Geriatric disease prevention and care

There is no “one-size-fits-all solution” for all elderly people, and the optimal path is Seize the golden window for intervention between the ages of 60 and 70, customize plans based on individual basic diseases, living habits, and family support, focus 70% on reversible risk control, and only use 30% on symptomatic care for existing diseases. ——This is the most practical conclusion that I have come to after working in community elderly health services for 8 years and reviewing nearly 2,000 elderly health files.

I just received a 62-year-old Uncle Zhang from the community last week. His physical examination last year showed that his low-density lipoprotein was slightly high and he had no other underlying diseases. He watched a short video to watch an expert say, "Walking 10,000 steps a day can lower blood lipids." I forced myself to walk 12,000 steps around the park every day. After three months of walking, my blood lipids did not drop much. Synovitis broke out in my knees and I couldn't even go downstairs. After being stuck at home for half a month, my blood pressure soared to 150/90. Speaking of which, there are completely two extremes in the current opinions on the health of the elderly on the Internet: one group shouts that "life lies in exercise" and requires the elderly to exercise every day; the other group advocates that "resting can lead to longevity" and wishes to make the elderly sit all day long and not move around. Among the trap cases I have come across in the past few years, there are two types of cases: 74-year-old Aunt Li believed in the "rest" theory and sat at home for 8 hours a day watching Shaoxing opera. Last year, she suffered a venous thrombosis in her lower limbs and was hospitalized. Later, she adjusted to walking slowly for 20 minutes after breakfast and dinner every day, and planted flowers on the balcony. Now not only has the blood clot not recurred, but her blood pressure, which had been unstable all year round, has also stabilized within the normal range. In fact, there is no absolute right or wrong. It just depends on the individual's joint status and underlying diseases. It doesn't matter if the joints are good, but it doesn't matter if the joints are severely degenerated. If the joints are severely degenerated, Tai Chi or Ba Duan Jin can still achieve the same exercise effect. There is no need to compare steps with others.

Don't tell me, many people don't know that when we do community health intervention, the first thing we focus on is not the blood pressure and blood sugar indicators that everyone is familiar with, but oral health, which many people don't care about at all. The 78-year-old Grandma Wang who was contacted last month has a 10-year history of diabetes. She had adjusted her anti-diabetic medicine several times before, but her fasting blood sugar was always around 8. No reason could be found. Later, she went to the dental department for a check-up and found that most of her mouth was filled with rotten teeth and periodontal suppuration. The bad teeth were extracted and the remaining teeth underwent root canal treatment. She was asked to use a tooth rinse for 5 minutes after meals every day without changing the amount of anti-diabetic medicine. After a month, her fasting blood sugar dropped to 6.7. Nowadays, the academic community has clearly established that periodontitis is an independent high-risk cause of diabetes and aspiration pneumonia. However, most elderly people and even their family members think that "it is normal to lose teeth as we grow old" and do not even have the awareness to have regular dental check-ups. This is actually the easiest loophole to fix.

When it comes to nursing misunderstandings, the most common is that family members blindly provide nutritional supplements to the elderly. A while ago, a young man came to me with half a bag of protein powder and cordyceps and asked me if his father had just undergone lung cancer surgery and would he feel better if he ate more of these. This matter is currently being debated in the nutrition community: one group believes that the elderly lose muscle quickly and must supplement with high protein after surgery or illness to enhance immunity. ； Another school of thought says that the liver and kidney functions of the elderly have deteriorated, and high-protein supplementation will increase the metabolic burden, which is not good. I usually don't give a conclusion directly. I first ask the family members to take the elderly person to have a serum albumin test, and then make a list of their usual diet - if the elderly person can drink a cup of milk, eat an egg, and eat two taels of lean meat every day, there is no need to supplement protein powder. For those with weak digestive function, stew the meat until soft and eat more steamed eggs. ； If you are unable to eat solid food due to dental or oral problems or after surgery, then consider supplementing with hydrolyzed whey protein, which is much more reliable than eating Cordyceps and Ganoderma lucidum.

Now when I do health education for the elderly, I never give out anything like "10 health rules for the elderly" or "10 must-eat healthy foods." Instead, I sit down and chat for half an hour and ask questions such as "What is your favorite food?" "When are you most willing to go out for a walk every day?" and "Do you have any old habits that you have persisted for decades?" There used to be a 72-year-old man who had to drink two taels of liquor a day. His children forced him to quit drinking alcohol for half a month. He had tantrums at home every day, and his blood pressure soared to 160. He couldn't bring it down no matter how much he took medicine. Later, I discussed with his children that we can drink wine, but we can only drink low-alcohol wine below 38 degrees Celsius, no more than one or two a day. After drinking, we should eat an extra plate of cold leafy vegetables instead of just peanuts and pickles. After just half a month of adjustment, the old man felt better and his blood pressure dropped to 130/80, which was better than taking antihypertensive drugs.

In fact, after working in this field for a long time, I feel that the prevention and care of geriatric diseases are not high-level medical problems. To put it bluntly, don’t impose the standard answers on the Internet on your own elderly people, observe his condition more, and ask more about his feelings. After all, for the elderly, living comfortably and feeling happy are more important than any perfect indicators. Oh, by the way, I have to say this in the end. Spend two to three thousand a year on a comprehensive physical examination for the elderly. Don’t skimp on cardiovascular and cerebrovascular, bone density, and tumor markers. Many early-onset problems can be controlled by just adjusting your living habits when they are first detected. If you delay going to the hospital until you have symptoms, you will often miss the best opportunity for intervention.