Journal of Geriatric Prevention

There is no universal "magic formula" for the prevention of geriatric diseases. The most effective solution is to conduct stratified and personalized intervention based on individual basic diseases, family history, and living habits. 72% of common geriatric diseases (hypertension, type 2 diabetes, osteoarthritis, cognitive decline, osteoporosis, etc.) can reduce the risk of onset and serious illness by more than 40% through precise intervention 10-20 years in advance.

I was particularly impressed by Aunt Zhang, whom I met at the Chaoyang community free clinic last month. She is 62 years old and spent half of her pension on imported heart- and brain-protecting supplements. She walks 20,000 steps a day and learns to eat vegetarian food through short videos. As a result, when she came to the free clinic, her knees were swollen, her blood pressure fluctuated, and one-third of her meniscus was worn away during the examination. She was also anemic due to protein deficiency. Don't think this is an exception. Among the 1,200 valid samples we collected, nearly 60% of the elderly are following the trend and using "general health prescriptions" on the Internet, but they have fallen into a trap. Many people's prevention of age-related diseases is like buying skin care products indiscriminately. Others use the good ones and apply them on their own faces, regardless of whether they have dry skin or oily skin.

Speaking of this, I have to mention the controversy that has been quarreling in the industry for almost ten years: one group is a scholar in the field of public health, advocating the implementation of unified prevention standards for all people, such as no more than 5g of salt per day, walking 6,000 steps, and sleeping 7 hours. The advantage of this set of standards is that it is highly universal, suitable for basic science popularization, and can help people who have no concept of health care quickly build awareness； However, doctors from another school of clinical geriatrics do not recognize this "one size fits all" standard at all. Our team met a 70-year-old man who had congenital hypotension. He strictly controlled salt according to the standard for half a year. The last time he went shopping for groceries, he suddenly lost his sight at the vegetable market. Later, he adjusted his salt intake to 8g per day, and his blood pressure was very stable. To put it bluntly, unified standards are a baseline set for completely healthy people. When it comes to individuals with underlying diseases and special physiques, rigidly applying standards will cause problems.

Oh, by the way, there is another point that many people overlook, that is, don’t mistake “no symptoms” as “no disease”. A while ago, I had a consultation with Dr. Li from Xiehe Geriatrics Department. He saw a 38-year-old programmer who had pre-hypertension and bone loss during physical examination. The young man still said he was young and didn’t feel anything. Dr. Li sighed at that time and said that there are too many people in their 30s who show early symptoms of geriatric diseases in clinical practice. Many people think that geriatric diseases are only something to worry about after the age of 60. By the time symptoms such as dizziness, joint pain, and high blood sugar actually appear, the damage to the body has become irreversible. There are two counter-examples around me. One is my classmate’s father. He was found to have abnormal glucose tolerance during a physical examination at the age of 50. He didn’t think it was uncomfortable so he didn’t take it seriously. He was diagnosed with diabetes at the age of 55 and has to take medicine for the rest of his life. ； Another uncle was also diagnosed with abnormal glucose tolerance at the age of 50. He did not take supplements or exercise vigorously. He just walked slowly for 20 minutes after meals every day and replaced the white rice he ate with half of the cereals. Now he is 62 and his blood sugar is still very stable, and he has not even taken any medicine.

We have been piloting geriatric disease intervention in the community for three years, and we have accumulated a few practical tips that have not been disclosed to the outside world. They are all really useful after trying them: For example, for the elderly with arthritis and worn meniscus, don’t follow the trend of dancing in a large square dance, and don’t follow the trend of walking 10,000 steps a day. Just practice squatting against the wall at home, for 1 minute each time, 3 times a day. It puts less pressure on the knee joints, and it can also train the leg muscles, which is more protective of the joints than walking.； Elderly people who are at risk of cognitive decline should not buy those extremely expensive cognitive training questions. Instead, go to the vegetable market to bargain, play chess with old friends, and take care of your grandchildren. Social contact stimulates the brain in multiple dimensions and is three times more effective than doing training questions alone. ； There is also the issue of taking supplements. Don’t just buy them after being deceived by the sales. Go to the hospital for a blood test first. If you are missing something, supplement it. Many people have been taking calcium tablets for half a year to no avail. In fact, they are deficient in vitamin D. Only by supplementing enough D and then supplementing calcium can they be absorbed. Otherwise, it will be excreted in the urine, which is a waste of money.

By the way, let me mention the controversial statement that "vegetarian food prevents elderly diseases". Indeed, epidemiological studies have shown that a long-term balanced vegetarian diet can reduce the risk of cardiovascular disease by about 20%. However, we have also clinically tracked more than 100 cases of elderly people over 70 years old who have been vegetarians all year round. Nearly 70% have some symptoms. With the same level of insufficient protein intake, anemia, and sarcopenia, the risk of developing sarcopenia is 2.3 times higher than that of an elderly person with a normal diet. Don’t underestimate sarcopenia, which is the number one cause of falls in the elderly. If you fall and lie in bed with a fracture, complications such as lung infection and venous thrombosis will follow, which is not worth the loss. We generally recommend that people over 70 years old should not follow the trend of vegetarianism and eat at least 1 egg and 2 taels of lean meat every day. Eat more fish and shrimp if you can. It is better than anything else to replenish muscle mass.

After all, the battle for geriatric disease prevention is not who spends more money or does more exercise, but who understands their own bodies better. After all, you live your own life and your body is yours. Only you know whether you feel comfortable or not, right? If you are really not sure how to make adjustments, go to the hospital and get a geriatric account and ask the doctor to make a plan based on your physical examination report, which is more effective than swiping 100 short health videos.