Geriatric Medicine Sensible Practice in Modern Societies Liang-Kung Chen, MD PhD FRCP Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital; Department of Family Medicine, Kyung Hee University, Seoul, South Korea

The world is ageing

And ageing fast Taiwan 24 years

Even faster in Asia

Aging is associated with multimorbidity

6 Aging is associated with disabilities

Landi F et al. J Clin Epidemiol 2010;63:752-9 Disease or disability?

Landi F et al. J Clin Epidemiol 2010;63:752-9 Disease or disability?

Landi F et al. J Clin Epidemiol 2010;63:752-9 Aging, multimorbidity, and disability

Care complexity predicts mortality Chen LK, et al. J Am Med Dir Assoc 2010;11:567-71

Expenditure of disease and function

Age-friendly health care system 12

Integrated health care for older people 13

Age-friendly physical environment 14

Registration Intern Med Family Med Case Manager CGA Geriatricians Rehabilitation Neuropsychiatry Care Planning Integrated outpatient Geriatric services 15

Effectiveness of reducing polypharmacy 16

17

Less health care expenditure

Less burden of morbidity

Geriatric Evaluation and Management Unit 20 Admission Geriatricians Case Manager CGA Multidisciplinary team Care Planning Case Management

Patients with multiple complex needs 564 patients admitted to GEMU in 2011 with mean age of 84.1 years (74.1% males), 72.2% admitted from communities, 56.4% had high school education or above 21

Focus on long-term functional outcomes Case-control design to compare functional outcomes 22

Focus on long-term functional outcomes Randomized controlled trial to compare functional outcomes 23

Young, et al. Health Soc Care Community 2005;13: % re- admitted at follow- ups 36% 12- month mortality Functional decline Burden on care 832 frail older patients followed at 3 rd, 6 th, 12 th months after discharges Challenges after hospital discharges 24

1.Elderly veterans admitted to acute medical wards with functional decline prior to hospital dischrges 2.No need for intensive medical visits, laboratory or oxygen use 1.Age < 65 years 2.Admitted due to following causes a.Elective procedures (except arthroplasty) b.Acute conditions of terminal cancer patients c.Cancer patients needing scheduled chemo- or radiotherapy 3.Lack of rehabilitation potential 4.Refusal of referrals 5.Lack of functional decline at index hospitalizations Inclusion criteria Non-inclusion criteria 25 Community hospital-based intermediate care

Week 0Week 4P value Barthel index 46.7± ±31.3 <0.001 IADL 3.0±2.73.6± Braden scale 18.7± ±3.2 <0.001 STRATIFY 0.9±1.10.5±0.6 <0.001 TUG 30.1± ±6.0 <0.001 Pain2.5±3.01.2±2.0< Short-term functional improvement

27 HR=0.38, P=0.03 Cox regression model Long-term survival benefits

Socio-health integration in long-term care Based on periodic functional assessments for residents of long-term care facilities 28

29 Assessment Minimum data set Prognosis Quality Case mix Care plan Trigger Asia’s biggest MDS research group

Reducing health care expenditure 30

31 Dementia Care Research and Education Park

32 Dementia-friendly physical environment

Non-pharmacological treatment first 33 Art therapy Music therapy

It is another glory of Taiwan in health care as the first Center for Excellence in Asia after the National Health Insurance Program 34 Center for Excellence, GARN, IAGG