Over 45 Million Elderly Chinese Need Care Amid Deep Aging Trend

Over 45 Million Elderly Chinese Need Care Amid Deep Aging Trend
A group of elderly Chinese in Beijing, on April 7, 2007. (AFP via Getty Images)
Shawn Lin

The number of elderly people who need care in China has exceeded 45 million and is expected to reach 60 million by 2030, according to a recent survey. Characterized by large scale, deep degree, and rapid acceleration, China’s aging trend is different than that of other countries.

Authored by a team of social scientists from China’s Peking University, a paper that projects the care needs of China’s elderly population was published in The Lancet Public Health on Nov. 21.

The team analyzed data from surveys conducted across 28 provinces in China. The surveys were conducted from 2011–2020, with 46,619 respondents aged 60 or older.

The study identified three levels of need for care based on the elderly’s mobility and ability to perform activities of daily living (ADL) and instrumental activities of daily living (IADL).  ADL consists of six items:  dressing, bathing, eating, moving from bed to chair, using the toilet, and continence. The IADL category includes more complex activities such as housework, cooking, shopping, managing money, and taking medications.

Those with difficulty in activities of daily living (ADL) were classified as level 1 dependents.

Those with difficulty in ADL and cooking, shopping, and taking medications were classified as level 2 dependents.

Those with any difficulty in ADL or IADL were classified as level 3 dependents.

Trends in functional dependency of older adults between 2011 and 2020. (The Lancet Public Health)
Trends in functional dependency of older adults between 2011 and 2020. (The Lancet Public Health)

The results of the survey indicated that in 2020, 20.61 million elderly in China were level 1 dependents; 36.33 million were level 2 dependents; and 45.3 million were level 3 dependents.

As the population ages, there will be more and more elderly people in need of care in China. Based on the model, the research team predicts that China will see 29.71 million level 1 dependents, 49.07 million level 2 dependents, and 59.32 million level 3 dependents by 2030, a 39 percent increase (14.02 million people) from 2020.

People who are older, female, less educated, live in rural areas, don’t have toilets or running water at home, and live far from health centers tend to need more care, the study noted.

In China, care for the elderly is traditionally provided by the family. Over the past three decades, however, large numbers of adult children have migrated from the countryside to the cities, and the availability of family care in rural areas has declined dramatically. Therefore, reducing the dependency of older adults to address the care burden is regarded as “a prime strategy” by the Chinese regime.

Interestingly, the study noted that dependency across all levels declined between 2011 and 2020. However, that does not offset the projected increase in elderly Chinese, given the country’s shrinking birthrate.

Five Characteristics of China’s Elderly Population

Although aging is a global phenomenon, China’s aging problems differ from that of other countries. According to the China Aging Research Report 2022 published by Chinese macroeconomist Ren Zeping in late September, the aging trend in China presents five characteristics:

1. China already has a huge elderly population. In 2020, China had 191 million people over the age of 65 (note: the author’s age limit differs slightly from that referenced in the Peking University study) or 13.5 percent of the population. It is expected that by 2057, the number of people over 65 years old in China will peak at 425 million, accounting for 32.9 percent to 37.6 percent of China’s total population.

2. China is aging more rapidly than other countries. In 2001, the population over 65 years old in China exceeded 7 percent, marking the beginning of an aging society. In 2021, the population aged 65 or above accounted for over 14 percent. It only took 21 years for China’s population to become “deeply aging”—a much more rapid shift than France’s 126 years, Britain’s 46 years, or Germany’s 40 years.

3. Extreme aging and empty-nest problems are increasing. The number of people aged 80 or above in China is 36.6 million in 2020 and is expected to rise to 159 million by 2050. The very elderly face more serious health problems. In addition, increased migration from rural to urban areas means an increased number of empty-nesters and elderly people living alone.  This offsets the advantage of family-based care that has been a tradition in China.

4. China’s old-age dependency ratio has risen significantly, concentrating the burden of elder care. The old-age dependency ratio is 19.7 percent in 2020 and is expected to exceed 50 percent in 2050, meaning that for every two young people there is one old person to support. The high cost of caring for the elderly and raising children puts pressure on young people from both sides.

5. Chinese people age more rapidly than they increase in wealth. China’s per capita GDP is close to the lower limit of developed economies, but its aging rate of 13.5 percent is already higher than the average level of 10.8 percent of middle and high-income economies. In addition, many elderly Chinese are still helping to support their families. Elderly Chinese face the double pressure of heavy economic burdens and inadequate pensions.

A Chinese woman in her 90's, living alone in Shaoxing, Eastern China's Zhejiang Province. (Epoch Times)
A Chinese woman in her 90's, living alone in Shaoxing, Eastern China's Zhejiang Province. (Epoch Times)

Zero-COVID Discourages Childbearing

The main causes of population aging are an increase in life expectancy and a decline in fertility. The Chinese regime has adjusted its fertility policy in recent years, changing the “one-child policy” to a “two-child policy” and then a “three-child policy.” However, the changes does not appear to have had a significant effect, due in part to the COVID-19 pandemic.
More Chinese women are delaying or even giving up childbearing in the face of the Chinese Communist Party’s strict “zero-COVID” policy, and the number of babies born in China in 2022 has fallen to a record low, Reuters reported on Aug. 8.
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