To the Editor: We read with great interest the article by Flaherty et al.,1 in which they provided an overview of the population demographics and healthcare statistics in the People's Republic of China focusing on the older Chinese population, its current care system, and geriatrics. We appreciate the authors and the Journal for the interest in introducing the largest aging population in world to the American geriatrics community. In addition to congratulating the authors' accomplishment of such an overview, we have the following comments.

The figure of 130 million Chinese older adults and subsequent population figures provided in Table 1 of the article are rather conservative. On February 25, 2006, the China National Committee on Aging (CNCA), the most authoritative government agency on aging in China, announced that there were 143 million Chinese people aged 60 and older at that time,2 10% more than the above figure. According to the CNCA, China's aging population has been growing at a rate of 3.28% annually since 2001 and is expected to reach 437 million by 2051.2 This suggests an even greater challenge for the Chinese healthcare system and the need for developing quality geriatrics care for the largest and ever-growing older adult population in the world.

Regarding geriatrics development as a medical subspecialty in China, a significant number of major medical centers in large cities have established geriatrics clinical services and research centers or laboratories on aging. There are also several Chinese geriatrics and aging journals, including the Chinese Journal of Geriatrics, a monthly subspecialty medical journal established by the Chinese Medical Association (China's equivalent to the American Medical Association) in 1982.3 However, as Flaherty et al. note, there are no formal geriatric fellowships or national board certifications.1 The quality of the geriatrics departments or programs at different medical institutions is highly variable. Because physicians and researchers in geriatrics and aging research are usually from other subspecialties, their programs mostly focus on specific organ systems rather than geriatric syndromes or comprehensive geriatric care of the whole person in the older adult population. In addition, most geriatric clinical programs or departments provide care for government officials, current or retired, and some of them are established in military hospitals. They usually have stable financial resources and do not need to compete for patients and scarce healthcare dollars. Furthermore, health information and clinical data for government officials and military personnel are usually kept confidential and not allowed in scientific investigation or reporting. All these are potential factors that hinder further development of geriatric medicine as a subspecialty, as well as scientific advancement in aging research in China. In addition to the language barrier, these may also contribute, at least to some extent, to the lack of international collaboration and scientific exchange.

Given the sheer number of older adults and their urgent need for quality geriatrics care in China, it is important to think creatively about how to help promote further development of geriatric medicine and aging research in this “aging giant.” The significance not only is apparent in improving healthcare for older Chinese persons, but also lies in the potentially tremendous impact on the economy and society in China as well as around the world. Such efforts have recently started to emerge. For example, an international geriatrics collaborative project between the Johns Hopkins University School of Medicine and Peking Union Medical College (PUMC) Hospital in Beijing was initiated in 2006. Funded by the China Medical Board of New York, a private foundation, this 4-year project aims to establish a geriatric medicine program at PUMC Hospital. Geriatrics training of PUMC Hospital physicians and nurses is provided in the Division of Geriatric Medicine and Gerontology at Johns Hopkins as part of the “training the trainers” program. A geriatrics demonstration ward is now open in the Department of Medicine at PUMC Hospital. With subsequent funding, potentially from the Chinese government, private foundation(s), and other sources, the long-term goal of this project is to establish the PUMC geriatrics program as the flagship to promote geriatrics education, quality care, and aging research throughout China. As described in the article by Flaherty et al., there are many unique characteristics of the Chinese older population, the needs and support of Chinese older adults, and the overall Chinese healthcare system and financing mechanisms. Geriatrics program development in China, as such, should take these unique characteristics into account and be tailored to the Chinese culture and society. It is likely that the American geriatrics community will learn and benefit from such collaborative efforts as well.


Conflict of Interest: This work was supported in part by the China Medical Board of New York, CMB#06-836 (Drs. Leng and Shen). Dr. Leng is a current recipient of the Paul Beeson career development award in aging research, K23 AG028963. The editor in chief has reviewed the conflict of interest checklists provided by the author and has determined that none of the authors have any financial or any other kind of personal conflicts with this letter.

Author Contributions: Contributions from the Chinese authors include being the major Chinese partners for this international geriatrics collaborative project (Drs. Tian, Lu, Li, and Shen) and helping to identify aging demographic statistics and Chinese geriatrics journal (Drs. Xie and Kang). Contributions from Hopkins authors include initial planning of the project and grant proposal (Drs. Leng, Lazarus, Durso, and Fried), manuscript drafting (Dr. Leng), and program implementation (Drs. Leng, Lazarus, Durso, Park, and Fried). All authors participated in manuscript editing.

Sponsor's Role: None.