Elderly Health Promotion Action

The core answer of the elderly health promotion action has never been an indicator task that can be completed by "doing a few physical examinations for the elderly and giving a few health lectures". Its essence is a set of personalized support systems that fit the real life trajectory of the elderly and cover multiple physical, psychological and social needs. This is the core conclusion that I came to after nearly a year of participating in related projects in the community and stepping through countless pitfalls.

To be honest, the pit we stepped on at the beginning could hold a basketful. Following the standardized plan given by superiors, a two-hour health class is held every Wednesday morning, and a table is set up at the door to measure blood pressure for free. As a result, the people who come and go are always the young elderly who have plenty of time, those who have to take care of their grandchildren, those who have to rush to the morning market to buy vegetables, and those who have inconvenient legs and feet and cannot go downstairs. They can't even touch the moving edges. At that time, we privately complained about the stubbornness of the old man. We were given regular medical knowledge, but we turned around and believed the neighborhood rumors that "celery juice packs can cure high blood pressure" and "health supplements can open blood vessels." It wasn't until we followed Aunt Zhang's daily life for half a month that we realized that our plan was fundamentally not suitable for her life: She has to send her grandson to school at 7 o'clock every day. After buying groceries, she has to make lunch for her family of four. In the afternoon, she has to pick up her baby from school and accompany her to do homework. Not to mention taking two hours to listen to lectures, she even has little time to sit down and rest for 10 minutes. She only believes in celery juice because "it can be done easily without spending extra time."

There are actually different opinions on how to implement health promotion for the elderly in the industry. No one is absolutely right and no one is absolutely wrong. Practitioners with a clinical medical background mostly insist on "prioritizing indicators" and believe that the core goal is to improve the control rate of common elderly chronic diseases such as hypertension and diabetes, and to improve the health literacy assessment scores of the elderly. There is no need to create too many "shows" that have nothing to do with medical care.” ； Practitioners with a background in public health and social work prefer "needs first" and feel that indicators are only results. If the elderly live alone and no one reminds them to take medicine, have limited mobility and cannot even go to community hospitals, and have children who are not at home all year round and have no one to talk to, these practical problems cannot be solved, and no matter how perfect the medical plan is, they cannot be implemented. Grandpa Li I met before is a very typical example. He is 72 years old and has a history of COPD for 5 years. His previous regular follow-up indicators have been very stable. After his wife died of a heart attack last winter, he was hospitalized twice in half a year. His oxygen saturation could not go up. He adjusted the medication plan several times, but nothing happened. As a result, the community social worker later invited him to join the flower and bird interest group downstairs. A group of old men and women gathered together every day to study raising succulents and feeding stray cats in the community. Without adjusting the medication for three months, his oxygen saturation returned to the normal range, and even the cough that he often had before was much reduced.

We no longer engage in the "unified time and unified content" approach to activities now. They are all based on the needs of the elderly: we have designed a "10-minute shoulder and neck relaxation exercise at the school gate" for the elderly who are picking up their babies, which can be done while waiting for the babies to get out of school.； For the elderly who live alone and have inconvenient legs and feet, we arrange "chatting + health monitoring" at home twice a week, and help check whether the medicine has expired and whether they need to buy commonly used medicines on their behalf. ； For those elderly people who particularly believe in the marketing of health care products, we do not go up and accuse them of being deceived. Instead, we ask them to be "health supervisors" in the community and let them follow us to teach other elderly people about health care knowledge. Gradually, they will be able to distinguish what is formal science popularization and what is marketing rhetoric. Last month, there was an uncle Wang who spent more than 30,000 yuan on a physiotherapy bed. He took the initiative to tell the old people about his experience of being deceived.

Some colleagues have also complained to me, saying that this is too labor-intensive, especially in many remote areas and counties. There are only a few people in the community health service center to take care of thousands of elderly people, so it is impossible to be so detailed. This is actually very true. We are also exploring low-cost implementation methods. For example, we have now found a group of young elderly people who are in good health and have plenty of time to serve as "health ambassadors" and provide them with simple training. They are all neighbors, and their words are more effective than those of us in white coats. We don't need to pay much extra. We only need to give some rice and oil as rewards every month. The cost has been reduced by more than half, and the effect is better than before. According to the elderly health monitoring data released by the National Health Commission in 2023, in communities across the country that have carried out standardized elderly health promotion actions, the elderly's chronic disease control rate has increased by 18.7% on average, and the fall incidence rate has decreased by 12.3%. However, nearly 40% of communities are still engaged in "flooding"-style activities, spending a lot of money, but the elderly do not have a high sense of gain.

Last week I went to Aunt Zhang’s house for a follow-up visit, and I saw her holding a small wrinkled book at the gate of the community, explaining how to keep a blood pressure diary to a few old sisters who were waiting for their grandson to get off school. She also had a palm-sized portable anti-hypertensive recipe printed by us in her pocket. When the wind blew her silver hair, she smiled and said that her blood pressure was stable now, and she planned to take her grandson to climb Phoenix Mountain in the suburbs on the weekend. You see, there is no one-size-fits-all health promotion plan for the elderly. After all, it just takes the real life of every elderly person into serious consideration in action.