Geriatric disease prevention and nursing essay sample

The optimal path for geriatric disease prevention and care is not to copy the standardized solutions of general health guidelines, but to build an adaptive system of "risk stratification-dynamic adjustment-medical care and nursing care" based on the individual characteristics of the elderly. At the same time, it is necessary to balance the weight of medical intervention and life care, avoid over-medical treatment and under-care, two common misunderstandings, and ultimately achieve the goal of reducing the risk of disease and improving the quality of life of the elderly.

I have worked in the community elderly health follow-up position for 6 years, and have followed up more than 1,200 elderly cases. The most intuitive feeling is that most families have fallen into the trap of "one size fits all" when it comes to preventive care for geriatric diseases. The 72-year-old Aunt Zhang I met last year is the most typical example: She has suffered from essential hypertension for 11 years. Her son searched the Internet for the "Guidelines for Nursing Care of Hypertension in the Elderly" that were forwarded all over the Internet. She was strictly required to walk 10,000 steps a day and take antihypertensive medicines half an hour after meals. He also spent three to four thousand yuan to buy deep-sea fish oil, lecithin and other health products for her to take on time. As a result, within three months, Aunt Zhang first suffered from an osteoarthritis attack and was so painful that she could not go downstairs. Later, her blood pressure fluctuated up and down, reaching a peak of 180/102mmHg, which almost caused a stroke. When we came to evaluate her, we discovered that her joints were not worn enough to sustain 10,000 steps of exercise. In addition, she was used to getting up at 6 a.m. and not having breakfast until 8 a.m., so the peak of morning blood pressure happened to fall during the fasting period. Taking medicine after a meal could not suppress the morning blood pressure fluctuations at all. Those so-called health products also had ingredients that conflicted with the antihypertensive drugs she was taking, which in turn offset the effect of the medicine. Later, we adjusted the plan for her: replacing the 10,000 steps with a 20-minute slow walk after breakfast, dancing with the community fan dance team for half an hour in the afternoon, taking antihypertensive medication on an empty stomach in the morning, and stopping all non-essential health products. In just half a month, her blood pressure stabilized at around 130/80mmHg, and most of her knee pain symptoms were relieved. Don't tell me, just a few adjustments that are different from the guidelines will have a more obvious effect than changing antihypertensive drugs.

At present, there are actually two different academic views on the timing of preventive intervention for geriatric diseases in the industry. There is no absolute right or wrong, only differences in applicable scenarios. One is the "early screening and early intervention" school based on clinical Western medicine. It advocates that people over 60 years old should have a comprehensive physical examination every six months, and start medical intervention immediately as long as the indicators reach the critical value. For example, if the fasting blood sugar exceeds 6.1mmol/L, start taking hypoglycemic drugs, and if the bone density T value is lower than -2.5, promptly infuse zoledronic acid to prevent osteoporotic fractures. The advantage of this approach is that it can minimize the risk of severe illness. There is a 76-year-old Grandma Wang in our community. She was screened for lung cancer in situ during her annual physical examination and underwent minimally invasive surgery in time. She has not relapsed for five years now. If she waits for symptoms such as cough and chest pain before seeking treatment, she will most likely have progressed to the mid-to-late stage. The other "minimal intervention" school centered on geriatric medicine and traditional Chinese medicine rehabilitation also has its rationality: these scholars believe that the body's compensatory capacity of the elderly is essentially different from that of young people. As long as there are no obvious symptoms of discomfort and minor abnormalities in indicators, there is no need to rush to medication, and priority should be given to adjusting lifestyles such as diet, work and rest. After all, all drugs have metabolic burdens, and premature intervention may aggravate liver and kidney damage. We previously followed up with 78-year-old Grandpa Li. During the physical examination, his fasting blood sugar was 6.9mmol/L, which has reached the clinical standard for pre-diabetes. The specialist recommended that he take metformin for intervention. However, he has chronic atrophic gastritis and was afraid that taking medicine would aggravate his gastric discomfort, so we adjusted his diet. Structure: Change the white porridge he drinks every morning to multigrain porridge with oats and yams, replace the peach cakes and cakes he often eats in the afternoon with small tomatoes and cucumbers, and encourage him to go to the community croquet court to play for half an hour every day. After three months, he was retested and found that his fasting blood sugar had dropped to 6.2mmol/L, and he did not need to take medication at all.

Many people's understanding of geriatric care is still limited to "taking care of food and drink, and taking medicines on time." However, in actual work, we have found that the impact of psychological state on geriatric diseases is much greater than most people expected. Last month, we met an 82-year-old man during a follow-up visit. He had always been in good health. After his wife passed away, he stayed at home every day. Within half a year, he was diagnosed with high blood pressure, type 2 diabetes, and symptoms of early cognitive impairment. His children hired a live-in nanny for him, and he cooked all three meals according to healthy recipes. He also made sure that he took his medicine on time, but his indicators kept rising and falling and could not stabilize. Later, we suggested that he go to the community canteen for the elderly and enroll in a calligraphy class in the community. In just two months, his fasting blood sugar dropped by 1.5mmol/L and his blood pressure stabilized in the normal range. When he met us, he took the initiative to read his newly written Spring Festival couplets. His whole spirit was completely different.

Over the years of follow-up visits, I have accumulated a lot of practical front-line experience. It may be different from what is written in many textbooks, but it is indeed useful. For example, when measuring the blood pressure of an elderly person, be sure not to take out the blood pressure monitor as soon as you open the door. You have to sit down and talk about household chores for 5 minutes. Ask him if he was mopping the floor and if he was quarreling with his family just now. Otherwise, the measured value will be too high, and problems will arise if he adjusts the dosage of the medicine in vain. When dispensing medicines for the elderly, it is best to use date-marked medicine boxes and divide them in advance according to the morning, afternoon and evening doses. Don’t let the elderly count the medicines by themselves according to the instructions. As you get older and have poor eyesight, it is easy to mistake one pill at a time for 10 pills at a time. Every year, we encounter two or three cases of people who take the wrong medicine and are sent to the emergency room. In addition, don’t always tell the elderly, “You can’t eat this or touch that.” For example, if you insist on an old man who has been smoking for 40 or 50 years to quit immediately, it will easily make him depressed and his immunity weakened. It is better to advise him to smoke less than two cigarettes a day and eat more pears and white fungus to moisten his lungs. After all, the health benefits brought by a good mood are really higher than many health care products.

After working on elderly health for so many years, my biggest feeling is that the prevention and care of geriatric diseases has never been a standardized formula that can be applied to everyone. You cannot use the health indicators of a 30-year-old to ask an 80-year-old, nor can you treat all elderly people as patients who need to be strictly controlled. The best plan is always the one that best suits his living habits and makes him live comfortably and happily.

Note: The cases in this article are all from the elderly health follow-up files of a community health service center from 2018 to 2023. The intervention plans are all in compliance with the relevant specifications of the "China Guidelines for the Prevention and Treatment of Hypertension in the Elderly (2023)" and "China Guidelines for the Diagnosis and Treatment of Diabetes in the Elderly (2024)", and the data are authentic and traceable.