State of minds
China is ill prepared for a consequence of ageing: lots of people with dementia
ON A stage decorated with tinsel and fairy lights, Liu Changsheng is singing “The East is Red” into a microphone, wearing a yellow and grey tracksuit. For Mr Liu, the Maoist anthem of the 1960s may arouse memories more vivid than those he has of his immediate past. Now in his seventies, he has dementia, an incurable brain disease that is often revealed by a loss of short-term memory. For two years Mr Liu has lived at the Qianhe Nursing Home in northern Beijing in a facility for around 75 dementia patients. They are among the few sufferers of this condition in China who receive specialist care.
Dementia has mostly been a rich-world sickness, because it becomes more common as people live longer. China is fast catching up. Life expectancy increased from 45 in 1960 to 77 now, and the population is ageing rapidly: one person in six is over 60 now; by 2025 nearly one in four will be. Factors that increase the (age-adjusted) risk of developing dementia are also on the rise, including obesity, smoking, lack of exercise and diabetes.
Already about 9m people in China have some form of dementia. In absolute terms, that is more than twice as many as in America. It is also more than double the number in India, a country with a population similar in size to China’s but a much younger one. Nearly two-thirds of China’s sufferers have the form known as Alzheimer’s, cases of which have tripled since 1990.
The number of Alzheimer’s patients may increase another fourfold between now and 2050.
China’s government is woefully unprepared for this crisis, with a severe lack of health-care provision for sufferers. So too is the public. Despite recent public-information campaigns, many Chinese regard dementia as a natural part of ageing, not as a disease, and do not know that it is fatal. Others see it as a psychological ailment rather than a degeneration of the brain itself. It carries a stigma of mental illness, making sufferers and their relatives reluctant to seek help.
This compounds the suffering caused by dementia: active management can sometimes slow its progress.
Even at the Qianhe Nursing Home, where Mr Liu lives, some aspects of the care appear crude.
A shared “activity” space for dementia sufferers has no games or toys to entertain them; relatives are discouraged from visiting more than once a week for fear of “disturbing” their kin (in the West, care homes encourage visits, which can be stimulating and provide a sense of warmth and familiarity). Some dementia patients end up in psychiatric wards, which cannot deal effectively with their specific requirements. There is an acute shortage of medical workers qualified to treat sufferers. One reason is that few are attracted to the work. Zhang Xiurong, 50, a care assistant at Qianhe, is paid less than 3,000 yuan ($450) a month, close to the average national migrant wage, to provide all patients’ basic needs 12 hours a day, with only four days off a month. “No Chinese parent wants their one daughter to work in a hospital cleaning bedpans,” says Michael Phillips of the Shanghai Jiao Tong University School of Medicine.
In the West most patients go to a care home for the final brutal stages of the disease, which can last more than a year. In China families carry most of the burden from beginning to end. The government has long underinvested in social care, assuming that adult children will take responsibility. But this is unsustainable. Plunging birth rates since the 1970s, exacerbated by a one-child-per-couple policy, mean that the number of working-age adults per person over 65 will fall by 2050 from ten to 2.5. Migration into cities is leaving some elderly people in the countryside without family members to care for them.
Need for new thinking
In any country care can be expensive, both for families and governments. In China the government will find itself having to spend much more as relatives prove unequal to the task.
Because family members rarely understand the condition, more than 90% of dementia cases go undetected, according to a study led by Ruoling Chen of King’s College in London. Sufferers will benefit when the government at last realises it has to step in.