geriatric health assessor

Elderly health assessors are not just "form fillers" who only fill out questionnaires, nor are they "health registrars" in nursing homes. They are the core hub connecting elderly medical care, elderly care, and family support. Each assessment report they output directly determines whether an elderly person's subsequent care plan is accurate, and can even provide early warning of high-risk events such as falls, disability, and cognitive decline 3 to 6 months in advance.

Last month, I came to evaluate Aunt Zhang Guiying, who lives in the old city, and I encountered the most typical cognitive bias. Her son asked for leave and was at home. As soon as he opened the door, he told me, "My mother has a bad memory. She has no problem eating and walking. You can just take a test. I have to go to work in the afternoon." I didn't answer. I changed my shoes and squatted down to touch the polished floor tiles in her house. Then I helped my aunt walk around the living room twice. The walking speed was only 0.6 meters/second. The standing and walking test took 14 seconds. It was already a clear high risk of falling. Later, after chatting with her aunt alone for ten minutes, she secretly took out three boxes of different painkillers from the cabinet in the bedroom. She said that her knees had been hurting for more than half a year and she did not dare to tell her son because she was afraid that he would have to hire a caregiver to waste money. She usually walked by holding on to the wall and only walked faster when outsiders came to the house. When the final assessment report came out, in addition to a high risk of falling, early symptoms of mild cognitive impairment were also screened out. We made three suggestions to the family: cover the living room floor tiles with non-slip mats, install handrails in the bathroom, and come to the community twice a week for cognitive training and knee joint rehabilitation. Last month, my family specially sent me a message, saying that my aunt now dares to go downstairs to buy groceries by herself, and she has never fallen down once.

I have been in the industry for almost 5 years, and I have seen many misunderstandings about this profession from the outside world. Even within the industry, there is still no completely unified implementation standard. There is a group of colleagues who firmly adhere to "standardization first" and believe that all assessments must strictly adhere to the scoring items of the national standard "Assessment of the Elderly's Competencies", and the grade cannot be adjusted if there is a difference of 0.5 points. The advantage is that it is fair enough. Whether it is reimbursement for long-term care insurance or grading of nursing homes, they will all be measured with the same ruler, and there will be no disputes. ； But the problem is also obvious. Many elderly people become nervous when they see appraisers in work clothes. They can dress and eat by themselves at home, but their hands are so shaking during the evaluation that they can't even button their buttons. If they are scored according to the scale, they will be classified as moderately disabled. Instead, they will put an unnecessary burden on their families and the elderly. The other group prefers "practical first". Before the assessment, they chat with the elderly for half an hour about daily life, ask about their eating and sleeping situation in the past three months, and ask caregivers and neighbors for cross-verification. They even choose a meal spot to come to see the elderly's eating status. The results are more in line with the elderly's real life, but the shortcomings cannot be avoided: there is a lot of room for subjective judgment, and it is inevitable that some people deliberately conceal it in order to get more long-term care insurance subsidies.

Oh, by the way, a while ago, a customer who works on AI health came to talk to us, saying that he wanted to build an AI assessment system that could produce a report by taking a few minutes of video of an elderly person walking and eating, thus eliminating the high cost of a manual trip. I gave him a copy of the assessment record from last week. It was an 88-year-old man whose children were abroad. He had lived in a nursing home for three years. Every time the nurse said he didn't eat well, he said he had eaten. On the day I went for the evaluation, I brought a box of oranges and sat with him in the yard chatting for forty minutes about his time as a soldier. Then he secretly told me that he felt that the nurse poisoned his food and poured it out every time when no one was paying attention. He had lost almost ten pounds in three months. This kind of health risk hidden behind emotions cannot be discovered by AI even if it takes a hundred videos.

In fact, many people think that the threshold for our industry is low. Isn’t it just a matter of chatting with the elderly and filling out a form? Not really. You need to know some common sense about geriatric medicine to distinguish between normal aging and early manifestations of Alzheimer's disease. ； You have to understand some psychology and know that you can't be direct when asking questions. If you want to ask an old man whether his memory is good, you can't just say "Do you often forget things?" You have to say "Let's play a little game. I will tell you three words. Can you tell me again later?"” ； You even need to understand that parents are divided, and know that some elderly people dare not say they are uncomfortable in front of their children, so they have to find a way to separate their children and talk alone.

A few days ago, I was having late-night snacks with some colleagues, and someone joked that we were "the gatekeepers of the quality of life of the elderly." I thought it was too grand. We just do a small job: dig out the pain that the elderly are embarrassed to say, the small abnormalities that are not discovered by their families, and the risks hidden behind "I'm fine", and find the most comfortable way for them to live. After all, for the elderly, no matter how good the score on the scale is, it is not as practical as walking at home without falling, eating two big bowls, and remembering the name of the old neighbor.