Prof Kenneth Rockwood is Director of Geriatric Medicine Research at Dalhousie University, Canada, adjunct Professor of Geriatric Medicine at the University of Manchester and serves on the International Advisory Panel of Age and Ageing journal.
The Chinese Geriatrics Society met on May 24 2014, brought together for the 7th National Conference on Prevention and Control of Common Diseases in Elderly People. As a speaker and honorary conference co-chair, I’ve been able to see some of the workings up close. Geriatrics transcends many aspects of culture, so that much would be familiar to any BGS meeting attendee – and not just the apparently universal audiovisual glitches (I did not go unspared).
The plenary talks treated the topics of our tribe. Chief amongst these was “common diseases and their joint management”, a more literal translation from the Chinese, but more in the spirit of what must be done, and less unlovely, or so it seems to me, than “multimorbidity”, as is the fashion. Alzheimer’s disease, Parkinson’s disease and stroke each got their own consideration. The challenges of multidisciplinary management and of persisting pain (separate talks, as it turned out) firmly oriented as to being at a geriatrics conference.
Many of the shorter talks featured complex techniques in molecular biology, genetics and imaging (and the ubiquitous TAVI, of course). Much of this work was narrowly focused, striking me as more what one might hear at any of the various “ology” conferences. There is a reason for that. In China, I’ve met many geriatric neurologists and geriatric cardiologists and even geriatric surgeons. Geriatrics in China is a broad tent, with specific geriatric medicine training being only a nascent development.
Some considerable prestige attaches to geriatrics in China. Respect for elders is embedded in Chinese culture, a tendency that has not been harmed by generations of gerontocracy. Indeed, the Institute of Geriatrics at the Beijing Hospital has for years been a nexus of multidisciplinary expertise, attending to an array of high government and party officials.
Many corridor conversations resonate: not enough beds, challenges in integrating health and family care, Emergency Department pressures. In Chinese culture, filial piety often translates into a desire to do – and to be seen to have done – “everything”. This is one context in which frailty assessment emerges. I’m sympathetic, but also concerned. The goal of understanding frailty is to make care more rational – more suited to good patient outcomes. Sometimes, this properly results in forgoing interventions that will do more harm than good. But it can come perilously close to rationing care. This we must guard against – starting by making dangerous care less dangerous.
The point is amply made by one of the session chairs. Dr. Chan Yu-Ling is amongst the oldest active geriatricians. At age 80, she has seen immense cultural, scientific, professional and social change. She remains not just a busy clinician, but an active individual, who enjoys regular walks in the mountains. Even so, the respect that Dr. Chan commands can get lost in her daunting medical history (including primary thyroid and lung cancers). The lessons of studying frailty, rooted in the desire to help people navigate the vicissitudes of ageing, must consider their stories and goals and strive to make care better. This is the work of geriatrics societies everywhere.