Introduction

3.1.1 Population aging in China

The United Nations defines aged society as 10% of the total population in a country (or region) being aged 60 years old and above. Another definition is if those aged 65 years old or over account for 7% of the total population, country or region (Xu, 1998).

According to the 1% population sampling survey report of China conducted in 2005 by the National Bureau of Statistics of China, there were 144.08 million older persons aged 60 or over, who accounted for 11.03 percent of the total Chinese population.

Regarding the aged population aged 65 and over, the total number was 100.45 million, constituting 7.69 percent of the total population (National Bureau of Statistics of the People's Republic of China, 2006). From this perspective, China became an aged society in 2005. Moreover, according to the data of the sixth national census of China in 2010, there were 177,648,705 older adults aged 60 years old or over, accounting for 13.26 percent of the total population (of which 118,831,709 aged 65 years or over;

approximately 8.87 percent of the total population) (National Bureau of Statistics of the People's Republic of China, 2011). This shows that during these five years, the population aged 60 years or over increased by about 33.56 million people (the population aged 65 and above increased by about 18.38 million). Such a number is equivalent to the total population of Canada in 2011 (Government of Canada, 2012).

As the aging trend proceeds, some researchers predict that the proportion of the elderly aged 65 years or more will reach 14.3 percent in 2025, further increasing to 26 percent in 2050 (Xie, 2004).

As the aged population increases in China, the number of the disabled elderly is also rising. The National Committee on Aging of China conducted a survey on both the urban and rural disabled elderly in 2010, and the results showed that there were about 33 million partly or fully disabled elderly in late 2010 in China, of which 10.8 million of them were totally disabled (6.23 percent). Within the fully disabled urban elderly, the number of "mild disability", "moderate disability" "severe disability "

were 2,338,900, 269,800 and 507,600 respectively (Zhang et al., 2011). Based on this national survey, the forecast is that the partly or fully disabled elderly will reach 40 million in 2015, accounting for 19.5 percent of the total elderly population (with fully disabled elderly around 12.4 million, accounting for 6.05 percent of the overall elderly population), an increase of 7 million people compared to 2010 (Zhang, 2011).

Thus, the absolute number of the disabled elderly would also substantially increase together with growth in the number of the general elderly. How to deal with the increasing number of the disabled older persons, to improve their quality of life, is now a serious problem.

85 3.1.2 Literature review

3.1.2.1 Chinese scholars’ researches

Studies recently began on the long-term care of the elderly in China. The existing research from Chinese scholars can be divided into three main categories. The first category mainly introduced the implementation background, contents and features of the LTCI system that has been established in many developed countries, which aimed to provide useful information for the future creation of a long-term care insurance system in China. Wang examined the Japanese long-term care insurance system (Wang, Lin, et al., 2013); Shi and Liu studied the Germany long-term care insurance system (Shi & Liu, 2011); and Wu and Chen investigated the Netherlands long-term care insurance system (Wu & Chen, 2012). There are also some studies which rather than examining the long-term care insurance system of one country, introduced and compared the long-term care insurance system in several countries simultaneously.

Chen compared the long-term care insurance system in the EU countries (Chen, 2002);

Yin conducted a comparative study on the long-term care insurance system in Germany, Japan, the United States and the United Kingdom (Yin, 2011); and Chen also compared the long-term care insurance system of the United Kingdom, Sweden, Japan and the United States (Chen, 2013).

The second category mainly explored the possibility and necessity of establishing the suitable long-term care system in China. Most of these studies presented various embodiments which were based on the empirical analysis of existing data, and showed feasible and reasonable programs. Lin measured and evaluated the future financial equilibrium of the long-term care insurance fund of China (Lin, 2013); and Wang proposed that a pilot study be conducted in the economically developed regions in accordance with China's conditions (Wang, 2012).

As for the third category, these studies collected the related information about the need for LTC of the elderly by social survey, and represented the current situation of the provision and unmet needs of the LTC. Chen used the data from the survey of

"influencing factors of the health and longevity of the Chinese elderly in 2000" to analyze the existing resources and the conditions of supply of care for the Chinese urban elderly (Chen, 2004), Yin and Du used the nationwide data about the health of the Chinese elderly conducted by Peking University in 2008 (covering 16,566 older persons aged 65 years or over) to analyze the current status and trend of the need for LTC of the elderly (Yin & Du, 2012). Wang et al. explored the need for LTC of the elderly who had assisted the Xinjiang Province and their care providers by participating in the social survey (Wang, Feng, et al., 2013).

3.1.2.2 Other researcher’s studies (non-Chinese scholars)

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A large number of studies have been conducted by researchers outside China, and because of the high levels of social and economic development these research projects were more detailed and in-depth. Their research about the relationship between socioeconomic status and the need for LTC, the association between mental health and the need for LTC, and the correlation between socioeconomic status and mental health, are described below.

Regarding the relationship between SES and NLTC, McKevitt et al. showed that, among the 1,251 UK elderly who has suffered a stroke, the elderly living in poverty-stricken areas reported relatively higher unmet care needs than other economic groups (McKevitt et al., 2011). Hoi le et al. studied the determinants of the Vietnam elderly aged 60 years or over and the results showed that socioeconomic status, such as education level, working status and household income, affects the need for LTC among the elderly respondents (Hoi le et al., 2011). Laporte et al. found that individuals with a lower socioeconomic status have a higher propensity and intensity of care needs among the Canada home-based elderly (Laporte et al., 2007). A long-term study among the 35,926 Finnish elderly conducted by Martikainen et al.

suggested that those elderly with a lower socioeconomic status are more likely to use the LTC service; and showed the impact of socioeconomic status on the entry of institutional care is stronger on the women than men. It should be noted that women of pension age have a higher likelihood of receiving long-term care than men because of their longer life expectancy and probability of living alone (Martikainen et al., 2009).

Concerning the association between NLTC and mental health, research has shown that sick or frail populations, such as stroke patients (Wolfe et al., 2011), those with mental retardation (Reid et al., 2011) or the elderly with dementia (Kim et al., 2011), suffer a higher likelihood of mental illness (such as tension and depression), and are in higher need for LTC. Another population of interest is veterans. Sorrell and Durham found the long-term care facilities provided by the United States Department of Veterans Affairs, cannot meet the needs of those veterans with cognitive decline nor the home care service, and that the need to invest more resources in order to meet the future caring needs of an increasing number of veterans is urgent (Sorrell &

Durham, 2011). Samuelsson et al. followed up 192 elderly people who received home care or institutional care in southern Sweden for 25 years and showed that among these older persons, 53 percent of them had dementia and 34 percent of them had some degree of mental illness (Samuelsson et al., 2003).

The research focusing on the relationship between socioeconomic status and mental health is abundant. Socioeconomic status here mainly refers to the individual's education level, income, occupation or employment status. Existing studies consistently show that there is an negative relationship between socioeconomic status

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and mental health; namely individuals with a lower socioeconomic status have a higher possibility of suffering from mental health problems (Gong et al., 2012); Or in other words, people with the lower socioeconomic status had the higher likelihood of being with mental illness (Mavrinac et al., 2009; Sani et al., 2010). Specifically, individuals with higher incomes, compared to those with lower incomes, have better mental health (Huijts et al., 2010; Theodossiou & Zangelidis, 2009); as do those who are employed (Baron-Epel & Kaplan, 2009). In addition, concerning the relationship between education and mental health, one study conducted among the Japanese population showed that there is a significant linear correlation between the education level of the female and their mental health, while such an association does not exist in the Japanese male (Honjo et al., 2006).

3.1.2.3 Summary of the literature and the objective

In summary, research about the LTC issues in China has only recently begun. Most research is qualitatively focusing on comparing the national LTCI systems in different countries to verify the necessity and feasibility of the implementation of a LTCI system in China, while a few are quantitative studies related to the LTC issues. What is more, there are no studies exploring the relationship between socioeconomic status, mental health and the need for LTC. Compared with studies undertaken by Chinese researchers focusing on LTC issues in China, early research on the LTC issues conducted by foreign scholars involved more substantial total numbers, and are therefore more comprehensive and detailed.

Specifically, the previous research that examined the relationship between socioeconomic status and mental health is relatively substantial, followed by the research focusing on the relationship between socioeconomic status and need for LTC, while fewer studies clarified the association between the mental health and the need for LTC. However to date, there is still no research that clearly articulates the relationship between socioeconomic status, mental health and need for LTC at the same time.

Based on the summary of the previous research, the purpose of this study can be summarized as follows:

1) To investigate the extent that the need for LTC of the Tibetan urban elderly is satisfied;

2) To explore the structural relationship between the socio-economic status, mental health and the need for LTC among the Tibetan urban elderly.