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| | Psychogeriatrics in China | | 2005-2-22 0:35:17 Institute of Mental Health, Peking Unive Yu Xin M.D |  Institute of Mental Health, Peking University, Huayuanbeilu, 51, Haidian District, 100083, Beijing, P. R. China.
Telephone: 86-10-82801999; Facsimile: 86-10-62026310; E-mail: yuxin@bjmu.edu.cn;
Abstract: Ageing is a global problem. China, which is the most populated nation in the world, became an elderly country in the beginning of this century. The unpredicted ageing process brings about challenges to Chinese society and health care system as well. Chinese psychiatrists are even facing greater challenges since geriatric psychiatry is still at its infancy. To obtain reliable epidemiological data on mental disorders of elderly in such a huge country like China seems an impossible mission. However, a quite few of epidemiological studies that were conducted with reliable diagnostic criteria and instruments may depict a gross picture of current situations on mental health of Chinese elderly. Data about dementia are inconsistent. Prevalence rates of AD and VD vary in studies. Besides the difference on methodology, difference of residential location (north vs. south, rural vs. urban) may contribute to the etiology of dementia. Contrary to the inconsistent results of dementia, prevalence of depression is consistently low, no matter in which age group. Cultural aspects may play a role in the development of depression in elderly. We need more studies in order to understand this issue better.
When new China was founded in 1949, there were only 50-60 psychiatrists working in a few of big cities such as Shanghai, Beijing, and Guangzhou, etc. Since the average life expectancy was 45 then, it was impossible and unnecessary to implement psychogeriatric service.
In 1958, the first national diagnostic criteria on mental disorders were released by the Chinese Society of Neurology and Psychiatry. It included 14 categories of mental disorders in which "elderly psychosis" was listed. However, lack of detailed description made this criterion less useful. In 1978, a revised version of diagnostic criteria on mental disorders was put into use. "Senile dementia" was firstly considered by Chinese psychiatrists although most of psychiatrists had never heard of "Alzheimers disease". The economic reform, which began in 1978, brought about tremendous change to Chinese society. The average economic growth rate in the last 2 decades is 8% and the gross national product exceeded $1000 billion last year. Social and economical transition has both good and bad effects on ageing-related problems in China.
The rate of aging is accelerating in recent years while the proportion and absolute number of elderly people in the total population is increasing. The life expectancy of Chinese reached 70 years by 1993. Now there are more than 100 million people aged above 60 in China. The elderly people was 10.16% of the population in 2000. In Beijing and Shanghai, one in five residents is elderly.
Table 1. Data from 4 population surveys in China1)
PopulationSurvey Aged population (million)* total population (million) Percent of total population (%)
1953 41.54 567.44 7.32
1964 42.20 694.58 6.08
1982 76.65 1003.79 7.64
1990 98.21 1143.33 8.59
*age population refers to people aged over 60;
Table 2. Prediction of the ageing Population in China2)
Population prediction Total population in China (million) Aged population (million)* Aged/total population (%)
1985 1049.00 86.00 8.20
1990 1143.33 98.21 8.59
1995 1197.00 116.0 9.69
2000 1270.00 129.00 10.16
2025 1498.00 264.00 17.63
2050 1547.00 331.00 21.40
*age population refers to people aged over 60;
The 1% sampling survey showed that the average family size in 1995 was 3.7, a 0.3 reduction compared to 1990 national population survey. Thus, in China, the traditionally valued extended family in which three generations or even four generations live together is weakened. Shortage of caregivers could be a serious problem for physically fragile and mentally ill elderly.
With the astonishing change in society and public health, Chinese psychiatrists also face a great challenge never before met. In 1997, there are 485 psychiatric institutions all over China, which can offer 107,362 beds. 13,912 doctors are working in psychiatric hospitals. Unfortunately, facilities, which are available for elderly patients, are very limited. Accurate statistical figures are not available, but it is estimated that less than 10% of beds in each psychiatric hospital serve the elderly. Qualified geriatric psychiatrists are even fewer, proportionally.
In view of the urgency of health service facilities for elderly, nursing homes and hospices for elderly have been established in both rural and urban areas in the last five years. Some of them are funded by local government, some of them are run privately for profit. Most of them mainly admit the elderly without caregivers or elderly with terminal illness. They all face similar problems: shortage of expertise and of policy guidance. Sometimes they are even facing shortage of patients as, under the influence of the old Chinese tradition, elderly are not willing to go to nursing homes because they believe it is for the childless, and their children are not willing to send their parents to nursing homes because they are afraid of "losing face".
(Edited by Shuping,Tan) | | [CLOSE] |
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Ministry of Health, (2003) No.013
ICP:No.040657