Charlotte Ikels

The Experience of Dementia in China

This paper reports the results of a longitudinal study carried out in urban China on the health and mental status of 200 elders 70 years of age or older and focuses on the experience of dementia. While older people and their families are aware of the phenomenon of dementia, it does not evoke the kind of dread that is common among Americans. This different response can be traced to beliefs about dementia, cultural values, and situational features of contemporary Chinese life.

Constructing and deconstructing the self: Dementia in China

Within the research and clinical communities inChina senile dementia is recognized as either aprogressive neurological disease that isassociated with aging but is not an inevitablepart of it or as a concomitant of vasculardisease. These understandings are onlypartially shared by ordinary Chinese many ofwhom, on the contrary, view dementia as anatural aspect of aging. Nevertheless theelderly seem less fearful and family membersless appalled by the prospect of dealing withdementia than is the case in countries like theUnited States. While high rates ofintergenerational co-residence and othersituational factors moderate the impact ofdementia and facilitate the delivery of care tothe demented, these facts alone areinsufficient to account for these differentresponses. Rather four cultural concepts: (1)the heart/mind, (2) the nature of morality, (3)the nature of the self, and (4) filial pietytaken together construct a distinctiveexperience of dementia in China that preservesthe self far longer and rewards the care-givermore profoundly than is the case in the UnitedStates.

Aging and disability in China: Cultural issues in measurement and interpretation

Aging is no longer an issue of concern only to industrialized countries. Recent estimates project that by the year 2000 there will be 590 million people aged 60 or older worldwide. Of these 590 million approximately 61% will be living in lesser developed countries. Thus, these countries will shortly face critical decisions concerning the impact of these aging populations on state plans for economic development. China, the country with the largest anticipated number of elderly in the world, provides an instructive case of how one developing country is attempting to balance the needs of the elderly with those of the nation as a whole. In particular the rapid aging of the Chinese population has prompted official concern about the financial implications of providing health care to increasing numbers of disabled or frail elderly. This paper reports the efforts of one study to determine the extent of disability and frailty among the urban elderly and the strategies they and their family members have developed to cope with it. The research was conducted between June 1987 and January 1988 in two neighborhoods of Canton, the capital of Guangdong Province. Two hundred households, each containing at least one member 70 years of age or older, were randomly selected from household registration lists. In each household a 1-2 hr interview was conducted with the elder (or, in the case of those too disabled to participate, a proxy) on the following topics: personal background, proximity and contact with kin, household composition and organization, health and functionality, use of medical services, work history, income sources, daily activities, and attitudes regarding intergenerational relations. The paper is divided into five parts addressing the following topics: (1) China and research on aging, (2) comparative data--problematic aspects, (3) methodological issues to consider when investigating disability, (4) the findings of the study, and (5) the significance of ideological, environmental, and political factors in mediating the experience of age-associated disability in China.

Perceptions of the Adult Life Course: A Cross-cultural Analysis

A team of seven anthropologists conducted a coordinated, cross- cultural investigation to examine how structural and cultural variables shape the strategies people employ to assure themselves a secure old age. Central to the investigation was the goal of determining how people in the societies involved (Hong Kong, the United States, Ireland, and Botswana) perceive old age and its place in the adult life course, e.g. whether they view old age as an improvement or a decrement compared with other stages of life and the characteristics on which they base their views. The seven sites were selected to ensure broad representation in terms of the key structural variables of scale, complexity, subsistence pattern, residential mobility, and population structure. Both across and within sites people differed in their willingness and ability to discuss the concept of the life course. We attribute this variation to five factors: (i) characteristics of the social field, (2) education, (3) cultural salience of age categorisation, (4) predictability of life events, and (5) variability in timing of normative social or work roles.

Economic Reform and Intergenerational Relationships in China

The process of modernization in China is occurring in a context of rapid population ageing—the reverse of the sequence in the West—and presents serious challenges to the tradition of reliance on family and work unit support. This paper examines the impact of post-Mao economic reform, including the de-collectivization of agriculture, the loosening of restrictions on migration, and housing and enterprise reform, on the support systems of Chinas elderly. Delivering family support has become increasingly problematic, and researchers and policy-makers have begun urging the Chinese government to take practical steps to alleviate the situation. They point out that most children are doing whatever they can, but that the financial and opportunity costs of providing care exceed what is possible. They urge the government to address problems of elderly poverty by developing rural pension schemes, major illness insurance and long-term care insurance, by increasing hospital and community health services for the elderly, and by training basic-level workers in the special needs of the elderly.

Household composition of the elderly in two rural villages in the People's Republic of China.

This paper reports on the household composition of a sample of elderly residing in two villages in Zhejiang Province, China, one that is prospering under the post 1978 economic reforms and another that is not. It reveals that while a large proportion of the elderly in both the study villages are part of single generation households, the two villages differ with respect to the composition of the single generation household category. In the prosperous village, 50% of the elderly are living alone or with a spouse and 6% are living “by turns” (rotating between sons residences). In the less prosperous village, 26% are living alone or with a spouse while 22% participate in “by turns” arrangements. The paper suggests that a failure to separate analytically the “by turns” arrangements obscures the extent to which Chinas rural elderly now live in economic units separate from their offspring and masks important aspects of the differential impact of the new economic reforms on the household situation of the elderly in different villages.

The Resolution of Intergenerational Conflict: Perspectives of Elders and Their Family Members

ideally, in accordance with Confucian norms emphasizing subordination of the individual to the family, an authoritarian family hierarchy based on age and gender, and loyalty to the family rather than to the community or state (Hsu, 1985; King and Bond, 1985; Tu, 1985). Despite vigorous challenges to these norms by students and intellectuals during the May Fourth Movement (Chow, 1967) and throughout the Republican period, most of the Chinese population continued to accept arranged marriage, patrilocal residence, and the value of filial piety. In the early years following the establishment of the People’s Republic of China in 1949, Confucian norms were declared &dquo;feudal,&dquo; and individuals were urged to redefine themselves in Marxist terms as members of classes rather than families (Metzger, 1977; Munro, 1977). Authoritarian relationships within the family were denounced: Individuals were given the right to marry or divorce regardless of the wishes of parents and were urged to sacrifice their own as well as their family’s narrow goals for the sake of socialism. The Chinese government quickly realized the potential consequences of undermining traditional family structures and by the late 1950s was reminding young people that they could not shirk their obligations to senior family members (Chen and Chen, 1959). In the late 1970s and early 1980s, official norms began to shift again. The negative impact of political campaigns and of bureaucratic

Parental Perspectives on the Significance of Marriage.

A three year anthropological study among families of Chinese and of Irish ancestry was carried out in the Greater Boston area from 1978 to 1981. The objectives of the study included determining the impact of traditional values, the immigration experience, and life in America on parental expectations of adult children. Interviews and participation in community activities revealed the persistence of traditional attitudes. Their operationalization, however, has been substantially modified. Parents seldom control the career or marital choices of their children, but they continue to expect that adult children will be their comfort in old age.

Ethical Issues in Organ Procurement in Chinese Societies

In the West, the topic of organ transplantation in China has been sensationalized and reduced to discussions of executions.1 This narrowed focus has led to a failure by outsiders to recognize the complex nexus of forces that have led to the Chinese use of executed prisoners as organ sources. It has also led to a failure to acknowledge that there are other ethical issues, less dramatic perhaps but certainly worthy of consideration, involved in procuring organs for transplantation. My goal in this paper is to broaden the discussion to include two other topics ? living donations and presumed consent ? that raise questions of ethics and to look not only at China but at Hong Kong, Taiwan and Singapore as well. All have been performing transplants for over two decades, and despite their political and economic differences they share in common a cultural heritage that influences what is deemed acceptable in the area of transplantation. They are also intimately linked in that organ shortages in Hong Kong, Taiwan and Singapore have propelled their nationals (as well as people from as far away as the United States) to go to China for transplants. I will limit my discussion to kidney transplantation not simply because kidneys are the most frequently transplanted organs but also because they can be obtained from both living and deceased donors and because there are life-

Older immigrants and natural helpers

Since the enactment of the Immigration Act of 1965, immigrants from Europe have been replaced increasingly by immigrants from Latin America and Asia. The latter, in particular, are from societies so dissimilar from the United States that they face major adjustment problems. Many of the older immigrants come as parents of American citizens, but despite reunification with their families, they may experience a sense of isolation due to limited opportunities to interact with other people. Case studies of natural helpers (individuals who are not employed in the helping professions but voluntarily choose to spend part of their time informally helping others) operating within the Chinese community in Boston reveal how their services complement those of the formal sector. The characteristics which make them both approachable and credible to older immigrants as well as their possible recruitment as outreach workers are discussed. ka]Key Words kb]older immigrants kb]natural helpers kb]Chinese community kb]patterns of immigration