Dignified life

Peking Union Medical College Hospital's department of geriatrics, established in 2006 by Liu, the chief physician, is one of the first of its kind in China.

"As chronic diseases have become the main cause of death and disability among the elderly, and about 80 percent of seniors die from such diseases, the focus of elderly care is on preventing disease, organ failure, function decline and other adverse events," Liu said.

"If seniors are partially disabled, we help them function as much as possible, but if they are completely disabled, we need to help them live a dignified life in their last days."

The approach adopted by doctors seeing geriatric patients is different from that of specialized diagnosis and treatment departments in hospitals, which center on seniors' daily living activities.

"We need to accurately care for the elderly who have several chronic conditions to check whether they have taken inappropriate medication, or if they have any illnesses occurring at the same time," Liu said.

"In geriatrics, we do this through medication. If the person is sick and his or her diseases are co-occurring, their treatment will be aimed at reducing lipids (organic compounds that are insoluble in water), hypertension and platelets (tiny blood cells). It's the same for every patient," she said.

In cases where multiple chronic conditions coexist, it may not be good for elderly patients to take medication prescribed by doctors in various fields.

Liu said: "We first ask patients about all the medication they are taking. We then spend a lot of time trying to see which drugs are not working, whether there are overlapping medication errors, and if any of the drugs are putting the patient at risk.

"For example, our department has stopped prescribing enteric aspirin for primary prevention of cardiovascular diseases, which is used in specialist clinics, because of the risk it poses to older adults."

Such medication is designed to withstand stomach acid and pass through the stomach before fully dissolving in the small intestine.

Teamwork is particularly important, with pharmacists, psychologists, rehabilitation therapists, nurses and doctors playing key roles in geriatrics departments' daily work.

Comprehensive geriatric assessment — a multidisciplinary diagnostic and treatment process that involves all staff members in the department — identifies seniors' medical, psychosocial and functional capabilities, enabling a coordinated plan to be drawn up for each patient's needs.

Liu said, "These procedures are aimed at treating a particular disease, but as chronic illnesses are incurable, we shift our focus to maintaining functions among the elderly."