Elderly Care Provision and the Impact on Caregiver Health in China

• Published date: 01 September 2022
• Author: Jingyi Ai,Jin Feng,Yangyang Yu
• Date: 01 September 2022
• DOI: http://doi.org/10.1111/cwe.12443

©2022 Institute of World Economics and Politics, Chinese Academy of Social Sciences

China & World Economy / 206–226, Vol. 30, No. 5, 2022

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*Jingyi Ai, Post-doctoral researcher, Fudan Institute on Aging, Fudan University, China. Email: jyai19@fudan.edu.cn;

Jin Feng (corresponding author), Professor, School of Economics, Fudan University, China. Email: jfeng@

fudan.edu.cn; Yangyang Yu, Associate Professor, Shanghai University of Finance and Economics, China.

Email: yu.yangyang@mail.shufe.edu.cn. This research was supported financially by the National Natural

Science Foundation of China (No. 71974036) and Humanities and Social Sciences of Ministry of Education

Planning Fund (No. 19YJA790111).

Elderly Care Provision and the Impact

on Caregiver Health in China

Jingyi Ai, Jin Feng, Yangyang Yu*

Abstract

With the fast pace of population aging, industrialization, and urbanization in China, the

main source of elderly care is changing. Using China Health and Retirement Longitudinal

Survey data, we investigate the elderly care provision situation and fi nd that spouses are

currently the most important elderly care providers in China. We use a model to depict

the trade-off between a caregiver’s own health and the care quality obtained by the care

recipient. The model predicts that under some conditions, the caregivers will provide

care at the cost of their health. Employing a stratifi ed propensity score matching method,

we fi nd that spouses’ caregivers are more likely to have depression, physical pain, and

hypertension than noncaregivers. The negative effects are larger for caregivers with

a high level of care intensity or less support from other resources. Female spousal

caregivers tend to suffer more from depression and physical pain than male spousal

caregivers. Our fi ndings suggest that policies toward “healthy aging” should target not

only the disabled elderly but also their spousal caregivers who are also elderly people.

Keywords: elderly caregiver, health of the elderly, population aging

JEL codes: I14, J14, J16

I. Introduction

Population aging in China is driving an increasing demand for elderly care, similar to

other aging societies. There were 180 million older people with chronic diseases in 2019

among the Chinese population and 40 million older people with disabilities affecting

their activities of daily living (ADLs) or instrumental activities of daily living (IADLs).

Home-based care provided by family members as caregivers is the main source of

©2022 Institute of World Economics and Politics, Chinese Academy of Social Sciences

Elderly Care Provision and Caregiver Health 207

elderly care worldwide. In the tradition of Chinese fi lial piety, children were the primary

caregivers in the past. However, shrinking family sizes, low fertility rates, and socio-

economic changes are making it increasingly diffi cult for adult children of the elderly to

fulfi ll their traditional duties. Due to the fast pace of industrialization and urbanization,

an increasing number of young adults migrate to larger cities to pursue job opportunities

and improve their competitiveness in the labor market. Thus, more elderly people are

“left behind” in rural and semi-rural areas. As in some Organisation for Economic

Co-operation and Development (OECD) countries (Groenou et al., 2013; Bertogg and

Strauss, 2020), the spouse is becoming a primary source of elderly care in China.

Providing elderly care is physically and emotionally demanding, especially for

spousal caregivers who are also older people. The literature shows that caregiving has

adverse eff ects of providing care on their own health (Bom et al., 2019; Schmitz and

Westphal, 2015; Bertogg and Strauss, 2020). Even though spousal caregivers may

recognize the adverse effects on their own health of providing care, their altruistic

motives and compassion also play a role in the decision-making. When the price of

home-based care provided by the market is high, and the quality of such service is not

satisfactory, taking on the responsibility for an elderly spouse is a rational decision.

From a policy perspective, “healthy aging” has been recognized as a priority globally,

and China is making robust eff orts toward this goal.1 While healthy aging policies have

emphasized caring for older people with disabilities, our study suggests that the health

of spousal caregivers is an additional topic that requires special focus.

The paper is the fi rst study to identify the eff ects of elderly caregiving on spousal

caregivers’ health using survey data and strict identifi cation strategies in China. Some

studies for the OECD countries have found adverse eff ects on the physical and mental

health of caregivers (Hirst, 2005; Coe and Van Houtven, 2009; Litwin et al., 2014;

Schmitz and Westphal, 2015; Kaschowitz and Brandt, 2017), whereas Schmitz and

Westphal (2015) found that the effects on caregivers’ mental health fade over time

and there are no significant effects on their physical health. Roth et al. (2018) found

that caregiving positively correlates with caregivers’ mortality rate. Some studies have

specifi cally investigated the health eff ects on spousal caregivers and found signifi cant

adverse eff ects (Jenkins et al., 2009; Sandoval et al., 2019; Bertogg and Strauss, 2020),

which are explained by the age of caregivers and the close relationships between

caregivers and care recipient s.

1Healthy aging is a term introduced by the World Health Organization (WHO) at the World Health Assembly

held in 1987 (https://apps.who.int/iris/handle/10665/163849). The WHO defi nes healthy aging as “the process

of developing and maintaining the functional ability that enables wellbeing in older age” (WHO, 2017. p. 1).