The significance of geriatric disease prevention

The core significance of geriatric disease prevention is to use the lowest health investment to maximize the quality of life benefits - for individuals, it reduces suffering and preserves dignity; for families, it reduces burdens and reduces internal consumption; for the public medical system, it squeezes redundancy and improves efficiency. This is currently recognized as the health intervention with the highest input-output ratio in the entire field of geriatric medicine. I am not just saying this in vain. I have been doing health education for the elderly for 6 years and I have seen too many examples.

Last week at a community free clinic, I met two old neighbors of similar age, 63-year-old Uncle Zhang and 64-year-old Aunt Li. Both were diagnosed with essential hypertension ten years ago. Uncle Zhang always felt that "medicine is only half of the poison". He would not take medicine if he was not dizzy. He could not live without bacon and wine. Last month, he suffered a cerebral infarction and was sent to the ICU. After the rescue, he could not move half of his body. His wife had to take care of him all day. His son, who originally worked in other places, quit his job and came back to run rehabilitation and medical insurance. The rhythm of the family was completely disrupted. Aunt Li is just the opposite. She checks her blood pressure regularly every day, takes antihypertensive drugs, walks with the square dance team for an hour in the morning and evening, and only eats pickled vegetables and bacon twice during the New Year. Now she can still carry her grandson to the amusement park, and sign up for group tours with her old sisters on weekends. Her life is more comfortable than that of many middle-aged people. You see, the only difference between them being the same physical foundation is the word "prevention", and their lives are completely different.

There is actually a lot of controversy over the prevention of geriatric diseases nowadays, and there are quite a few people who go to both extremes. One type is the "lay-down" group, who believe that "no one will get sick when they get old, and prevention is useless." There are also many elderly people who are afraid of spending money and are a little uncomfortable and have to wait until they are hospitalized. I have met many such elderly people. In fact, the current chronic disease prevention and control technology has long been mature. Common geriatric diseases such as hypertension, diabetes, and chronic obstructive pulmonary disease can be controlled as long as early intervention is performed, and more than 90% of them can be controlled, and they will not develop to the point of disability. Data released by the National Health Commission last year can also prove that there are more than 40 million disabled and semi-disabled elderly people in our country, and nearly 70% of them are disabled due to preventable chronic diseases. If prevention is done early, these elderly people can fully maintain their ability to take care of themselves.

Oh, by the way, there is another type of "over-anxious people" who regard prevention as the "secret of immortality". They buy expensive health products and do dozens of useless screenings throughout the year, which in turn damages their bodies. Last month, a 76-year-old man came to our department for a liver function test. His transaminase was three times higher. When I asked him, I found out that he had attended a health lecture and bought more than 30,000 yuan of "antihypertensive and thrombolytic health products" in one go. He ate five or six kinds of them every day, which caused drug-induced liver damage. In fact, the prevention of geriatric diseases is never more expensive, nor is it "don't eat anything" or "check everything". Geriatricians in regular hospitals will give you individualized assessments. For example, if you have a family history of lung cancer, you can just do a low-dose CT every year. If you don't have it, there is no need to do PET-CT blindly and waste money on radiation.

Don’t just calculate the accounts of individuals and families, but look at the entire public medical system. The accounts of geriatric disease prevention are more cost-effective. At present, my country's chronic disease diagnosis and treatment expenditure accounts for more than 60% of the total health expenditure, and a large part of it is the cost of treating complications of chronic diseases in the later stages. For example, if a patient with high blood pressure spends hundreds of dollars on antihypertensive drugs and monitoring every year, he may not develop complications throughout his life. ； But if it develops into cerebral infarction or kidney failure, one hospitalization will cost tens of thousands, and subsequent dialysis and rehabilitation will be a bottomless pit. It will be a huge burden on both the medical insurance fund and the family. If the popularity of geriatric disease prevention can be increased, the saved medical insurance funds can be used to treat more severe and rare diseases, which is equivalent to increasing the efficiency of medical resources in the entire society.

I always like to make an analogy when chatting with the elderly. Prevention of geriatric diseases is like regular maintenance of an old house that has been lived in for decades. It does not mean repairing the old house to look like it was just built, nor does it mean spending money on luxurious decoration. It means checking from time to time whether the wiring is aging and whether the water pipes are leaking. Small problems should be repaired in time. Don't wait until the wall peels off or the water pipe bursts to rework. Then the money spent and the suffering will be a lot.

To be honest, many people now have a too narrow understanding of geriatric disease prevention and think it is just "treating diseases". In fact, this is not the case. What it protects is the initiative in your life after you get old - you can eat and cook what you want, go out to play chess and walk with your old friends, and don't have to lie in bed and rely on others to take care of you. You don't have to look at the faces of your juniors to live your life. This dignity is more valuable than anything else.