Healthy Aging: West Meets East How Health Care Systems Work

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2 Germany China Russia Healthy Aging: West Meets East How Health Care Systems Work Liang-Kung Chen, MD, PhD Professor and Director, Aging and Health Research Center, National Yang Ming University; Director, Center for Geriatrics and Gerontology, Taipei Veterans General Hospital

3 About me Liang-Kung Chen, M.D., PhD Professor and Director, Aging and Health Research Center, National Yang Ming University Director, Center for Geriatrics and Gerontology, Taipei Veterans General Hospital President, Taiwan Association of Integrated Care Personal research interest Age-friendly healthcare Frailty, sarcopenia and cognition Publication ( ) Over 200 SCI-indexed articles Editorial board Editor-in-Chief, Journal of Clinical Gerontology and Geriatrics, Journal of Metabolic Syndrome Associate editor, Journal of Frailty and Aging, BMC Geriatrics [SCI] Editorial Board, Geriatrics and Gerontology International [SCI], Age and Ageing [SCI], and others

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5 Data source:

6 Asia ages faster than others 25 years years Interval between 65+ people reaching 7% of total population to 14% 85 years years

7 Different status of aging in Asia 45% 40% 35% 30% 25% 20% 15% 10% 5% Taiwan Japan South Korea China India Malaysia Indonesia Thailand Phillipines 0% Countries with population > 10 million 7

8 Japan, South Korea, Taiwan, Singapore Data source: with modification

9 Into the super-aged countries

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11 51.1% dementia will be in Asia

12 60.3% hip fractures will be in Asia

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14 Inadequate healthsocial integration Emphasis on hospital care Lack of good referral system

15 Taiwan becoming regional innovative center of care for older people Age-friendly policies Age-friendly healthcare facilities Age-friendly cities New health services Integrated outpatient services Inpatient geriatric services Intermediate care services Dementia care services Long-term care services

16 Promoting age-friendly services Fellowship training and CME for all specialties Integrated care Public policy Education Service model Policy

17 World first national standards for age-friendly healthcare facilities 228 verified, including 156 hospitals, 29 primary health centers, and 43 long-term care facilities in Taiwan New standards under development Regional impact Japan, Hong Kong and South Korea are interested

18 Benefits for integrated care Medications Reduction% Medical Cost Reduction % Quality of Care Increase% One-Stop Integrated Service Reduce Polypharmacy Increase Quality of Care Reduce Medical Cost

19 ,8 5,6 5,4 5,2 5,0 4,8 4,6 4,984 4,926 5,614 5,240 - Pre Post 4,4 Pre Post case contorl case contorl Tao P, et al., Geriatr Gerontol Int 2012;12:612-21

20 Unmet post-acute care needs 36% mortality in a year 25% re-admission in first 3 months High nursing home admissions Young, et al. Health Soc Care Community 2005;13:

21 Asia leading post-acute care system Chen LK, et al. Ann Med 2010;42:

22 Culture-sensitive dementia care

23 Improving behavioral symptoms 1 0,5 0-0,5 Case Control -1 Delusion Agitation Aggression Hallucination Anxiety Sleep disturbance Chen RC, et al., Geriatr Gerontol Int 2014;14:

24 Post-acute care Agefriendly hospitals Stroke Fractures Functional need Institutional LTC Community & Home-based LTC Community Primary heath care Health promotion Home medical care Community Social care

25 Strong international collaboration National Center of Geriatrics and Gerontology, JAPAN Integrated Center on Aging and Health, TAIWAN International Collaboration of Orange Platform

26 Long-term care insurance since 2008 with coverage limited for severely disabled older people Tax-based long-term care plan since 2008 for all disabled older people (economically deprived seniors prioritized) Long-term care insurance since 2000 with full coverage for all disabled older people

27 Health care reform in Japan 一般病床 (107 萬床 ) 療養病床 (23 萬床 ) 長照療養病床 長照設施 (92 萬人 ) 入住型服務 (31 萬人 ) 依據地區性病床數調整 中期照護 居家服務

28 Taiwan works with the world Geriatric specialist training in Taiwan is US model, and adds international experiences

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31 West meets East Taiwan can be the window

32 Liang-Kung Chen, MD, PhD Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan