By 2025, the proportion of geriatric departments in tertiary and above general hospitals should be greater than or equal to 60%, compared with 31.8% in 2020.
During the "14th Five-Year Plan" period, the mainland will enter a moderately aging society, and the proportion of people aged 60 and over will account for more than 20% of the total population. At the same time, more than 78% of the elderly suffer from at least one chronic disease, and the number of disabled elderly people will continue to increase ...
Compared with the health needs of the elderly, the relevant institutions, teams, services and policy support are insufficient. Therefore, high-level documents such as the Opinions of the CPC Central Committee and the State Council on Strengthening the Work of Aging in the New Era, the 14th Five-Year Plan for the Development of the National Aging Undertaking and the Old-age Service System, the Guiding Opinions on the Establishment and Improvement of the Elderly Health Service System, and the Guidelines for the Construction and Management of Geriatric Medicine Departments (Trial Implementation) are frequently issued.
On March 1, another national document on the work of aging, the "14th Five-Year Plan for Healthy Aging" (hereinafter referred to as the "Plan"), was jointly issued by the National Health Commission and 15 other departments, clarifying the development goals and work indicators for promoting healthy aging during the "14th Five-Year Plan" period.
Among the main indicators, by 2025, the proportion of geriatric departments set up in secondary and above general hospitals should be greater than or equal to 60%, while this figure will be 31.8% in 2020; the standardized health management service rate of urban and rural communities for the elderly aged 65 and above will reach more than 65%, and the health management rate of traditional Chinese medicine will reach more than 75%.
In terms of institutional construction, requirements are put forward for the construction of rehabilitation hospitals, nursing homes (centers) and hospice wards above the second level
In principle, each provincial capital city and prefecture-level city with a permanent population of more than 3 million shall set up at least one rehabilitation hospital of second-level or above; at least one county-level public hospital with a permanent population of more than 300,000 shall have a rehabilitation medicine department; and at least one county-level public hospital with a permanent population of less than 300,000 shall set up rehabilitation medicine outpatient clinics. By 2025, the proportion of rehabilitation (medicine) departments in tertiary Chinese medicine hospitals will reach more than 85%.
In principle, each county (city, district) should build 1 nursing home (center); in each national hospice pilot city (district), each county (city, district) should set up at least 1 hospice ward, and community health service centers and township health centers with conditions should set up palliative care beds.
Lay out a number of regional geriatric medical centers, and strengthen the construction of the National Clinical Medical Research Center for Geriatric Diseases. Through new construction, renovation, expansion, transformation and development, strengthen the construction of geriatric hospitals, rehabilitation hospitals, nursing homes (centers, stations) and preferential care hospitals, and encourage areas with rich public medical resources to transform some public medical institutions into rehabilitation and nursing institutions.
By the end of the "14th Five-Year Plan" period, the proportion of geriatric departments established in general hospitals at the second level and above should reach more than 60%, and the construction of geriatric departments in chinese medicine hospitals at the second level and above should be accelerated. By 2025, more than 85% of general hospitals, rehabilitation hospitals, nursing homes and primary medical and health institutions will become age-friendly medical institutions.
In addition, the "Plan" also emphasizes the role of traditional Chinese medicine in the health of the elderly, requiring the strengthening of the capacity building of traditional Chinese medicine health services for the elderly in provincial-level traditional Chinese medicine treatment centers, formulating relevant standards and norms, training and promoting appropriate technologies of traditional Chinese medicine, and improving the special service capacity of traditional Chinese medicine.
In terms of talent training, by 2025, no less than 20,000 geriatric physicians will be trained
10,000 backbone medical staff of the Geriatric Department and medical and nursing institutions of second-level and above general hospitals across the country will be trained in the knowledge and skills of diagnosis and treatment combined of offline and online. Carry out online training for medical staff of national medical and nursing care institutions, and plan to train 200,000 people.
Carry out online training for 5,000 backbone medical personnel engaged in hospice care in the national hospice pilot city (district), and carry out offline training for 2,000 backbone medical personnel.
At the same time, the standardized training of internal medicine and general medicine residents will strengthen the content of geriatrics disciplines, and continue to promote the standardized training of geriatric specialists.
By 2025, no less than 20,000 geriatric physicians will be trained, no less than 10,000 nursing nurses will be trained, and each geriatric medical staff and medical staff engaged in hospice care services in the pilot areas of hospice care will receive at least one professional training.
Support colleges and universities and medical and health institutions that open medical majors to strengthen the construction of geriatrics and related disciplines, and give policy preferences in the introduction of talents, scientific research funds, teaching funds, etc.
Geriatric care shifts to a multi-disease co-treatment model, and TCM physicians are encouraged to participate in family doctor contracts
Specific to medical institutions, the "Plan" recommends strengthening the management of geriatric syndrome and actively carrying out high-risk screening for hospitalized elderly patients such as malnutrition, falls, pulmonary embolism, aspiration and falling from bed.
Comprehensive assessment services for the elderly will be carried out in comprehensive hospitals, rehabilitation hospitals, preferential care hospitals, nursing homes, and medical and nursing institutions at the second level and above, and promote the transformation of geriatric medical services to a multi-disease co-treatment model.
For primary medical and health institutions, the Plan requires them to strengthen their ability to diagnose and treat common diseases, multiple diseases and chronic diseases of the elderly. By 2025, the standardized health management service rate of urban and rural communities for the elderly aged 65 and above will reach more than 65%, and the health management rate of traditional Chinese medicine for the elderly aged 65 and over will reach more than 75%.
Qualified community health service centers, township health centers and other grass-roots medical and health institutions may add nursing beds or nursing units, and promote the construction of nursing institutions to care areas for elderly dementia patients and community care points for elderly dementia patients, so as to meet the needs of care services for elderly dementia patients.
Encourage grassroots medical and health institutions with surplus medical resources to use existing resources to carry out integrated medical and nursing services; encourage TCM physicians to actively participate in family doctor contract services, and provide personalized TCM services for the elderly.
Increase the proportion of rehabilitation and nursing beds in primary medical and health institutions. Support the construction of continuous medical and health institutions in rural areas, and support rural medical and health institutions to use vacant beds to open beds for rehabilitation, nursing and palliative care.
In urban communities, we will build nursing stations for the elderly as the main service object, and provide home-based medical care services for the disabled, disabled, elderly and long-term sick elderly people with limited mobility.
Actively publicize the knowledge, techniques and methods of TCM health care suitable for the elderly, carry out TCM health examinations, health assessments, health interventions, medicine and dietary therapy science popularization activities, promote traditional TCM sports projects such as Tai Chi, Baduanjin, And Wufeng Opera, and cultivate and establish a healthy and scientific lifestyle and concept.
Increase support for home medical services, and promote the construction of market-oriented medical care institutions
According to the "Plan", it will increase the support for home medical services, encourage qualified hospitals and grass-roots medical and health institutions to provide home medical services such as family beds and home visits for elderly or disabled elderly people with medical service needs and limited mobility, chronic diseases, disease recovery period or terminal stage, and after discharge, and at the same time improve the risk prevention and control mechanism of home medical services, improve prices and other related policies.
Encourage qualified primary medical and health institutions to provide home care and day care services for elderly patients. Encourage all localities to actively carry out community and home rehabilitation medical services on the basis of grass-roots medical and health institutions.
Support large-scale old-age institutions to set up medical and health institutions, and include them in the designated scope of medical insurance in accordance with regulations; guide social capital to set up medical and nursing care institutions, and promote the construction of a number of collectivized and chained medical and nursing institutions that are affordable to the people and have guaranteed quality.
Encourage the strengthening of early screening and management of key chronic diseases, neurodegenerative diseases, and high-incidence malignant tumors in the elderly population
In terms of preventive health care, the Plan calls for strengthening the early screening, intervention, classification management and health guidance of key chronic diseases such as hypertension, diabetes and coronary heart disease in the elderly population, as well as neurodegenerative diseases such as Alzheimer's disease and Parkinson's disease.
Promote early screening, early diagnosis and early treatment of malignant tumors with high incidence in the elderly; encourage all localities to carry out visual, auditory, and bone health management services for the elderly; establish an emergency response mechanism for public health emergencies in the elderly, and strengthen the prevention and control of major infectious diseases such as AIDS and tuberculosis in the elderly.
At the same time, the elderly oral health action and the alzheimer's prevention and treatment action are implemented, the National Action Plan for Responding to Alzheimer's Disease is formulated, the pilot work of cognitive function screening intervention for the elderly is promoted, and a comprehensive prevention and control mechanism for early screening, early diagnosis and early intervention of alzheimer's disease is established.
In terms of protection, the "Plan" proposes to include the necessary funds for promoting healthy aging in the budget at the same level, and at the same time improve the outpatient drug guarantee mechanism such as hypertension and diabetes, so that the elderly who suffer from chronic diseases need long-term medication or serious and extraordinarily serious diseases that require long-term outpatient treatment, and thus lead to higher self-financing costs and basic living difficulties, are included in the scope of medical assistance according to regulations.
Source: Medical Community Think Tank
Editor-in-charge: Zheng Huaju
Proofreader: Zang Hengjia
Plate making: Xue Jiao