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China's 1-child policy could backfire on its elderly

August 29, 2007

Saint Louis University researcher reflects concerns in journal article

ST. LOUIS -- China's efforts to control population growth in the present may cause problems for the county's senior citizens in the future.

This prediction comes from a Saint Louis University School of Medicine researcher who spent a year in China studying its geriatric policies and practices.

Joseph H. Flaherty, M.D., associate professor of internal medicine in the division of geriatric medicine at Saint Louis University, said China's 1979 policy of limiting couples to one child may leave some older Chinese without a family member to care for them.

"Everything is fine right now. Today's older Chinese had no restrictions so they had five or six children. They have plenty of caregivers. But these caregivers were limited to having a single child. What happens in 30 years when they turn 80" Their support will fall entirely on that only child. And, what if that child marries" Now you're talking about caring for four older adults.

"The Chinese tradition of taking care of your family is strong -- maybe the strongest in the world -- but I don't know whether that tradition is going to be strong enough to counterbalance the pressures of today's society."

Flaherty says those pressures include finding a job. Both men and women are expected to work in China today and the pressure to find work forces people to move around.

"In the past, it was almost forbidden for you to move away from your family, your city or your village but now, it's necessary if you want to find work. Are you going to take your 80-year-old parents with you" If you're married, are you going to take both sets of parents with you" These are questions I don't think were considered when the one-child policy was instituted."

Flaherty notes that couples with money can hire a baomu, a type of live-in maid who provides care for an older person. But while this person may have eldercare training there are no standards.

Flaherty spent a year (October 2005-September 2006) visiting Chinese homes, universities, hospitals and nursing homes in three major cities: Beijing, Shanghai and Chengdu -- all cities with populations of more than 10 million. His findings and experiences are contained in his article, China: The Aging Giant, in the August issue of The Journal of the American Geriatrics Society.

Flaherty says that by 2030, 336 million Chinese will be over the age of 60. If the burden of care for senior citizens shifts from family to facilities, such as nursing homes, the country would be unprepared. While China has nursing homes, it has far fewer than most developed countries. It is predicted that Beijing alone would have to construct 48 new nursing homes a year to keep up with the aging population.

On the up side, Flaherty observed that the Chinese elderly who are in nursing homes appear to be happier than many of their U.S. counterparts in nursing homes.

"One big reason is room. Chinese elderly who live at home are usually living with multiple generations in an apartment or flat. In a nursing home, they have their own room, maybe even their own bathroom. Being placed in a nursing home is not necessarily a negative experience in China, which was refreshing to see."

Flaherty also was impressed with the community networks Chinese elderly establish for themselves.

"Here in the United States, it's easy for an older adult to become isolated. They drive to the store, get what they need and come home. In China, the cities are so overcrowded it's almost impossible not to socialize. You don't drive as much. You walk. If you are older, you have to get out and shop because your children are busy working. You have to engage with your neighbors because they're right on top of you. I think this forced socialization and the walking keep them healthy."

Flaherty says it is important to keep an eye on China's policies toward its aging population because within 25 years the country will be a leading power. How China treats its elderly may be mimicked by other countries.

Flaherty, who also has studied aging in Japan and Hong Kong, expects to go back to China in October for follow-up studies.

Saint Louis University