The Vanishing Mind
A recreation room at the Shanghai No. 3 Elderly Home, which cares for people with Alzheimer’s disease or dementia.
By DAVID BARBOZA
Published: January 12, 2011
SHANGHAI — Last year, an expensive, red-brick residential complex opened here, equipped with a hair salon, cinema, toy-cluttered game rooms and a karaoke suite offering the latest in pop music.
The Vanishing Mind
A Difficult Road Ahead
Articles in this series are examining the worldwide struggle to find answers about Alzheimer’s disease.
Qilai Shen for The New York Times
Qiu Jinzhen, who is suffering from dementia, at the nursing home in Shanghai.
The residents are not Chinese yuppies. They are older patients with Alzheimer’s disease or dementia in a nursing home that is on the forefront of a new effort by China to deal with its exploding elderly population.
“This is the best place we could imagine,” says Miao Yuqiang, a 49-year-old Shanghai bus driver who helped his 81-year-old mother enroll here. “By the time we found this nursing home, we were desperate.”
While many countries are struggling to cope with rapidly aging populations, in China there are forecasts that within three decades there could be nearly 400 million people over the age of 60 and, partly because of the one-child policy, a declining number of working-age people to care for them.
Recognizing the difficult road ahead, China is beginning to educate the public and the medical community about dementia, and big cities are making plans to build new facilities, like the Shanghai No. 3 Elderly Home.
The shift in attitudes is remarkable. A decade ago, many families were ashamed to admit that their elders had such a disease. And because of a lack of awareness about the disease, many dementia patients were confined to the psychiatric wards of hospitals, which placed steel bars over the windows.
But today, a growing number of families are desperate to place relatives in a nursing home. The problem, health experts say, is that there simply are not enough.
Health experts are predicting severe strains on the state and on working families here. And those strains could be compounded by the lack of awareness about Alzheimer’s disease and other forms of dementia, even among medical professionals in China.
“This is an impending health crisis for China, and it may even exceed what’s happening in the U.S. because of the one-child policy,” said Rhoda Au, an associate professor at the Boston University School of Medicine.
In Shanghai, China’s wealthiest and most dynamic city, an estimated 120,000 residents have Alzheimer’s disease or some form of dementia. But city officials can identify only a handful of nursing homes trained to care for dementia patients.
Worries about the growing ranks of the elderly are amplified by what is being dubbed the 4-2-1 problem. In part because of the one-child policy, soon a single person in China will be expected to help support two parents and four grandparents. And as the elderly live longer, they are more likely to develop dementia, which requires expensive care.
To cope with a severe shortage of nursing homes, Shanghai is proposing what it calls the 90-7-3 plan, which means 90 percent of the elderly will need to be cared for at home, while 7 percent make occasional visits to a community center and 3 percent live in nursing homes.
“We’re planning to build at least one nursing home that can care for dementia patients in every district,” Zhang Fan, deputy director of social welfare at the Shanghai Civil Affairs Bureau, said in a telephone interview. “Every year, we’ll need at least 5,000 additional beds.”
One of the major challenges will be figuring out who will pay for professional care. In the 1990s, China dismantled its old “iron rice bowl” system of cradle-to-grave financial support from the state. It was part of a move toward a more market-oriented economy. But it now means the nation’s social safety net is weak, and care for the elderly is underfunded.
Boston University is now conducting a study to measure dementia rates in China and to identify the factors that lead to higher risk. The aim is to slow the onset of the disorder and alleviate the heavy health care costs.
There is now pressure for speedier action. Although the Chinese have a tradition of caring for their elders at home, families in big cities complain about a lack of options.
Lu Peiyu has been struggling to find a place for her 63-year-old husband, who received a diagnosis of dementia three years ago. A former accountant, he is sitting at home because no one can be found to treat him.
“We thought about sending him to hospitals, but he ran away twice in two years,” said the man’s son-in-law. “The problem is there’s so far not a single nursing home that offered a suitable place for my father-in-law. Professional hospitals are all filled up, and private nursing homes don’t have qualified people.”
Mr. Miao, the Shanghai bus driver, is among those fortunate enough to have found a nursing home that can treat dementia.
His family’s ordeal is common here. Two years ago, his elderly mother began showing signs of memory loss after striking her head on the pavement outside her home.
She was hospitalized for a month. When she returned home — where she lived with her youngest son, Mr. Miao, his wife and their then 20-year-old son — she began to show signs of severe memory loss.
“She started getting lost on the street,” said the woman’s daughter-in-law, Luo Yuqin. “She’d even forget to turn off the boiling water on the stove.”
Today, Mr. Miao’s mother is at the Shanghai No. 3 Elderly Home and uses a wheelchair. She has lost her ability to speak and is prone to emotional fits, Mr. Miao said.
Mr. Miao visits her twice a week. A few Saturdays ago, he came with snacks and a plastic bag stuffed with hard-boiled eggs.
“Ma, is everything O.K.?” he said as he fed his mother from a small bottle of milk. Then, Mr. Miao’s wife jumped in, saying: “They really take care of her. We’re working people. We both drive a bus long hours. What would we do without this place?”
Dr. Zhang Naizi, president of the Shanghai No. 3 Elderly Home, says the center tries to care for dementia patients with a system of personalized attention that was first developed in Europe. The system includes keeping the patients active with memory games and insisting that the nursing staff constantly make hand contact with the patients, by simply rubbing their arms or hands while speaking to them, hoping to make them feel more secure.
He says the new facility has a multimedia room that can display images of Shanghai streets, and even images that appear to show the neighborhoods of the patients. This is supposed to make them feel at home. Many patients also wear GPS armbands that help the staff monitor their locations.
“I am proud to say we’re the first professional center for dementia patients,” Dr. Zhang said. “We are the first in the whole country. Ten years ago, dementia patients were sent to psychiatric wards. Things are different now.”
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