SEARCH

SEARCH BY CITATION

Keywords:

  • international geriatrics program development;
  • China;
  • aging

Abstract

  1. Top of page
  2. Abstract
  3. THE CONTEXT AND OPPORTUNITY
  4. THE JOINT VENTURE
  5. RECOMMENDATIONS
  6. FUTURE PROSPECTS
  7. ACKNOWLEDGMENTS
  8. REFERENCES

China has the world's largest and most rapidly growing older adult population. Recent dramatic socioeconomic changes, including a large number of migrating workers leaving their elderly parents and grandparents behind and the 4:2:1 family structure caused by the one-child policy, have greatly compromised the traditional Chinese family support for older adults. These demographic and socioeconomic factors, the improved living standards, and the quest for higher quality of life are creating human economic pressures. The plight of senior citizens is leading to an unprecedented need for geriatrics expertise in China. To begin to address this need, the Johns Hopkins University School of Medicine (JHU) and Peking Union Medical College (PUMC) have developed a joint international project aimed at establishing a leadership program at the PUMC Hospital that will promote quality geriatrics care, education, and aging research for China. Important components of this initiative include geriatrics competency training for PUMC physicians and nurses in the Division of Geriatric Medicine and Gerontology at JHU, establishing a geriatrics demonstration ward at the PUMC Hospital, faculty exchange between JHU and PUMC, and on-site consultation by JHU geriatrics faculty. This article describes the context and history of this ongoing collaboration and important components, progress, challenges, and future prospects, focusing on the JHU experience. Specific and practical recommendations are made for those who plan such international joint ventures. With such unique experiences, it is hoped that this will serve as a useful model for international geriatrics program development for colleagues in the United States and abroad.

Aging is a global concern. According to a recent report issued by the U.S. Census Bureau and commissioned by the National Institute on Aging, there are more than 500 million adults aged 65 and older worldwide, and this older adult population grows by approximately 870,000 each month.1 Although industrialized countries, including the United States, have higher percentages of older adults, developing countries have a larger and faster-growing older adult population. In 2008, 313 million, or 62% of the world's older adults lived in developing countries, a number that is projected to rise to more than 1 billion, or a projected 76% of the world's elderly population.1 To care for this large and rapidly growing older adult population worldwide, there is an increasing need for geriatrics expertise in many regions outside of the United States, especially in the developing countries. This also represents a great opportunity for international dissemination of geriatrics knowledge and development of geriatrics programs.

Although there have been brief international geriatrics scholarly exchanges and collaborations between China and the United States, to the best of the authors' knowledge, there is no report of international geriatrics program development in China. This article describes a 4-year joint international initiative between Johns Hopkins University (JHU) School of Medicine and Peking Union Medical College (PUMC) to establish a leadership geriatrics program at PUMC Hospital that will promote quality geriatrics care, education, and aging research across China. In 2006, the China Medical Board (CMB), a U.S.-based private foundation, recognized the importance of geriatrics development in China and provided funding for this project. This article describes the context and history of this project, as well as its ongoing progress, challenges, and future prospects. With such unique experiences presented from both sides of this partnership, it is hoped that this will serve as a useful model for international geriatrics program development for colleagues in the United States and abroad.

THE CONTEXT AND OPPORTUNITY

  1. Top of page
  2. Abstract
  3. THE CONTEXT AND OPPORTUNITY
  4. THE JOINT VENTURE
  5. RECOMMENDATIONS
  6. FUTURE PROSPECTS
  7. ACKNOWLEDGMENTS
  8. REFERENCES

The Demographic and Socioeconomic Context in China

China has experienced rapid modernization over the past 2 decades and has emerged as a global economic power. The successful 2008 summer Olympics in Beijing displayed China's economic and cultural prosperity. Meanwhile, China faces another kind of growth: its aging population. China defines old age as 60 and older, as do most of the European countries. According to this definition, China has more than 160 million older adults, more than half of the current total U.S. population. In 2008, China had approximately 106 million adults aged 65 and older, the largest aging population in the world and 1.5 times the 71.5 million older adults projected for the United States by 2030.1–4 In addition, China's aging population has grown at an annual rate of 3.3% since 2001 and is expected to reach 437 million by 2051.2 The number of adults aged 80 and older has grown rapidly in China as well. According to the United Nations international population database,5 it is projected that China will have more than 34 million octogenarians in 2020—nearly three times as many as projected in the United States.4,5 The need for quality geriatric care and support for such a large and rapidly growing older adult population in China is unprecedented.

China is a country with strong family values; traditionally, younger family members take care of older adults. However, recent socioeconomic and family structural changes have made this traditional family support unsustainable. First, rapid economic development in certain areas has caused many young and middle-aged persons to leave home for job opportunities. Although the exact size of this mostly rural migratory workforce is uncertain, it was estimated to be up to 100 million in 2007.6 Migrating workers often leave elderly parents and grandparents behind, resulting in loss of functional support, including access to health care. Older adults and young children are the only people living in many rural areas and some less economically developed regions for the majority of the year. In addition, the “one child” policy implemented more than 2 decades ago has caused significant family structural change, leading to the “inverted pyramid” family structure or “4:2:1 paradigm.” The “4:2:1 paradigm” describes the social family structure of four grandparents, two adult children, one grandchild.7,8 This raises a serious challenge for two adults who were born in the 1980s without brothers or sisters; they are married and now responsible for caring for both sets of aging parents and grandparents. These socioeconomic factors, coupled with the population demography described above, have made Chinese government authorities and leading medical institutions acutely aware of the pressing need for geriatrics expertise in China. As China continues to make economic progress and improve the quality of life for its citizens, the development of modern geriatrics is a critical national concern.

The Opportunity to Introduce American Geriatrics Expertise to this Aging Giant

Overviews of the current status of geriatrics and healthcare support for older adults in China have recently been provided.9,10 While it is not the intention of this article to provide a systematic review of what is being done in geriatrics in China, it is sufficient to state that further development and modernization of geriatrics are necessary to meet the care needs of the large Chinese older adult population. A significant number of medical institutions in major metropolitan areas have established geriatrics clinical services and gerontological research centers and laboratories over the past 1 to 2 decades, but the quality of these programs is highly variable. Because the majority of physicians and researchers in geriatrics and gerontology are from other subspecialties, their programs tend to focus on individual organ systems rather than the whole person. They lack important modern geriatrics and gerontology concepts, such as geriatric syndromes, comprehensive geriatric assessment and care, functional rehabilitation and maintenance, and population and biomedical aging research. In addition, these geriatrics programs were designed primarily to provide care for current or retired government officials, and some of them reside in military hospitals. The latter have stable financing and do not need to compete for patients and scarce healthcare dollars. Although there is a significant body of literature on healthcare concerns related to this large population of retired government officials, most published work focuses on policies and age-related diseases of individual organ systems such as the cardiovascular system.11–13 Moreover, health information and clinical data for government officials and military personnel are not easily accessible to the public or allowed for scientific exchange and medical research. There are no formal geriatrics fellowship training programs in China or national board certification in geriatrics as there are in more-established specialties (e.g., cardiology and pediatrics).9 Existing geriatrics programs and departments provide training for residents who choose to work there under the supervision of directors and more-senior physicians who themselves are specialists in other areas (e.g., cardiology, gastroenterology, psychiatry) without any formal or required curriculum. Therefore, the existing geriatrics programs in China are far from achieving uniform high quality or academic rigor.

The need for high-quality clinical and academic geriatrics and gerontology programs in China creates an opportunity for U.S. leadership in these fields. The following describes the ongoing experience at JHU as an example of such an international effort on geriatrics program development at PUMC in Beijing, China.

THE JOINT VENTURE

  1. Top of page
  2. Abstract
  3. THE CONTEXT AND OPPORTUNITY
  4. THE JOINT VENTURE
  5. RECOMMENDATIONS
  6. FUTURE PROSPECTS
  7. ACKNOWLEDGMENTS
  8. REFERENCES

The Two Institutions

The Rockefeller Foundation founded PUMC in 1906, which was modeled after the JHU Medical School. It has been the only 8-year medical school in China until recently. (In China, students go to medical school directly from high school.) The PUMC Hospital is a premiere general and tertiary care hospital that has played a leading role in the development of most medical subspecialties in China. Each medical subspecialty has its own inpatient ward, but there have been no geriatric medicine services. Although PUMC Hospital has had a general internal medicine (GIM) program for several years, the GIM department has its own subspecialty inpatient ward and mostly focuses on solving a few complex problems rather than providing comprehensive care for adult patients. As such, there are significant difficulties in providing quality care for older patients. For example, frail elderly patients with comorbid conditions often are transferred between subspecialty wards, and their care lacks a generalist providing comprehensive care oversight. In addition, subspecialists (as in the United States) typically lack training in the evaluation and management of falls, delirium, dementia, pressure ulcers, incontinence, polypharmacy, multimorbidity, frailty, and other common geriatric syndromes. To begin to address these challenges, the central Chinese government has commissioned the PUMC Hospital to build a senior care facility with 200 inpatient beds and outpatient clinics. The PUMC leadership has consequently recognized the urgent needs for geriatrics expertise and made a clear commitment to the development of modern geriatrics program.

The Division of Geriatric Medicine and Gerontology at JHU administers comprehensive multidisciplinary geriatric services across a broad continuum, including inpatient rehabilitation; an orthopedic–geriatric comanagement hip fracture service; subacute and chronic inpatient medical management of complex patients; a chronic ventilator unit; an inpatient geriatric medicine–psychiatric unit; inpatient and outpatient wound care programs; a comprehensive memory evaluation center co-led by geriatrics, psychiatry, and neurology; palliative care; traditional long-term care; Program of All-Inclusive Care for the Elderly (PACE); elder house call program; and geriatrics primary and subspecialty outpatient clinics (geriatric assessment clinic, memory center, geriatric oncology, osteoporosis, and urinary incontinence). The Division also has well-established programs in undergraduate and postgraduate geriatrics education and in aging research. In addition, a full-time physician faculty member (SXL) of Chinese descent in the Division was previously trained and worked at the PUMC Hospital.

A Brief History of the Development of the Program

After extensive discussions, PUMC leadership endorsed creation of a partnership with an U.S. geriatrics program. These discussions intensified once the senior care facility was commissioned to the PUMC Hospital and a JHU geriatrics faculty member (SXL) who had working experience and ongoing contacts with PUMC joined them. The concept of developing an international geriatrics program at PUMC hospital in partnership with JHU was formulated in early 2005. At the same time, a number of meetings were held among the leadership and faculty in the Division of Geriatric Medicine and Gerontology at JHU to explore the opportunity and to evaluate faculty support and buy-in. An informal inquiry for funding was made to the CMB, a private foundation in the United States that provides funding for healthcare improvement and biomedical research in China and Southeast Asia. Other important steps included a series of international telephone conferences with PUMC leadership to finalize specific and concrete commitments from the PUMC Hospital, including a matching fund of 1 million yen (Chinese RMB, approximately US$125,000) and dedicated hospital infrastructure, facility, and staff support for this effort. By the end of 2005, a formal grant proposal was submitted to the CMB for funding. As a result, a fund of close to US$1 million was secured to support this 4-year JHU–PUMC joint venture for the development of an international geriatrics program at PUMC Hospital. This program was initiated in July 2006.

Specific Objectives and Components of the Program

The following specific objectives of this joint venture were delineated in the CMB grant proposal.

  • 1
    Develop an effective and self-sustaining geriatrics organizational infrastructure at PUMC
  • 2
    Provide geriatric training for PUMC physicians in internal medicine and other related specialties and subspecialties and nurses at JHU, focusing on introduction of U.S. geriatric expertise and integrating the needs of Chinese older adults
  • 3
    Evaluate PUMC trainees' geriatric competency and develop a career path as academic geriatricians for their professional growth after they return to China
  • 4
    Establish a 30-bed inpatient geriatric demonstration ward at PUMC Hospital with gradual expansion to 100 beds and creation of geriatrics outpatient clinics
  • 5
    Create multidisciplinary geriatrics teams and care pathways
  • 6
    Develop clinical protocols specific to geriatric syndromes prevalent in elderly Chinese patients
  • 7
    Establish long-term collaborative partnerships in aging research between PUMC and the JHU Division of Geriatric Medicine and Geronotology
  • 8
    Integrate and foster collaborative aging research efforts across medical specialties and subspecialties at PUMC Hospital
  • 9
    Establish scholar exchange programs between PUMC and JHU, including consultative site visits to PUMC by JHU geriatric faculty
  • 10
    Obtain resources from government and private sources to make this a self-sustaining program at the conclusion of the CMB funding
  • 11
    Develop Chinese national and international conferences, under the banner of the CMB sponsorship, jointly by PUMC and JHU faculties with the goal of disseminating geriatrics expertise and competency and to promote aging research across China

Important Program Components and Current Progress

To accomplish the above objectives, several important components have been identified for this ongoing joint venture. The following provides a brief description of each of these components along with the progress that has been made thus far.

“Train the Trainers” Program at Johns Hopkins

The Division is responsible for leading the “train the trainers” program. The goal is to create a cadre of PUMC internists and other healthcare providers with geriatric skills who will serve as the backbone of the international geriatric program at PUMC and become the future leaders (or “trainers”) of geriatric medicine and gerontology in China. JHU and PUMC faculty leaders of this joint venture jointly interview candidates. Selection of PUMC trainees is based on their commitment to caring for older patients, clinical skills, English-language skills, leadership potential, interest in aging research, and willingness to come to JHU for an extended period of time and then return to China. For the development of a multidisciplinary geriatric care team, PUMC trainees include internists, nurses, and physicians from other specialties, including neurology, neuropsychiatry, neuropsychology, physical and occupational therapy and rehabilitation, and nutrition. The duration of geriatric training varies depending on the job descriptions of the trainees: 3 months for nurses and physicians in other specialties, 6 months for internists, and 1 year for the person who will lead the program at PUMC.

Didactic sessions and bedside training are the main components of this “train the trainers” program. The didactic sessions include geriatric health services orientation lectures during the summer14 and weekly geriatric medicine grand rounds (clinical, social, and scientific foundations of geriatric medicine, Thursday afternoons between 3:30 and 5:00 p.m.).15 PUMC trainees attend Current Topics in Geriatrics, the annual JHU geriatric medicine continuing medical education course. They also participate in all of the teaching sessions for geriatric medicine fellows (e.g., fellows' morning report, Monday and Wednesday noon conference). In addition, they attend medical grand rounds at Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center.

Bedside training, limited to mentored observership, includes rotations through the continuum of geriatric care services described earlier. These rotations are typically 2 to 6 weeks.

The didactic and bedside training plan can be modified to individual trainee's interests and focus areas. In addition, special arrangements have been made to provide significant training in aging research, introduction of other special geriatric care models such as that at local Continuing Care Retirement Communities (CCRC), and leadership training for the individual designated as the geriatric medicine program leader, whose training occurred over a 1-year period. A special geriatric nursing training program has been developed and implemented for the training of PUMC hospital nurses that includes didactic teaching of the theory and practice of geriatric nursing (in collaboration with the JHU School of Nursing) and clinical rotations through inpatient geriatric units for bedside training of nursing protocols.

To address the challenge of competing Division faculty teaching time (see Challenges and Concerns below), only two PUMC trainees are invited at a time. In addition, they are provided with ample reading materials, including the latest edition of American Geriatrics Society (AGS) Geriatrics Review Syllabus, Geriatrics at Your Fingertips, and other geriatric medicine and gerontology textbooks. Other pertinent printed and online materials are also provided, and trainees are asked to review them before and after each lecture and rotation so that they make the best use of these training opportunities.

As an integral part of this program, the quality of training is evaluated regularly. While clinical skills assessment is limited because trainees are not able to perform hands-on patient care for regulatory reasons (see Challenges and Concerns below), the focus is on assessing trainees' knowledge and attitudes. Assessment is based on a set of geriatric core values developed by the AGS16 with the following major components:

  • 1
    After each clinical rotation, trainees submit a written report describing what they have learned and how it can be modified and applied to geriatrics development in China.
  • 2
    Trainees have debriefing meetings with the program director (SXL) every other week or more frequently if necessary. These regular evaluation sessions provide ongoing assessment of the training progress. Trainees also provide feedback about the training program.
  • 3
    Formal and informal reports of each trainee are provided from supervising Division faculty of the clinical rotation.
  • 4
    A midterm examination with a set of board-type questions adapted from the materials published by the AGS for the preparation of Geriatric Medicine Board for PUMC physician trainees with a training period of 6 months or longer to further assess their geriatrics knowledge base.

Based on the assessment outlined above and feedback from the trainees, clinical rotations and didactic teaching are adjusted accordingly to further strengthen their training. The findings from these evaluations are also reported back to the PUMC leadership.

By October 2009, the fourth month of the final year of this 4-year joint venture, 12 PUMC trainees (4 registered nurses, 4 senior resident physicians, 2 instructors/assistant professors, 1 associate professor, and 1 full professor) had finished or were in training at JHU. In addition to the qualitative evaluation for their geriatric competency described above, scores from the midterm examination provide a preliminary quantitative measurement of learning for some trainees. Because they had had no prior geriatrics training, scores of 55% to 95% obtained from this board-type examination demonstrate a variable but significant grasp of geriatric knowledge base by the trainees. No final examination is administered because of the short duration of the training. As this article focuses on the JHU experience, the learning experiences of the PUMC trainees will be described elsewhere.

Geriatrics Demonstration Ward at the PUMC Hospital

With the infrastructure, facility, and staff support committed from PUMC Hospital, a 30-bed geriatric inpatient demonstration ward was officially opened in May 2007. A multidisciplinary geriatric care team is being constituted from among PUMC trainees who have finished their training at JHU and have returned to PUMC Hospital. Clinical care pathways for specific geriatric syndromes are gradually being developed in the geriatric demonstration ward. In addition, nursing protocols for fall prevention, skin care, and maintenance and support for instrumental activities of daily living (IADLs) and activities of daily living (ADLs) are being implemented.

Faculty Exchange Between JHU and PUMC and On-Site Consultation by JHU Geriatrics Faculty and Leaders from Other U.S. Academic Medical Institutions

Shortly after the initiation of this joint venture in 2006, faculty exchanges between JHU and PUMC have provided opportunities for initial needs assessment and planning. Subsequently, six JHU faculty members including the chairman of the Department of Medicine have visited PUMC and provided on-site consultation. They conducted morning rounds and clinical case discussions in the geriatric demonstration ward at PUMC Hospital, during which they provided consultative expert opinion for the evaluation and management of complex elderly Chinese patients. These faculty and faculty from other leading academic geriatrics programs in the United States have also given lectures and workshops on important topics in geriatric medicine and gerontology including development of a successful academic geriatric program, aging of the cardiovascular system, chronic disease management in older adults, evaluation and treatment of osteoporosis, and other important topics in clinical geriatrics and aging research.

Challenges and Concerns

The program has met the milestones set forth in the initial proposal, although there are significant challenges to implementing a program of this type. First, because the PUMC physician trainees do not have clinical credentials required by the U.S. healthcare system, they are appointed as mentored clinical observers and cannot participate in direct patient management or physical examination of patients. This significantly limits the educational experience. Second, because China is not an English-speaking country, English deficiency is sometimes a major barrier to the learning ability of PUMC trainees. As described earlier, adequate English-language skill is one of the selection criteria of the trainees. As a result, although some PUMC trainees have difficulty expressing themselves in English, almost all of them have excellent reading and listening comprehension. In addition, the JHU geriatric faculty member of Chinese descent (SXL) is fluent in Chinese (Mandarin) and helps PUMC trainees to understand complex clinical terms and geriatrics concepts in Chinese when necessary. Simultaneous Chinese translation was provided for all English lectures and seminars given by U.S. geriatric faculty at PUMC. Third, the Division has many learners (e.g., medical students, residents, fellows) competing for faculty teaching time. Adding the PUMC trainees intensifies this challenge. Fourth, approximately one-third of the CMB funding is allocated to JHU for the support of the training effort and faculty exchange, but the cost in time and effort of JHU faculty and staff and travel expenses for faculty exchange are significant. The CMB funding allocation, although substantial, does not cover all of the opportunity cost. The estimate gap is approximately $50,000. In addition, the living and traveling expenses of the PUMC trainees are not trivial, although the PUMC budget adequately covers them.

While all PUMC trainees have returned or are committed to returning to China, the uncertainty that all trainees will return could be another challenge. Additionally, how to keep the trainees' commitment to geriatrics after they return to PUMC and whether all of them will play a role in geriatric development in China are important questions that remain to be answered.

In summary, these are likely common challenges for international geriatric development programs. Some of them have been addressed or can be addressed in future endeavors like this, whereas others can be extremely difficult, if not impossible, to address. These challenges and concerns should be kept in mind in future planning for such international joint ventures.

RECOMMENDATIONS

  1. Top of page
  2. Abstract
  3. THE CONTEXT AND OPPORTUNITY
  4. THE JOINT VENTURE
  5. RECOMMENDATIONS
  6. FUTURE PROSPECTS
  7. ACKNOWLEDGMENTS
  8. REFERENCES

The “aging wave” is not limited to the United States; aging in some developing countries such as China is more like a “tsunami.” This has created a great opportunity for worldwide promotion of geriatric medicine and a global market for U.S. geriatric expertise. Some academic geriatric programs and professional organizations have begun their effort for international geriatric program development and knowledge dissemination. In 2009, for example, the AGS launched the AGS Ambassador Program to build a strategic alliance with international societies and ensure that older adults have access to high-quality, patient-centered care around the world. Based on the ongoing experiences in this joint venture with PUMC described above, the following recommendations are made:

  • 1
    Assess the need for geriatric expertise in the country of interest. This can be accomplished through in-depth examination of population demography, economic development, and existing geriatric services and overall healthcare support for older adults in that country.
  • 2
    Identify a strong partner (or partners). The long-term objective is to develop or work with a flagship program that will lead geriatric development or knowledge dissemination across that country. It is also critical to assess the level of need, enthusiasm, and commitment at the partner institution to ensure that there is a strong and long-lasting partnership necessary for a successful international joint venture.
  • 3
    Identify a funding source (or sources). Although the overall goal is to build a mutual partnership that will improve health care for older adults in that country, it is important to secure adequate funding to cover the opportunity cost for the U.S. partner institution and enough funding and resources for program development and dissemination at the partner institution in that country. Funding can be from private foundations, particularly those specifically set up for a country or region; the local or central government of that country; local or national organizations; or philanthropy. Once the funding is secured, it is important to work out budgetary terms between partner institutions.
  • 4
    Establish specific objectives and concrete steps to achieve them. It is important to keep in mind that each country has its own traditions, values, and characteristics in the healthcare system and policy, as well as the socioeconomic environment related to the support for older adults. For example, China has its own deeply held cultural beliefs and health policy concerns, and it was attempted to modify the program to account for substantial differences in attitude toward hospitalization, feelings about death, and availability of support services in the outpatient arena, to name just a few. In addition, cultural diversity should be taken into consideration in future dissemination of geriatrics in China because it has more than 50 recognized ethnic groups or nationalities. Therefore, it is imperative to integrate U.S. geriatric expertise that will be adjusted to the culture and society of that country to better serve the care needs for older adults in their own settings.
  • 5
    Evaluate one's capacity for international geriatric training or knowledge dissemination. It will compromise the quality of the training and other missions of the U.S. institution if the system is overloaded.
  • 6
    Anticipate major challenges and make plans for addressing them.

FUTURE PROSPECTS

  1. Top of page
  2. Abstract
  3. THE CONTEXT AND OPPORTUNITY
  4. THE JOINT VENTURE
  5. RECOMMENDATIONS
  6. FUTURE PROSPECTS
  7. ACKNOWLEDGMENTS
  8. REFERENCES

Building on the progress that has been made thus far, the JHU–PUMC joint venture aims to continue to strengthen the multidisciplinary geriatrics care team in the demonstration ward and expand to geriatric outpatient clinics (e.g., urinary incontinence, falls, memory clinics) and inpatient consultative services across the PUMC Hospital with the goal of establishing a geriatrics department; develop advanced clinical and translational aging research platform that will foster collaboration between specialties and medical subspecialties at PUMC and strengthen the partnership with the Division of Geriatric Medicine and Gerontology at JHU; obtain funding and resources to continue the support for this effort; organize Chinese national and international conferences for the dissemination of geriatric knowledge and promotion of aging research across China; and lead the national effort to establish certification in geriatric medicine based on examination of geriatric competency in China.

It is hoped that the JHU–PUMC joint venture will serve as a successful example and a useful model of international geriatric program development and that the geriatric community in the United States and around the world can learn from it.

ACKNOWLEDGMENTS

  1. Top of page
  2. Abstract
  3. THE CONTEXT AND OPPORTUNITY
  4. THE JOINT VENTURE
  5. RECOMMENDATIONS
  6. FUTURE PROSPECTS
  7. ACKNOWLEDGMENTS
  8. REFERENCES

We would like to thank Dr. Myron Weisfeldt, Osler Professor and Chair of Department of Medicine, Johns Hopkins Hospital; Dr. Liu Qian, past President of the PUMC Hospital and currently Vice Minister of the Ministry of Health; Dr. Zhao Yipei, President of the PUMC Hospital; Drs. Lu Chongmei and Li Dongjing; and other members of the leadership at JHU and PUMC for their support of this project. We would also like to thank Drs. Roy Schwartz and Lincoln Chen, past and current Presidents of the CMB for their enthusiastic support. In addition, we would like to thank all geriatric and nursing faculty at JHU for their contribution and support, and educational staff members (Mrs. Dorothy Becraft, Laura Gibson, and Denise Baldwin) for their excellent logistic support.

Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper.

This project is funded by the CMB (06-836).

Dr. Leng is a current recipient of the Paul Beeson Career Development Award in Aging Research (K23 AG028963).

Author Contributions: All authors contributed to project concept and design, project implementation, and preparation of manuscript. All meet criteria for authorship.

Sponsor's Role: None.

REFERENCES

  1. Top of page
  2. Abstract
  3. THE CONTEXT AND OPPORTUNITY
  4. THE JOINT VENTURE
  5. RECOMMENDATIONS
  6. FUTURE PROSPECTS
  7. ACKNOWLEDGMENTS
  8. REFERENCES
  • 1
    Kinsella K, Wan H. The U.S. Census Bureau, International Population Reports, P95/09-1, An Aging World: 2008. Washington, DC: U.S. Government Printing Office, 2009.
  • 2
    “Zhongguo chengxiang laonian renkou zhuangkuang zhuizong diaocha yanjiu baogao(quanwen) “[The Report on the National Survey of Aging population distribution in the urban and rural area of China(complete version)] [on-line]. Available at http://www.cnca.org.cn. (The official website of Chinese National Committee on Aging) Accessed March 2010.
  • 3
    “jianding buyi zou zhongguo tese tongchou jiejue renkou wenti de daolu” [Comprehensive and unique approach to solve the population issues of China] [on-line]. Available at http://www.gov.cn/wszb/zhibo275/content_1128255.htm Accessed March 2010.
  • 4
    Federal Interagency Forum on Aging-Related Statistics. Older Americans 2008: key indicators of well-being. p. 1–10. Federal Interagency Forum on Aging-Related Statistics, Washington, DC: U.S. Government Printing Office, March 2008.
  • 5
    United Nations International Population Database [on-line]. Available at http://www.un.org/esa/population/unpop.htm Accessed March 2010.
  • 6
    “Wanshan fuwu guanli tizhi yindao renkou youxu liudong”[Guiding population migration by improving government service and management system] [on-line]. Available at http://www.gov.cn/wszb/zhibo275/content_1128987.htm Accessed March 2010.
  • 7
    Aging in Contemporary China [on-line, English version]. [on-line]. Available at http://www.chinainstitute.org/educators/curriculum/aging/introduction.html Accessed March 2010.
  • 8
    Liu H, Liu Y. Only one-child and the marriage structure in the future. Chin J Popul Sci (English version) 1996;8:395402.
  • 9
    Flaherty JH, Liu ML, Ding L China: The aging giant. J Am Geriatr Soc 2007;55:12951300.
  • 10
    Leng SX, Tian XP, Durso SC The aging population and development of geriatrics in China. J Am Geriatr Soc 2008;56:571573.
  • 11
    Manion M. Retirement of Revolutionaries in China: Public Policies, Social Norms, Private Interests. Princeton, NJ: Princeton University Press, 1993.
  • 12
    He Y, Chang Q, Huang JY “Zhongguo Xi'an laonianren zhongfeng fabinglu siwanglu he weixian yinxu de yanjiu” [Study on mortality, incidence and risk factors of stroke in a cohort of elderly in Xi'an, China]. Zhonghua Liu Xing Bing Xue Za Zhi [Chinese Journal of Epidemiology] 2003;24:476479.
  • 13
    Li YF, Cao J, Fan L Prevalence of isolated systolic hypertension and analysis on its relative factors in 1002 cases over 80 years old in retirement centers for army officers. Chinese Med J (English version) 2006;119:14731476.
  • 14
    McNabney MK, Willging PR, Fried LP The “continuum of care” for older adults: Design and evaluation of an educational series. J Am Geriatr Soc 2009;57:10881095.
  • 15
    Burton JR, Roth J. A new format for grand rounds. N Engl J Med 1999;340:1516.
  • 16
    AGS Core Writing Group of the Task Force on the Future of Geriatric Medicine. Caring for older Americans: The future of geriatric medicine. J Am Geriatr Soc 2005;53:S245S256.