In China, there are only about 300 qualified physicians to treat more than 9 million dementia sufferers. The shortage is overwhelming families and threatening resources from an already stretched welfare system as the country ages.
When 71-year-old Shi Anquan chops firewood or visits the market in his northern China village, his wife Yuhua, also 71, plods quietly behind. Shi, a farmer, has given up tilling the land to devote himself full time to his wife’s care, reminding her to bathe and change her socks. The village’s single nursing home won’t take patients with mental disease. The nearest hospital doesn’t have dementia specialists. Shi must travel with his wife to visit doctors 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,” said 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 the world’s largest group of Alzheimer’s sufferers, according to a 2013 article in the medical journal Lancet. Although countries from the U.S. to France also struggle with Alzheimer’s, the stakes are higher in China, where the numbers are poised to balloon as the population ages and rapid industrialization boosts risk factors from pollution to diabetes.
Life expectancy in China has increased seven years to 76 since 1990. The flip side of that progress is that an aging population has combined with rapid modernization to fuel a rise in mental illness from depression to Alzheimer’s even as the nation has directed only limited resources toward the elderly.
“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 care givers,” said Kit Yee Chan, lead author of the Lancet article.
There were an estimated 5.7 million Alzheimer’s patients in China in 2010, 53 percent higher than a decade earlier and twice as many as earlier estimated by the international health community, according to the June Lancet study.
Shi had to wait years to find a specialist for his wife, whose memory loss, combined with violent outbursts, began five years ago. She’s accused him of stealing her money and she has chased Shi around the house, hitting him on the legs with an iron rod.
While local doctors suspected Alzheimer’s, the nearest county hospital didn’t have a specialized unit to make a formal diagnosis and the anti-psychotic prescribed there left her constantly dazed.
Last year, a distant relative mentioned a woman in a neighboring village who improved after seeing Yu Xin, a doctor and professor of clinical psychiatry at the Institute of Mental Health at Peking University. The couple made the journey last July to visit Yu, who has since been treating Yuhua with an anti-depressant that has milder side effects than her previous medication.
Even so, the disease continues to turn the couple’s life upside-down. Yuhua sticks close by her husband, panics when she doesn’t see him, and has become lost on occasion when she has stepped out to look for him.
Their days bear little resemblance to the couples’ former routines and rhythms. During the previous 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 ruled the roost. Their daughter-in-law does the house work and their 40-year-old son, Shi Shuanzhu, travels frequently for odd-jobs such as trading fertilizer and corn. The elders mostly fend for themselves other than meal time, with Yuhua increasingly dependent on her husband for the smallest of tasks.
“Now, I wake up in the middle of the night to cover her with the blanket because she can’t even do it herself,” said Shi who must also contend with his own heart condition. “How can I mind doing this, she’s looked after me for fifty 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 are increasingly stressed. For decades, China’s family planning laws have permitted only one child per couple in many parts of the country. Today, that policy has brought about a shortage of caregivers even as the nation rapidly ages and longevity increases.
The “informal system of family care might break down over time with the large internal migration, rapid rise in the cost of living, reduced average family size and fewer young family members,” said Chan, who spent 18 months canvassing Alzheimer’s data with colleagues.
Alzheimer’s, the most common form of dementia, advances slowly, progressively blocking the brain’s nerve cells from functioning properly.
Changes in the brain first rob people of their ability to form memories. As they deteriorate, Alzheimer’s victims may have difficulty walking or swallowing. An individual with Alzheimer’s can live from 5 to 20 years after initial diagnosis.
For decades, dementia, or chidai as it is called in Mandarin, was associated with sluggishness and stupidity in China, the world’s most populous country, contributing to a dearth of care.
While the non-profit China Alzheimer’s Project estimates that there are probably about 300 dementia specialists, it says that is a “rough” projection and the number of world-standard doctors available may be even less.
Alzheimer’s trajectory in China closely tracks the career of Yu, the 48-year-old doctor, who has been working with the Shi family. Yu recalls his university supervisor asking him to do a fellowship in dementia in 1990. He declined and chose instead to specialize in schizophrenia, a disease more common among young people.
“I didn’t want to do dementia at the time because I couldn’t find enough patients,” he said.
Some years later, his bosses asked him to build a specialty in geriatric psychiatry, and this time he agreed. Yu soon witnessed a surge in Alzheimer’s patients across China.
“It was very quick, in the space of 10 to 15 years it suddenly went from zero to a big problem,” said Yu. “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.”
It’s not just changing demographics fueling the rise of Alzheimer’s. Modernization is also playing a role. Evidence shows that diabetes, smoking, high-fat diets and hypertension are Alzheimer’s risk factors, said Raymond Chang, an associate professor of anatomy at the University of Hong Kong and founder of its Alzheimer’s Disease Research Network. The country already has the highest number of diabetics on the globe as economic development has transformed diets and lifestyles.
Some recent findings also link Alzheimer’s to air pollution, which has surged in cities such as Beijing. While the data is preliminary, one study by the University of Nevada published 2012 in the Journal of Environmental and Public Health suggests that air pollution may boost an individual’s risk of developing the disease by speeding up age-related oxidative changes in the brain.
“Smokey air, particulate matter -- these things don’t just affect your lungs, they can also go to your brain,” says Chang. “It’s a multi-hits process: your environment, your living style, your eating habits -- it all leads to how much you might get Alzheimer’s.”
At Beijing Geriatric Hospital, among the few public facilities offering specialized services for the elderly, the mental-health wing is a drab, two-story yellow building with only about 20 rooms on each floor.
Some real-estate investors are now seeing business opportunities in the shortage of care. Vcanland Senior Living Group in October 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 help calm patients.
Still, specialized services like Vcanland’s are rare and families like Shi’s all across China are mostly left to their own devices.
Shi is resigned to his and his wife’s fate in the face of the disease that has ravaged their lives.
“Whichever one of us goes first, it’s going to be heaven’s will,” he says sitting with Yuhua in their living room. “I just hope I’m there to look after her, all the way till the end.”