Caring for China’s elderly population: realities, challenges and future prospects

Ongoing population ageing is expected to be one of the most prominent sociodemographic changes throughout the twenty-first century and will generate wide-reaching impacts in nearly all social spheres. As the number of elderly people continues to increase rapidly, concern is growing about the capacity and sustainability of aged care systems; caring for elderly people might be one of the most pronounced challenges created by population ageing in many societies. Current understanding of the looming challenges of aged care and the associated socioeconomic consequences is far from adequate. To better understand the impacts of the challenges of aged care for elderly individuals, their families and society, this thesis investigates multiple aspects of ageing and aged care in the context of China, particularly focusing on the current status, future prospects and potential health and economic implications of aged care. The thesis first examines the overall level of health of the elderly in China by estimating healthy life expectancy of the Chinese elderly population, which is a fundamental indicator reflecting population health and demand for aged care services. The thesis considers both physical and cognitive aspects of health when measuring population health, while previous research tends to take only one of these two aspects into account. Results show that after considering both physical and cognitive aspects of health, the healthy life expectancy of the Chinese elderly population experiences a significant decline and suffers distinct disadvantage compared with that of their counterparts in developed countries. Substantial differences are also documented regarding the healthy life expectancy of the Chinese elderly population in terms of a wide range of sociodemographic dimensions, including gender, urban–rural divide, region, educational level, marital status and health state at age 60. In addition, the thesis examines the development of the recently established home-/community-based care services in urban China, exploring how elderly people utilise this relatively new type of care service and what factors affect this utilisation. Results indicate a relatively low current rate of utilisation but a significantly higher expected future utilisation rate for home-/community-based care services among the Chinese urban elderly population, suggesting a potentially largely unmet demand for home-/community-based care services in China. Results also show a strong effect of institutional determinants on utilisation of home-/community-based care services, implying a vital role for familial and societal connections in elderly people’s aged care arrangements. Moreover, the thesis examines the involvement of family members in aged care provision and the consequences for family caregivers’ wellbeing. Results reveal increasing and intensifying participation in caring for parents at home among Chinese women over the period 2000–15, and a clear negative effect of caregiving on female objective health and self-rated subjective health, but no significant effect of caregiving on life satisfaction. Further, a set of projections on future demand and costs of aged care services is made. Projection results show that the size of both the total Chinese elderly and disabled elderly population will substantially increase by 2050, and that while demand for aged care services will soar as a whole, substantial heterogeneity exists regarding demand for different forms and types of aged care services. The demand for home-/community-based care and for some of the more specific types of aged-care services, such as eating assistance and shopping assistance, manifesting the most striking growth during the study period. Through these multidimensional analyses, the thesis provides a comprehensive examination of aged care from both demand and provision perspectives, and caregivers and care recipients’ points of view, as well as current status and future prospects, revealing extensive socioeconomic impacts of population ageing. The results from the thesis suggest that the provision of aged care services will become a severe challenge in the near future for ageing societies like that in China, which will bring heavy burdens, though to different extents, for individuals, family and the state. Results from this thesis also imply that proactive and pertinent policy responses are urgently needed to cultivate sufficient, appropriate and sustainable aged care provisions for the growing elderly population globally to enable the elderly to improve their quality of life and to age with dignity.