In 2020 China became one of the first pilot countries of the World Health Organization Integrated Care for Older People (WHO ICOPE). As one of the Home & Community Elderly Care Service Reform Pilots funded by the Central Government, the Geriatrics Department of Peking Union Medical College Hospital took on the pilot project with support and guidance from WHO to explore ways of localizing the international model of combining health and social care services. The project is jointly launched by the Department of geriatrics and home-based service institutions. Under the guidance and support of top experts in gerontology, geriatrics, aging health policy and education at home and abroad, it helps the elderly to improve their quality of life, reduce the risk of disability and dementia, and effectively deal with a series of elderly health management problems.The project will guide the coordination and integration of different service resources with the common goal of improving quality of life for the elderly. Older adults admitted to the pilot project after mass screening will go through comprehensive assessment before receiving a personalized care plan. Professional integrated care managers will provide 1-to-1 service consultation, coaching, regular health intervention and follow-ups.

The Geriatrics Department has worked with multiple departments in the hospital to formulate the PMUCH Age-Friendly Service Management System and offered training modules for Age-Friendly Hospitals on the internal learning platform on the interpretation and implementation of relevant policies, characteristics of elderly patients and detailed healthcare practice. From theory to practice, the professionalism and effectiveness of geriatric care services are constantly improved. The Clinical Medicine major (4+4 pilot classes) now has 18 compulsory course hours of Introduction to Geriatric Medicine & Palliative Medicine for undergraduate students, and has included the course into the Clinical Core (CC) module in order to strengthen the concept of people-orientation, continuous medical care continuum and age-friendly services from the undergraduate education level.

The PUMCH Geriatrics Department leveraged innovative care model to provide solutions to the difficulties that older patients face under the COVID-19 pandemics in accessing medical consultation, medications, treatment etc. This has helped improve mutual trust between doctors and patients, and strengthened whole-process management of elderly patients’ health status by the medical staff.

Correspondent: Luo Teng

Reporter: Wang Lu

Translator: Kang Lin

Editor: Yang Hongbo