Academic journal article Development and Society

Care Issues at the End-of-Life in China

Academic journal article Development and Society

Care Issues at the End-of-Life in China

Article excerpt


China has been an aging society since year of 2000. She encountered many new demographic and social issues. Among them, the size of the population is not as crucial as the age structure1. Although China has the tradition to take care of the elderly, changes in age structure as well as social changes as a result of economic reform and open policy generated challenges dealing with the care of the growing old-age population and forced the government and the society as a whole to develop new approaches and new policies to reduce the potential burden for individual families or society. How much care exactly the aging population on the average need is one of the major concerns. Earlier researches found out that among elderly population the higher the ADL score, the more hours needed for care per week. On the average, the elderly based on a survey in 2011-12 received 23.1 hours of care a week; however, the elderly had severe limitation in ADL needed about 115 hours of care, which was 69% of total hours a week (Zhou and Feng 2015). The elderly over 80 years, on the average, needed 92 days of care towards the end of their life, while the oldest-old with poor health usually needed 124.5 days of care (surveys in 1998 and 2000; Zhan 2004). Among general old population (65+, a survey in 2005), on the average, 11 days of full care were needed within the last month of their life, 33 days needed within the last six months and 47 days needed within the last year of their life (Gu et al. 2007). The care that the elderly need toward the end of life is part of long-term care, or should be called the end-of-life care.

In 2012, the Chinese government, for the above concern, redefined and promoted "new 24 filial piety,"2 in hoping to encourage younger generations keeping the old-age care tradition. However, the reality is that the older people today under such spectacular social and economic changes are very different from the elderly in the past in terms of financial, health and family status. Our society should well prepare for balancing the need of care and search for and generating available sources of care. However, the needs and the available sources are always difficult to be matched and balanced. Therefore, under this general background, an important alternative needs to be considered and discussed is the end-of-life issue since life expectancy is improved significantly in China but not necessarily healthy one. More people die at older or oldest age with long-term chronic diseases. Being able to live to old age is a blessing, but also a burden with certain long-term diseases. Thus, both the elderly and their families more likely need to deal with the issue of peaceful death.

Following a general discussion of mortality among Chinese population, this article examines how Chinese, individuals and the society as a whole, prepare for the care needs of the elderly towards the end of life. The care ranges from emotional to physical care of the elderly. We will discuss individual awareness of the end of life issue and the social preparations to deal with the issue, especially living will. The artile also explores the development of the societal preparations or programs on palliative care (called by different Chinese names) and hospice with an emphasis on the latter. All these issues are rather new to Chinese, however, are gaining more attention in the society today.

Mortality in China

Chinese are living longer today. According to the statistics by the National Health and Family Planning Commission, life expectancy before 1949 (the establishment of the People's Republic of China) was as low as 35 years (Table 1). It has been increased gradually and dramatically and reached to 74.8 in 2010, which was about 2.1 times that of earlier years. In 2010, Chinese males lived 8.8 years and females lived 11.1 years longer compared to males and females in 1970s respectively. Female Chinese benefited more from the improvement of life expectancy than male Chinese. …

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