Resumen de Transformation of a Geriatric Department in China
Birong Dong, Jirong Yue, Li Cao, Ming Yang, Ning Ge, Hao Qiukui, Lujia He, Ying Wang, Joseph H. Flaherty
China has the world’s largest elderly population, and theoldest-old population, with a current disability rate greaterthan 50%, will triple in the next 35 years. The field ofgeriatrics is young, because almost all geriatric depart-ments were established after 2000, and so faces many chal-lenges. Management of diseases and hospital care is thefocus. Senior physicians were trained in other subspe-cialties, such as pulmonary or cardiology, and juniorphysicians entered geriatrics departments as masters ordoctorate students after medical school. The inadequacy ofpost-acute and long-term care facilities has caused longhospital stays. There are no national systematic geriatrictraining programs, national board examinations, or qualifi-cations in geriatrics. These challenges were used as aframework for guiding changes in the Department of Geri-atrics at West China Hospital, Sichuan University. Thesechanges have included international experiences and col-laboration for physicians and nurses, revision of depart-mental conferences, and special training for a uniquegroup of caregivers called hugong (untrained caregivershired by families to be at the bedside of hospitalized indi-viduals). The most significant yet challenging part of thetransformation has been to develop and modify Western-based geriatric models of care (e.g., Acute Care of theElderly unit, delirium prevention and management models,palliative care). Lastly, the department established Tianxia(in the sky) Doctors, an internet-based platform to connectthe department’s interdisciplinary team to other hospitals,nursing institutions, home-based care service stations, com-munity health service centers, and pharmacies throughoutthe region.
