Lecture content on prevention and treatment of geriatric diseases

The core logic of prevention and treatment of geriatric diseases is never to wait for symptoms and then go to the hospital to find "special medicines", nor to copy the uniform "health packages" on the Internet, but to catch the signs of small decline in organ function in advance and make individual adjustments based on one's basic diseases, living habits, and even personality characteristics. This is the most practical experience I have accumulated in the community for 8 years.

Think about it, our bodies are just like the old houses we have lived in for decades. Water pipes get clogged and walls peel off slowly. It is impossible that we were fine yesterday and suddenly suffered a heart attack and stroke today. You may all know Aunt Li from Building 3 of our community last month. She has been taking antihypertensive drugs for 5 years. Every time she was tested in the community, her score was 130/80. It seems pretty standard, right? As a result, I suddenly had a cerebral infarction last month and was sent to the emergency room. Fortunately, I was rushed to the emergency room without any sequelae. Later, it was discovered that she had H-type hypertension, and her homocysteine ​​level was three times higher than that of ordinary people. Conventional antihypertensive drugs alone did not cover the risk points, so she had to take extra folic acid supplements. She had never checked this indicator before, so she fell into a trap.

When it comes to the control standards for high blood pressure, in fact, there is no completely unified statement in the industry: Our country’s 2023 version of the elderly hypertension guidelines recommends that elderly people aged 65 to 79 first lower it to below 140/90, and then lower it to 130/80 if they can tolerate it. Elderly people over 80 years old can relax to 140/90. After all, lowering it too low may cause dizziness and falls due to insufficient blood supply to the brain.； However, the American ACC guidelines recommend that patients with hypertension of all ages should try to lower their blood pressure to below 130/80 as long as they can tolerate it, which can further reduce cardiovascular and cerebrovascular risks. You see, no one is right or wrong. The core thing is whether you can tolerate it and whether you have carotid artery stenosis or insufficient blood supply to the brain. Don't impose other people's standards.

Speaking of taking medicine indiscriminately, I think of a 68-year-old Uncle Zhang whom I met two years ago. He heard from an old colleague that taking aspirin can prevent heart attack and cerebral infarction. Let me make it clear here that there is a lot of controversy about the use of aspirin: if you have had a myocardial infarction, cerebral infarction, or had a heart stent, or your carotid artery has a stenosis of more than 50%, as long as you do not have contraindications such as gastric ulcers or bleeding tendencies, you must take it for a long time. This is the consensus ； But if you just have high blood pressure and no clear evidence of atherosclerosis, there is really no need to follow the trend. Domestic and foreign guidelines do not recommend that healthy elderly people regularly take aspirin to prevent blood clots. On the contrary, the risk of bleeding is higher than the benefit.

There are also many people who are superstitious about "10,000 steps a day." Last year, Uncle Wang in our community was 72 years old and had degenerative lesions in his knees. In order to lower his blood sugar, he walked 15,000 steps a day. After walking for 3 months, he had effusion in his knees and was so painful that he could not get out of bed. Finally, he went to an orthopedic department to drain the effusion. In fact, there is no unified standard for exercise. For an elderly person with good joints and a normal weight, walking six to seven thousand steps a day is enough. If you have bad knees and are overweight, it is better to go swimming or do leg resistance training on a chair. It puts less pressure on the joints and has good blood sugar control effects. There is no need to struggle with your knees.

Many diabetic patients always feel that they are insulated from sweetness when they have the disease. Last time, an aunt was afraid of high blood sugar, so she only ate 2 taels of rice a day, and did not dare to touch half a mouthful of fruit. In the end, she fainted in the vegetable market due to low blood sugar. How dangerous. Nowadays, the view of endocrinologists is not to completely quit sugar, but to calculate the total calories. For example, if you were greedy and ate a small piece of watermelon today, then you would eat less than half a bowl of rice at noon. As long as the total calories are controlled, your blood sugar will remain stable, which is better than completely abstaining from food and causing malnutrition and weakened immunity.

When I usually do follow-up visits for everyone, I always advise everyone to prepare a small book with a few dollars. You don’t need to remember any professional terms, just write a few sentences: what you ate today, how far you walked, whether you feel dizzy, and how much your blood pressure was measured. Even if you had an argument with your wife today and you are in a bad mood, you can write it down. You can show it to the doctor in two months. If you go to the hospital temporarily and use too much to measure your blood pressure or draw a blood vessel, the doctor can tell at a glance what is wrong with you.

What I’m talking about today are not standard answers. Everyone’s house type is different, and the repair methods are of course also different. Next time you come to the community health service center to measure your blood pressure, tell us about the medicines you usually take, any discomforts you have, even small things like you feel like you haven't been sleeping well or eating poorly recently, and we will adjust them one by one. It will be much more reliable than spending a lot of money on health care products and blindly following other people's health prescriptions.

Oh, yes, one last bonus. After today’s meeting, everyone can go to the door to register and get a free homocysteine ​​test. Uncles and aunts with high blood pressure can get it tested, so as not to step into the trap like Aunt Li.