The significance of geriatric disease prevention

The core value of geriatric disease prevention has never been the pursuit of "not getting sick at all", but it can extend the healthy life expectancy of individuals by 3-8 years, reduce the burden of family care by more than 60%, and reduce the aging-related medical expenditure of the whole society by nearly 40%. This is the consensus conclusion reached by the WHO in the past 10 years after tracking the world's 2 million elderly population.

Last week I met 62-year-old Aunt Zhang at a community free clinic, and my feelings about this data became clear. In the past two years, she always found it "very troublesome to take regular blood pressure checks and take antihypertensive drugs, and I didn't feel uncomfortable taking any medicine." She suffered a stroke last winter and her left limb was semi-paralyzed. She used to be able to pick up her grandson from school and dance square dances every day, but now she has to have her husband help her even when she gets up to drink water. Her son has to pay more than 8,000 yuan in rehabilitation fees every month. Her original plans to change cars and take her children to the beach have been put on hold.

In fact, there is no absolute standard answer in the academic community about how to prevent it. The two groups have been arguing for nearly ten years. One group is the "radical prevention group", which advocates a full set of in-depth screenings every year after the age of 50, and all indicators should be aligned with young people's standards as much as possible. For example, resting blood pressure should be stable below 120/80mmHg, and low-density lipoprotein should be reduced to less than 1.8mmol/L. People who meet the indications are recommended to take long-term statins and low-dose aspirin for primary prevention. Their clinical data shows that this program can reduce the incidence of cardiovascular and cerebrovascular accidents by more than 45%. The other group is the "moderate group" who pays more attention to the quality of life of the elderly. They believe that there is no need for elderly people over 75 to have such strict indicators. It is enough to control blood pressure within 140/90mmHg. Excessive medication will increase the metabolic burden on the liver and kidneys, and even increase the risk of orthostatic hypotension, falls and gastrointestinal bleeding, which is not worth the gain.

Putting aside these academic debates, in the daily lives of ordinary people, the significance of prevention is actually much more real than what is written in the data. The 70-year-old Uncle Li in our neighborhood used to drink 20 taels of white wine every day when he was young. He weighed 180 kilograms at his heaviest. The year before last, he was diagnosed with severe fatty liver and high blood pressure. After being seriously warned by the doctor, he stopped drinking. He walked five kilometers around the park every morning and only ate seven-cent full for dinner. He just climbed Mount Huangshan with the senior group last month. In the photo of the welcoming pine tree posted on WeChat, he stood straight with his hands behind his back, and his face was brighter than many people in their fifties. You said that he is also 70 years old. He and those old people who stay in bed every day and have to be fed by their families are basically living two different lives.

When I was rotating in the geriatrics department, I met too many family members crying at the entrance of the ICU, clutching their payment slips. It was either that they didn’t want to be treated, or that they really couldn’t afford it. There was an 81-year-old man who had never tested his blood sugar. He didn't even know he had diabetes. He was already in a coma when he was sent here due to ketoacidosis. He stayed in the ICU for 17 days and spent 220,000. He finally left. His three children are ordinary office workers. In order to raise money for treatment, the old house left by the old man was put up for sale. The eldest son told us with red eyes, "If we had reminded him more often to check his blood sugar and take some anti-diabetic drugs, he would never have reached this stage."

I previously checked public statistics from the National Health Commission. Last year, 42% of the country's total medical insurance expenditures were spent on the treatment of chronic diseases and geriatric complications for people over 60 years old. If half of the elderly people can take basic prevention measures in place, tens of billions of medical insurance funds can be saved a year. The money can be used to add equipment to grassroots hospitals and build school buildings for children in remote areas. It is cost-effective no matter how you calculate it.

I have been doing community health education for almost 5 years, and the two sentences I have heard the most are "I am not sick, so why spend so much money on a physical examination?" "People will definitely get sick when they get old, and prevention is useless." In fact, this is not true. Just like the car you drive at home, it is usually serviced every 5,000 kilometers. If minor problems are repaired in time, it can be driven for more than ten years. If you never take care of it and don't care about bumps and bumps, it may be scrapped directly after driving for three to five years. The human body is actually the same.

Of course, it doesn’t mean that everyone is anxious about the indicators every day and can’t even eat. As mentioned before, moderation is enough. Smoking less than two cigarettes on a daily basis, drinking less alcohol, walking for half an hour every day, having a routine physical examination every year, and having minor problems diagnosed promptly are better than anything else. In fact, to put it bluntly, the prevention of geriatric diseases is never about "aging". What is about preventing is lying in bed and suffering when you get old, and it is also about preventing the children at home from running around and being in trouble.

This is not a rough statement.