Objectives Aging populations in rural areas of low and middle income countries will increasingly need care. However, formal support is severely limited and adult children are frequently unavailable due to morbidity, early mortality, employment and migration. We aimed to describe how care is shared within and between households for older adults in a rural South African setting. Methods We conducted quantitative interviews with 1012 household members and non household caregivers of 106 older adults living with or at risk of cognitive decline in rural Mpumalanga, South Africa. Using descriptive statistics and regression analysis, we described how care is shared, with particular attention to generational patterns of care. Results Informal care was spread among family, friends, and neighbours, with minimal paid support. This care was most commonly provided by unemployed female relatives one or two generations younger than the recipient. However, a small number of paid caregivers, also mostly female, provided the most intensive care. Spouses nevertheless commonly considered themselves primary caregivers. Discussion Informal care for older adults in rural South Africa was spread widely. A predominance came from co-resident family reflecting shared history, reciprocal relationships, and easy access to care tasks within the household but with important contributions from others. A deeper understanding of how informal care for older adults is shared in settings where formal care is absent is essential for developing targeted interventions.

The authors have declared no competing interest.

This research was supported by the National Institute on Aging of the National Institutes of Health (R21 AG059145) to Lenore Manderson and Guy Harling.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study received ethics approval from Wits Human Research Ethics Committee (Medical; M200373), University College London REC (152311/001) and Mpumalanga Province Health Research Ethics Committee, letters of support from the Mpumalanga Department of Health and the Agincourt Community Advisory Group.

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All data produced in the present study are available upon reasonable request to the authors