According to the 2020 China population census, the proportion of older adults over the age of 65 exceeds 11% in all four provinces: 16.93% in Sichuan, 13.27% in Zhejiang, 13.3% in Beijing and 11.10% in Fujian. The degree of ageing in these four provinces was among the highest in the country, which was representative to a certain extent. In addition, the ratio of men to women aged 65 and over is 0.87:1, which was similar to the ratio of men to women included in this study. This study was conducted in four provinces with National Geriatrics Centers or National Clinical Research Centers for Geriatric Diseases. These four provinces were chosen because, on the one hand, they are led by the hospitals where the geriatrics centers are located, which ensures the scientific and rigorous implementation of the study, and on the other hand, they are representative of the four provinces with the highest ranking of aging among Chinese provinces. In addition, the four provinces were also selected to be geographically representative.
Currently, there is no universally accepted international standard for the phenotypes of geriatric syndromes. In 2013, geriatric societies across the Asia–Pacific region proposed that geriatric syndromes should encompass conditions such as dementia, incontinence, delirium, falls, hearing impairment, visual impairment, sarcopenia, malnutrition, and frailty [19]. Similarly, the Education Committee Writing Group (ECWG) of the American Geriatrics Society identified 13 common geriatric syndromes, which include dementia, inappropriate prescribing of medications, incontinence, depression, delirium, iatrogenic problems, falls, osteoporosis, sensory alterations (hearing and visual impairment), failure to thrive, immobility and gait disturbances, pressure ulcers, and sleep disorders [19]. In contrast, the standard for healthy Chinese older adults (WS/T802—2022) delineate nine criteria for assessing older adults health, which encompass self-care abilities, age-related changes in vital organs without significant functional abnormalities, controlled health risk factors within an age-appropriate range, good nutritional status, essentially normal cognitive function, a positive and optimistic attitude, sufficient health literacy and maintenance of a healthy lifestyle, active participation in family and social activities, and strong social adaptability [22] . Frailty is a common and important geriatric syndrome. It is associated with many adverse clinical outcomes. The overall weighted prevalence of frailty among community-dwelling older adults in China was 9.9%, with the prevalence of frailty showing an increasing trend year by year in China [13]. Dementia has become a global challenge as a disease whose prevalence is gradually rising with increasing global ageing [23]. Falls, as a common syndrome experienced by one in three of the older adults annually, were also included in this study [24]. Sarcopenia is associated with a variety of adverse health outcomes in older adults, and the incidence of it in Chinese older adults is increasing as China’s aging population rapidly progresses [12]. Malnutrition is one of the most common syndromes. Malnutrition leads to a decline in quality of life, intrinsic capacity, health and an increase in medical costs, placing a greater burden on the family and on social and medical resources [25]. Drawing from the importance and clinical incidence of each geriatric syndrome, this study included six prevalent geriatric syndromes: dementia, frailty, sarcopenia, urinary incontinence, malnutrition, and falls.
This study revealed that among the six major geriatric syndromes, the highest awareness rate is for falls (62%), followed by dementia (55.1%), malnutrition (54.7%), frailty (40.5%), urinary incontinence (37.7%), and sarcopenia (36.0%). Awareness rate varied widely between different geriatric syndromes. The high awareness rate for falls is related to their high incidence. Falls are common among the older adults, with about 29% of those aged 65 and above living in the community experiencing falls each year [26], and among those over 80, one in two falls annually [24]. A study showed that the prevalence of falls among community-dwelling older people in China was as high as 14.3% [27]. Another study based on Prevention and Intervention on Neurodegenerative Disease for Elderly in China (PINDEC)project showed that the falls prevalence rate was 14.7% after complex weighting among the 21,084 Chinese community-dwelling older adults included in this study [28]. According to the Chinese Center for Disease Control and Prevention, falls have become the leading cause of injury-related deaths among Chinese individuals over 65 [29]. As people age, the decline in physical functions makes the older adults more susceptible to fractures, infections, and other complications from falls. Prolonged bed rest after a fall can further lead to pressure ulcers, malnutrition, and an increased incidence of various geriatric syndromes. The prevention and control of falls among the older adults have become an international consensus [30]. Initiatives to prevent falls in the older adults have been incorporated into the “Healthy China 2030” Planning Outline and the “Healthy China Action (2019—2030)”. The increase in awareness of falls is an important outcome of these initiatives.
In terms of frailty awareness, Lina et al. [13] reported that the overall weighted prevalence of frailty in China was 9.9%, with a higher prevalence of 12.7% observed in the southwestern region, including Sichuan. They noted that frailty prevalence increased with age and was significantly higher among females and rural residents. These findings align with our study, where the awareness rate of frailty in Sichuan was found to be 14.5%. We observed a decrease in awareness with increasing age and a relatively low awareness among females and older adults residing in rural areas.
Among all geriatric syndromes studied, awareness of sarcopenia was found to be the lowest. The concept of sarcopenia was relatively late to gain recognition, having been first proposed by Rosenberg in 1997. The Asia Working Group for Sarcopenia (AWGS) further refined the definition of sarcopenia in 2019 as the “age-related loss of skeletal muscle mass plus loss of muscle strength and/or reduced physical performance” [31]. A cross-sectional study conducted in Malaysia [18] revealed moderate to low public knowledge of sarcopenia, with only 6.9% of respondents demonstrating a good understanding of the condition. Our findings align closely with these studies, indicating that awareness of sarcopenia, especially among the older adults, remains low.
Our study investigated the awareness of various geriatric syndromes among the older adults populations in four provinces: Beijing, Fujian, Sichuan, and Zhejiang. These regions were selected to provide a diverse geographic representation. The findings indicate that awareness rates of all geriatric syndromes were highest in the Beijing area compared to the other three provinces. In particular, the older adults in the Zhejiang region demonstrated substantial awareness in areas such as dementia, frailty, malnutrition, and falls. Conversely, awareness among the older adults in Sichuan was notably lower.
The relatively high awareness of geriatric syndromes in Beijing may be linked to the region’s advanced economic development as well as targeted health literacy education initiatives for the older adults. Health literacy is defined as the ability of individuals to access, comprehend, and utilize basic health information and services to make informed decisions about their health [32, 33]. It acts as a midstream determinant of health and can be effectively enhanced within high-risk groups [32]. Research indicates that nearly 40% of respondents encounter challenges in accessing, understanding, evaluating, and applying health information. Furthermore, 8.18% of individuals exhibit inadequate health literacy, while 30.94% face difficulties related to health literacy [34]. According to data released by the Beijing Municipal Health Commission in 2018, there is a noticeable decline in health literacy with advancing age; the highest literacy rate was observed in the 30 to 39 age group at 41.7%, whereas the lowest was in the 60 to 69 age group at merely 14.1% [35]. By 2020, the health literacy rate among the older adults aged 60 to 69 in Beijing showed improvement, rising to 17.2%, an increase of 3.1 percentage points from 2018 [36]. The National Health Commission’s assessment in 2023 reported that the overall national health literacy rate was 29.70%, with Beijing residents achieving a rate of 40.5% [37, 38]. Comparatively, in Zhejiang, the health literacy rate stood at 41.54% in 2023 [39]. In Fujian, it was 30.27% in 2023 [40], while in Sichuan, the rate reached 27.7% in 2021 [41].
Health literacy extends beyond individual capabilities, encompassing the responsibility of organizations to render health-related information and services accessible and comprehensible to the public [42]. Globally, governments are enhancing the health literacy of their populations through the formulation of targeted policies and programs, inspired by the growing scholarly interest in health literacy [43]. Specifically, Beijing has incorporated initiatives to improve residents’ health literacy within the frameworks of the ‘Healthy China 2030’ and ‘Healthy Beijing 2030’ planning outlines. The city has also developed a comprehensive older adults health service system, which includes health education aimed at geriatric syndromes and the implementation of health management programs for the older adults that integrate artificial intelligence to monitor their health status. In Zhejiang, the ‘Five Major Actions’ policy on older adults health services has facilitated early screening and timely intervention for issues such as vision, oral health, nutritional status, cognitive functions, and psychological health, thus improving awareness of these syndromes among the older adults. Furthermore, hospitals in Zhejiang rated second class and above have established geriatric departments dedicated to enhancing the management of geriatric syndromes and promoting comprehensive geriatric assessment techniques, thereby improving health education for hospitalized older adults patients. In Sichuan, free health management services, including health examinations for those aged 65 and over, are provided with a focus on the integrated prevention and treatment of major chronic diseases such as hypertension and diabetes. Annually, at least 6.5 million older adults individuals aged 65 and over benefit from free health check-ups and other health management services, emphasizing the integration of medical care and health maintenance.
Inconsistently with our expectations, smokers and drinkers performed better than non-smokers and non-drinkers in the awareness survey. Probably because smokers and drinkers were the focus of more attention and health education by clinicians in health education because smoking and drinking in older adults are associated with many adverse clinical outcomes.
Our study provided a comprehensive overview of the prevalence of multiple geriatric syndromes and analyzed factors influencing awareness rates within the same cohort of older adults. The objective was to furnish evidence that could inform the development of future health promotion policies, with the ultimate goal of enhancing health literacy concerning geriatric syndromes. Future initiatives should prioritize tailored health education for older adults with diverse characteristics to effectively promote health. There were some limitations to this study. Due to the large number of geriatric syndromes included in this study, the factors affecting the awareness rates of individual geriatric syndromes could not be discussed in depth. Secondly, whether there was an interaction between the awareness rates of the geriatric syndromes included in the study needs to be further explored in future work. In addition, this study did not investigate the correlation between the prevalence of geriatric syndromes and their awareness rates among participants. In the future, it is expected that more detailed data on the prevalence of geriatric syndromes and their awareness rates in each province can be included, and corresponding intervention and follow-up studies can be conducted to provide more reliable evidence to support the prevention, health education, and intervention guidance of geriatric syndromes.
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