Will China be able to care for millions of dementia sufferers?
Experts warn the government must plan for the huge numbers likely to suffer with the condition in the coming decades as the nation’s population rapidly ages
In a large room at a care centre in Shanghai’s Putuo district, nursing worker Xu Maohua looks into the eyes of an elderly man.
“Zou Zhengming, am I Han Yuanzhu?” asks Xu, referring to the patient’s wife.
Zou, a 66-year-old man who has lived with dementia for six years, raises his eyes, looks at Xu for a time and says, “No, you are not.”
The answer wins him a thumbs-up from Xu who goes on to ask, “Shall we sing the song The East is Red?” She claps to the rhythm, sings some lyrics and Zou finally joins in.
This is a typical scene at this day care institution, among only a few facilities in Shanghai to target the city’s burgeoning population of senior citizens affected by dementia.
Day centres offer some respite for family members acting as carers for those afflicted with the condition. Zou’s wife Han sends him to the centre at 8.30am each day from Monday to Friday and picks him up at 4.30pm.
At this government-subsidised centre, eight dementia patients including Zou are looked after by nursing workers. The patients also have handicraft and rehabilitation sessions to slow their progressive loss of memory and cognitive skills – the main symptoms of dementia.
The centre is a great relief for Han, she says, but its services are rare.
While there are hundreds of senior citizens’ homes in Shanghai, the city with the biggest elderly population on the mainland, many of these institutions either reject people with dementia or charge at least 4,500 yuan (US$680) per month to accept them. The average monthly pension in Shanghai is about 3,500 yuan.
Experts say China – faced with a rapidly ageing population – is not ready to tackle the swiftly growing number of dementia patients requiring nursing staff and care.
Reports of elderly people with dementia found wandering lost in the street are commonplace in China’s press, with appeals for help to look for lost patients also often widely circulated on social media.
The number of people with Alzheimer’s disease around the world is expected to reach 75.6 million by 2030, according to research published by the World Health Organisation last year. China has the world’s largest population of people with dementia. Some 9.6 million people had the condition in 2010, almost double the 5.1 million reported in 2000.
The number of people with dementia in China is also projected to reach 14.1 million by 2020 and 23.3 million by 2030, costing the country up to US$114.2 billion.
Most dementia patients in China stay at home and are cared for by their families.
The authors of the WHO report said: “It seems possible that China’s one-child policy, which was implemented in the late 1970s and only phased out from 2015, will leave too few adults in the 2030s to give sustainable informal care to all of the dementia cases.
“Given the huge economic burden of dementia, policymakers in China are advised to make dementia a national health priority and to develop a strategic nationwide action plan. Failure to take appropriate action now will allow the economic burden of dementia to grow even further and could, in the long term, cause dysfunction throughout China’s entire health care system.”
Wang Quan, who studies ageing at Wuhan University’s public health school, agreed with this assessment, saying China urgently needed to follow Japan’s example in tackling the issue.
With one of the world’s most rapidly ageing populations, Japan has launched a national strategy to form a network to support dementia patients.
“This disease will bring families a huge amount of human resource costs,” Wang said. “Most patients are tended by their relatives and their families will feel more and more pressure.”
Wang said his team had submitted a proposal to the Ministry of Human Resources and Social Security, and the National Health and Family Planning Commission, on a national strategy for dementia. He was told the state authorities were considering the idea.
“It’s an imminent issue. When these single children have no siblings to share their duties, the government should weigh in to provide help,” Wang said.
Yang Hongjie, a doctor at the Shanghai Neuromedical Centre, said dementia, mainly caused by Alzheimer’s disease, could not be cured and there was no effective medicine to treat it.
One important method to delay patients’ deterioration was to have other people keep them company and chat with them, she said.
“Many relatives of my patients complain they want to stay with their parents and look after them, however, they can’t do that for multiple reasons, including having no time,” Yang said.
Zou Zhengming and his wife have two adult children who are busy with their own lives.
Han said her son and daughter both live in Shanghai, but did not often come to nurse their father because they were at work and had their own children to look after.
“[I feel guilty that I am] not able to help them raise their children. How can I ask them to come to care their father? That will saddle them with troubles,” she said.
Zou’s condition is deteriorating year by year.
Two years ago he could still recognise the door of their home, but it meant nothing to him now, said Han. She used to take him out to walk in the streets, but refrains from doing so now as he would try to cross the road without a green signal at crossings.
“I don’t have enough energy to hold him back [from jaywalking],” Han said.
At home she needs to watch her husband around-the-clock. Zou frequently claims he is hungry even when he has eaten just minutes earlier. His wife also has to turn off the microwave oven in case he puts odd things inside to cook.
Han began to send Zou to the day care centre in their community in the first quarter of this year. Before that she described herself as his 24-hour maid over the past six years.
“At that time, I felt exhausted and for some seconds an idea popped up in my mind that I’d like to leave home and leave him alone,” she said.
The day care centre that opened in May last year is several minutes walk from Han’s home. Sending her husband to the centre offers her a break and is also cheap – 35 yuan per day for the nursing fee and 10 yuan for lunch.
Song Yangfeng, a trainer at Meiting Sunshine Senior Citizens Caring Home, which operates the centre, said there was a strong demand for their services from dementia patients, but her organisation had to adopt strict screening for applicants.
They turned down dementia patients whose condition was too severe and would not take people living far from the centre, she said.
There are more than 40 government-subsidised, community embedded care centres across Shanghai to accommodate people with serious dementia, the local news website Kankanews.com reported. Each centre has 10 to 40 beds.
Wang at Wuhan University said Shanghai was at the vanguard in tackling ageing issues in China, with many other cities failing to attach importance to the problems. “In those places, there are no kinds of elderly institutions willing to accept dementia patients,” he said.
Zheng Zhigang, a sociologist at the Beijing-based Eurasian System Science Research Association, also warned that China was not fully prepared for the coming challenge presented by increasing numbers of dementia patients.
“In numerous cities, the support network has just started to be built or is not there,” he said.