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China faces an aging tsunami. By the end of 2016, the number of older adults aged 60 and older reached 230 million. This number is projected to reach 418 million by 2035 and peak at 487 million by 2053. The number of individuals aged 80 and older, the oldest adults, reached 26 million and continues to grow by 1 million a year. The socioeconomic context, characterized by an inverted pyramid family structure and the number of “empty nesters,” has greatly compromised traditional Chinese family support for older adults. This article aims to provide an overview of geriatrics development in China. It begins with a brief account of the dramatic demographic shift, major socioeconomic factors, China's healthcare system, and reform related to senior health with a historical perspective. It then describes recent advances in government policy and support and development of a geriatrics physician workforce, care models, primary care networks, and privately owned senior care facilities and support services. Although it is impossible to cover all aspects of the topic, it is hoped that this article provides readers an overall picture of Chinese geriatrics and senior healthcare development in a complex and evolving healthcare system. Geriatrics communities in the United States and around the world will undoubtedly learn and benefit from the unparalleled and continued efforts to address this unprecedented opportunity and challenge in China. [ABSTRACT FROM AUTHOR]

Objectives: To characterize the distribution of an index of healthy aging—the Chinese Healthy Aging Index (CHAI)—in Chinese adults aged 60 and older according to sociodemographic characteristics and geographic region and to examine the association between the CHAI and mortality, disability, and functional limitation over 4 years. Design: Nationally representative cohort study. Setting: China Health and Retirement Longitudinal Study. Participants: Chinese adults aged 60 and older (N=3,740). Measurements: Six CHAI components (systolic blood pressure, peak expiratory flow, Telephone Interview for Cognitive Status, estimated glomerular filtration rate, fasting glucose, C‐reactive protein) were scored 0 (healthiest), 1, and 2 (unhealthiest) according to sex‐specific tertiles or clinically relevant cut‐points and summed to construct the CHAI (range 0–12). Results: Mean CHAI score was 5.6; 5.7% had a score of 0 to 2 (healthiest), 23.0% a score of 3 or 4, 37.5% a score of 5 or 6, and 33.8% a score of 7 to 12 (unhealthiest). Participants who were younger, more educated, and married were much more likely to have an ideal CHAI profile (score 0–2). Age‐adjusted prevalence of an ideal CHAI profile ranged from 1.7% in the south to 8.1% in the north. After multivariable adjustment, persons with a CHAI score of 3 to 12 had substantially higher odds of mortality, disability, and functional limitation than those with a score of 0 to 2. The CHAI further stratified outcomes for persons with no clinically recognizable comorbidities. Conclusion: Substantial variation exists in the CHAI according to sociodemographic characteristics and geographic regions. The CHAI could identify Chinese elderly adults with low risk of adverse outcomes and provide incremental value for risk prediction beyond clinically diagnosed comorbidities. [ABSTRACT FROM AUTHOR]

Background Significant differences exist between eastern and western diets, and the way in which Chinese dietary intake relates to specific cognitive domains remains unclear. We aimed to assess the association between dietary patterns ( DPs) and cognitive decline in Chinese elderly. Setting Participants were recruited from the elderly health checkup program of a teaching hospital in Taipei, Taiwan. Participants A total of 475 elders (age ≥65) were included in this prospective cohort study. Measurements The outcome comprised the decline of global and domain-specific cognition between baseline (2011-2013) and follow-up (2013-2015). Dietary data from the previous year were collected via a food frequency questionnaire at baseline, and a factor analysis was performed to identify DPs. Multivariable linear regression and logistic regression models were used to assess associations between Chinese DPs and cognitive decline over 2 years adjusting for selected covariates. Results Three DPs (vegetable, meat, and traditional) were identified. Moderate- or high-score 'vegetable' DP significantly protected against decline of logical memory (recall I: β = 0.16-0.18, odds ratio ( OR) = 0.42-0.48; recall II: β = 0.17-0.21); while high-score DP increased executive function decline (β = −0.22). A high-score 'meat' DP was related to decline of verbal fluency-total score (β = −0.19); while moderate- or high-score 'meat' DP protected against attention decline (β = 0.20-0.22). High-score 'traditional' DP protected against decline of logical memory-recall I (β = 0.18). No significant association was observed for global cognition. Conclusion These findings suggest that three DPs identified in Chinese elderly were associated with different cognitive domains. Further research is needed to explore the efficacy of dietary interventions in reducing cognitive decline in older adults. [ABSTRACT FROM AUTHOR]

Objectives To examine the cross-sectional associations between self-reported postlunch napping and structured cognitive assessments in Chinese older adults. Design Cross-sectional cohort study. Setting China. Participants Individuals aged 65 and older from the baseline national wave of the China Health and Retirement Longitudinal Study ( CHARLS) (N = 2,974). Measurements Interview-based cognitive assessments of orientation and attention, episodic memory, visuospatial abilities, and a combined global cognition score incorporating these assessments. Other self-reported or interview-based assessments included postlunch napping duration, nighttime sleep duration, demographic characteristics, health habits, comorbidities, functional status and social activities. According to reported napping duration, older adults were categorized as non-nappers (0 minutes), short nappers (<30 minutes), moderate nappers (30-90 minutes), and extended nappers (>90 minutes). Results Postlunch napping was reporting in 57.7% of participants for a mean of 63 minutes. Cognitive function was significantly associated with napping ( P < .001). Between-group comparisons showed that moderate nappers had better overall cognition than nonnappers ( P < .001) or extended nappers ( P = .01). Nonnappers also had significantly poorer cognition than short nappers ( P = .03). In multiple regression analysis, moderate napping was significantly associated with better cognition than non- ( P = .004), short ( P = .04), and extended napping ( P = .002), after controlling for demographic characteristics, body mass index, depression, instrumental activities of daily living, social activities, and nighttime sleep duration. Conclusion A cross-sectional association was found between moderate postlunch napping and better cognition in Chinese older adults. The cross-sectional design and self-reported measures of sleep limited the findings. Longitudinal studies with objective napping measures are needed to further test this hypothesis. [ABSTRACT FROM AUTHOR]

Objectives To investigate time trends in incidence of activity of daily living (ADL) disability of Chinese older adults and to explore factors potentially contributing to trends. Design Population-based prospective study using a multistage, randomized, cluster sampling process. Setting Nine provinces of China. Participants Three consecutive cohorts of people aged 60 and older from the China Health and Nutrition Survey: cohort 1993-2000 (n = 831), cohort 1997-2004 (n = 1,091), cohort 2000-2006 (n = 1,152). Measurements Disability in ADLs was defined as inability to perform at least one of five self-care activities (transferring, dressing, toileting, bathing, feeding). Data were analyzed using Cox and generalized estimating equation models. Results The incidence (per 1,000 person-years) of ADL disability decreased significantly from 35.3 in 1993-2000 and 28.9 in 1997-2004 to 24.3 in 2000-2006 in Chinese older adults (Ptrend < .001). The incidence of ADL disability decreased significantly in men and women, in young-old adults (aged 60-74), and in those living in rural areas (all Ptrend ≤ .02) after controlling for multiple potential influential factors. Of the five ADL items, decline in incidence of disability was significant in transferring (Ptrend < .001) and bathing (Ptrend = .002) and marginally significant in toileting ( Ptrend = .06) but stable in dressing (Ptrend = .38) and feeding (Ptrend = .26). Conclusion The incidence of ADL disability decreased from 1993 to 2006 in older adults in China, especially in transferring and bathing, independent of sociodemographic, lifestyle, and chronic health conditions. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the effectiveness of the Chinese version of the Montreal Cognitive Assessment Basic (Mo CA- BC) as a screening tool for detecting mild cognitive impairment ( MCI) in Chinese elderly adults. Design Cross-sectional. Setting Huashan Hospital, Shanghai, China. Participants Individuals with MCI (n = 264) and mild Alzheimer's disease ( AD) (n = 160) were recruited from the Memory Clinic, Huashan Hospital; cognitively normal controls were recruited from Jinshan Community, Shanghai, China (n = 280). Measurements Mo CA- BC scores. Results The Mo CA- BC had good criterion-related validity (Pearson correlation coefficient Mo CA- BC vs MMSE = 0.787) and reliable internal consistency (Cronbach alpha = 0.807). The optimal cutoff scores for MCI screening were 19 for individuals with no more than 6 years of education, 22 for individuals with 7 to 12 years of education, and 24 for individuals with more than 12 years of education. The Mo CA- BC was superior to the MMSE for detecting MCI, with optimal sensitivity and specificity across all education groups using the above cutoff scores. Conclusion The Mo CA- BC is a reliable cognitive screening test across all education levels in Chinese elderly adults, with high acceptance and good reliability. [ABSTRACT FROM AUTHOR]

This study examined patterns of onset of activity of daily living ( ADL) disability in a nationally representative sample of older adults in mainland China. Using longitudinal data from the Chinese Longitudinal Healthy Longevity Survey from 1998 to 2008 (N = 5,570), nonparametric methods were used to evaluate median age at onset of various ADL disabilities and differences in the incidence of disabilities according to sex. The sampled older Chinese adults developed ADL disabilities, on average, between the ages of 89 and 94. Women were likely to experience later onset than men. The results also show that the oldest adults generally lose bathing ability, followed by toileting, transferring, dressing, eating, and finally, continence. This order-derived from estimated median age at onset-was also found to be highly prevalent in subsequently disabled respondents in the sample. The disability experience of older adults in China is somewhat similar to that of older adults in Western developed countries; elderly adults tend to lose ability in activities that require lower extremity strength earlier than those that require upper extremity strength. The relative importance of the various ADL items in the hierarchical ordering has implications for early intervention to reduce the risk of functional disability in older adults and those at risk of transitions of care. [ABSTRACT FROM AUTHOR]

To determine the clinical presentation, findings, and outcomes of older adults (> 60) with severe acute respiratory syndrome (SARS) and compare these with a control group of younger patients (≤60). Retrospective cohort study. A community-based, acute hospital in Hong Kong. All adult inpatients with a clinical diagnosis of SARS. Clinical presentations, investigations, treatment, and 30- and 150-day mortality. There were 52 young and 25 older patients with a mean age±standard deviation of 39.5±11.7 and 72.1±7.2, respectively. Fever, chills, and diarrhea were more common in younger patients, whereas decrease in appetite and general condition occurred only in older patients. The prevalence of positive reverse-transcriptase polymerase chain reaction for SARS-associated coronavirus (SARS-CoV) in nasopharyngeal secretions and stool samples was similar in the two groups. The prevalence of positive serological tests for SARS-CoV was significantly lower in older patients (42% vs 92%, P<.001). This was largely due to incomplete testing in elderly patients. Older patients were more likely to develop secondary nosocomial infection, be admitted to an intensive care unit, and require mechanical ventilation. The cumulative 30- and 150-day mortality rates were 3.8% and 7.6%, respectively, in young patients with SARS and 56% and 60%, respectively, in older patients ( P<.001). Older patients with SARS more often presented with nonspecific symptoms, and the prognosis was poor. Reverse-transcriptase polymerase chain reaction was useful in diagnosing SARS in older patients, but the role of serological tests in individual elderly is limited. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To investigate sociodemographic characteristics (SDCs) and health status of older Chinese newly admitted to a nursing home (NH) and to compare them with the characteristics of residents from other racial/ethnic groups. DESIGN: Secondary analysis of the admission Minimum Data Set Plus (MDS+). SETTING: A New York City municipal NH near Chinatown. PARTICIPANTS: Two hundred fifty-eight (125 Chinese, 57 white, 53 Hispanic, and 23 black) of 292 residents consecutively admitted from November 1992 to May 1997 were selected after excluding those younger than 60 or transferred from another NH. MEASUREMENTS: SDCs, health status parameters (cognitive performance, physical functioning, mood/behavior patterns, and psychosocial well-being), and morbidity information (most-frequent diagnoses/conditions and medication use) documented in or generated from the MDS+. RESULTS: The majority of these Chinese were first-generation immigrants and spoke primarily Cantonese or Mandarin Chinese. Compared with whites, they were more likely to be married, less likely to have lived alone, more likely to be using Medicaid, less likely to make medical decision alone, and more likely to depend on family members for decision-making. Nearly three-quarters of Chinese had cognitive impairment. There was an underdiagnosis of dementia in the Chinese subjects on admission. Severe dependence in activity of daily living was identified in more than one-third of Chinese. Fewer Chinese were using psychotropic medications on admission than the whites. Similar to other groups, many of the Chinese subjects were incontinent of bowel and bladder and had chewing or swallowing problems, hypertension, anemia, and stroke. CONCLUSION: This is the first systematic report of the SDCs and health status of a group of newly admitted older Chinese to an urban NH in the United States using the Minimum Data Set database. These findings suggest that Chinese residents are as frail as other racial/ethnic residents... [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which addresses China's One-Child Policy and long-term medical care in the U.S., and it mentions an effort to slow the aging of China's population, as well as information about the millions of older residents in Shanghai, China.