China: The Aging Giant

Authors

  • Joseph Henry Flaherty MD,

    1. From the Department of Internal Medicine, Division of Geriatrics, Saint Louis University School of Medicine, St. Louis, Missouri
    2. Geriatric Research, Education and Clinical Center, St. Louis Veterans Affairs Medical Center, St. Louis, Missouri
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  • Mei Lin Liu MD,

    1. Department of Geriatrics, Peking University First Hospital, Beijing Medical University, Beijing, China
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  • Lei Ding MD,

    1. Department of Geriatrics, Peking University First Hospital, Beijing Medical University, Beijing, China
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  • Birong Dong MD,

    1. Department of Geriatrics, West China Hospital, Sichuan University, Sichuan, China
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  • Qunfang Ding MD,

    1. Department of Geriatrics, West China Hospital, Sichuan University, Sichuan, China
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  • Xia Li MD,

    1. Department of Psychogeriatrics, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, WHO Collaborative Research and Training Center on Mental Disorder, Shanghai Mental Health Research Institute, Shanghai, China.
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  • Shifu Xiao MD

    1. Department of Psychogeriatrics, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, WHO Collaborative Research and Training Center on Mental Disorder, Shanghai Mental Health Research Institute, Shanghai, China.
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Address correspondence to Joseph Henry Flaherty, MD, Department of Internal Medicine & Division of Geriatrics, Saint Louis University School of Medicine, and the Geriatric Research, Education and Clinical Center, St. Louis VA Medical Center, St. Louis, Missouri, 1402 S. Grand Blvd, Room M238, St. Louis, MO 63104. Email: Flahertyinchina@yahoo.com

Abstract

This article examines the changing demographics of China, with particular attention paid to the effect of the one-child policy in relation to long-term care of older people. It also examines the current state of health care for older people. Long-term stays characterize hospital care. Most geriatric syndromes are less common in hospitalized older people (e.g., delirium, falls), but some (e.g., polypharmacy) are more common. A high volume of patients and brief targeted visits characterize outpatient care. Nursing homes exist in China, but relatively fewer than in the most developed countries.

Geriatric departments in university-based hospitals primarily have developed out of a need to care for retired government officials and workers. There are no formal geriatric fellowships or national board certifications in geriatrics

Health care is primarily based on fee for service. Not all elderly have healthcare insurance. Although costs of health care and medications are less expensive than in the United States, they are relatively high for lower-and middle-class Chinese and have increased more quickly than has the standard of living in the past 20 years.

Family and community support for older people is strong in China. Some older people have one-to-one care from a baomu (literally “protection” (bao) “mother” (mu)), a type of live-in maid who also provides care for the older person. Some of the challenges facing China in the care of its aging population are how to increase geriatric research and training, how to care for the uninsured or underinsured, and how to handle the inevitable growth of disabled and frail older people.

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