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How to improve future health care quality for elder patients: A perspective from Taiwan Association of Gerontology and Geriatrics (TAGG)

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How to improve future health care quality for elder patients: A perspective from Taiwan Association of Gerontology and Geriatrics (TAGG)

Cheng-Chieh Lin, MD, Ph.D.

Dean / Professor, School of Medicine, China Medical University, Taichung, Taiwan President, Taiwan Association of Gerontology and Geriatrics

Taiwan has the fastest ageing population in the world. In response to the care needs due to fastest ageing population, the mission of Taiwan Association of Gerontology and Geriatrics (TAGG) is to promote the highest levels of health care quality for older people by playing an crucial role in development of geriatric care models and assessment tool training program in the seamless care system, and provision of training and education program in geriatric medicine and gerontology for governmental and non-governmental organizations, and fostering collaboration between health professionals, policymakers, and scholars and researchers of diverse areas to create aged friendly environment to achieve the greatest impact.

In the past few years, TAGG helped many health care organizations including local hospitals to set up comprehensive geriatric assessment (CGA) in clinical practice through Taiwan’s Medical Care Network plan. CGA is a multidimensional, multidisciplinary diagnostic instrument including physical, mental, social, environmental, and economic domains. Through the comprehensive geriatric assessment, then early prevention, early diagnosis, and early treatment can be done to promote healthy and active aging. The TAGG is executing the integrative geriatric delivery service program to create a workable and sustainable model for providing these services.

Post-acute care is a care model, closing the gap between short-term and long-term care. Local hospitals are suitable for providing post-acute care. Most of Taiwan public hospitals are required to be responsible for providing post-acute care. Post-acute Care for Cerebrovascular Diseases

(PAC-CVD) payment program holding by National Health Insurance Administration are improving the vertical integrate medical service system, and early recovering loss of independent in stroke patients. A total of 39 multi-hospitals groups participate the payment program. The Gerontological Society of the ROC has a project funding by government to establish the guideline of post-acute care in Taiwan.

In addition to medical care affairs, TAGG is interacting with other organizations to pursue the goal of maintaining autonomy and independence for the older people in the framework for active ageing: continuing participation in leisure, social, cultural and spiritual activities in the community, as well as with the family, allowing older people to continue to exercise their competence, enjoying respect and esteem, and maintaining or establishing supportive and caring relationships.

As early as in the 1960s, the Geriatrics courses have been offered in medical schools in Taiwan. The rapid progress in geriatric and gerontological service, education and research has been made since 2001 due to the set-up of geriatrics specialist training. In 2003, the National Health Research

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Institutes established Division of Geriatric Medicine and initiated a geriatrics specialist training program. The first training program was set up in 2006 and till now there are a total of 14 training hospitals along with 15 training programs. Now there are 1,362 members in TAGG and 861 of them are geriatrics specialists. In addition, there is an annual increase by about 20 new training

physicians. As for academic programs, three universities have set up undergraduate, master, and PhD programs in geriatric medicine to conduct teaching and research work. To provide the

opportunities of post-graduation education and learning, TAGG has hosted Asia Pacific Geriatrics Conference in 2014 and is bidding to host 2019 Asia / Oceania Congress of Gerontology and Geriatrics.

Since 2010, the Health Promotion Administration (HPA) has launched the accreditation of "Age-Friendly Health Services" in Taiwan. The health service institutions should improve their quality of service by implementing the Framework of Age-Friendly Health Services" to establish an environment meeting the needs of the older adults with various health conditions. Hospitals and allied healthcare institutions should further join force to expedite cross-disciplinary resource integration for ongoing promotion of holistic elder care and active aging. Now, a total of 68

hospitals are qualified. Taiwan is the first place where such an accreditation is nationally promoted by the government. Director Chiu is the key person to enable successful nationwide plan. Recently PHA is launching a project named “Age-Friendly City” to strengthen the local government

departments’ commitment to promote policies and strategies on age-friendly environment. These projects have created changes in the practice environment that improves the health of older adults, their families, and communities.

Currently, the establishment of a seamless integrated care model that includes acute care, interim care, long-term care and terminal care is ongoing, which is an important cornerstone to activate our aging society. In the future, there is a need for our nation to set up a National Center of Gerontology and Geriatrics Excellence to take a lead for academic research and education,

policy-making and industrial development in the field of gerontology and geriatrics. The urgent work to be accomplished for achieving the highest quality of life and well-being of all people as they experience ageing at individual and societal levels is to establish the medical care integrated with in home service for the elderly, to enhance the PGY training program in geriatrics and the subspecialists training for capacity of geriatric care, to promote age-friendly hospitals and

communities, to develop electronic technology for elderly care, to launch the insurance coverage of acute, post acute and long-term cares, and to connect governmental health care and social

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