Core information for senior health

The core of elderly health has never been "zero disease" or "all normal indicators", but to maintain the ability to live independently as much as possible, retain a sense of control over life, and balance disease control and quality of life on this basis. There is no unified standard that applies to all elderly people.

Many people's understanding of elderly health is still based on "the lower the indicator, the better, and the more medicines are safer," I have been working in community elderly health clinics for almost 6 years and have encountered too many extreme cases. 72-year-old Aunt Zhang has been suffering from diabetes for 10 years. Her children have been watching her to control her blood sugar. They dare not touch white porridge and can only eat two bites of cucumber. The last time she checked, her glycosylated hemoglobin was 6.2%, which is better than many young people. However, when she walked in, her feet were weak and she almost fell. The albumin was only 32g/L, almost 10 points lower than the normal value. When asked, she said that she has been feeling exhausted in the past two months, and she has to take a break twice to go downstairs to buy groceries. I told her that your blood sugar control is too strict. For a person in his 70s, it is perfectly fine to relax the glycation level to 7%. If you are hungry and malnourished, if you fall and fracture, the risk is more than 10 times greater than if your blood sugar is a little higher.

At this point, I have to mention that there are indeed two different ways of thinking about the assessment of elderly health in the academic community. There is no absolute right or wrong, but they are just suitable for different groups of people. One is to follow the disease management logic of adults, giving priority to controlling blood pressure, blood sugar, blood lipids and other indicators within the standard range, and delaying the progression of the disease as much as possible. This idea is very suitable for the elderly aged 60-70, with good physical foundation and no serious complications. Early control of indicators can indeed reduce the risk of cardiovascular and cerebrovascular diseases in the next 20 to 30 years. The other is the "whole-person functional assessment" idea that has been promoted by geriatric medicine in the past 10 years. It no longer focuses solely on indicators, but first assesses the elderly's cognitive level, daily activity ability, nutritional status, and social support. For elderly people over 80 years old who already have multiple comorbidities and cognitive decline, the indicator requirements will be actively relaxed. Request: For example, the blood pressure does not need to be stuck at 140/90, it is acceptable within 150/90, and hypoglycemic drugs do not need to be too strong to avoid the risk of hypoglycemia - after all, for an old man who struggles to even eat by himself, "being able to eat by himself" is much more important than "blood fat lower than 0.3mmol/L".

Don't tell me, many families spend tens of thousands of yuan to buy health care products and high-end physical examination packages for the elderly, but ignore the little things that most affect the health of the elderly. I followed up with an 80-year-old Uncle Li last year. His son and daughter were out of town, so I bought him a whole box of protein powder and deep-sea fish oil. As a result, when the old man got up at night in winter, he stepped on a plastic basin on the ground and fell. He fractured his hip. After lying down for three months, the lung infection went away. Later, I went to his house and saw that the toilet didn't even have a handrail, the light bulb was 15 watts, and it was too dark. There was a lot of debris on the floor. This problem could be fixed for a few hundred yuan, but no one paid attention. Public monitoring data now show that falls are the number one cause of injury and death for people over 65 years old, with a higher mortality rate than cancer and cardiovascular and cerebrovascular diseases. No matter how much calcium supplements you buy for the elderly, it is better to first lay down anti-slip mats at home, change the lights, clear away debris, and install handrails in the toilet. These are the things that can really save lives.

There is another common misunderstanding that needs to be clarified: many elderly people are afraid of the "three highs" and eat vegetarian food all the time, even daring not to touch eggs and milk. This is really a big mistake. I recently admitted a 78-year-old man who was hospitalized with pneumonia and lost a lot of weight. I asked him what he usually eats, and he said he was afraid of high blood lipids. He only ate steamed buns with vegetables every day and only one egg a week. He didn’t touch milk at all. He was diagnosed with sarcopenia syndrome and hypoalbuminemia. A common cold turned into severe pneumonia. He stayed in the ICU for half a month and spent hundreds of thousands to save him. In fact, the nutritional needs of the elderly are higher than those of young people, especially protein. They need to eat at least 1.2g per kilogram of body weight every day, which is equivalent to a 60-kilogram old man. He needs to drink a glass of milk, eat an egg, and add two ounces of lean meat every day. As long as he does not have severe hyperlipidemia or renal insufficiency, there is no need to be afraid of eating these. If you have enough muscle mass, your immunity will be good, you will be able to walk steadily, and will not fall easily. This is the basis of health.

Don’t always think that it’s normal for the elderly to “forget things”, have a bad temper, or have body aches that cannot be detected. These are likely to be neglected emotional problems. I once had a 75-year-old Aunt Wang who always complained of headaches and chest pains. She had no problems after a head CT or coronary angiogram. Later, after chatting with her, I found out that after her husband left, her children were out of town and she stayed at home by herself every day without anyone to talk to. I suggested that she join the senior citizen choir in the community, which has three activities a week. She went there with some hesitation. After three months, she went for a follow-up examination and said that the number of pains was reduced by 80%, and her overall complexion was improved. In fact, the social needs of the elderly are no less than those of the young. Don't always think that letting the elderly eat and drink well is filial piety. Chat with them more and encourage them to go out and play with their old friends. It is more effective than any tonic.

After all, elderly health is never a cold numerical table, and there is no "standard answer" that must be followed. If you have just retired and are in good health, you can climb mountains, travel, and strictly control your goals, and you will have no problem living another twenty or thirty years. ； If you are 80 or 90 years old and have underlying diseases, you don’t have to force yourself to quit this or that. If you want to eat something sweet, just take a few bites, take a walk if you want, lie down and take a rest if you don’t want to move. Only those days when you can make your own decisions are truly healthy.