Geriatric disease prevention and care

It has never been the pursuit of "complete cure" or "indicators completely in line with young people", but on the basis of accepting the irreversibility of aging, maximizing the preservation of the elderly's ability to take care of themselves, reducing the risk of disability, and allowing the elderly to live comfortably and with dignity.

Two years ago, when I was following up at a community health service center, I met 72-year-old Aunt Zhang. She had a 10-year history of hypertension and early-stage osteoarthritis. She had listened to popular science on the Internet and insisted on lowering her systolic blood pressure to below 120mmHg, so she secretly added half a tablet of antihypertensive medicine. As a result, when she got up in the morning to buy groceries, she fell dizzy and suffered a fractured patella. She lay down for three months. She was able to buy groceries and dance in the square, but then she had to use crutches to walk. Instead, her quality of life dropped a lot.

This is the misunderstanding that many people have about the prevention of geriatric diseases. They always think that the lower the indicator, the better. If any problems are detected, they must be eradicated. In fact, this is not the case at all. Take the physical examination that everyone cares about most now. The views of different academic schools are quite different: the guidelines of Western evidence-based medicine clearly state that elderly people over 65 years old and without high-risk factors for cancer do not need to undergo a full set of tumor screenings every year, such as prostate-specific antigen screening and low-dose spiral CT lung cancer screening. If the life expectancy is less than 10 years, over-screening may cause harm from excessive medical treatment such as needle biopsy and unnecessary surgery, which will affect the quality of life. ； The Chinese school of traditional Chinese medicine that treats pre-diseases prefers to observe daily micro-changes, such as whether your walking pace suddenly becomes shorter, drooling while sleeping, or coughing easily when eating. These small signals can provide early warning of emergencies such as stroke and Parkinson's disease better than an annual physical examination. The two ideas actually have their own reasons and can be combined. There is no need to argue about right and wrong.

I chatted with many nurses in the geriatric department of tertiary hospitals. They said that to prevent geriatric diseases, the elderly at home would not stock up on health products. Instead, they would do a few small things: the salt spoons at home should be replaced with 2g-limited salt spoons, with a maximum of 3 spoons per person per day. This is not a complete ban on salt. Many elderly people are afraid of high blood pressure and do not eat even salt. Instead, they are prone to hyponatremia, fatigue, and falls.； Another thing is to encourage the elderly to hold more mineral water bottles to practice arm strength instead of sitting all the time. As their muscle mass increases, even if they fall, they will be less likely to fracture. This is more effective than taking any calcium tablets. Oh, by the way, there is also the controversy over exercise. In the past, there were always people arguing about whether the elderly should walk more or less. In fact, is there any unified standard? If you are overweight or have worn knees, don’t stick to the KPI of 10,000 steps a day. Just swim or sit on a chair and do ankle pump exercises. If your weight is normal and your joints are good, walking 7,000 to 8,000 steps is absolutely fine. Your comfort is the most important thing.

Let’s talk about nursing. Many family members think that geriatric care is about “taking care of people well and not being hungry or freezing.” In fact, there are many ways to do it. Take rehabilitation care after stroke as an example. In the past, many family members thought that they had to rest for a long time after getting sick, so they made the elderly people lie in bed every day. As a result, they developed bedsores and pneumonia within two months, and instead walked faster. Uncle Li, who I had visited before for follow-up, could not move his left side after a cerebral infarction. The nurse he hired at first found it troublesome. He would lie flat on his back every time he was fed, often choking and coughing. Later, we came to teach him several times. During feeding, the bed was rocked to 30 degrees, and every two Turn over once an hour. After turning over, use hollow palms to rub the sacrococcyx and heels, which are prone to redness, for two minutes. He sits with support for half an hour every day. Now Uncle Li can stand up by himself while holding on to the table. He has not even suffered from repeated lung infections before.

There is another controversial point: Many family members think that the elderly should be hygienic and give them a bath every day. In fact, the current consensus in the geriatric department is that the oil secretion of the elderly's skin is less than one-third that of young people. Washing every day will destroy the skin barrier, making the whole body itchy and prone to eczema. Washing 2-3 times a week is enough, and you must apply moisturizer after washing. Don't think that the elderly do not need to apply these things, and they will really avoid a lot of sins. I met an 80-year-old man last week who secretly halved his antihypertensive medication. He said that taking too much antihypertensive medication hurt his kidneys. As a result, he suffered a cerebral hemorrhage at home and was sent to the emergency room. Fortunately, he was sent to the emergency department in time and no serious problems occurred. Do you think this is a loss? Many elderly people are afraid of the side effects of taking medicine, and instead ignore the risks of not taking medicine. This is something that needs to be reminded repeatedly.

As for nutrition, the old idea was that the elderly should be light, eat less meat, and preferably eat more porridge. Now new research has completely reversed it: elderly people over 75 years old should supplement more high-quality protein. An egg, a cup of milk, and two taels of lean meat a day are standard. Don’t be afraid of high cholesterol. As long as it is not severe hyperlipidemia, this amount is completely fine. Otherwise, muscles will lose quickly, sarcopenia will appear, you will stagger when you walk, and you will get a fracture if you fall, which will be more troublesome. Of course, some experts say that it is still necessary to eat light foods. This depends on the elderly person's physical condition. If he has severe gout or hyperlipidemia, of course he must control it. If not, there is really no need to deliberately eat vegetarian food. It is true that eating is a blessing for the elderly.

In fact, after working on elderly health for so many years, my biggest feeling is that there has never been a standard answer to the prevention and care of geriatric diseases, nor are there any golden rules that must be followed. The core is to treat the elderly as an independent individual, not a bunch of abnormal indicators. If he likes to eat something salty, he can eat a little bit, and if he likes to go out for a walk, he can do it as much as possible. As long as it is within a safe range, he can do it as comfortable as possible and live happily, which is more effective than any panacea.