A research agenda for ageing in China in the 21st century (2nd edition): Focusing on basic and translational research, long-term care, policy and social networks

Abstract

One of the key issues facing public healthcare is the global trend of an increasingly ageing society which continues to present policy makers and caregivers with formidable healthcare and socio-economic challenges. Ageing is the primary contributor to a broad spectrum of chronic disorders all associated with a lower quality of life in the elderly. In 2019, the Chinese population constituted 18 % of the world population, with 164.5 million Chinese citizens aged 65 and above (65+), and 26 million aged 80 or above (80+). China has become an ageing society, and as it continues to age it will continue to exacerbate the burden borne by current family and public healthcare systems. Major healthcare challenges involved with caring for the elderly in China include the management of chronic non-communicable diseases (CNCDs), physical frailty, neurodegenerative diseases, cardiovascular diseases, with emerging challenges such as providing sufficient dental care, combating the rising prevalence of sexually transmitted diseases among nursing home communities, providing support for increased incidences of immune diseases, and the growing necessity to provide palliative care for the elderly. At the governmental level, it is necessary to make long-term strategic plans to respond to the pressures of an ageing society, especially to establish a nationwide, affordable, annual health check system to facilitate early diagnosis and provide access to affordable treatments. China has begun work on several activities to address these issues including the recent completion of the of the Ten-year Health-Care Reform project, the implementation of the Healthy China 2030 Action Plan, and the opening of the National Clinical Research Center for Geriatric Disorders. There are also societal challenges, namely the shift from an extended family system in which the younger provide home care for their elderly family members, to the current trend in which young people are increasingly migrating towards major cities for work, increasing reliance on nursing homes to compensate, especially following the outcomes of the 'one child policy' and the 'empty-nest elderly' phenomenon. At the individual level, it is important to provide avenues for people to seek and improve their own knowledge of health and disease, to encourage them to seek medical check-ups to prevent/manage illness, and to find ways to promote modifiable health-related behaviors (social activity, exercise, healthy diets, reasonable diet supplements) to enable healthier, happier, longer, and more productive lives in the elderly. Finally, at the technological or treatment level, there is a focus on modern technologies to counteract the negative effects of ageing. Researchers are striving to produce drugs that can mimic the effects of 'exercising more, eating less', while other anti-ageing molecules from molecular gerontologists could help to improve 'healthspan' in the elderly. Machine learning, 'Big Data', and other novel technologies can also be used to monitor disease patterns at the population level and may be used to inform policy design in the future. Collectively, synergies across disciplines on policies, geriatric care, drug development, personal awareness, the use of big data, machine learning and personalized medicine will transform China into a country that enables the most for its elderly, maximizing and celebrating their longevity in the coming decades. This is the 2nd edition of the review paper (Fang EF et al., Ageing Re. Rev. 2015).

Keywords: Ageing policy; Dementia; Inflammageing; Oral ageing; Sexually transmitted diseases; Square dancing.

Fig. 1

Age-related demographic factors and the changing population demographics over time, as well as disease demographics in the elderly in Mainland China. A. Changes of crude death rate (CDR), total fertility rate (TFR), % population ≥ 65 years old, and life expectancy at birth (years) from 1950 to 2050. B. The changing population demographics in China in 1950, 2019, and a predicted figure in 2050. Horizontal bars are proportional to number of males (blue) and females (red). *For 1950, data of 5-year groups over 80 are absent, thus are shown in 80 + . Data source: Population Division of the Department of Economic and Social Affairs of the United Nations. (see: https://population.un.org/wpp for more details). C-D. Demographics showing the major diseases affected to (C), and death in (D) the elderly in China between 1990 (yellow) and 2017 (green). Data source: Global Burden of Disease Study 2017 (GBD 2017) Results, Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2018. Available from http://ghdx.healthdata.org/gbd-results-tool.

Fig. 2

Morbidity and mortality of selected diseases by age in 2017and 1990. (AB)— Morbidity (A) and mortality (B) in the elderly in China in 2017. (CD)— Morbidity (C) and mortality (D) in the elderly in China in 1990. The three age groups used were <20 years, 20-65 years, and >65. Data source: Global Burden of Disease Study 2017 (GBD 2017) Results, Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2018. Available from http://ghdx.healthdata.org/gbd-results-tool. (E) Disability-adjusted life years (DALYs) (millions) in the elderly (65+) in China in 2017.

Fig. 3

A summary of morbidity and mortality of major infectious diseases in China. A-B. Reported infectious cases (A) and death cases (B) of statutory top 10 infectious diseases by Chinese Center for Disease Control and Prevention (CCDC) in 2017. C-D. The top 5 infectious cases (C) and death cases (D) of the 65 years or older in 2016. E. The morbidity and mortality of viral hepatitis, pulmonary tuberculosis (P.TB), influenza, HIV infection and AIDS by Age. The 3 age groups used were as <20 years, 20-65 years, and 65 years or older. F. The morbidity and mortality of the subtypes of viral hepatitis by Age. The 3 age groups used were as <20 years, 20-65 years, and 65 years or older. G-H. Morbidity and mortality trends of five infectious diseases by age from 2004 to 2016. The morbidity (C) and mortality (D) rate (per 10,000 people) of viral hepatitis, pulmonary tuberculosis (P.TB), influenza, HIV infection and AIDS from 2004 to 2016 were extracted and presented as general (open) or aged (65 years or older, closed) population. All data were collected from China Public Science and Health Data Center (CPC) (www.phsciencedata.cn).

Fig. 4

Yearly increase of the Chinese centenarians as well as gender, regional, and geographical differences. A-B. Changes of the numbers of centenarians in China over time. By 2017, the population of near-centenarians (those aged 95+, A) and centenarians (B), increased nearly 10 % per year. The data exacted from the Population Sample Survey (2003-2009, 2011-2017), the 6th Population Census of China (2010) and projection (2020-2050) of China's National Bureau of Statistics. C. Women account for 75 % of the total number of centenarians in China and the proportion of rural centenarians is far higher than that of urban area. Data source: China's 2010 population census, excluding Hong Kong, Macau and Taiwan area. The map was made by R. D. Geographical distribution of the relative number of centenarians. The proportion of centenarians in China's total population (centenarian ratio) has a significant regional imbalance. Data, China's 2010 population census, excluding Hong Kong, Macau and Taiwan area.

Fig. 5

A summary of responses to achieve healthy longevity of the elderly in China. In response to the ageing society and in order to improve the quality of life of the elderly in China, strategies at societal, individual, and cellular levels are presented, detailed in the text. The art of traditional Chinese paper cutting ‘松鶴延年’ (May you enjoy longevity like the pines and the cranes, whereby both considered long living in Chinese culture) was from shutterstock with paid standard license.