Aging Medicine: a platform to understand health needs in rapidly aging populations

With this issue, Aging Medicine launches as the official English-language journal of the Chinese Geriatrics Society. Dr. Jian-ye Wang and I are honored to be the founding co-Editors-in-Chief. The mission of the journal is to provide a showcase for research on geriatrics in China as it helps the world’s most populous country address the growing demand for health care that inevitably accompanies population aging, especially in a time of important medical advances. We welcome contributions from around the world and are joined by a distinguished editorial board. This board has been selected both to honor the past and to look forward to the further development of the specialty of geriatrics by welcoming some of its brightest young stars. Geriatrics in China has an interesting history which contrasts with that in many parts of the world in which it developed exclusively as a medical subspecialty. They join their geriatrician colleagues across several medical disciplines, including intensive care medicine, as well as from neurology, emergency medicine, and public health. This “broad tent” approach has in its focus the care of older people. It is informed by the cultural notion of filial piety, in which there are family and social duties toward older adults. China’s society is aging rapidly, in both relative (the proportion aged 60+ years) and absolute (the median and average ages) terms. With that fact come inevitable stresses, to which China is not immune. For example, a specific challenge is that of how Chinese culture honors its elders. The notion of filial piety places a special obligation on the health care of older adults. How the desire to do “the very best” for a person translates into care can be a fraught issue. When is “the very best” to accept death, and aim for the best palliative care? When does it mean to press ahead against stiff odds? These are not simply technical issues. At the same time, knowing what decision is best means understanding what the range of plausible outcomes might be. Within China, as in many other countries, the care that can be provided in urban areas will differ from that available in rural areas. Given its vast size, and the importance of the physical environment on health, there will be natural experiments in how healthspan and lifespan vary. Everywhere, across the life course, the degree of social vulnerability will be important to the health of people. This, inevitably, will be especially important in late life, when mortality is at its highest. Aging Medicine, in aiming to showcase Chinese geriatrics, will welcome papers that reach across issues of biology, medicine, social and cultural norms and expectations, public health medicine, and health economics. We will welcome articles in various aspects of care, including the care of older patients from a variety of medical and surgical specialties, and in public health. We will be especially interested in models of care from China—both established and new—and in innovations that can inform better care here and elsewhere in the world. We aim to explore the interface between traditional Chinese medicine and contemporary geriatric medicine, especially in relation to such frailty syndromes as delirium, chronic pain, functional limitations, and bowel and bladder disorders. We will be especially keen to understand how social factors affect the development of geriatric syndromes, as well as the development and lethality of frailty. Another focus will be on organizational and administrative features. For example, in China, on the one hand, primary care remains in development, and on the other, annual health check routines allow a great deal of information to be compiled about individuals’ health over an important part of their life course. This rich combination means that there will be important to opportunities to evaluate how health system factors affect healthspan and lifespan. Especially in the first several issues, we will be keen to receive systematic reviews. Some of these should take care to summarize the situation in China. For this reason, we will be interested in reviews which include the most relevant Chinese-language papers for the topics under consideration. Questions such as this, and more broadly about how social, economic, and health factors interact, are at the edge of our contemporary understanding of the health of older adults around the world. If Aging Medicine can harness some of the massive resource of dedicated Chinese geriatricians and scholars from many disciplines to help advance that understanding, we will have truly met an important mandate, for China and beyond.