geriatric health assessor

Elderly health assessors are not replicas of medical examiners, nor are they "pseudo-health consultants" selling health care products. Their core value is to piece together a complete picture of the health fragments scattered among the elderly's physical examination reports, medical records, daily habits and even family environment, and to step on the brakes on the deterioration of disability and chronic diseases in advance. They are the key intermediate hub connecting the elderly, their families, and medical resources.

Last week, I went to work with Xiao Zhou, an evaluator at the community station, and met 68-year-old Aunt Zhang Guiying. The physical examination she just had last month showed that her blood sugar and blood pressure were at critical levels. After reading the report, her children only said, "Just eat less sweets." As a result, Xiao Zhou came in and walked around and found three things that were not detected in the physical examination: In order to control sugar, the aunt only eats one or two staple foods a day. When she got up to get the thermos bottle, she shook it twice. The signs of orthostatic hypotension were already obvious.； The non-slip mat at the door of the bathroom was rolled up. My aunt almost fell over it last month and didn’t dare to tell her child. ； The "pure natural antihypertensive tea" given to her by her neighbor on the bedside table conflicts with the Sartan antihypertensive drugs she is taking. Recently, she has always said that this is mostly the reason for her dizziness. You see, the numbers on the physical examination report are all static. What the appraiser is looking for are the risks hidden behind the numbers that can really put the elderly in trouble.

The industry has been arguing for almost five years about whether evaluation should be strictly based on scales or rely more on empirical judgment, and there is still no unified statement. Most of those who hold the "full quantification" view are young people who have just entered the industry. They feel that ADL (Ability of Daily Living), IADL (Instrumental Ability of Daily Living), and nutritional risk screening scales have all been clinically verified. Scores are the most fair and less error-prone. Especially when it comes to the assessment of long-term care insurance benefits, there is no dispute about the scores written in black and white. But Sister Li, a veteran appraiser who has been working for eight years, does not recognize this. She has met too many elderly people who are afraid of causing trouble to their children. During the assessment, they deliberately say "I can do it." Now every time she comes to the house, she will chat with the old man for twenty minutes about home life, what he likes to eat, and whether he can dance in the square dance downstairs. Her eyes scan the old man to see whether he is holding the table when he gets up, whether he is shaking when holding a water glass, and whether he is out of breath when talking. In fact, there is nothing wrong with both ideas. In the final analysis, what is important is not to have beautiful scores, but to be able to really solve the problem.

Many people think that the geriatric health assessment is just a process when applying for long-term care insurance and is usually useless. Let me talk about a case that particularly impressed me. Last year, there was a 72-year-old Uncle Wang. His children took him for a free assessment just to make up the money. The old man himself said that he was very healthy and could ride a tricycle to buy groceries. During the evaluation, it was found that he had lost 8 pounds in six months. He said he had lost his appetite because of the hot weather, so the teacher in charge of the evaluation insisted on having him undergo a gastrointestinal angiogram. In the end, he was found to have early-stage gastric cancer, which was promptly removed and he is now recovering very well. His family later sent him free-range eggs several times. This kind of risk hidden behind the illusion of "toughness" can be easily missed if the routine physical examination does not ask about living habits.

Of course, this industry is not as glamorous as everyone thinks. Currently, there are less than 100,000 elderly health assessors in China who have undergone standardized training, corresponding to the 280 million elderly people over the age of 60 across the country. The gap is ridiculously large. Many appraisers from small institutions just take up the job after just two weeks of training, fill in the scales blindly, and miss out the elderly who really need it. It’s no wonder that many people think this profession is just a formality. Moreover, most people's understanding of this profession is still that it "just does physical examinations" and "is about the same as a nursing worker." The salary is not much higher than that of ordinary community workers. There are not many young people who are willing to work hard.

After working in this business for a long time, you will actually find that what we evaluate is never a bunch of numbers and grades, but whether the elderly can walk downstairs steadily, whether they can eat a bowl of hot rice by themselves, and whether they can not be frightened or afraid of falling. It's nothing great, it's just to find out the minor problems that the old man himself doesn't take seriously and his family members don't notice, and stop them before they become serious diseases.