(July 2010) Over the past two decades, China’s population has been aging rapidly. As a result of China’s “one-child” policy and low mortality, the proportion of elderly citizens will continue to grow very quickly, increasing the stress on an already troubled health care system.

The Division of Behavioral and Social Research at the National Institute on Aging (NIA) supports research on the health of China’s elderly population. This work has contributed to understanding the characteristics of China’s oldest-old (ages 80 and older) and the dilemmas in meeting their health care needs. This newsletter reviews some recent research—both NIA-sponsored and other research—that explores these challenges.

Demographic Context

China adopted a one-child policy in 1979 in order to stem population growth and ensure economic stability. This policy prohibits couples from China’s ethnic majority from having more than one child. The policy did slow population growth, increasing access to vaccinations and to improved disease care and treatment. But with fewer children and improved living standards, the proportion of elderly in China’s population has grown substantially over the last 20 years. By 2000, China’s population ages 65 and older was almost 90 million, and the elderly could number well over 300 million by 2050 (Figure 1). The cohort of oldest-old was 12 million in 2000 and, by 2030, could number over 40 million (Kincannon, He, and West 2005).

Growth of China’s elderly population is happening at a time of rapid increase in urbanization and industrialization, all of which have weakened traditional family support networks (Jackson 2010). Because of a limited institutional care system, China’s elderly have predominantly received care in the home; only 2 percent are institutionalized. The elderly living in institutions are more likely to reside in urban areas, have less access to family-care resources, and exhibit poorer health than community-residing elders (Gu, Dupre, and Liu 2007). Yet, according to Gu and colleagues, poor health is not the primary indicator of institutionalization. The elderly who remain in the community are able to do so primarily because they have familial support and care. But as the elderly population continues to grow and the availability of family caregivers decreases, more elderly with poor health will need to seek care in institutions.

Will Thompson is an intern at the Population Reference Bureau.