face challenges: workforce shortages, rising costs, and dependence on informal caregivers reveal the limits of formal care (Campbell et al., 2010; Hashimoto et al., 2020).\u003c/p\u003e\n\u003cp\u003eIn many low- and middle-income countries, population ageing is advancing rapidly, but support systems lag behind. In sub-Saharan Africa, public health advances such as vaccination and lower early-life mortality have increased the number of older adults, but care systems have not kept pace (Aboderin, 2017). Families, particularly women, bear the majority of care responsibilities (Schatz \u0026amp; Ogunmefun, 2007). South Asia has similar trends, with demographic changes outstripping policy and services (Lloyd-Sherlock et al., 2018).\u003c/p\u003e\n\u003cp\u003eSri Lanka is one of the fastest-ageing countries in South Asia. Its population reached old age sooner than other countries in the region. In 1990, about 9% of people were aged 60 or older; this rose to 12.4% in 2012 and about 17% (almost 4\u0026nbsp;million) in 2024 (UNDESA, 2024; WHO, 2025). Projections suggest around 26% will be 60 or older by 2050, making Sri Lanka one of the fastest-ageing societies in Asia. This shift happens in a lower-middle-income setting with limited ability to expand formal income security and long-term care for older adults.\u003c/p\u003e\n\u003cp\u003eA key trend is the growth of the \u0026apos;oldest-old\u0026apos; group. In 2024, people aged 80 and above made up about 1.9% of the population, or 449,000 people. Most are women due to higher longevity (UNDESA, 2024; WHO, 2025). This group will grow by 2050, raising long-term care needs. Noncommunicable diseases cause most disability among older adults in Sri Lanka. Conditions like diabetes, joint problems, hearing loss, stroke, Alzheimer\u0026rsquo;s, and dementia are common in those over 75 (WHO, 2025). More falls, poor vision, and cognitive decline add to care needs in late old age. This is challenging because geriatric services are limited.\u003c/p\u003e\n\u003cp\u003eSri Lanka\u0026rsquo;s ageing population faces a key challenge. Weak geriatric and long-term care systems mean families give most elder care. National policy promotes healthy ageing, but resources for long-term care are limited (WHO, 2025). In 2021, only 31% of older adults had a pension. Many depend on family or must work longer (ILO, 2022). Older adults, especially women, are leaving the workforce, reducing income security. This increases reliance on female family caregivers, who often lack support. Urbanisation further strains families by weakening kin networks and threatening the sustainability of home-based care.\u003c/p\u003e\n\u003cp\u003eUrbanisation is changing caregiving in Sri Lanka. Rapid urban growth and migration decrease the number of co-resident caregivers. More young family members are moving to cities or abroad for work, leaving older adults with a spouse, an adult child, or non-resident caregivers. These non-residents manage care from afar. In cities, caregiving must fit with jobs, childcare, and other duties, leading to time, emotional, and financial pressure. Women, who remain the main caregivers, bear the heaviest burden even as they join the workforce (Ruwanpura, 2016; Watt et al., 2014).\u003c/p\u003e\n\u003cp\u003eCities like Colombo, Gampaha, and Kandy show these changes. They have dense populations, rising living costs, more women in the workforce, and less extended family support. Cities may offer better healthcare but also present new challenges: time demands, transportation, housing issues, and more reliance on informal or paid care. These challenges increase family caregiver stress and reduce consistency of home care (Phillipson, 2013; Buffel et al., 2018).\u003c/p\u003e\n\u003cp\u003eNighttime light imagery proxies urban economic activity, infrastructure, and population density (Henderson et al., 2012; Elvidge et al., 2017). The above images show Sri Lanka\u0026rsquo;s light radiance in 2014 and 2024, highlighting rapid urbanisation in the Western and Central provinces. Colombo, Gampaha, and Kandy are key for this study.\u003c/p\u003e\n\u003cp\u003eMost research on elder caregiving in Sri Lanka focuses on rural areas or demographic data, leaving the impacts in urban areas underexplored. This gap hinders development of policies for urban realities; formal care is limited in cities, so families remain main caregivers.\u003c/p\u003e\n\u003cp\u003eThis study explores family caregivers\u0026rsquo; experiences of home-based care for older adults in selected urban and semi-urban areas of Sri Lanka. Using qualitative interviews and structured analysis, it presents detailed insights on caregivers\u0026rsquo; challenges, stress, and coping as family systems and urban contexts change. By sharing caregivers\u0026apos; views and linking them to broader trends, it adds to Sri Lanka\u0026rsquo;s limited qualitative elder care literature. The findings aim to inform urban-responsive care policy, community support, and solutions for family caregivers amid rapid demographic change.\u003c/p\u003e"},{"header":"2. Literature Review","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003e2.1 Global Perspectives on Family-Based Caregiving in Ageing Societies\u003c/h2\u003e\n \u003cp\u003ePopulation ageing is a major twenty-first-century transformation. It reshapes labour markets, family structures, and care systems worldwide. The World Health Organization (WHO, 2021) projects that the population aged 60 and older will reach 2\u0026nbsp;billion by 2050, with the fastest growth in low- and middle-income countries, where formal care infrastructure is underdeveloped. However, these numbers overlook the main source of care: families. Women in families bear the majority of caregiving duties.\u003c/p\u003e\n \u003cp\u003eA growing body of international research documents the personal costs of family-based caregiving. In Canada, Australia, and much of Western Europe, studies show that family caregivers face time scarcity, social withdrawal, and exhaustion. These consequences worsen where formal services are limited or fragmented (Chappell \u0026amp; Funk, 2011; Funk et al., 2013). Research has shifted away from viewing these challenges solely as personal burdens. Longitudinal and life-course studies now view caregiving as a role that intensifies over time. It intersects with employment, gender expectations, and institutional conditions that affect caregivers\u0026rsquo; vulnerability (Luo et al., 2019; Lilly et al., 2020). In the United States and Western Europe, this shift has influenced policy debates. Caregiving is increasingly seen as a public health issue rather than a private responsibility. Schulz and Eden\u0026rsquo;s (2016) review reinforced this view, showing that excluding family caregivers from policy is a structural failure rooted in outdated beliefs about family flexibility.\u003c/p\u003e\n \u003cp\u003eIn South and East Asian contexts, caregiving unfolds within distinct normative landscapes but faces comparable structural strains. Intergenerational norms of filial obligation remain culturally powerful, but they do not operate in a vacuum: in India and China, women increasingly manage caregiving demands alongside paid employment and childcare, often without any formal support (Sharma \u0026amp; Chakrabarti, 2020). In South Asia specifically, daughters, daughters-in-law, and spouses remain the primary providers of daily care for older relatives, their labour framed as a cultural duty and therefore rendered invisible to policy (Rathnayake \u0026amp; Siop, 2020). Rapid urbanisation, declining fertility, and rising female labour force participation are simultaneously reducing the pool of available caregivers and intensifying the demands placed on those who remain, a structural squeeze whose policy consequences have not been adequately addressed in any South Asian setting.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003e2.2 The Sri Lankan Caregiving Literature: Three Strands and Their Limits\u003c/h2\u003e\n \u003cp\u003eResearch on family caregiving in Sri Lanka follows three main approaches. Each offers useful insights but leaves key issues unexplored. First, national demographic data show the rapid ageing of the population and a growing gap between care needs and formal provision. This demonstrates the urgency of the policy issue. Second, policy-oriented studies examine legal frameworks and welfare systems. They often highlight the gap between policy promises and actual service delivery, especially in long-term and community care (Herath \u0026amp; Wickramasinghe, 2018; Perera, 2022). Third, empirical studies use cross-sectional surveys to measure caregiver burden, psychological distress, and social factors. While this work reveals high strain, especially for women, it treats caregiving as a static condition. It rarely explores the lived experience, how caregiving begins and grows, or the structural factors that shape its sustainability. Recent qualitative research has begun to explore loneliness, dependency, and the emotional side of care from caregiver and older adult perspectives (Fernando et al., 2019; Wickrama \u0026amp; Wijesekara, 2023). Most of this research is rural or institutionally focused. Unique issues of urban living, labour-market inflexibility, commuting, weak neighbourhood networks, and housing constraints are rarely studied. As a result, Sri Lanka\u0026rsquo;s caregiving literature mostly reflects rural settings, missing the rising demographic pressures in cities.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003e2.3 Persistent Gaps: The Urban Dimension and the Need for Integrated Frameworks\u003c/h2\u003e\n \u003cp\u003eThis review finds two connected gaps: one substantive and one methodological. The main substantive gap is the lack of qualitative research on family caregiving in Sri Lanka\u0026rsquo;s urban and peri-urban areas. These settings have the highest population density and the greatest shifts from multigenerational households. They also have the sharpest conflict between work and care. Urbanisation has reduced residential proximity of kin, neighbourhood support, and time for care. These changes make caregiving in Colombo, Gampaha, and Kandy very different from rural areas. Yet, urban caregiving remains largely unstudied.\u003c/p\u003e\n \u003cp\u003eThe methodological gap is also important. The field relies on demographic data, policy analysis, and surveys to examine outcomes such as caregiver burden, job withdrawal, and distress. However, this evidence lacks details on how these outcomes develop. Without life-course or social-ecological frameworks, we cannot see how caregiving builds over time or how household and neighbourhood factors influence support. These frameworks also help explain how policies and housing markets affect caregiving. The lack of integrated frameworks is the field\u0026rsquo;s biggest methodological limitation.\u003c/p\u003e\n \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\n \u003ch2\u003e2.4.1 A Life Course and Social Ecological Conceptual Framework for Family Caregiving in Urban Sri Lanka\u003c/h2\u003e\n \u003cp\u003eThe study\u0026rsquo;s framework, shown in Fig. \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e2.1\u003c/span\u003e, draws from two key theoretical traditions. Life course theory, from Elder and others (Elder et al., 2003; Settersten \u0026amp; Angel, 2011), focuses on the timing of life events, relationships, and structural factors that influence life paths. Applied to caregiving, this approach shows how responsibilities build gradually\u0026mdash;through a parent\u0026rsquo;s decline, a sibling\u0026rsquo;s migration, or household changes. These demands often peak when employment, parenting, and care needs overlap.\u003c/p\u003e\n \u003cp\u003eSocial ecological theory, elaborated by Bronfenbrenner (1979) and applied to health inequalities by Dahlgren and Whitehead (2007), situates individual experience within nested environmental systems: the immediate household, the extended family and neighbourhood, and the broader structural environment of policy, labour markets, and cultural norms. In urban caregiving contexts, this framework is analytically essential because it makes visible the ways in which structural forces, employment inflexibility, inadequate community services, and gendered policy assumptions determine the conditions under which caregivers operate, without reducing caregiving to purely structural determination or to individual choice. Together, these frameworks position caregiving as simultaneously a biographical process and a structurally embedded practice. This integration marks a substantive conceptual advance over existing Sri Lankan research, which has examined caregiving at either the individual or policy level without adequately connecting the two. The study contributes both empirically to the underdeveloped qualitative literature on urban caregiving in Sri Lanka and conceptually to broader scholarly debates on how to understand, support, and sustain family care in rapidly ageing and urbanising societies.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"3. Methodology","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003e3.1 Study Design and Analytical Orientation\u003c/h2\u003e\n \u003cp\u003eThe methodology adopted in this study aligns with the research questions. Family caregiving in urban Sri Lanka is shaped by life histories, family dynamics, and broader forces such as urbanisation and labour-market demands. The availability of formal long-term care remains limited. To address these complexities, the research design was structured to assess the subjective dimensions of caregiving, including its meanings, tensions, and adaptive strategies, rather than solely measuring standard outcomes. Consequently, a qualitative design was selected, as it is widely recognized as the most suitable approach for these objectives. Qualitative research enables in-depth exploration of lived experiences and relationships, which quantitative surveys cannot fully capture, regardless of their design (Green \u0026amp; Thorogood, 2018; Pope \u0026amp; Mays, 2006).\u003c/p\u003e\n \u003cp\u003eThe study used two main theoretical approaches: the Life Course Perspective and Social Ecological Theory. These frameworks shaped the analysis but were not used as rigid templates. The Life Course Perspective shows how caregiving roles arise from personal experiences and transitions. These are shaped by personal history, family ties, and social context (Elder et al., 2003; Settersten \u0026amp; Angel, 2011). Social Ecological Theory, first developed by Bronfenbrenner (1979) and later expanded by Dahlgren and Whitehead (2007), places individual experiences within nested layers of environmental systems. These range from the home and neighbourhood to the community and larger structures such as policy and labour markets. Together, these theories explain how caregiving is both affected by and contributes to changes in urban society, linking individual pathways with social structures.\u003c/p\u003e\n \u003cp\u003eThis dual theoretical base connects individual caregiving experiences to wider urban and societal conditions by specifying that the Life Course Perspective traces caregiving as it unfolds across a person\u0026rsquo;s life, while the Social Ecological Theory situates these trajectories within layered social, community, and policy environments. By integrating these two frameworks, the study addresses a methodological gap identified in the literature review and clarifies how personal histories and external forces, such as urbanisation, shape and are shaped by family caregiving in these specific settings.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003e3.2 Study Setting\u003c/h2\u003e\n \u003cp\u003eResearchers conducted fieldwork in three Sri Lankan districts: Colombo, Gampaha, and Kandy. They chose these districts to represent varying urbanisation and demographic trends, each uniquely shaping caregiving. Colombo, the country\u0026rsquo;s main city, has a high population density and a busy economy. The city experiences higher costs, more nuclear families, and long commutes. Gampaha, just north of Colombo and part of Greater Colombo, is experiencing rapid industrial growth and new housing. This growth leads to increased commuter traffic and weaker community services. Kandy, the second-largest city and the cultural capital of the Central Province, is surrounded by mountains, with growth occurring along valleys, making it more challenging to access health and support services. Nighttime satellite images, discussed earlier, reveal rapid growth in these districts between 2014 and 2024. These images help contextualize caregiving conditions.\u003c/p\u003e\n \u003cp\u003eSelecting multiple sites enables comparison between urban environments and avoids assumptions of urban uniformity. This approach follows established guidance for qualitative research on social change in diverse cities (Phillipson, 2013; Buffel et al., 2018). It underscores the importance of situating personal experiences within specific local contexts.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003e3.3 Participants and Recruitment\u003c/h2\u003e\n \u003cp\u003eThe study included 12 older adults aged 70 or above and 12 primary family caregivers, selected to directly inform the research objectives. Including both groups provided insight from multiple perspectives, capturing not only caregiver challenges but also the feelings and concerns of older adults.\u003c/p\u003e\n \u003cp\u003eCaregivers were recruited through local health and administrative networks, as is common in studies of older adults in South Asia. Local trust and relationships aided recruitment and research quality. Older adults were selected from the same households as caregivers to capture shared caregiving situations.\u003c/p\u003e\n \u003cp\u003eMaximum variation sampling was employed, including caregivers of different genders, family roles, occupations, and household types (Patton, 2015). This approach reveals how diverse backgrounds shape caregiving experiences, rather than presenting a single narrative. Participation was voluntary and uncompensated.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003e3.4 Development and Piloting of Interview Guides\u003c/h2\u003e\n \u003cp\u003eResearchers tested the guides before fieldwork with two caregivers and one older adult in an urban area outside the study sites. This piloting clarified and improved the wording of the question and identified topics that needed more sensitive framing. Researchers checked the order of questions to ensure emotional appropriateness for older or vulnerable participants. These steps align with good qualitative interviewing practices (Turner, 2010; Braun \u0026amp; Clarke, 2013). After piloting, researchers slightly modified both guides. They did not include data from pilot interviews in the main analysis.\u003c/p\u003e\n \u003cp\u003eSemi-structured interview guides were developed through a step-by-step process, informed by prior research and the study\u0026rsquo;s conceptual framework. Semi-structured interviews are commonly used in caregiving studies due to their flexibility and ability to support comparison. This approach allows exploration of issues important to each participant while maintaining consistency across interviews (Kallio et al., 2016; Charmaz, 2014). Separate guides were created for caregivers and older adults to reflect their distinct perspectives.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003e3.5 Data Collection\u003c/h2\u003e\n \u003cp\u003eResearchers collected data through in-depth, semi-structured interviews in Sinhala, the participants\u0026rsquo; first language. They conducted interviews in participants\u0026rsquo; homes. This setting provides richer, context-based descriptions of caregiving and family life as participants speak where care occurs (Opdenakker, 2006; Luff et al., 2000). Researchers observed the room layout, assistive devices, and proximity to neighbors\u0026mdash;notes that added context to participants\u0026apos; stories.\u003c/p\u003e\n \u003cp\u003eThe first author conducted all interviews face-to-face. They have training and experience in qualitative research and in interviewing older adults and families in Sri Lanka. Interviews lasted 40 to 75 minutes. Duration depended on communication style and situation. With consent, all interviews were audio-recorded. Detailed field notes were written after each interview. These notes captured context, nonverbal cues, and thoughts not in the audio. Taking notes after interviews is a well-established practice in qualitative research (Emerson et al., 2011).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003e3.6 Transcription and Translation\u003c/h2\u003e\n \u003cp\u003eAll interviews were transcribed verbatim in Sinhala. Then they translated it into English. Translating qualitative data goes beyond merely rendering words from one language to another. This process involves choices that shape meaning, especially in cross-cultural caregiving research. Many cultural phrases lack direct English equivalents (Temple \u0026amp; Young, 2004; Squires, 2009).\u003c/p\u003e\n \u003cp\u003eTo ensure translation quality, a bilingual researcher reviewed about 25% of English transcripts. The team discussed discrepancies to achieve the best resolution. This aligns with good practice for multilingual qualitative research. Full back-translation was not used. Careful attention was paid to preserving caregiving concepts in English. The focus was on meaning, not literal wording.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003e3.7 Ethical Considerations\u003c/h2\u003e\n \u003cp\u003eEthical approval\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003efor the study was obtained from the relevant institutional body before fieldwork began. Written and verbal informed consent were obtained from all participants before each interview. The process was conducted in Sinhala to ensure full comprehension. Participants were clearly informed of their right to withdraw at any point without consequence. They were told about the voluntary nature of participation. They learned how their data would be stored, used, and reported. These procedures follow international ethical guidelines for research involving human participants, including older adults and caregivers who may be relatively vulnerable (World Medical Association, 2013).\u003c/p\u003e\n \u003cp\u003eAdditional ethical safeguards were applied when interviewing older adults who showed signs of frailty or cognitive limitation. In these cases, interviews were conducted at a slower pace, with more frequent pauses and opportunities for rest. The researcher remained attentive to signs of fatigue or distress. These practices follow ethical guidelines for gerontological qualitative research. They recognize the need for flexibility and responsiveness when working with older adults with varying cognitive and physical capacities (Dewing, 2007; Hellstr\u0026ouml;m et al., 2005). All identifying information was removed from transcripts and research outputs. Pseudonyms were assigned to all participants to ensure full anonymity.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003e3.8 Data Analysis\u003c/h2\u003e\n \u003cp\u003eData were analysed using Framework Analysis. This is a rigorous, structured, and transparent qualitative analytic method. It was developed for applied social and health research. Framework Analysis is widely used in studies on complex social phenomena in policy-relevant contexts (Ritchie \u0026amp; Spencer, 1994; Gale et al., 2013). It was chosen here for its systematic, matrix-based approach. This lets researchers manage large volumes of qualitative data while keeping analytical transparency. It also helps compare data within and across cases. These qualities are important in a study involving multiple participant types across three geographically distinct sites.\u003c/p\u003e\n \u003cp\u003eThe analytic process followed five stages: familiarisation with the data through repeated reading of transcripts and field notes; development of an initial analytical framework based on emerging patterns and informed by the study\u0026rsquo;s theoretical orientation; indexing of data against the framework; charting data into thematic matrices; and interpretive mapping to identify patterns, associations, and explanations. The analytical framework was developed inductively from participants\u0026rsquo; accounts and refined iteratively to ensure responsiveness to the data. The life course and social ecological perspectives introduced in Chap.\u0026nbsp;2 informed the interpretive stage, enabling the understanding of caregiving challenges across individual biographical, household relational, and structural levels. Data management was supported by QDA Miner [2]qualitative analysis software.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003e3.9 Methodological Limitations and Transferability\u003c/h2\u003e\n \u003cp\u003eAs a qualitative study conducted in three selected urban districts, the findings are not intended to be statistically generalisable to all family caregivers in Sri Lanka or other national contexts. This is an inherent and accepted characteristic of qualitative research design rather than a limitation. The study\u0026rsquo;s aim was to generate theoretically grounded, contextually rich insights into how caregiving is experienced, organised, and sustained under conditions of urbanisation and population ageing, rather than to produce representative estimates of prevalence or distribution (Lincoln \u0026amp; Guba, 1985).\u003c/p\u003e\n \u003cp\u003eThe appropriate evaluative standard for qualitative research of this kind is analytical transferability: the extent to which the conceptual insights and interpretive frameworks generated by the study can illuminate caregiving dynamics in comparable settings and provide practically useful evidence for policy and practice development (Tracy, 2010). In both respects, this study makes a substantive contribution. The processes documented, including the gradual accumulation of caregiving responsibilities across life transitions, the structural incompatibility between urban employment demands and caregiving duties, the erosion of informal support networks, and the cultural framing of help-seeking as morally problematic, are not unique to the three districts studied. These findings reflect broader dynamics of urbanisation and demographic ageing that are reshaping family caregiving across South Asia and beyond, indicating that the study\u0026rsquo;s findings have analytical relevance beyond their immediate geographical context.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"4. Results and Findings","content":"\u003cp\u003eThis chapter presents findings from in-depth, semi-structured interviews with family caregivers and older adults residing in urban and peri-urban districts of Sri Lanka. As described in Chap. 3, data were analysed using Framework Analysis. This method is rigorous and transparent. It enables systematic organisation and interpretation of complex narrative accounts, while preserving the depth and particularity of individual experiences (Ritchie \u0026amp; Spencer, 1994; Gale et al., 2013). The analytical process was informed throughout by the life-course and social-ecological perspectives introduced in Chap. 2. Together, these provided a conceptual vocabulary for understanding caregiving. They emphasise that caregiving is not a static role but a dynamic, socially embedded process, shaped simultaneously by individual biographical trajectories, household relational dynamics, and the broader structural conditions of urban life.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4.1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eParticipant Profile (n\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eSub-Category\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eFrequency (n\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\n \u003cp\u003eRespondent Type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eOlder Adults (70+)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e50.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eCaregivers (family \u0026amp; paid)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e50.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e37.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e62.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e\n \u003cp\u003eAge Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e30\u0026ndash;39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e40\u0026ndash;49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e50\u0026ndash;59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e60\u0026ndash;69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e70\u0026ndash;74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e75\u0026ndash;79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e80 and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\n \u003cp\u003eMarital Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e62.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e29.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eSingle / Other\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cem\u003eSource: Primary data generated by the author.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e4.1\u003c/span\u003e shows that the sample included substantial variation across key sociodemographic characteristics. Women made up 62.5% of participants. This aligns with the gendered patterns of caregiving observed in South Asian contexts, as discussed in the literature review (Rathnayake \u0026amp; Siop, 2020; Sharma \u0026amp; Chakrabarti, 2020). Daughters were the largest group of caregivers, followed by spouses. This reflects the intersection of gender, kinship expectations, and life course position examined in this chapter. The age range of older adult participants, 70 to 80 years and older, corresponds to stages of increasing functional dependency and comorbidity. This is consistent with the morbidity profile of Sri Lanka\u0026rsquo;s older population (WHO, 2025). About 29% of participants were widowed. This highlights caregiving vulnerabilities associated with spousal loss, including increased care needs and reduced household caregiving capacity.\u003c/p\u003e\n\u003cp\u003eAcross interviews, caregivers did not describe challenges as discrete or isolated difficulties. Instead, they spoke of interconnected pressures that accumulated and intensified over time. Often, these pressures were unanticipated and difficult to address. Framework Analysis of the data yielded four interrelated thematic domains: (1) caregiving across life transitions; (2) time scarcity and employment\u0026ndash;care tensions in urban settings; (3) shrinking family networks and the erosion of informal support; and (4) emotional strain, moral duty, and silent endurance. These domains are not mutually exclusive. Rather, they cut across and reinforce one another. They operate simultaneously at household, community, and structural levels in ways that reflect the multi-layered analytical framework developed in Chap.\u0026nbsp;2.\u003c/p\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n \u003ch2\u003e4.1 Caregiving Across Life Transitions: An Accumulation of Responsibilities\u003c/h2\u003e\n \u003cp\u003eA common and important pattern in the interviews was the gradual growth of caregiving jobs over time. Caregivers rarely said they chose this role clearly. Instead, their tasks built up slowly due to life events, like a parent struggling with daily chores, a sibling moving away for work, a spouse dying, or a child leaving home for school or work. Over time, caregiving became the main part of daily life, often happening without caregivers fully realizing it.\u003c/p\u003e\n \u003cp\u003eA middle-aged daughter caring for her mother in Gampaha captured this process with particular clarity:\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;At first, it was just helping with hospital visits. Then, slowly, she couldn\u0026rsquo;t manage cooking or bathing.\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eNow everuthing is with me \u0026ldquo;.(Caregiver, female, Gampaha)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eThe gradual, often imperceptible nature of this transition has theoretical significance. Life course scholarship notes that major role transitions typically occur through incremental changes rather than sudden ruptures (Elder et al., 2003; Settersten \u0026amp; Angel, 2011). The data reveal that urban structural conditions accelerate and complicate these trajectories. As detailed in the introduction, internal and international labour migration has reduced the number of co-resident family members in all three study districts. As caregiving responsibilities intensify, fewer household members are available to share these duties.\u003c/p\u003e\n \u003cp\u003eSome participants described being part of the \u0026apos;sandwich generation\u0026apos;, balancing care for aging parents and young children. This mix of duties placed significant stress on caregivers in their forties and fifties, who also held busy jobs (Lilly et al., 2020; Luo et al., 2019). There was little support from official bodies; caregivers handled these challenges on their own, seeing them as tiring but expected parts of family life.\u003c/p\u003e\n \u003cp\u003eOlder adults knew well the burden their growing needs put on their families. They did not just accept care passively. Many felt both grateful and uneasy about needing help and often worried they were disrupting their children\u0026rsquo;s lives.\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eShe has her job and her children. I never thought I would depend on her like this.\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cem\u003e(Older woman, 78 years, Kandy)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eThis shared awareness caregivers feeling the weight of their role and older adults seeing how their needs affect their families shows a part of caregiving that surveys often miss. It points out that family care is about relationships and complex feelings, which, as found in Section \u003cspan refid=\"Sec21\" class=\"InternalRef\"\u003e4.4\u003c/span\u003e, lead to emotional strain and a sense of duty.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n \u003ch2\u003e4.2 Time Scarcity and Employment\u0026ndash;Care Tensions in Urban Settings\u003c/h2\u003e\n \u003cp\u003eThe conditions of city life affected caregiving in many ways that were hard to solve. Most caregivers also had jobs, and the demands of work and care often clashed each day, with no formal help or adjustments from their employers. Long commute times to work, fixed job hours, and sudden care needs made it hard to do either job well.\u003c/p\u003e\n \u003cp\u003eA male caregiver employed in Colombo articulated this structural dilemma with directness:\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eIf something happens during office hours, there is no option. I either take leave or ignore work calls..\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cem\u003e(Caregiver, male, Colombo)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eThe way this caregiver puts it \u003cstrong\u003e\u0026lsquo;no option\u0026rsquo;\u003c/strong\u003e, \u0026lsquo;\u003cstrong\u003eboth have consequences\u003c/strong\u003e\u0026rsquo; points to a bigger problem: there is no policy that lets people care for family during work hours without risking their job. As noted earlier, this is common in city job markets across many growing countries. There, work rules usually prioritize job tasks over care needs when setting policies (Lloyd-Sherlock et al., 2018; Ruppanner et al., 2023).\u003c/p\u003e\n \u003cp\u003eWomen caregivers regularly spoke about handling the full load of both paid work and unpaid care, with neither side recognizing the other. The effects were serious and sometimes permanent. Some stopped working full-time, turned down job advancement, or left their jobs to care for their families. This hurt their future financial security, especially since pensions only reach about 31% of older people (ILO, 2022). While caregivers called these their personal choices, these decisions show how care work is divided by gender when there is no larger policy to share caregiving duties across society.\u003c/p\u003e\n \u003cp\u003eIt is important to situate these experiences within the specific urban geographies of the three study districts. Across all three settings, the daily rhythms of urban employment left caregivers with limited time, energy, and flexibility to respond to the unpredictable and often time-sensitive demands of care (Phillipson, 2013; Buffel et al., 2018).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\n \u003ch2\u003e4.3 Shrinking Family Networks and the Erosion of Informal Support\u003c/h2\u003e\n \u003cp\u003eA recurring theme across interviews was the contrast between participants\u0026rsquo; experiences of caregiving in the present and their earlier expectations or their parents\u0026rsquo; and grandparents\u0026rsquo; experiences of care as a shared family responsibility distributed across a network of co-resident and nearby kin. The social ecology of care that many participants had grown up with, characterised by multi-generational households, proximate extended family, and active community reciprocity, had been substantially eroded by the time they assumed primary caregiving roles.\u003c/p\u003e\n \u003cp\u003eThe distribution of caregiver relationships within the sample is itself revealing. Daughters constituted the largest single group of caregivers (4 of 12), followed by spouses (3), with sons and daughters-in-law each accounting for 2 caregivers, and only 1 caregiver from other relatives. This concentration of caregiving responsibility within a narrow range of close relationships, and particularly among daughters, reflects the convergence of gendered cultural expectations, residential proximity, and the absence of alternative care options that the literature review identified as characteristic of South Asian urban caregiving contexts (Rathnayake \u0026amp; Siop, 2020). A caregiver in Kandy gave voice to this concentration directly:\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eEarlier, there were many people in the house. Now it\u0026rsquo;s just me. Others help financially sometimes.\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cem\u003e(Caregiver, female, Kandy)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eThe phrase \u0026lsquo;others help financially sometimes\u0026rsquo; warrants particular attention, as it reflects a pattern observed across multiple interviews: absent family members such as siblings, adult children, or other relatives provided occasional financial support from a distance, while the practical, daily, and physically demanding aspects of care remained the sole responsibility of one individual. This asymmetric distribution of caregiving labour, \u003cstrong\u003ewhere financial contributions substituted for but did not genuinely share the burden of direct care\u003c/strong\u003e, resulted in primary caregivers experiencing substantial isolation in managing everyday care demands.\u003c/p\u003e\n \u003cp\u003eThe erosion of informal community support beyond the household was equally significant. Neighbours and extended kin occasionally provided emotional support or short-term practical assistance, but such help was described as irregular, unpredictable, and insufficient for sustained personal care. Formal community services were largely absent from participants\u0026rsquo; accounts, or were perceived as inaccessible, inappropriate for ongoing personal care needs, or culturally misaligned with expectations of family-based provision. An older man in Colombo captured the changed texture of neighbourhood relations with an observation that resonated across multiple interviews:\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo; People are kind, but everyone is busy.no one has time like before\u0026ldquo;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e(Older man, 82 years, Colombo)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eThis observation is more than a nostalgic reflection on social change; it is a precise description of what social ecological theory terms the transformation of the mesosystem the layer of social relationships beyond the household that once provided a resource buffer for families managing care demands (Bronfenbrenner, 1979). Urban busyness, residential mobility, and the individualisation of household life have collectively weakened this buffer, leaving individual caregivers to absorb demands that were once distributed across a broader social network (Aboderin, 2017; Buffel et al., 2018).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\n \u003ch2\u003e4.4 Emotional Strain, Moral Duty, and Silent Endurance\u003c/h2\u003e\n \u003cp\u003eThe fourth domain to emerge from the analysis concerned the emotional and moral dimensions of caregiving. Caregivers in this study did not simply describe the practical challenges of managing time, employment, and shrinking support networks; they also spoke, with considerable openness and often evident effort, about the emotional terrain of their caregiving lives, the fatigue, the guilt, the anxiety, and the sense of isolation that accompanied sustained care provision. What made these accounts analytically distinctive was that emotional strain and moral obligation were not experienced as separate or opposing forces. Rather, they were deeply intertwined: it was precisely because caregiving was understood as a moral imperative, rooted in cultural expectations of filial responsibility, that the emotional costs of caregiving were so difficult to acknowledge, articulate, or act upon.\u003c/p\u003e\n \u003cp\u003eA daughter caring for her father in Colombo described this intertwining with candour:\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eSome days I feel very tired, even angry. Then I feel guilty for thinking like that. He is my father.\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cem\u003e(Caregiver, female, Colombo)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eThis account encapsulates a dynamic that was reproduced, in various forms, across the caregiver interviews: the experience of negative emotion exhaustion, frustration, even resentment, followed immediately by the experience of guilt at having had that feeling, rooted in the moral framework of filial duty. The emotional consequences of caregiving were thus compounded by the moral requirement to suppress or disavow them, producing, as the data consistently revealed, a pattern of silent endurance rather than active coping, help-seeking, or self-care. This pattern has been documented in qualitative caregiving research across South Asian contexts, where moral obligation both sustains care and intensifies the psychological strain of those who provide it (Sharma \u0026amp; Chakrabarti, 2020; Roy et al., 2020).\u003c/p\u003e\n \u003cp\u003eThe reluctance to seek help was a direct expression of this moral framing. Caregiving was understood as a private family matter, and the prospect of involving external services or sharing care responsibilities with non-family members was perceived as a failure of filial duty rather than a rational response to unsustainable demands. This reluctance was not confined to formal services; it extended to seeking support from neighbours, friends, or community organisations, all of which risked exposing a family\u0026rsquo;s private care arrangements to outside judgement. Women, in particular, described bearing this reticence alongside the practical and emotional burdens already documented, reinforcing the gendered dimension of silent endurance that runs through all four thematic domains.\u003c/p\u003e\n \u003cp\u003eThe emotional dimensions of the caregiving relationship, however, were not experienced only by caregivers. Older adults in the sample demonstrated a reciprocal and often quietly distressing awareness of the costs their care needs imposed on their families. Rather than experiencing their dependency as natural or uncomplicated, they expressed concern, guilt, and a sense of inadequacy about the disruption their care requirements created for their children\u0026rsquo;s lives:\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;I know they don\u0026rsquo;t complain, but I can see their tiredness \u0026ldquo;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e(Older woman, 75 years, Gampaha)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eIt indicates that interventions focusing solely on caregiver burden, without addressing the emotional experiences of older adults, are likely to offer only partial relief, as the relational dynamics generating and sustaining emotional strain operate at the level of the relationship rather than the individual.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"5. Discussion","content":"\u003cp\u003eThe findings of this study challenge established understandings of family caregiving in rapidly ageing and urbanising societies. By examining caregivers and older adults across three Sri Lankan districts through life-course and social-ecological frameworks, the study demonstrates that caregiving is not adequately captured by burden metrics. Rather, it emerges as a biographical and structural process with notable and worsening consequences for health, household economies, and policy. This discussion situates the four thematic domains within the international literature, focusing on the mechanisms that generate caregiving strain rather than solely documenting its existence.\u003c/p\u003e\n\u003cdiv id=\"Sec23\" class=\"Section2\"\u003e\n \u003ch2\u003e5.1 Caregiving as a Life Course Process: Accumulation, Transition, and Entrapment\u003c/h2\u003e\n \u003cp\u003eThe most theoretically significant finding concerns the process by which caregiving roles are assumed. Participants did not describe a conscious decision; instead, they depicted an accumulation of minor, individually unremarkable acts of assistance that ultimately resulted in a full-time, largely irreversible role. This observation is consistent with life course scholarship, which suggests that major role transitions consolidate gradually (Elder et al., 2003; Settersten \u0026amp; Angel, 2011). The present study contributes additional evidence regarding the structural conditions that accelerate and limit the possibility of reversal. When labour migration disperses potential caregivers, the remaining family member is not gradually drawn into care but is instead left without alternatives. This structural dimension of role entrenchment remains underexplored in South Asian caregiving research, which has predominantly treated the assumption of care as a cultural norm rather than a structural necessity (Rathnayake \u0026amp; Siop, 2020).\u003c/p\u003e\n \u003cp\u003eIntegrating the life course caregiving framework of Schulz et al. (2020) reveals the intersection of work, family, and ageing trajectories. This convergence at mid-life often creates experiences that cross-sectional measures fail to capture. Existing Sri Lankan studies mostly rely on such measures, thereby missing crucial temporal implications for the design of preventive interventions. Identifying caregivers earlier, during the accumulation phase, is vital for effective support before role entrenchment sets in.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\n \u003ch2\u003e5.2 Urbanisation, Time Scarcity, and Employment\u0026ndash;Care Conflict\u003c/h2\u003e\n \u003cp\u003eThe employment\u0026ndash;care conflict identified in this study highlights a structural incompatibility between urban labour markets and family care arrangements. These care arrangements have developed without policy intervention to manage their intersection. Caregivers in Colombo, Gampaha, and Kandy reported that employment requires a predictable presence. In contrast, caregiving demands availability at unpredictable times. No formal mechanisms, such as caregiver leave or flexible working arrangements, exist to ease this tension. This observation is consistent with comparative evidence: urban labour markets intensify caregiving strain by prioritizing productivity over care (Lloyd-Sherlock et al., 2018; Ruppanner et al., 2023). District-level specificity also emerges from the analysis. In Colombo, metropolitan density confines caregiving to the margins of the working day. In Gampaha, industrial growth has lengthened commutes but brought no supporting community infrastructure. In Kandy, mountainous geography creates time scarcity, shaped by both the landscape and labour-market demands (Jayaratne \u0026amp; Wickramasinghe, 2020). Policy responses that treat urban caregivers as a homogeneous group risk missing these distinct mechanisms.\u003c/p\u003e\n \u003cp\u003eWomen disproportionately experience the consequences of the employment\u0026ndash;care conflict. These include reduced working hours, limited career advancement, and withdrawal from the labour market. This pattern reflects a structurally gendered care regime. The regime lacks employment accommodations. Limited pension coverage in Sri Lanka reaches only 31% of older adults (ILO, 2022). This worsens the issue. Women who leave the labour market to care for others forfeit pension contributions. This loss increases their financial vulnerability throughout life. The situation represents a policy failure at the intersection of ageing, gender, and social security. It highlights the need for coordinated reform.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec25\" class=\"Section2\"\u003e\n \u003ch2\u003e5.3 Shrinking Informal Support Networks and the Paradox of Urban Proximity\u003c/h2\u003e\n \u003cp\u003eLiving arrangement data show that 58.3% of older adults reside with a primary caregiver, 25% with extended family, and 16.7% alone with periodic visits. This distribution offers only a superficial view of family involvement. Qualitative evidence complicates the picture. Co-residence does not mean caregiving is shared. In many households, daily caregiving falls to one person. Non-resident family members contribute only occasionally. This does not redistribute care labor. This pattern has direct policy implications. Co-residence is the most common indicator in administrative assessments used to signal care adequacy. However, it is an unreliable proxy that masks the fact that care is concentrated on a single, often overburdened, individual. Actual task distribution must be assessed before making claims about household care capacity.\u003c/p\u003e\n \u003cp\u003eThe structural forces that concentrate caregiving responsibilities work as an interconnected system. Labor migration reduces the number of potential caregivers. Declining fertility means there are fewer siblings to help. High urban housing costs limit the likelihood of multigenerational co-residence (Aboderin, 2017; United Nations, 2023). More older adults now live alone. Though this trend remains limited, it likely signals the direction of future trends (Buffel et al., 2018; Phillipson, 2022). A central paradox emerges: living near urban services does not guarantee access to them. Caregivers often lack the time, flexibility, or cultural approval to use them. Unless employment constraints and moral frameworks discouraging help-seeking are addressed together, service expansion will not improve care sustainability.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec26\" class=\"Section2\"\u003e\n \u003ch2\u003e5.4 Moral Responsibility, Emotional Strain, and the Limits of Individual Endurance\u003c/h2\u003e\n \u003cp\u003eThe moral framing of caregiving as a filial obligation is well documented across South and East Asian contexts (Sharma \u0026amp; Chakrabarti, 2020; Roy et al., 2020). This study analyzes how such framing, combined with urban structural conditions, generates adverse outcomes. The stress-health process model, adapted from Schulz et al. (2020) and shown in Fig. \u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e5\u003c/span\u003e\u0026thinsp;\u0026minus;\u0026thinsp;3, guides the analysis. Here, the key factor was how caregivers\u0026apos; moral appraisal of stressors transformed challenges into evidence of duty and coping into evidence of failure. This framing inhibited help-seeking, task redistribution, and service engagement\u0026mdash;the model\u0026rsquo;s primary buffering mechanisms.\u003c/p\u003e\n \u003cp\u003eThe health consequences sleep deprivation, hypertension, musculoskeletal pain, depression, and social withdrawal align with findings from the stress process literature (Pearlin et al., 1990; Schulz \u0026amp; Eden, 2016). These effects reinforce each other; for example, sleep deprivation may exacerbate depression and pain, which in turn further diminish well-being. As deteriorating health reduces caregiving capacity, perceived demand rises, leading to greater emotional suppression and undermined self-care. Disrupting this cycle requires active interventions tailored to underlying value systems, since relying on information provision or passive service availability alone is insufficient.\u003c/p\u003e\n \u003cp\u003eThis study adds to the scholarship by identifying bidirectional suffering in caregiver-care recipient relationships. Older adults were acutely aware of the costs their dependency imposed. They felt ongoing distress about the burden they represented. This awareness influenced the caregiving dynamic. Caregivers, observing their relatives\u0026rsquo; guilt, intensified efforts to seem uncomplaining. This deepened emotional suppression and reinforced patterns that perpetuated stress. In line with interdependent wellbeing frameworks (Martire et al., 2010; Monin \u0026amp; Schulz, 2009), these findings challenge models treating caregiver burden and older adult wellbeing as separate issues. The two are fundamentally interconnected. Effective relief of caregiving strain requires attention to both sides of the dyad.\u003c/p\u003e\n \u003cp\u003eAcross all four domains, the findings converge on one conclusion: the costs of demographic ageing and urbanisation are absorbed almost entirely by individual family caregivers disproportionately women without institutional recognition or structural support. The caregivers in this study were not failing; they were enduring under conditions that make sustained care progressively unsustainable. The study\u0026rsquo;s contribution is to specify the biographical, structural, cultural, and relational mechanisms by which unsustainability is produced the proper objects of the policy reform developed in the chapter that follows. .\u003c/p\u003e\n\u003c/div\u003e"},{"header":"6. Conclusion","content":"\u003cp\u003eSri Lanka\u0026rsquo;s demographic evolution is among the fastest in South Asia. Yet, the policy environment has not adapted. This study explored how family caregivers in urban and peri-urban Colombo, Gampaha, and Kandy manage care for older adults despite this policy lag. It used qualitative interviews analyzed using Framework Analysis, guided by life-course and social-ecological frameworks (UNDESA, 2024; WHO, 2025). The evidence indicates that in many households, caregiving has reached its structural limits. It is no longer just under pressure.\u003c/p\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003e6.1 Principal Findings\u003c/h2\u003e \u003cp\u003eThis study finds that caregiving in urban Sri Lanka is an accumulating biographical process. It is not a single, isolated role. The process intensifies gradually over the years before its impact becomes apparent. Its slow onset makes it hard to renegotiate once in place (Elder et al., 2003; Schulz et al., 2020). Earlier Sri Lankan caregiving research used cross-sectional measures. It has missed this temporal aspect. Policy interventions often arrive too late to be preventive. Two more findings clarify this context. First, living near services does not guarantee access. Employment structures limit caregivers\u0026rsquo; availability during working hours. Cultural norms of filial obligation also discourage help-seeking. This paradox means expanding formal services is not enough without structural and cultural reforms (Roy et al., 2020; Sharma \u0026amp; Chakrabarti, 2020). Second, emotional suffering is bidirectional in these households. Older adults feel they are burdens, which increases caregiver strain. This reinforces the suppression and appraisal patterns that fuel the stress cycle (Martire et al., 2010; Monin \u0026amp; Schulz, 2009). Interventions that address only caregivers offer, at best, only partial relief.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003e6.2 Policy Implications\u003c/h2\u003e \u003cp\u003eThe national policy framework\u0026rsquo;s continued reliance on the family as a self-sufficient care unit (Ministry of Social Welfare, 2018) is not only outdated but also actively harmful, as it legitimizes the structural neglect of caregivers whose capacity is already exhausted. Three reform priorities emerge directly from the evidence. First, community-based care infrastructure, including respite services, adult day centres, and formal home care, is essential but will remain underutilized unless accompanied by community engagement strategies that reframe help-seeking as consistent with filial responsibility. Second, employment reform is imperative. The women in this study who reduced their working hours, declined promotions, or exited the labour market entirely did so without any structural alternatives, and the financial consequences, compounded by Sri Lanka\u0026rsquo;s pension coverage reaching only 31% of older adults (ILO, 2022), will affect them throughout their lives. Flexible working arrangements, caregiver leave, and phased return-to-work provisions are not marginal adjustments; they are mechanisms through which the cost of demographic ageing is either distributed equitably or, as at present, concentrated on the least protected. With 26% of Sri Lanka\u0026rsquo;s population projected to be aged 60 or above by 2050 (UNDESA, 2024), the opportunity for proactive reform is diminishing. Future Directions\u003c/p\u003e \u003cp\u003eThe findings are not statistically generalisable, though the structural dynamics documented are analytically transferable across rapidly urbanising low- and middle-income contexts (Lincoln \u0026amp; Guba, 1985; Tracy, 2010). The exclusion of employers, policymakers, and service providers from the sample is a limitation that future multi-stakeholder research should address. Longitudinal designs tracking caregiving households over five to ten years would capture how responsibilities accumulate and health consequences compound in ways no cross-sectional design can, and comparative studies across rural, peri-urban, and metropolitan settings would produce the geographically differentiated evidence that calibrated policy reform requires.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec30\" class=\"Section2\"\u003e \u003ch2\u003e6.4 Concluding Remarks\u003c/h2\u003e \u003cp\u003eThe caregivers in this study were not exceptional. They were ordinary people doing what their families and society expected, under conditions that have become structurally untenable. What this study establishes is that their situation is not the inevitable cost of demographic ageing or the natural expression of cultural obligation it is the product of identifiable and addressable policy failures. The evidence is in place. The demographic urgency is established. What remains is the political will to treat caregiving as the collective social responsibility it already is in practice, and to build the systems that reflect that reality.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthical Approval\u003c/strong\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eFunings\u003c/strong\u003e \u003cp\u003eNo Funding\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eno responsible corresponding author\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAboderin, I. (2010). Understanding and advancing the health of older populations in sub-Saharan Africa: policy perspectives and evidence needs. \u003cem\u003ePublic Health Reviews\u003c/em\u003e, \u003cem\u003e32\u003c/em\u003e(2), 357-376.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBraun, V., \u0026amp; Clarke, V. 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Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. \u003cem\u003eAdministration and Policy in Mental Health and Mental Health Services Research\u003c/em\u003e, \u003cem\u003e42\u003c/em\u003e(5), 533\u0026ndash;544. https://doi.org/10.1007/s10488-013-0528-y\u003c/li\u003e\n \u003cli\u003ePatton, M. Q. (2015). \u003cem\u003eQualitative research and evaluation methods\u003c/em\u003e (4th ed.). SAGE Publications.\u003c/li\u003e\n \u003cli\u003ePearlin, L. I., Mullan, J. T., Semple, S. J., \u0026amp; Skaff, M. M. (1990). Caregiving and the stress process: An overview of concepts and their measures. \u003cem\u003eThe Gerontologist\u003c/em\u003e, \u003cem\u003e30\u003c/em\u003e(5), 583\u0026ndash;594. https://doi.org/10.1093/geront/30.5.583\u003c/li\u003e\n \u003cli\u003ePhillipson, C. (2025). The Political Economy of Ageing and the Second Coming of Neoliberalism: Building an Emancipatory Gerontology. \u003cem\u003eKZfSS K\u0026ouml;lner Zeitschrift f\u0026uuml;r Soziologie und Sozialpsychologie\u003c/em\u003e, \u003cem\u003e77\u003c/em\u003e(4), 505-527.\u0026nbsp;https://doi.org/10.1007/s11577-025-01012-1\u003c/li\u003e\n \u003cli\u003ePope, C., \u0026amp; Mays, N. (Eds.). (2006). \u003cem\u003eQualitative research in health care\u003c/em\u003e (3rd ed.). Blackwell Publishing. https://doi.org/10.1002/9780470750841\u003c/li\u003e\n \u003cli\u003eSpann, A., Vicente, J., Allard, C., Hawley, M., Spreeuwenberg, M., \u0026amp; de Witte, L. (2020). Challenges of combining work and unpaid care, and solutions: A scoping review. \u003cem\u003eHealth \u0026amp; Social Care in the Community\u003c/em\u003e, \u003cem\u003e28\u003c/em\u003e(3), 699-715. https://doi.org/10.1111/hsc.12912\u003c/li\u003e\n \u003cli\u003eRitchie, J., \u0026amp; Spencer, L. (1994). 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Qualitative interview design: A practical guide for novice investigators. \u003cem\u003eThe Qualitative Report\u003c/em\u003e, \u003cem\u003e15\u003c/em\u003e(3), 754\u0026ndash;760. https://doi.org/10.46743/2160-3715/2010.1178\u003c/li\u003e\n \u003cli\u003eUnited Nations Department of Economic and Social Affairs. (2024). \u003cem\u003eWorld population prospects 2024: Summary of results\u003c/em\u003e. United Nations. https://population.un.org/wpp/\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. (2025). \u003cem\u003eSri Lanka: Facts and figures \u0026mdash; healthy ageing\u003c/em\u003e. WHO Regional Office for South-East Asia. https://www.who.int/srilanka\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Family caregiving, Urban ageing, Life course perspective, Social ecological theory, Sri Lanka","lastPublishedDoi":"10.21203/rs.3.rs-9115626/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9115626/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eSri Lanka is one of the most rapidly ageing societies in South Asia, experiencing concurrent demographic and urban transitions while formal long-term care infrastructure remains critically underdeveloped. Urbanisation is reshaping family structures, labour market demands, and community support networks, thereby straining families' capacity to sustain home-based elder care. However, these dynamics are insufficiently examined in the existing literature, which predominantly focuses on rural settings and cross-sectional measures of caregiver burden. This qualitative study addresses this gap by exploring the lived experiences of family caregivers providing home-based care for older adults in three urban and peri-urban districts of Sri Lanka: Colombo, Gampaha, and Kandy. In-depth, semi-structured interviews were conducted with 24 participants, comprising 12 older adults aged 70 years and above and 12 primary family caregivers. Data were analysed using Framework Analysis, informed by life course and social ecological perspectives. Four interrelated thematic domains emerged: (1) caregiving across life transitions; (2) time scarcity and employment\u0026ndash;care tensions in urban settings; (3) shrinking family networks and the erosion of informal support; and (4) emotional strain, moral duty, and silent endurance. Collectively, these domains indicate that caregiving in urban Sri Lanka is a dynamic, cumulative process shaped by structural forces that current policy frameworks have yet to adequately recognise or address. The findings highlight the urgent need for urban-responsive elder care policy, including caregiver-inclusive employment reform, community-based respite and support services, and culturally sensitive implementation strategies that position help-seeking as consistent with filial responsibility.\u003c/p\u003e","manuscriptTitle":"Caregiving Across the Life Course in Rapidly Urbanising Sri Lanka: Structural Incompatibility, Eroding Networks, and the Limits of Filial Obligation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-22 05:48:51","doi":"10.21203/rs.3.rs-9115626/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3c2c0b3d-847f-4df7-8a5e-644ec79fdb0f","owner":[],"postedDate":"April 22nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-22T05:48:52+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-22 05:48:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9115626","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9115626","identity":"rs-9115626","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}