1. 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

2. The world is ageing

3. And ageing fast Taiwan 24 years

4. Even faster in Asia

5. Aging is associated with multimorbidity

6. 6 Aging is associated with disabilities

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

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

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

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

11. Expenditure of disease and function

12. Age-friendly health care system 12

13. Integrated health care for older people 13

14. Age-friendly physical environment 14

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

16. Effectiveness of reducing polypharmacy 16

17. 17

18. Less health care expenditure

19. Less burden of morbidity

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

21. 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

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

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

24. Young, et al. Health Soc Care Community 2005;13:307-12. 25% 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

25. 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

26. Week 0Week 4P value Barthel index 46.7±29.871.9±31.3 <0.001 IADL 3.0±2.73.6±2.7 0.007 Braden scale 18.7±3.920.7±3.2 <0.001 STRATIFY 0.9±1.10.5±0.6 <0.001 TUG 30.1±10.720.6±6.0 <0.001 Pain2.5±3.01.2±2.0<0.001 26 Short-term functional improvement

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

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

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

30. Reducing health care expenditure 30

31. 31 Dementia Care Research and Education Park

32. 32 Dementia-friendly physical environment

33. Non-pharmacological treatment first 33 Art therapy Music therapy

34. 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