Interpretation of the Standards for Elderly Health Management Services

The core essence of the "Elderly Health Management Service Standards" is the health service baseline defined by the state for the permanent elderly over 65 years old, rather than a mandatory and unified standardized service template. All institutions that provide elderly health services must adhere to the bottom line of required services. At the same time, the service content can be flexibly adjusted according to the individual health status and actual needs of the elderly. There is no absolute standard that "if you do not follow the process, you must violate the regulations."

Last week, I was working as a public health supervisor at the Balizhuang Community Health Service Center in Chaoyang District. I happened to meet 71-year-old Aunt Zhang Guilan, who took the nurse's arm and asked, "In previous years, the physical examination was done after drawing blood and measuring blood pressure. Why are you asking me to do questions like recognizing pictures and drawing clocks this year?" Is it a coincidence to charge a fee? ”It's normal to have such questions. After all, many people's impression of this standard is still at the level of "KPI assessment form for primary hospitals", and few people have really cared about the details inside. The set of questions that Aunt Zhang did is a new cognitive function preliminary screening item in the 2021 version of the standards. It costs less than two yuan and can be completed in 10 minutes. It can detect more than 80% of the early signs of Alzheimer's disease. Many communities have not spread it before, so the elderly naturally find it novel.

Nowadays, there are actually two voices in the industry regarding the implementation standards of standards, and there is no absolute right or wrong. One is to adhere to the "absolutely unified" standard and feel that none of the 12 must-do items listed in the specification can be missed. Even if the elderly just had a physical examination at the tertiary hospital last week, they must do it again to ensure that the data uploaded to the public health system is unified over the same period. ； The other is more practical. I feel that as long as it is a formal report from a tertiary hospital within 3 months, except for blood sugar and blood pressure that require dynamic monitoring, other items can be reused directly. There is no need for the elderly to run back and forth and draw two tubes of blood repeatedly. I met 82-year-old Uncle Li in Shunyi before. He was bedridden in the advanced stage of Parkinson's disease. The staff of the strict camp insisted on visiting him for routine urine collection, but his family struggled for three days without collecting the specimen. In the end, they followed the flexible camp's plan and used his hospitalization report from a month ago. He was also given pressure ulcer assessment and home care guidance that were allowed by the regulations. The effect was much better than rigid regulations. I have been a grassroots public health supervisor for 8 years, and I am actually more inclined to this kind of flexible operation - think about it, if an elderly person with limited mobility is forced to go to the hospital in order to collect the items required by the regulations, if he falls or gets bumped, it will violate the original intention of health management, right? Of course, there are also some grassroots institutions that distort the requirements of the standard in order to increase the completion rate. For example, they directly fill in the normal form without doing cognitive screening for the elderly. This is a real violation of the standard, and it is also what we focus on during supervision.

Oh, by the way, there is another benefit that many people don’t know: the regulations clearly require that free elderly health management services once a year are not tied to household registration. As long as you have lived locally for six months, even out-of-town elderly people who come to help take care of their children can enjoy it for free with a residence permit or even just registered residence information in the community. Last year, I gave a lecture in a community in Tongzhou District. On the spot, three aunts who came from Anhui to raise their grandchildren registered for the physical examination quota for that year. Before, they thought they could only get it if they had a local household registration.

In fact, this standard is like the common medicine box we prepare for the elderly at home. The iodophors, cold medicines, and antihypertensive drugs in it are essential, corresponding to the required items in the standard such as lifestyle assessment, basic physical examination, routine hematuria, liver and kidney function, blood sugar and lipids, and electrocardiogram.； But if an elderly person in your family has diabetes, you will definitely need to add an additional blood glucose meter, and if you have rheumatism, you will need to add plasters. These are the personalized adjustments allowed in the regulations. You don’t have to stick to the medicine box list to only put those few items. I have seen many communities that have done well. They have changed the dry "dietary guidance" in the regulations into a local recipe booklet for the elderly, and replaced "the daily salt intake should not exceed 5g" with "don't always eat pickles. A meal of pickles is equivalent to eating half a beer can of extra salt." The elderly understand and are willing to follow it, but the effect is much better than strictly reading the regulations.

To be honest, the standards have been revised three times in the past few years, and each time the changes have been made to make them more down-to-earth. From the earliest requirements, which only required basic physical examinations, to later adding cognitive screening and fall risk assessment, to now explicitly allowing the reuse of external reports that meet the requirements, they are essentially based on the needs of the elderly. It is really not a cold assessment document. If you have an elderly person over 65 years old in your family, drop by the community health service center after get off work this week and ask, maybe you can catch the last train for this year’s physical examination.