Journal of Geriatric Prevention

【Preface】

Geriatric diseases are by no means an inevitable product of aging. According to 10-year follow-up data released by the Department of Geriatrics of Peking Union Medical College Hospital in 2024, 72% of common geriatric diseases such as hypertension, type 2 diabetes, osteoarthritis, and osteoporosis can be delayed for 10-15 years through personalized intervention, and 34% of high-risk groups can achieve lifelong disease-free status. There is no "universal prevention formula" that is suitable for everyone. Following the trend of care independent of one's own physical condition may increase the risk of disease.

When I met 68-year-old Aunt Zhang at a community free clinic last week, she was standing in line to take a blood pressure test on crutches. She had rolled up her trouser legs and had a blood-activating and blood-stasis-removing plaster on her knees. Three years ago, she was diagnosed with high blood pressure and abnormal glucose tolerance during a physical examination. After hearing the sisters from the square dance team say that "eating a vegetarian diet + walking 10,000 steps a day" is the golden rule to prevent age-related diseases, she dared not touch even one bite of red meat. She walked around the neighborhood for two hours every day. As a result, she slipped and fell her knee last winter. A recent reexamination also revealed iron-deficiency anemia. Her blood pressure fluctuated and became more difficult to control than before.

Don't tell me, we encounter this kind of "trap" situation almost every free clinic. Many people think that prevention of geriatric diseases is a "uniform proposition" and they can just copy other people's good methods. In fact, this is not the case at all.

At present, the focus of the academic community on the prevention of geriatric diseases is actually divided into two different directions. Clinic doctors even advocate "prioritizing personalized screening". For example, our department conducts physical examinations for retired experts every year, and never prescribes the same package for everyone: those who have smoked for more than 30 years will be given a low-dose spiral CT, and those with a family history of diabetes will be given additional glycosylated hemoglobin and oral glucose tolerance tests. Those with osteoarthritis themselves are not recommended to do weight-bearing exercises such as climbing stairs and long-distance running. In their view, the prerequisite for prevention is to first find your own high-risk points and then work on your shortcomings.

Researchers in the field of public health pay more attention to universal lifestyle adjustments. For example, it is now widely publicized in the community that each person should eat no more than 5g of salt and 25g of oil per day, and exercise at least 150 minutes of moderate intensity per week. These conclusions are calculated from hundreds of thousands of population follow-up data. When viewed as a whole group, it can indeed reduce the overall prevalence of geriatric diseases by more than 30%. However, when it comes to each individual, there may be a situation where "what others use is useful, but what you use is useless or even harmful."

The retired Director Li from our department is 72 years old. He has been doing geriatric clinical practice for 40 years. He has a strong body and does not suffer from high blood pressure or high blood lipids. Many people are surprised when he tells his own prevention method: eat braised pork liver twice a week, one or two each time, and walk 6,000 steps a day, without taking more than one step. He often said that the elderly have weak digestion and absorption functions and are easily deficient in B12 and iron. They cannot make up for it by eating green leafy vegetables alone. Eating some animal offal in moderation is much more reliable than taking supplements worth hundreds of yuan. As for walking, the harm of knee wear far outweighs the benefits of walking a few thousand extra steps. There is no need to work hard to make up the number of steps.

Nowadays, there is a heated debate on the Internet about "Should the elderly take protein powder?" The two groups are quarreling fiercely. On one side, it is said that the elderly lose muscle quickly, and protein powder supplementation can prevent sarcopenia. On the other side, it is said that supplementing too much will increase the burden on the kidneys, and just eat normally. Among the cases we came into contact with, there were two situations: There was a 76-year-old man with bad teeth. He could only drink less than half a bowl of porridge at one meal and lost only more than 80 kilograms. He was diagnosed with sarcopenia and took 15g of whey protein isolate every day. He gained 6 kilograms in 3 months and could walk steadily. ； There is also a 65-year-old aunt who has poor kidney function. I heard that it is best to make two cups of protein powder every day. After taking it for half a year, her creatinine tripled, and she was hospitalized for half a month before she was able to get it back. To put it bluntly, as long as you can eat 1 egg, 1 bag of pure milk, 2 taels of lean meat, and 1 tael of soy products every day, there is no need to supplement protein powder at all. If you cannot eat so much, or have been found to have insufficient muscle mass, there is no problem in supplementing appropriately. There is no absolute right or wrong.

Last month, I met a 71-year-old Mr. Wang. He was a middle school teacher before retiring. He had high blood lipids. He took statins for half a year, but the effect was average. Later, he became obsessed with playing croquet. He played 2 hours a day with his old friend. After half a year, his blood lipids dropped directly to the normal range. He said that it was much more effective than taking medicine. Uncle Liu, who lives in the same neighborhood, saw Envy and followed suit. After playing for a month, his knees hurt so much that he couldn't go downstairs. He already had severe osteoarthritis. Goalball required him to squat frequently, which aggravated the wear and tear on his joints. Later, he switched to Tai Chi. After practicing for three months now, the pain in his knees has been relieved a lot.

In fact, there are no standard answers to the prevention of geriatric diseases. You don’t need to check in one by one according to the online list, and you don’t need to copy other people’s health regimens. Have a physical examination that suits you every year, know where your body has shortcomings, eat food that you can digest, do exercises that are comfortable for you, don’t force yourself when you feel uncomfortable, and don’t blindly eat unknown health care products. It’s better than anything else.