Cultural differences require a different approach for end-of-life care in China

by Li Binli
China’s aging population has increased to approximately 200 million and is larger than that of the whole of Europe. So the number of older patients is increasing with time. Meanwhile, thousands of hospitals have established an ICU in the last 20 years, and this has brought about a grim problem. For example, more and more older patients, who would have died within a short period of time in the past, may now achieve long-term survival. For these patients, intensive care just means extended life or postponed death. These hopeless patients occupy an already scarce medical resource, and this makes it impossible for some critically ill patients to receive effective treatment. Owing to the influence of Chinese traditional ethics and the lack of corresponding laws and regulations, overtreatment of hopeless patients frequently takes place. In fact, it is a futile treatment. Chinese society needs to develop approaches to address the appropriate delivery of critical care to the increasing population of older people, especially those with chronic life-limiting disease.

Elderly Hunan villagers prefer suicide to living without medical care

Mo Qiulian ties up small bundles of firewood as she murmurs to herself: “Why haven’t I died?”
The 67-year-old villager has thought of killing herself many times since she had a stroke in March, followed by four months of lying in bed unable to move before regaining some mobility in her upper body.
Mo is one of many elderly residents in Kongtong Village of Hunan Province who say they will commit suicide one day.
They look forward in fear to a lack of medical care to deal with diseases as they get older. They are uncertain what the future holds, feeling insecure because their children left for the city and may never return, the Sanxiang City Express said yesterday.

Beijing to provide more hospital beds for elderly

A new model that provides both healthcare and elderly care for senior citizens was proposed recently in Beijing. More than 9,000 healthcare institutions are expected to get licenses to offer beds to the elderly.
Beijing has 608 hospitals and 1,897 community health service centers. Even if only half of them each provide 20 beds, it will result in an increase of 25,000 beds.
More than 80,000 beds are available for the elderly in the city, but almost 30 percent of beds are unoccupied. Most people prefer locations that offer good medical services and avoid those with bad reputations. Thus, some places are almost full while others have 50 percent of their beds unoccupied.

Medical care for rural elderly hampered by 'unfilial' shame and urban migration

Zhu Chengyu strolls around her countryside courtyard as a form of exercise. Old age and illness blight her daily life.
The 78-year-old woman, who lives in Zhuhe village of Dong'e County in eastern China's Shandong Province, has been admitted to hospital five times this year for asthma and heart disease.
Medical expenses costing thousands of yuan was partly covered by basic medical insurance. The remainder, around 2,000 yuan, was a large sum for Zhu.
She has no other source of earnings apart from a monthly pension of 65 yuan (10.5 US dollars) and an annual payment of 800 yuan, which she gets from renting her 2.5 mu (0.17 hectares) of crop land.
What worries Zhu most is when she becomes ill. Nobody is around to take her to hospital.
"My only son and his wife work as migrants in cities and seldom come back home," Zhu said. "I am left alone."

Elderly Beijingers miss out on free flu vaccine

by Michael Woodhead

Most elderly people in Beijing are failing to take advantage of the government’s program of free influenza vaccine each winter, research shows.

Only 44% of people over 60 had influenza vaccination during the seasons from 2008 to 2011, according to a survey of almost 2500 elderly Beijing residents published in the BMJ Open journal this week.

The vaccination rates over three seasons were consistently below 50%, which is well below the WHO target of 75% for annual seasonal influenza vaccination for the elderly, said Dr Zheng Yang and co-researchers from the Institute for Infectious Disease and Endemic Disease Control at the Beijing Center for Disease Prevention and Control (CDC).

The low uptake of flu vaccine occurred despite the government policy to offer the vaccine free of charge to all vulnerable populations including older people via community health centres, the researchers said.

Analysis of the figures showed that flu vaccination was more likely among people living in rural areas of Beijing, people with a lower level of education and those who perceived themselves to be unwell.

“Influenza vaccine coverage in Beijing still remains suboptimal. Further work needs to be undertaken to ascertain whether the method of distributing the vaccine is adequate and whether health professionals are appropriately promoting the vaccine,” the researchers concluded.

“ Education efforts should continue to highlight the need for the vaccine among individuals who are at risk from the disease and its associated complications,” they added.

Read the full study at: BMJ Open

Health care for older Chinese people who lose their only child

by Li Yan and Wu Shufang
Over the past three decades, the one-child family planning policy in China has had a substantial role in population control and in boosting the economy. However, it has also brought about a new phenomenon of “childless” older people in China, and this group is expanding rapidly.
In 2011, the number of families who lost their only child across China rose to more than 1 million—a figure that is estimated to reach 10 million by 2035. In a country with a seriously flawed health system, elderly parents are heavily reliant on their children. The death of an only child at a time when parents are unable to have another can cause pronounced psychological trauma, including long-term grief, depression, and anxiety about a lonely old age without an adequate pension or proper health care.
Support from the government is essential in relieving the difficulties currently faced by the childless elderly in China, and the difficulties they face in the future. Such support includes three major aspects. The first is health and social care, including policies to support family care services, better quality nursing homes, and the creation of various community health-care services. The second is economic support. To many of these parents, loss of their offspring immediately means the loss of their only hope of financial security. Although the Chinese Government has begun to schedule plans for providing support to elderly people who have lost their only child, detailed regulations, practical enforcement at the grassroots level, and pension insurance are urgently required. The third aspect is that of spiritual comfort. Several local governments in China have taken steps to act on this; for example, in September, 2012, the Beijing municipal government launched a scheme to provide psychological support at community care centres for the childless elderly, and this scheme now covers around 3900 families in Beijing who have lost their only child. However, the gap in assistance is still vast. The government should increase cooperation with non-governmental organisations in setting up community service centres that can provide door-to-door services for the childless elderly, providing them with psychological care and emotional comfort. Another approach that could be considered by the government is the encouragement of volunteers and training of social workers to offer free psychological consultation and mental health interventions.
Moreover, the media should be encouraged to report on the childless elderly and raise attention to this newly vulnerable group.
Source: Lancet