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With longevity increasing and fertility rates dropping, Sheung-Tak Cheng, PhD, is nervous. Caregiving systems are already stretched thin, and he's worried that global population aging will finally break them.

"I feel a sense of urgency," says Cheng, winner of a 2007 Outstanding International Psychologist Award from APA's Div. 52 (International) and associate professor in the department of applied social studies at the City University of Hong Kong.

His primary concern is who will care for the ever-growing number of seniors, many with cognitive and functional impairments.

With the shift from extended to nuclear families, family caregiving has eroded. Instead, there's been a move toward institutionalization--even in China with its Confucian traditions of at-home care. Cheng wants to reverse that trend.

"No government in the world will be able to deal with the problem just by financing services," he says, noting that the sheer number of older people will overwhelm current systems of care. "More older people will have to be kept in communities and cared for by family members or neighborhood networks."

Cheng has come up with some surprisingly low-tech ideas for making that happen. He envisions a corps of volunteer caregivers trained in basic nursing. He's advising a housing agency that's building adjacent high-rises, one for older people, the other for their children. Even mahjong can help. In a 2006 study published in the International Journal of Geriatric Psychiatry (Vol. 21, No. 7), Cheng found that playing the game gave nursing home residents the same cognitive boost as dementia medication.

Cheng's research doesn't just sit on the shelf. In addition to advising the Hong Kong government, he shares his expertise with the United Nations. "There's now very strong consensus among policy-makers internationally that supporting family caregivers is one of the most important agenda items," he says.

In a forthcoming paper for the United Nations, Cheng urges countries to learn from one another. Cambodia and Vietnam, for example, still have time to prepare for population aging and can learn from the experiences of countries such as Japan that have relied excessively on high-end high-cost services to substitute family care. And China and India, which have always relied on family and neighborhood caregiving, can share creative, low-cost strategies with more developed nations.

Whatever they do, adds Cheng, it has to happen fast. "I'm afraid there's not much time," he says.

--R. Clay