Commentary / World

As Chinese live longer, Alzheimer's cases rise

by Cesar Chelala

China’s advances in public health have resulted in a significant increase in life expectancy, which has gone from under 60 years in the 1950s to 76 in 2012, according to the World Health Organization (WHO). However, this improvement has also resulted in an increasing number of people older than 60 and some of the diseases prevalent at that older age. Among them are different kinds of dementia, notably Alzheimer’s disease.

Although Alzheimer’s is the most common type, there are also other types of dementia characterized by altered memory, thinking, behavior and the ability to carry out everyday activities. Although they can start before the age of 65, after that age the likelihood of developing one of them roughly doubles every five years, exacting considerable personal, financial and social costs.

The BrightFocus Foundation estimated that there are 44 million people worldwide living with dementia, with numbers expected to reach 66 million by 2030 and 115 million by 2050. According to the medical journal Lancet, China has 9 million Alzheimer’s sufferers. Those numbers make Alzheimer’s and other kinds of dementia one of the most significant health and economic problems of the 21st century.

The impact of the dementias on the countries’ economies is not sufficiently appreciated. According to statistics from Alzheimer’s Disease International (ADI), the estimated worldwide total costs of dementias were $604 billion in 2010. If dementia were a country, it would be the world’s 18th largest economy, ranking between Turkey and Indonesia.

Those costs will soar in the next few decades. ADI estimates that by 2030 there will be an estimated 85 percent increase in costs, based on the predicted number of people with dementia at that time. Japan will not be exempted. As Japanese researcher Takaomi Saido told The Japan Times, “Alzheimer’s disease will destroy Japan’s social welfare system in the near future.”

The China’s Alzheimer’s Project (CAP) estimates that 75 percent of urban patients have not been diagnosed in a timely way. The proportion of those not diagnosed in rural areas is probably higher. This is happening despite the fact that there is increasing awareness about these diseases.

Presently, only the top-quality hospitals (of which there are approximately 700 in the country) can provide comprehensive diagnosis and treatment of Alzheimer’s disease.

The CAP reports that there are only approximately 1,000 physicians experienced to deal with this kind of diseases. The CAP also estimates that China is short of 10 million senior caregivers.

Several situations hinder more rapid progress to deal with this disease. Among those are the low level of public health education and the lack of public health research projects for the prevention of Alzheimer’s. The CAP, however, also notes that some local governments are encouraging the creation of Alzheimer’s care institutions.

Access to and affordability of health care is a serious problem, particularly in rural China. In addition, sick people have the added problem of diminishing care by relatives, many of whom have to migrate to urban areas in search of better economic conditions.

The Chinese government is now educating the public about dementia and big cities like Shanghai have developed plans to build new facilities to take care of the sick. However, there are still serious problems related to the care of the sick and the still inadequate social support system in the country.

Among the main challenges is who will pay for professional care, particularly since in the 1990s China has dismantled the system of financial support by the state. The nation’s social safety net is weak, and commercial insurance does not cover the disease nor non-hospital nursing care. In addition, community health service centers do not have the possibility of providing screening and special nursing care for patients with dementia.

Alzheimer’s Disease International recommends that every country should have a national dementia strategy, promoting early diagnosis and intervention, while at the same time developing the capacity of primary care services to have the basic competency for making a provisional diagnosis of dementia and take initial management measures.

Because of their complex consequences, Alzheimer’s disease, and dementias in general, are personal family and social diseases that demand urgent, new and innovative ways of being addressed. In China, which has one of the world’s fastest aging populations, the number of people with different kinds of dementia will only increase and the Chinese government should be prepared for this to occur.

Cesar Chelala, M.D., Ph.D., is an international public health consultant.