Daily care tips for the elderly

The core of daily care for the elderly has never been to copy the standardized process online. The core priority is always "preventing risks > improving comfort > respecting wishes". All techniques must be flexibly adjusted based on the individual situation of the elderly. There is no standard answer that is universally applicable.

Not long ago, I met Aunt Zhang, who lives in a nursing home for the elderly, at a community elderly care service station. She had red circles in her eyes and said that she was almost exhausted from taking care of her wife who was bedridden after a stroke. She strictly followed the instructions on the Internet to turn over every two hours, and set three alarm clocks at night to get up. As a result, she fainted due to high blood pressure, and her husband also refused to eat for three days in a row because she was always woken up and had a tantrum. Later, we came to the house for evaluation and found that her family had already replaced the thickened pressure-reducing mattress. The old man's skin was in good condition and he had no malnutrition problems. So we simply adjusted the frequency of turning over at night to once every four hours. In less than half a month, both of them were in much better condition.

Speaking of which, I have to mention the most troublesome problem for many family members, pressure ulcers, which are now officially named "pressure injuries" in medicine. The current domestic mainstream nursing guidelines do recommend turning over every 1-2 hours. This is aimed at high-risk groups with hypoalbuminemia, edema, and early redness. However, in recent years, European and American rehabilitation academic circles have also put forward a new point of view: If the elderly have good skin conditions, use decompression mattresses, and keep up with daily nutrition, there is no need to waste time, especially at night. High-quality sleep is more useful for improving immunity than forcing the time to turn over. There is also a little detail that many people don't know: when turning, don't pull the old man's arms and shoulders. First, place his outer leg on the inner leg. Hold the waist with one hand and the shoulder with one hand and turn it gently to avoid friction and break the skin. Place a small silicone pressure-reducing pad on the protruding places such as hips, heels, and shoulder blades. Don't use the rubber balloon favored by the older generation. The edge of the circle will compress local blood circulation, making it more likely to cause problems.

Many people focus on their skin and food while nursing, but accidentally leak something in their mouth. There was an 82-year-old Grandpa Li who lost his appetite drastically in half a month. His children took him for a checkup and found no problems. Later, we came to do a nursing assessment. When he lifted his lips, his mouth was full of oral ulcers. This is because his children were afraid of him choking, so they only dared to wipe it with a cotton swab dipped in water, but they couldn't wipe away the food residue at all. If the bedridden elderly cannot get up to rinse their mouth, don't use ordinary cotton swabs. Buy a textured oral care sponge stick, dip it in light salt water or medical mouthwash, and rub it between the teeth, the inside of the gums, and the tongue. Elderly people who wear dentures must take off their dentures at night, brush them clean with a special soft-bristled denture brush and non-foaming detergent, and soak them in clean water. Do not scald them with hot water, which will deform the resin dentures.

When it comes to eating, many people have heard that "bedridden old people should raise the head of the bed 90 degrees when eating." This principle is correct in itself, but it is not a rigid rule. If the old man has scoliosis, or has just undergone lumbar surgery and cannot sit up straight, he can shake it to 30-45 degrees. Another misunderstanding is that the elderly should always be fed mushy porridge and soft vegetables. Unless the doctor diagnoses dysphagia, don't always feed them too broken foods. If you don't eat food that needs to be chewed for a long time, the masseter muscles and swallowing function will deteriorate very quickly. I have seen several elderly people who could eat rice normally, but their children are afraid that they will get stuck and always make porridge. After half a year, they can't even bite soft steamed buns.

After talking about food, let’s talk about bathing. Many filial children think that they need to wash every day in summer to be clean. In fact, the oil secretion of the skin of the elderly is less than one-third of that of young people. Washing every day will damage the skin barrier. Dryness, itching, and eczema are common. Washing once or twice a week is enough in the north. In summer, if you sweat a lot, you can use a warm towel to wipe your armpits, neck, and groin. There are many small details when taking a bath: the water temperature should not exceed 40 degrees, and it is best to install a constant-temperature shower to prevent the elderly from scalding themselves by adjusting the water temperature. ； Handrails must be installed in the shower area and next to the toilet. Don’t think, “My old man is in good health and doesn’t need it.” If you fall down once, it will be too late. ； Instead of installing a ball lock that requires twisting, use a push-type lock on the bathroom door. Don't let the elderly lock the door from behind. Just put a small "In Use" sign on it. If you slip inside, people outside can open the door directly and go in. Oh, and there is another small detail to prevent falls. Carpets at home must be fixed and do not leave any warped edges. Electric wires on the ground should be put into storage boxes. Elderly people should not wear thin-soled plastic slippers at home. It is best to wear non-slip shoes with a heel. Even if you go to the living room to pour a glass of water, do not wear barefoot slippers. Many elderly people fall because they step on water stains or warped carpets at home.

Finally, what is most easily ignored is the emotional needs of the elderly. Many family members think that nursing care is about taking care of their food, drink, and toilet. In fact, the elderly who lose their temper, refuse to take medicine, and do not cooperate with care are mostly not "ignorant" but have emotions that they do not express. There used to be a 78-year-old Grandma Wang who always secretly threw away her antihypertensive medicines. Her children scolded her several times, but to no avail. Later, after chatting with her for an afternoon, she found out that she heard from her elder sisters that taking too much antihypertensive medicines would harm her kidneys. She also felt that taking medicines every month cost a lot of money and burdened her son. Later, her son took the bill and calculated with her, you only spend more than 30 yuan for medicines this month. If you have to be hospitalized for a stroke, it will cost several thousand a day, so she takes medicines on time.

In fact, after doing community care for the elderly for so many years, my deepest feeling is that there is never a perfect standard answer to nursing care. Online guides and expert advice are only references. You are facing a family member who has lived with you for decades. Observing his condition more and asking "are you comfortable" and "do you want to think about it" are more useful than trying to fixate on any standard. After all, our original intention of doing nursing is to allow the elderly to live comfortably, right?