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Dementia takes its toll in China
By Hamish McDonald, The Age
November 22, 2003
Gao Yuan knows his mind is going. He finds it hard to remember daily tasks, even when he writes out a list of things to do.
His wife says his logical thinking is not as good as it was. He recognises his old college classmates less easily than they seem to know him.
But the 76-year-old retired Beijing engineering professor is not going out without a fight. Mr Gao, accompanied by his wife Tang Yamei, 68, has consulted specialists and accepted their diagnosis. "I have senile dementia in its early stages," he says, with a wry smile.
For the past two years, Mr Gao has spent a hefty portion of his pension, about 750 yuan, or $A126, a month, on a drug called Aricept that inhibits the onset of dementia.
With the help of Beijing University's Institute of Mental Health, the couple also learned about habits that can keep an old mind ticking over: quizzing each other about things, for example, or looking through photo albums to keep family events fresh in memory.
But Mr Gao is an unusual example in China. Partly as a result of the one-child family planning policy, China has a population greying more than most other Asian developing countries. It now has about 134 million people over 60, about 10 per cent of the population. By 2050, the proportion will rise to 30 per cent.
Mental health care for the elderly is already at crisis point in China, experts say. Professor Yu Xin, a geriatric psychiatrist at the Beijing University institute, says China has 6 to 7 million elderly people with dementia, of whom at most 15 per cent ever see a psychiatrist or neurologist.
Depression is also rampant among the elderly. "We now have about 280,000 people killing themselves each year, and more than half of them are elderly people," he says.
The ideal in China has been for elderly people to live together in a household with two, even three, younger generations, to be venerated as a source of wisdom, and be taken out for exercise.
But this ideal is slipping into memory as offspring migrate for jobs, and living in high-rise apartments scatters the generations. "This ideal of four generations living together - I don't think it can happen anymore," Professor Yu said, citing a survey that showed, in Shanghai and Beijing, 70 per cent of old people lived alone.
Few of the doctors in China's public health clinics are trained to spot the symptoms of depression, and, outside major cities, few hospitals have a psychiatry department. Chinese also tend to hide emotional difficulties and look for physical causes, Professor Yu said.
For those who are diagnosed, the cost of inhibitor drugs is prohibitive - a 750-yuan-a-month regime like Mr Gao's is equal to an entire pension for most people.
Professor Yu said he spends a lot of time persuading families that medication is worthwhile. "I try to explain to them how important it is for your mother or your dad to take the medication, and actually that it can save you energy, effort and also money in the long run."
But often, patients and their families just disappear when dementia is diagnosed.
Boom cities in China's east and coastal regions such as Beijing, Shanghai and Shenzhen are building up modern psychiatric services, but inland areas have few resources.
Last month, however, China began opening up this hidden problem and looking for advice. Professor Yu's Beijing institute and Melbourne University's Centre for International Mental Health held a two-day workshop that may lead to a strategy for bringing mental health care to China's elderly. The collaboration, involving Australian leaders in geriatric care, builds on contacts built by Melbourne's pioneering professor of geriatric psychiatry, Edmond Chiu.
The Chinese psychiatrists plan a simple network that will teach physicians and neurologists to spot early symptoms of dementia or depression. But it requires many more specialists. "We can't follow the American or Australian model," Professor Yu said. "But I think 10 times or 20 times the current number can provide a very minimum service."
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© 2002 Global Action on Aging
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