Geriatric medicine in China: an old but emerging subspecialty

Although geriatrics has a very long history in China, it just has begun to evolve. China is progressing rapidly in the field of geriatric medicine and clinical research. Modernisation of geriatric medicine is needed to address the care needs of older people. China has over 230 million people aged 60 years and older, which is expected to exceed 400 million in the next twenty years [1–3]. Respect for older people is deep-rooted in Chinese culture, and this has been largely unaffected by a world afflicted with ageism and ageist stereotypes. China has recognised the health and social challenges of population ageing and has given high priority to overcoming them. The strategic health policy, ‘Healthy China 2030’ will inform all aspects of government policy, and emphasises innovation, scientific development, justice and fairness. It advocates preventive strategies, such as the promotion of physical exercise and healthy lifestyles, the development of healthy environments and a smoke-free law, as part of a move away from the traditional domination of healthcare by hospitals [4]. China is a large and diverse country with differing needs between cities and rural areas, and between regions, including Hong Kong, which already has well-developed older people’s services. Consequently, policies and progress are likely to differ across many sectors, including in the field of ageing. Healthy China 2030 anticipates the rapid increase in numbers of older adults, and well-trained geriatricians will be in great demand. The need for specialised geriatric care and ageing research has been recognised since the 1950s, and the first national conference on aging and geriatric medicine was held in 1964 [3]. The Chinese Medical Association introduced geriatric medicine as a subspecialty in 1981 [3]. As elsewhere, pioneer geriatricians in China were often medical specialists, primarily cardiologists, who developed an interest and expertise in caring for older people, and actively took part in research and academic activities [3]. However, most geriatric medical departments were mainly responsible for retired government officers, and specialised care was not accessible to the general older population [5,6]. In 2018, only 26.2% of general hospitals above primary level in Beijing had a geriatric medical department. More recently, geriatric medical departments have been strengthened and expanded. Under the elderly health promotion agenda of the Healthy China 2030 policy, this proportion will reach 50% by 2022, and 90% by 2030 [4]. Priority has also been given to improve geriatric medical training, continuing medical education and research. In 2015, China adopted a framework for training specialists known as ‘old people old method, and new people new method’. The ‘old method’ refers to developing the skills of senior doctors who have worked with older people but without specific geriatric medical training. The ‘new method’ refers to standardised training for residents in internal medicine, followed by a 2-year geriatric medical fellowship. In the Hong Kong Special Administrative Region, with an average life expectancy of 85 years, geriatric medicine is very well-established, with training adapted from the United Kingdom model. In response to health system needs, Hong Kong hospital geriatricians essentially also provide primary care services, as geriatric day hospitals are the only place to manage complex needs and assessments, as well as support to residential care homes, post-discharge home support teams and end-of-life care. As a result, training includes working in these settings to obtain specialist qualification after an exit examination. Most ageing research in China is in the epidemiology and management of common chronic diseases and geriatric syndromes including physical and cognitive frailty, sarcopenia, multi-morbidity, disability and dementia [7,8]. A number of very large cohorts such as the Beijing Longitudinal Study of Aging II [9], China Health and Retirement Longitudinal Study [10], China Comprehensive Geriatric Assessment Study [11] and Chinese Longitudinal Healthy Longevity Survey [12] have been established. Basic scientists and neurobiologists, in particular, have also achieved great success in the last few years. Clinicians, however, usually have little protected time for research. Research questions follow global trends around hot topics in ageing, rather than any particular focus on the local clinical priorities. Nonetheless, in recent years, the quality and quantity of ageing research have progressed greatly. The government has substantially increased its investment in older people’s research, including major projects such as ‘Organ Aging’ supported by the National Natural Science Foundation, and ‘Active Health’ supported by the Ministry of Science and Technology. Six national clinical research centres for geriatric disorders have been established across the country. The implementation of these initiatives will advance geriatric medicine research. Hong Kong geriatricians have been prominent in various Asian and international groups examining the applicability of international definitions to Chinese populations, for example, formulating a definition of sarcopenia that differed from the European consensus [13]. Many international exchange programs and collaborative projects are being conducted between major hospitals and universities worldwide and international organisations such as the World Health Organization (e.g. the ICOPE project [14]) to develop geriatric medicine, care models and research. Major international conferences focusing on frailty and sarcopenia [15], dementia [16] and geroscience [17] have been held. These programs have enabled clinicians and researchers to broaden their knowledge in geriatrics and increase international collaboration. The Chinese population is ageing rapidly, and swift progress is being made to develop preventive, primary care and specialist services in response. Geriatric medicine is emerging as one of the most advanced and appreciated subspecialties in China. There are both great challenges but also opportunities ahead for people working in the field of geriatric medicine. None. This study was supported by the National Key R&D Program of China, No. 2018YFC1312001.