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Saturday, December 2, 2023

Challenges of Elderly Care in China

ChinaChallenges of Elderly Care in China

The importance of healthcare for the elderly has gained more attention in recent years, especially as the world’s population continues to age. One person who knows this all too well is Jia Jun, a Beijing native whose mother has lived for over 80 years in their family’s hutong near Hufang Bridge in Xicheng district. In 1997, Jia’s mother suffered a cerebral hemorrhage at the age of 68. She was rushed to a hospital emergency center by a neighbor and remained in a coma for four days. This experience was a stark reminder of how crucial it is to have proper healthcare for the elderly.

Unfortunately, this was not the only health scare Jia’s mother has faced. Several years later, she suffered a stroke at home, which Jia had to quickly respond to by pushing her to the hospital in a wheelchair. Since then, Jia’s mother has been hospitalized four more times due to various medical problems. Jia has been taking her mother to see a doctor regularly, but as her mother’s health deteriorated and she was diagnosed with chronic obstructive pulmonary disease, Jia became increasingly fearful of taking her to the hospital in extreme temperatures.

Despite the challenges Jia has faced with her mother’s health, she is fortunate to have access to medical care. The increased attention paid to healthcare for the elderly has led to improvements in medical services and facilities. As more people around the world are living longer, governments and healthcare organizations are investing in research and resources to better serve the elderly population. However, access to quality healthcare for the elderly remains a global issue, and more needs to be done to ensure that everyone has access to the care they need as they age.

Jia Jun’s story illustrates the challenges faced by many individuals who are responsible for the care of aging relatives. Jia retired from her factory job at the age of 41 to care for her mother, who was then in her 70s. Since then, Jia has found a job in a restaurant close to home, which allows her to quickly attend to her mother when necessary. However, as her mother’s health has continued to decline, Jia’s responsibilities have increased significantly.

Jia’s mother has been diagnosed with multiple chronic conditions, including diabetes and hypoglycemia. She takes at least a dozen pills after each meal to manage her conditions. Jia has also taken on the responsibility of caring for her father-in-law, who is 90 and has dementia. After he had a fall during the night, Jia and her husband have become increasingly concerned about his ability to live on his own.

Jia acknowledges that providing care for her elderly relatives is a difficult and time-consuming task, but she feels a sense of obligation to do so. She understands that earning a living is important, but caring for her loved ones is her top priority. Jia’s situation is not unique in China, where the number of elderly individuals is rapidly increasing. According to the National Bureau of Statistics, more than 280 million people in China were 60 years old or older by the end of 2020, accounting for nearly 20 percent of the population.

Geriatric healthcare expert Liu Xiaohong explains that aging individuals in China often face multiple chronic conditions. At least 50 percent of individuals over the age of 65 have three or more chronic conditions. As a result, caregivers like Jia must navigate complex medical issues and ensure that their loved ones receive the appropriate care.

The challenges faced by Jia and other caregivers underscore the need for continued investment in geriatric healthcare. Healthcare providers, policymakers, and researchers must work together to ensure that the elderly population receives high-quality medical care and support. As China’s population continues to age, it is vital to prioritize the needs of the elderly and the individuals who care for them.

More than 78 percent of Chinese seniors aged 60 or above have at least one chronic disease, according to figures from the National Health Commission (NHC). While Jia’s mother and father-in-law’s chronic illnesses are not immediately life-threatening, they have had a significant psychological impact on Jia and her family, highlighting the need to rethink care for the elderly.

While aging and death are inevitable, there are opportunities to improve seniors’ self-sufficiency. In the past, medical insurance for acute care in China was specialized by organs and not specifically for the elderly. To address this, hospitals have developed a seniors-friendly environment, where interdisciplinary teams conduct a comprehensive geriatric assessment and manage reversible problems related to aging, enabling seniors to care for themselves and return home.

To meet the growing demand for elderly care, China has set up six national clinical research centers for geriatric diseases by the end of 2021. Additionally, more than 4,600 public hospitals at secondary level or higher have established medicine departments for geriatrics, according to the NHC.

These developments show that China is taking proactive steps to provide better healthcare for the elderly. However, there is still more work to be done to ensure that seniors can live with dignity and self-sufficiency as they age.

The department of geriatrics at Peking Union Medical College Hospital, established in 2006 by Liu Xiaohong, is one of the first of its kind in China. With chronic diseases being the leading cause of death and disability among the elderly, Liu believes that elderly care should focus on preventing disease, organ failure, function decline, and other adverse events. In cases where the elderly are partially disabled, Liu and her team help them function as much as possible, while completely disabled elderly are given a dignified life in their last days.

The approach adopted by doctors in the geriatrics department differs from specialized diagnosis and treatment departments in hospitals that center on seniors’ daily living activities. The team takes a personalized approach to care for elderly patients with multiple chronic conditions to check whether they have taken inappropriate medication or if they have any illnesses occurring at the same time. To achieve this, medication is used to help reduce lipids, hypertension, and platelets in patients.

Multiple chronic conditions coexisting can complicate medication prescription for elderly patients. To ensure optimal care, Liu and her team spend a lot of time trying to determine which drugs are not working and whether there are overlapping medication errors or any risks to the patient. For example, the department has stopped prescribing enteric aspirin for primary prevention of cardiovascular diseases, which is used in specialist clinics, due to the risk it poses to older adults.

In addition to providing specialized care for elderly patients with multiple chronic conditions, the Chinese government has made efforts to set up six national clinical research centers for diseases among geriatrics, and medicine departments for geriatrics have been established in over 4,600 public hospitals at the secondary level or higher. These measures indicate that the Chinese government recognizes the importance of geriatric care and is making efforts to provide specialized care to the elderly.

Comprehensive geriatric assessment is a crucial process in geriatrics departments that involves multidisciplinary diagnostic and treatment processes, where all staff members play a key role. Pharmacists, psychologists, rehabilitation therapists, nurses, and doctors work together to identify seniors’ medical, psychosocial, and functional capabilities, enabling a coordinated plan to be drawn up for each patient’s needs.

While specialized diagnosis and treatment departments focus on seniors’ daily living activities, geriatric doctors adopt a different approach when seeing geriatric patients. Liu, the chief physician at Peking Union Medical College Hospital’s department of geriatrics, said, “As chronic diseases have become the main cause of death and disability among the elderly, and about 80 percent of seniors die from such diseases, the focus of elderly care is on preventing disease, organ failure, function decline, and other adverse events.” Thus, geriatric doctors help partially disabled seniors function as much as possible, and those who are completely disabled to live a dignified life in their last days.

The goal of geriatric doctors is to accurately care for the elderly who have several chronic conditions, checking for inappropriate medication and any illnesses that may occur simultaneously. They do this through medication and aim to reduce lipids, hypertension, and platelets, regardless of the patient. In cases where multiple chronic conditions coexist, geriatric doctors spend a lot of time determining which drugs are not working, whether there are overlapping medication errors, and if any of the drugs are putting the patient at risk. By doing so, they can ensure that the seniors receive safe and effective medication.

Life expectancy continues to rise, which means that improving the health of the aging population is crucial for promoting care for seniors. According to Liu, the healthy “young old” should be given more work opportunities and social support to cultivate a positive mindset and embrace the arrival of an aging society. The official retirement age in China is 60, but average life expectancy has reached 78.2 years, and in many developed countries, a retirement age of 65 is preferred. Liu believes that active aging is essential to maintain a sense of happiness and contribute to society.

A research report by the McKinsey Health Institute in March revealed that average global life expectancy rose from 30 to 73 years from 1800 to 2017, but the proportion of those in poor health did not diminish over time. On average, 50 percent of people are in less-than-good health, including 12 percent in poor health. The report suggested that if people improve their environment, change their lifestyle, and take good care of their health, they can achieve about six years of healthy aging. Liu agrees with this notion and believes that nursing, medical treatment, social and environmental support are areas in which healthy aging can be attained.

Improving the health of the aging population is part of China’s long-term plan to promote care for seniors. Liu emphasized that it does not make sense to focus solely on the diseases that seniors have. The goal is to maintain and perform the function of the elderly, improve their quality of life, and make their families happy. By improving seniors’ healthy life expectancy, they can have more time to live independently. Therefore, comprehensive geriatric assessment, multidisciplinary diagnostic and treatment processes, and teamwork among pharmacists, psychologists, rehabilitation therapists, nurses, and doctors are crucial for elderly care.

To delay the progression of some medical conditions among seniors, scientific ideas and methods need to be adopted, and they need to be shown sufficient patience and perseverance. Bao Changxiao, a caregiver at a nursing home in Beijing, has looked after the elderly who are incapacitated, including those with senile dementia, for 24 years. She believes that the rate at which a chronic illness progresses in a senior patient can be slowed down if the right approach is taken to their care. Bao added that rehabilitation training helped an elderly man she cared for, who had a stroke and was barely able to get out of bed, to walk with the aid of a stick. Caregivers need to speak gently and encourage seniors to exercise daily.

Long-term care for the elderly requires experience, which is a combination of care, patience, and love. In addition to physical aging and pain, the elderly may experience psychological problems, which can be stressful for long-term caregivers. According to Bao, about 40 percent of the elderly she works with have problems such as apathy, a lack of communication, depression, anxiety, and irritability. Their families may initially be devoted to their care, but over time people become tired of this work, and they also have their own pressures from work and life. Bao has arranged for social workers to visit the elderly to listen to their concerns and help alleviate their psychological problems.

Resistance training can only work on the elderly if they cooperate and make efforts to receive it. Such training is essential for health and fitness. Bao, who mainly serves the elderly in Beijing’s Fengtai district, said residents in the area are increasingly beginning to think about how they and their loved ones deal with death. They prefer to make their own decisions so that their families suffer less.

Liu, from Peking Union Medical College Hospital, said that medicine for geriatrics is inseparable from palliative care. They propose integrated care to help the elderly take care of themselves as much as possible so that they can enjoy life. In addition, every person has the right to know about his or her illness and make decisions individually. They hope that older adults can live well and die well. The goal of long-term care for the elderly is to maintain and perform their functions, improve their quality of life, and make their families happy.

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