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照顾痴呆症护理者 - 2023-02-15

 



According to China's seventh national census, the country is witnessing an accelerated process of population aging. As of Nov 1, 2020, those aged 60 years and above numbered 264 million, up 86 million from 2010 to account for 18.7 percent of the total population. China's working age population fell by 45 million in the 10 years leading to 2020, with its share of total population falling from 70.14 percent to 63.35 percent.

As the aging of the population quickens, the burden of caring for senior citizens is mounting. Especially, the long-term care for senior citizens living with dementia has become an increasingly acute problem in China. Guaranteeing the quality and sustainability of long-term care for senior citizens living with dementia has become a social problem that concerns the well-being of tens of millions of households and requires better policy responses.

According to data from the China National Committee on Ageing, among people aged 60 and above in China, approximately 15.07 million people have dementia, an incidence rate much higher than the global average.

This is mainly because a relative shortage in medical and healthcare resources has resulted in low diagnosis and treatment, particularly in the rural areas. Add to that, a large proportion of elderly Chinese citizens have unhealthy dietary and no sports habits, other main causes of dementia. Currently, China has the largest population of people living with dementia in the world.

According to a World Health Organization report, as China's population continues to age, the number of dementia patients is expected to jump to 23.3 million in 2030, accounting for roughly 30 percent of the world total. Because of a lack of professional care service resources, over 90 percent of dementia patients in developing nations, particularly in rural areas, are cared for by informal caregivers such as family members and friends.

For long, China's elderly care and health policies view informal care as a private affair, thus providing insufficient support for it. Over the past few years, some local governments have launched community-based risk screening, classification and intervention projects for dementia, unveiled hospital bed construction goals for dementia patients, released some supportive policies for informal caregivers, and prioritized dementia care in social policies. However, those policies are yet to take effect, and strong measures to alleviate the burden of informal caregivers are still needed.

According to research findings across the globe, providing proper home-based care in a community for seniors with dementia could better maintain their dignity and quality of life, effectively slow down the progression of dementia, and reduce the burden on the national healthcare system and a country's medical insurance costs. However, for informal caregivers, caring for older adults with dementia usually means they have to shoulder a huge burden and costs from three aspects — a direct financial burden, which mainly includes medical and non-medical costs (transportation, nutrition, etc); an indirect financial burden, including the caregivers' losses in economic income and job opportunities because of the care duties; and the invisible losses in social contacts and emotional burden.

Senior citizens with dementia often have behavioral and psychological symptoms including aggressive behavior, sleep disorders, depression and memory loss. Further compounding the issue are stigmas and a lack of dementia literacy among the public.

These will put dementia caregivers under greater pressure compared with other caregivers and exact a significant social, physical and mental toll on them.

In 2015, a research team led by Jia Jianping from Xuanwu Hospital of the Capital Medical University found that the indirect financial burden and invisible losses in social contacts and emotional burden accounted for as high as 51.87 percent of the total costs. They also estimated that caring for dementia patients would cost 3.25 trillion yuan ($480 billion) by 2030.

The huge burden and costs will have severe adverse impacts on caregivers. According to studies, dementia caregivers are also more vulnerable to mental and physical health risks, reporting higher levels of stress, insomnia, depression, and higher incidence of chronic diseases. A fairly large number of dementia caregivers themselves are older adults. Over time, caregivers' health and emotional problems can easily lead to a decrease in their levels of attentiveness and care. In some extreme cases, the caregivers even ill-treat seniors with dementia.

International experience shows that government and society support for dementia caregivers is a good choice both conducive to the well-being of senior citizens with dementia and their families as well as cost-effective as a policy. Specifically, China's support policies for dementia caregivers should prioritize the three following areas.

China should increase the early diagnosis rate for dementia by improving dementia literacy across society. Many often mistake the disease with aging and refuse to go to hospital because they mistakenly consider "aging" and "cognitive loss" as a shame. Currently, around 40 million Chinese people are in the initial stages of dementia, also known as Mild Cognitive Impairment, among which one third to half will develop into dementia. Raising this group's rate of seeing a doctor would greatly delay the disease's progression and lower the incidence rate of dementia, fundamentally reducing the burden on caregivers.

Currently, China's long-term care insurance scheme is in its trial phase, with insufficient input from local governments and few policy arrangements for dementia care. Therefore, China needs to step up efforts to encourage commercial insurance providers to make up for the shortages in providing guarantees for dementia care.

Last, greater significance should be attached to building a community-based dementia prevention and care system. Take Shanghai's dementia-friendly community program as an example. A community-based services system aimed at alleviating the burden on dementia caregivers should factor in local conditions, consist of an inter-departmental and interdisciplinary working team, and make sustained efforts in creative trials and explorations. Furthermore, we need to improve the physical space in local communities, create a better cultural environment in communities, enhance the professional skills of community-based service agencies and caregivers, strengthen the cultivation of professionals, and achieve effective coordination between the government and social resources.

The author is Yang Fan, an associate professor with the China Institute for Urban Governance at Shanghai Jiao Tong University. The author contributed this article to China Watch, a think tank powered by China Daily.

Contact the editor at editor@chinawatch.cn.

Source: China Daily

 


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