3.7 RAPID GROWTH OF THE ELDERLY POPULATION IN CHINA
1982 (18), then continuously decreased to 15.23 per thousand in 1999 (19), and to 12.3 per thousand by 2004. The annual growth rate of the population has also consistently declined from 25.83 per thousand in the 1970s to 5.87 per thousand in 2004(22).
Just 30 years ago the country was concerned that it had too many children to support, but today the country is facing the opposite problem—there are now too few young people to provide for such a rapidly aging population. Figure 3.12 presents the most recent population pyramids for China, which show the projected change of population structure between 2000 and 2050. As reported by the State Bureau of Statistics(22), the population aged>65 years exceeded 100 million in China in 2005, accounting for 7.7% of the total population and an increase of 3%
from 2000 (Table 3.3).The growth of the elderly population in China is faster than the overall growth of the total population. The average annual increase of total population for those aged 65+ and 80+ was 2.68 and 4.67% from 2000 to 2005, compared to 0.63% for total population growth during the same span(23).
2050 2000
Fig. 3.12. Population pyramids for China: 2000 and 2050.
Source:World Population Prospects: The 2004 Revision(2005).
Table 3.3
Size and proportion of the elderly population in China by year 2000–2005 Year-end figure in millions
Year
Total population
Elderly population (65+)
Proportion of elderly population (%)
2000 1267.43 88.11 7
2001 1276.27 90.62 7.1
2002 1284.53 93.77 7.3
2003 1292.27 96.92 7.5
2004 1299.88 98.57 7.6
2005 1307.56 100.55 7.7
Source: Feng N, Xiao N.23rd Population Census Conference,Christchurch, New Zealand(23).
46 Wang and Bales
China is considered by Western standards to be a youthful country, with the elderly constituting only a moderate percentage of population. However, with a population of 1.3 billion, of which 7.8% is aged> 65 years, China has a larger total number of people aged > 65 years than in all European countries com- bined. In addition, the trend of population aging in large urban cities is much faster than in small cities and rural areas. For example, in 2004, the percent of people in Shanghai and Beijing aged > 65 years had already exceeded 15 and 10%, respectively (22).
3.7.2 Nutritional Status and Health Behaviors of Chinese Older Adults The previously reviewed changes in Chinese dietary patterns have important implications for health and the prevalence of chronic disease for those currently aged and those entering this demographic group in the near future. With an increase in prevalence of OW and OB of the middle-aged population, it is predicted that related chronic health conditions, including CHD, T2D, and cancer, will affect an unprecedented number of older people. On a more positive note, the prevalence of malnutrition has consistently declined in all populations of China, particularly within the category of those aged > 60 years, although there is still a disparity between urban and rural residents. The prevalence of malnutrition decreased from 9.0 and 20.3% in 1992 to 5.4 and 14.9% in 2002 for urban and rural populations, respectively.
3.7.2.1 CIGARETTESMOKING
Because health behaviors often cluster, we examined other important lifestyle factors to help gauge the current trends of adherence to prudent versus poor choices, looking at rates of smoking and alcohol use and physical activity patterns overall and in older adults. China has the largest number of cigarette smokers of any country in the world. As reported in the 2002 China National Health and Nutrition Survey, more than 50% of men aged 15 and above currently smoke, while fewer than 3% women of the same age group are smokers. About 62.5% men aged 50–54 are smokers (Fig. 3.13a), and 40% of those aged 75 and older report smoking. The overall smoking rate for people 15 years and older was higher in the rural (37.8%) than in the urban population (29.5%) in 2002, while the percentages were 39.2 and 34.5%, respectively, in 1996. Thus the smoking rate has slightly decreased in recent years, but most of the reduction was in urban rather than in rural areas(24). A 2005 report indicated that cigarette smoking was responsible for 7.9% of the total mortality in China; not surprisingly, the estimated risk was higher among men than women(13). With the high prevalence of smoking in China, lung cancer has consistently increased as a cause of mortality, moving from the 4th leading cause of death (in the 1970s) to the No. 1 leading cause of death among all cancers in the Chinese population in 2000. From 2000 to 2005, the incidence of lung cancer continued to increase, from 43.0 to 49.0 per 100,000 in males, and from 19.1 to 22.9 per 100,000 in females, increases of 14 and 20%, respectively(25). Elevated mortality risks from all causes were observed for current smokers of both sexes in a Chapter 3/ Global Graying, Nutrition, and Disease Prevention 47
3-year longitudinal study of 2,030 Hong Kong Chinese subjects aged>70 years, indicating that the effect of smoking on health is still apparent at older ages(26), and thus smoking cessation would be beneficial even at advanced ages.
3.7.2.2 ALCOHOLCONSUMPTION
Figure 3.13 b shows the proportion of Chinese who regularly consume alcohol (mainly liquor with 40–60% alcohol content). About 40% of men and 4.5% of women reported regularly drinking alcohol; men aged 50–54 showed the highest percent of alcohol use (48.4%). Alcohol use also appeared to decrease with age, and
0 10 20 30 40 50
%
50 55 60 65 70 75
Age in years
Men Women b
0 10 20 30 40 50 60 70
%
50 55 60 65 70 75
Age in years
Men Women a
Fig. 3.13. a: Percentage of smokers in the population by age and gender.b:Percentage of alcohol drinkers in the population by age and gender.
Source: Ma G, Kung L. Behavior and Lifestyle People’s Publishing House: Beijing, China, 2006(27).
48 Wang and Bales
urban residents had slightly lower consumption rates than rural residents(27). In recent decades, increase in alcohol consumption and related problems in China have become significant. While alcohol is a traditional part of Chinese life, commercial alcohol production in China has increased more than 50-fold per capita since 1952 (Fig. 3.14). Evidence suggests that people living in Northern China have higher levels of alcohol consumption than those in the south, that urban residents drink lower-strength beverages than do rural residents, and that some minority ethnic groups, such as those of Tibetan and Mongolian background, drink more than other ethnic groups(28). Evidence also indicates a marked increase in the preva- lence of alcohol dependence, which has become the third most prevalent mental illness in China(29).
3.7.2.3 PHYSICALACTIVITYBEHAVIORS
He et al.(13)linked physical inactivity with 6.8% of the total mortality in China, with the estimated risk of death being slightly higher among men than women and among urban residents than rural residents (especially among women). However, Chinese elderly are living quite actively in general, as most people over the age of 60 years do not own a car or drive. People who still work must walk to take a bus/
subway/train or ride a bike to go to the work place, while many elderly people take care of their grandchildren, the housework, and daily grocery shopping and exercise every day after retiring from work. Moreover, as illustrated in Fig. 3.15, participa- tion in organized programs of physical activity is quite common in the older Chinese community. Findings from the 2002 China National Health and Nutrition Survey indicated that those who participate in regular exercise were mostly those aged 50 and older (Table 3.4). About 9% men and 10% women aged 50–54 reported participating in regular exercise, with the most active group (21%) being men aged 70–74 (older age groups showed a decrease in activity). For women, the highest Fig. 3.14. Adult consumption of alcohol in China (per capita) from 1961 to 2001.
Source: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003.
Chapter 3/ Global Graying, Nutrition, and Disease Prevention 49
percent (17%) participating exercise was observed for those aged 65–69. A very large proportion of elderly people reported participating in exercise more than 3 times each week. Table 3.5 shows self-reported physical activity levels for men and women aged 50 and over who exercise regularly. There were more than 50% of men and 43% of women aged 50–54 who reported heavy physical activity levels, although the number declined with age(27).
Fig. 3.15. Organized physical activity for older adults is common in Chinese communities. Here, in the ‘‘Temple of Heaven Park’’ in Beijing, older adults (aged around 50 years and up, the typical age for retirement in China) gather daily to participate in a variety of group activities.
Table 3.4
Percent of Chinese adults (aged>50 years) who exercise regularly
Age group Men (%) Women (%)
50– 9.2 10.0
55– 13.2 13.9
60– 17.6 17.3
65– 20.5 17.3
70– 21.2 13.9
75– 17.4 9.5
Source: 2002 China National Nutrition Survey.
50 Wang and Bales
In summary, lifestyle choices in China continue to be shaped more by traditional parameters rather than any newly instituted efforts to pursue healthier behaviors.
Thus, while the negative risk factors of smoking and heavy alcohol use are continu- ing or increasing, the tradition of physical activity also continues as an important positive determinant of health.
3.7.3 Causes of Death, Illness, and Disability in Older Chinese Adults 3.7.3.1 LEADINGCAUSES OFDEATH
Age is an important risk factor for all degenerative diseases, along with factors of changing lifestyles and dietary patterns. Similar to the general population, the leading causes of death in older Chinese are also dominated by chronic diseases. CHD, stroke, and cancer are shown to be the top three causes of death for people aged 65+, ranking 8.1, 6.5, and 2.9 times higher than in those aged<65 (Fig. 3.16)(13).
Table 3.5
Physical activity levels of Chinese adults (aged>50 years) who exercise regularly Age group
Men (%) Women (%)
Light Moderate Heavy Light Moderate Heavy
50– 27.7 16.3 56.0 41.2 16.0 42.8
55– 35.0 14.8 50.0 50.5 14.0 35.5
60– 45.6 12.4 42.0 58.5 15.2 26.3
65– 51.7 13.9 34.4 65.8 14.7 19.6
70– 64.6 12.0 23.4 76.3 12.2 11.6
75– 76.9 8.4 14.7 86.4 7.4 6.5
Source: 2002 China National Nutrition Survey.
32.6 32.9
159.1 171.5
265.9 125
227.4
784.1
1121.4 1286.9
0 200 400 600 800 1000 1200 1400
Infectious disease Accidents & influenuza Heart diseases Stroke Cancer
< age 65 Infectious disease Pneumonia & influenuza Cancer Stroke Heart disease Age 65+
Fig. 3.16. Cause of death in China (100,000 person/yr) for those#65 and<65 years of age.
Source: He et al.(13).
Chapter 3/ Global Graying, Nutrition, and Disease Prevention 51
The prevalence of certain chronic health problems is shown in Table 3.6, for both urban and rural male and female populations. T2D, obesity, and high total choles- terol are 1.9-, 1.5-, and 1.3-fold higher in urban compared to rural areas for the older age group, with a similar regional pattern observed in the younger age group. Women have a higher occurrence of all diseases than men in both age groups(30).
3.7.3.2 SPECIALCONCERNSABOUTALZHEIMER’SDISEASE ANDQUALITY OFLIFE For a country with an already large and rapidly growing proportion of elderly, the increasing prevalence of Alzheimer’s disease (AD) is a major health issue affecting nutritional and overall quality of life. While AD is unfamiliar to most people in China, a recent survey by the Peking Union Medical College Hospital of 34,807 people aged>
55 years from Beijing, Xian, Shanghai, and Chengdu revealed that China had 3.1 million Alzheimer’s patients, accounting for 5.9% of the population above age 55 years.
The death rate due to Alzheimer’s disease was 14.4 out of 100 affected persons per year in China, similar to findings for Japan, England, and the United States(31). AD was more common in northern than southern China and in women than men.
Due to poor understanding of this disease, AD has been largely ignored by the Chinese public. The Peking Union Medical College Hospital study also found that only 23.3% of China’s AD patients sought medical advice, with 21.3% ultimately receiving medical treatment(31). About 48.8% of the study participants believed that the disease was a normal part of aging and nearly 96% of the people who took care of AD patients had never received any form of standard training.
3.7.3.3 OTHERRISKFACTORS FORPOORHEALTH-RELATEDQUALITY OFLIFE
Other health problems such as arthritis, hearing loss, dental disease, gastroin- testinal conditions, liver disease, and various disabilities may also interact with the Table 3.6
Percentage of Chinese adults with chronic health problems by age cohort
Total Men Women Urban Rural
Age 45–59 years
Overweight 29.0 26.3 31.4 37.4 25.8
Obesity 10.2 7.2 12.9 15.1 8.4
Hypertension 29.3 28.6 30.0 32.8 28.0
Diabetes 4.3 3.4 4.6 7.8 3.0
High cholesterol 4.7 4.0 5.4 7.0 3.9
High triglyceride 15.7 16.1 15.5 20.4 13.9
Age>60 years
Overweight 24.3 23.5 25.2 37.2 19.5
Obesity 8.9 6.6 11.2 16.0 6.2
Hypertension 49.1 48.1 52.0 54.4 47.2
Diabetes 6.8 6.5 7.1 13.1 4.41
High cholesterol 6.1 4.0 8.3 10.6 4.5
High triglyceride 14.8 11.8 17.7 20.5 12.6
Source: 2002 China National Health and Nutrition Survey.
52 Wang and Bales
need for dietary and other long-term care services for elderly Chinese individuals.
Psychological changes, especially depression, may also influence the nutritional and health status of some Chinese elderly; unfortunately, these changes have yet to be adequately studied in China.
3.8 TRADITIONAL VIEWS OF AGING IN CHINA: A POSITIVE