When 71-year-old Shi Anquan chops firewood or visits the market in his village in northern China, his wife, Yuhua, also 71, plods quietly behind. Shi has given up tilling the land to devote himself full-time to the care of his wife, reminding her to bathe and change her socks. The village’s single nursing home won’t take patients with mental diseases. The nearest hospital doesn’t have dementia specialists. Shi must travel with his wife to visit her doctor in Beijing, a three-hour trip each way with two bus changes.
“If someone is going to have Alzheimer’s, China is a rough place to have it,” says Benjamin Shobert, managing director of Rubicon Strategy Group, which advises companies on the senior-care market. “Aging will be the biggest crisis of the century for China, and Alzheimer’s is at the crux of the problem.”
China has 9 million Alzheimer’s sufferers, the world’s largest group of patients with the disease, according to a 2013 article in the medical journal Lancet. Since 1990, life expectancy in China has increased 7 years, to 76; the flip side of that progress is that longer life spans combine with stress and other modern afflictions to fuel a rise in mental illnesses ranging from depression to Alzheimer’s disease. The government has directed limited resources toward the elderly, and only 300 doctors in the country are qualified to treat dementia. “Caring for most dementia sufferers in China is left to family members with no or limited training or support from the state and at considerable physical, psychological, and financial costs to the caregivers,” says Kit Yee Chan, lead author of the Lancet article.
Shi waited years to find a specialist for his wife, whose memory loss began in 2009. She accused him of stealing her money and chased him around the house, hitting him on the legs with an iron rod. While local doctors suspected Alzheimer’s, the nearest hospital didn’t have a specialized unit to make a formal diagnosis, and the antipsychotic doctors prescribed left her in a daze. Last year a distant relative mentioned a woman in a nearby village who benefited from seeing Yu Xin, a doctor and professor of clinical psychiatry at the Institute of Mental Health at Peking University in Beijing. The couple made the journey last July to visit Yu, who has put Yuhua on an antidepressant with milder side effects.
The disease continues to turn the couple’s life upside-down. Yuhua panics when she doesn’t see her husband and has become lost on occasion when she steps out of the house to look for him. During five decades of marriage, Yuhua took charge of household duties, cooking and cleaning their single-story brick home in Xinhuaying Cun, a village in the shadow of the barren mountains on Beijing’s northern border.
The couple now lives with their youngest son’s family in the same house where Yuhua once did the cleaning and cooked the meals. Their daughter-in-law does the housework, and their 40-year-old son, Shi Shuanzhu, travels for odd jobs such as trading fertilizer and corn. Apart from mealtime, the elders mostly fend for themselves. “Now I wake up in the middle of the night to cover her with the blanket, because she can’t even do it herself,” says Shi, who must also contend with his own heart condition. “She’s looked after me for 50 years. I only hope I can stay healthy to take care of her.”
Shi and Yuhua are better off than many elderly couples in China, where traditional family structures, once built on the assumption that large families would care for their aged, are under increasing stress. For decades, China’s family planning laws have permitted only one child per couple in many parts of the country. That policy has brought about a shortage of caregivers. The “informal system of family care might break down with the large internal migration, rapid rise in the cost of living, reduced family size, and fewer young family members,” says Lancet author Chan, who specializes in population health studies at the University of Edinburgh.
Yu, the 48-year-old doctor who’s been working with the Shi family, says his university supervisor asked him to do a fellowship in dementia in 1990. He declined and chose instead to specialize in schizophrenia. “I didn’t want to do dementia, because I couldn’t find enough patients,” he says. Some years later, his supervisor asked him to build a specialty in geriatric psychiatry, and this time he agreed. Yu soon witnessed a surge in Alzheimer’s patients. “It was very quick. In the space of 10 to 15 years, it suddenly went from zero to a big problem,” he says. “In another 20 to 30 years, it’s going to be a big disaster. So how to mobilize the social and academic resources? We’ll need to do it all.”
Evidence shows that diabetes, smoking, high-fat diets, and hypertension are risk factors for Alzheimer’s, says Raymond Chang, an associate professor of anatomy at the University of Hong Kong and founder of its Alzheimer’s Disease Research Network. China has the most diabetics on the globe as rapid development has transformed diets.
Recent findings also link Alzheimer’s to air pollution, which has surged in cities such as Beijing. While the data are preliminary, one study by the University of Nevada published in 2012 in the Journal of Environmental and Public Health suggests that air pollution may boost the risk of developing the disease by speeding up age-related damage. “Smoky air, particulate matter—these things don’t just affect your lungs, they can also go to your brain,” Chang says.
Some real estate investors see opportunities in the shortage of care. Vcanland Senior Living Group has opened a 26-bed facility in the northern city of Tianjin catering to Chinese dementia patients by offering intellectually stimulating activities and rooms decorated to calm them. Such specialized services are rare. Shi is resigned to his and his wife’s fate in the face of the disease. “Whichever one of us goes first,” he says, “it’s going to be heaven’s will.”