Abstract
China faces an aging tsunami. By the end of 2016, the number of older adults aged 60 and older reached 230 million. This number is projected to reach 418 million by 2035 and peak at 487 million by 2053. The number of individuals aged 80 and older, the oldest adults, reached 26 million and continues to grow by 1 million a year. The socioeconomic context, characterized by an inverted pyramid family structure and the number of “empty nesters,” has greatly compromised traditional Chinese family support for older adults. This article aims to provide an overview of geriatrics development in China. It begins with a brief account of the dramatic demographic shift, major socioeconomic factors, China's healthcare system, and reform related to senior health with a historical perspective. It then describes recent advances in government policy and support and development of a geriatrics physician workforce, care models, primary care networks, and privately owned senior care facilities and support services. Although it is impossible to cover all aspects of the topic, it is hoped that this article provides readers an overall picture of Chinese geriatrics and senior healthcare development in a complex and evolving healthcare system. Geriatrics communities in the United States and around the world will undoubtedly learn and benefit from the unparalleled and continued efforts to address this unprecedented opportunity and challenge in China.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1462-1468 |
| Number of pages | 7 |
| Journal | Journal of the American Geriatrics Society |
| Volume | 66 |
| Issue number | 8 |
| DOIs | |
| State | Published - Aug 2018 |
Keywords
- China
- aging
- geriatrics
- healthcare reform
- senior healthcare
ASJC Scopus subject areas
- Geriatrics and Gerontology
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In: Journal of the American Geriatrics Society, Vol. 66, No. 8, 08.2018, p. 1462-1468.
Research output: Contribution to journal › Article › peer-review
}
TY - JOUR
T1 - The Aging Tsunami and Senior Healthcare Development in China
AU - Li, Xin
AU - Fan, Li
AU - Leng, Sean X.
N1 - Funding Information: International scholarly exchange and collaborations have increasingly been developed in geriatrics. For example, the annual Chinese Congress on Gerontology and Health Industry invites speakers from outside China to participate, and the Journal has published the presented work in abstract form each year in its September supplement since 2013.25–34 At the same time, geriatricians and geriatric researchers in China present their work at international conferences, including those of the AGS, Gerontological Society of America, and International Association of Gerontology and Geriatrics (IAGG), and geriatrics conferences in other Asian countries, Europe, and Australia. With financial support from Chinese funding agencies and academic institutions and grants from U.S.-based medical philanthropies (Table 2), including the China Medical Board (https://chinamedicalboard.org) and the Irma and Paul Milstein Program for Senior Health, Milstein Medical Asian American Partnership Foundation (www.mmaapf. org), talented Chinese scholars are able to obtain training and conduct collaborative research at leading academic institutions overseas. Almost all of these trainees return to China and will undoubtedly have a significant effect on the development of geriatrics and senior healthcare in China for decades to come. A major objective of this article is, in many ways, to facilitate further international scholarly exchange and collaborations. Funding Information: We would like to acknowledge a science and technology key project award (Grant No. 15KG136) from Tianjin Health and Family Planning Commission, China (to Dr. Xin Li), National Clinical Research Center for Geriatrics at the People's Liberation Army General Hospital (NCRCG-PLAGH) and one of its project awards (Grant No. NCRCG-PLAGH-2017010) from the Ministry of Science and Technology, China (to Dr. Li Fan), and funding from the Irma and Paul Milstein Program for Senior Health, Milstein Medical Asian and American Partnership (MMAAP) Foundation (www.mmaapf.org) (to Dr. Sean X. Leng). Conflict of Interest: No pertinent conflict of interest to declare. Author Contributions: XL, LF, SXL: concept. XL, LF: data gathering, fact checking, manuscript preparation. SXL: manuscript preparation, revision, correspondence. Sponsor's Role: None Funding Information: The interdisciplinary geriatrics care model was introduced through a collaboration project between PUMC and JHU funded by the China Medical Board. PUMC Hospital internists, nurses, nutritionists, pharmacists, physical and occupational therapists, and neuropsychologists who obtained geriatrics training at JHU have served as the backbone of the interdisciplinary care team upon their return. They have also established protocols and care pathways for the prevention and treatment of geriatric syndromes (e.g., delirium, falls, pressure ulcers, polypharmacy). The experience of this international collaboration was reported in 2010.35 The Department of Geriatrics at PUMC Hospital has since led the development of several care models, including comprehensive geriatrics assessments (CGA); geriatrics consultation to surgery and other specialties and other hospitals and senior care facilities; and more recently, palliative care. Many hospitals across China have started to develop and implement inpatient and outpatient geriatrics care models that fit into their own local healthcare environment. For instance, Dr. Flaherty led the effort to develop an Acute Care for the Elderly unit at West China (Hua Xi) Hospital in Chengdu, Sichuan Province (Dr. Joseph Flah-erty, personal communication). Funding Information: We would like to acknowledge a science and technology key project award (Grant No. 15KG136) from Tianjin Health and Family Planning Commission, China (to Dr. Xin Li), National Clinical Research Center for Geriatrics at the People’s Liberation Army General Hospital (NCRCG-PLAGH) and one of its project awards (Grant No. NCRCG-PLAGH-2017010) from the Ministry of Science and Technology, China (to Dr. Li Fan), and funding from the Irma and Paul Milstein Program for Senior Health, Milstein Medical Asian and American Partnership (MMAAP) Foundation (www. mmaapf.org) (to Dr. Sean X. Leng). Funding Information: The central Chinese government has also issued a number of national policies on senior healthcare and support. For example, one policy aims to promote a senior support model, termed “9064” in Beijing and “ 9073” in most other cities and regions, which means that 90% older adults will age at home, 6% or 7% in the community, and 4% or 3% in an institutional setting.17,18 To help implement this policy, the Ministry of Civil Affairs provides funding to support community senior daycare centers. It also provides substantial funding to subsidize LTC facilities and services (more on LTC below).17,19 For academic geriatrics development, the NHFPC has issued a policy that all large public hospitals are required to have a geriatrics clinical program.20 Along with this policy, a number of leading medical schools, such as Peking Union Medical College (PUMC), have established departments of aging and geriatrics that offer graduate courses on aging and geriatrics clinical rotations for medical students and residents. The NHFPC also provides funding to support Centers of Excellence in geriatrics. The initial cycle of funding was issued in 2015 to 32 large hospitals across China. In 2016, the NHFPC established the National Center on Geriatrics—the third national center, after one for cancer and one for cardiovascular diseases—demonstrating the emphasis on geriatrics and senior healthcare development at the national level. In addition, the Ministry of Science and Technology (MOST) has prioritized geriatrics and aging research for funding and provided grant support for aging research.21,22 In 2017, MOST funded 6 clinical research centers for geriatrics across the country. These are just a few examples of national government policy and support. Provincial and local authorities are developing numerous supportive policies and new initiatives for geriatrics and senior healthcare development. For example, the Jiangsu provincial government recently issued policies that will provide financial support and incentives in its jurisdiction, including incentive payments for nursing staff who have provided services to older adults for 5 years or more; funding for building a large senior care facility on the west side of Yangtze river in Nanjing; funding for establishment and operation of 1 to 2 older adult day care centers in at least 90% of communities and villages across the province; and other supportive measures, including an increase in monthly supplemental income for older adults with financial difficulties, with higher amounts for those aged 80 and older or with disability, senior meal services, travel services, and installation and maintenance of elevators in high-rise older adult housing.23 Publisher Copyright: © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society
PY - 2018/8
Y1 - 2018/8
N2 - China faces an aging tsunami. By the end of 2016, the number of older adults aged 60 and older reached 230 million. This number is projected to reach 418 million by 2035 and peak at 487 million by 2053. The number of individuals aged 80 and older, the oldest adults, reached 26 million and continues to grow by 1 million a year. The socioeconomic context, characterized by an inverted pyramid family structure and the number of “empty nesters,” has greatly compromised traditional Chinese family support for older adults. This article aims to provide an overview of geriatrics development in China. It begins with a brief account of the dramatic demographic shift, major socioeconomic factors, China's healthcare system, and reform related to senior health with a historical perspective. It then describes recent advances in government policy and support and development of a geriatrics physician workforce, care models, primary care networks, and privately owned senior care facilities and support services. Although it is impossible to cover all aspects of the topic, it is hoped that this article provides readers an overall picture of Chinese geriatrics and senior healthcare development in a complex and evolving healthcare system. Geriatrics communities in the United States and around the world will undoubtedly learn and benefit from the unparalleled and continued efforts to address this unprecedented opportunity and challenge in China.
AB - China faces an aging tsunami. By the end of 2016, the number of older adults aged 60 and older reached 230 million. This number is projected to reach 418 million by 2035 and peak at 487 million by 2053. The number of individuals aged 80 and older, the oldest adults, reached 26 million and continues to grow by 1 million a year. The socioeconomic context, characterized by an inverted pyramid family structure and the number of “empty nesters,” has greatly compromised traditional Chinese family support for older adults. This article aims to provide an overview of geriatrics development in China. It begins with a brief account of the dramatic demographic shift, major socioeconomic factors, China's healthcare system, and reform related to senior health with a historical perspective. It then describes recent advances in government policy and support and development of a geriatrics physician workforce, care models, primary care networks, and privately owned senior care facilities and support services. Although it is impossible to cover all aspects of the topic, it is hoped that this article provides readers an overall picture of Chinese geriatrics and senior healthcare development in a complex and evolving healthcare system. Geriatrics communities in the United States and around the world will undoubtedly learn and benefit from the unparalleled and continued efforts to address this unprecedented opportunity and challenge in China.
KW - China
KW - aging
KW - geriatrics
KW - healthcare reform
KW - senior healthcare
UR - http://www.scopus.com/inward/record.url?scp=85050502394&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85050502394&partnerID=8YFLogxK
U2 - 10.1111/jgs.15424
DO - 10.1111/jgs.15424
M3 - Article
C2 - 29974937
AN - SCOPUS:85050502394
SN - 0002-8614
VL - 66
SP - 1462
EP - 1468
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 8
ER -