In Taiwan, the year 2026 marks our transition into a “super-aged society,” where more than 20 percent of the population is over 65. Yet what strikes me most is not the demographic milestone itself, but what it does to the dinner table.
During Lunar New Year gatherings, I often observe a tense choreography among middle-aged children. Who will take father to his cardiology appointment? Who will accompany mother during the day? Who will handle the progression of memory loss no one wants to name?
These are not medical questions. They are family survival questions.
From the perspective of preventive medicine, aging does not begin with a catastrophic diagnosis. It begins with a long and quiet decline: slower gait speed, decreased grip strength, shrinking social circles, unintentional weight loss. Geriatricians call these subclinical changes. Families simply say, “Dad just isn’t the same.”
Once this decline accelerates, the burden shifts from the hospital to the household. And here lies the moral injury of aging in modern health care systems: We have built excellent infrastructures for treating acute disease, but far weaker systems for preserving daily function.
Yi-Dong-Yang: a new model
In Taiwan, we are pioneering a concept called “Yi-Dong-Yang,” or Medical-Exercise-Nutrition Integration. It is a model designed to intervene before disability becomes inevitable.
The philosophy is simple yet radical: Medicine evaluates the risk, exercise rebuilds the capacity, and nutrition fuels the resilience. It is not merely a fitness program for the elderly; it is a strategy to extend the number of years an older adult can live self-directed.
When a 75-year-old regains enough muscle strength to go to the market alone, take the bus, or visit friends, something profound happens. The burden shifts. The family still loves, but they no longer need to substitute for lost function. Autonomy becomes the most practical form of affection.
The sociologist in me sees this as a renegotiation of the intergenerational contract. The clinician in me sees it as preventive care. But the son in me sees it as the only way forward.
The longevity risk
What is happening in Taiwan is not unique. Japan calls it “the longevity risk.” The U.S. experiences it through Medicare strain and the silent sacrifices of family caregivers.
Yet beneath the policy language lies a simple truth: Aging collapses families long before it collapses health systems.
If we want to take aging seriously, we must move beyond the binary of “independent versus dependent” and consider the space in between, the years when older adults can still choose, contribute, and connect, if we give them the right scaffolding.
A preventive aging model does not ask families to love more. It asks society to support earlier. It protects the middle-aged from being consumed by caregiving, and the old from being stripped of dignity.
Perhaps the real measure of a mature society is not how long we keep people alive, but how long we allow them to remain themselves.
Gerald Kuo, a doctoral student in the Graduate Institute of Business Administration at Fu Jen Catholic University in Taiwan, specializes in health care management, long-term care systems, AI governance in clinical and social care settings, and elder care policy. He is affiliated with the Home Health Care Charity Association and maintains a professional presence on Facebook, where he shares updates on research and community work. Kuo helps operate a day-care center for older adults, working closely with families, nurses, and community physicians. His research and practical efforts focus on reducing administrative strain on clinicians, strengthening continuity and quality of elder care, and developing sustainable service models through data, technology, and cross-disciplinary collaboration. He is particularly interested in how emerging AI tools can support aging clinical workforces, enhance care delivery, and build greater trust between health systems and the public.
