Elderly health management

The core of elderly health management has never been a unified physical examination package, Internet celebrity health recipes or expensive health products, but a dynamic adjustment plan that fully adapts to individual physical conditions, living habits and psychological needs. There is no standard answer that suits everyone. Comfort, sustainability and no additional burden are the final judgment criteria.

Last week, I met 68-year-old Aunt Zhang during a consultation at the community health service center. She has been suffering from type 2 diabetes for 3 years. Last month, she spent more than 10,000 yuan to buy a so-called "sugar-free health magnetic therapy bed" with the little sisters from the square dance team. She also strictly followed the "Golden Diet for Sugar Control for the Elderly" on a certain video. The meal consisted of boiled broccoli and sugar-free oats. After eating it for half a month, my blood sugar did drop by 0.4 percentage points. However, I lost 6 pounds. I woke up at three o'clock in the morning every day and sat in a daze. When I came to see me, I muttered, "I feel like life is meaningless. I can't even touch the sauced pork buns I want to eat."

In fact, there is no unified standard for elderly health management in the industry. The idea of ​​​​traditional evidence-based medicine is very clear: chronic disease indicators must meet strict standards, glycosylated hemoglobin should be less than 7%, blood pressure should be controlled within 120/80mmHg, blood lipids must be within the reference line, a full physical examination should be done at least once a year, and problems should be intervened and treated early. This logic is completely fine for elderly people in their early 60s with no other underlying diseases. However, in the past two years, more and more geriatric medicine scholars have put forward different views: For the elderly over 75 years old, with multiple underlying diseases or weak, there is no need to stick to the target - it is acceptable to relax the glycated hemoglobin to 7.5% or even 8%, and as long as the blood pressure is stable within 140/90mmHg, there is no need to add additional medicine. After all, in order to reduce the glycated value by 0.5, making the elderly hungry every day will easily lead to problems of malnutrition and depression, which is not worth the gain.

Don’t believe it, a 78-year-old Uncle Li came to see me last month. His children bought him the best imported antihypertensive drugs and forced him to measure his blood pressure three times every morning, noon and evening. Whenever the value was higher, they rushed to add more medicine. As a result, Uncle Li’s heart beat faster when he thought of measuring his blood pressure, and his blood pressure got higher and higher. Later, we discussed changing the frequency of blood pressure measurement to once every morning when we wake up. If there is a party or walking and we are tired that day, we will skip the measurement altogether. We also slightly adjusted the dosage of antihypertensive medication so that we don’t have to stick to the 120 standard. Now Uncle Li’s blood pressure is stable and he can go to the park to play two games of croquet every day.

Many people have misunderstandings about traditional Chinese medicine’s health care for the elderly. They think it is all about drinking wolfberry, soaking feet, and taking moxibustion products. In fact, the veteran Chinese doctors we work with in the community never provide one-size-fits-all plans for the elderly. Elderly people with varicose veins in the lower limbs are not allowed to soak in hot water, otherwise the dilation of blood vessels will worsen the condition. ； Elderly people with a hot constitution are not allowed to drink wolfberry water. There was an old man who drank it in a thermos cup every day. He had nosebleeds every day after drinking it for half a month, so he drank chrysanthemum and Ophiopogon japonicus water instead. To put it bluntly, the logic of traditional Chinese medicine is more "smooth", adapting to the elderly's lifelong living habits, rather than forcefully changing the habits of half a lifetime.

To be honest, many online health science popularizations are written for young people and are not suitable for the elderly at all. I have seen too many children busy arranging this and that for their parents, buying a bunch of imported health care products and signing up for expensive fitness classes for the elderly. As a result, the old people turned around and hid the health care products on the top of the cabinet. They went to fitness classes just to cope with their children, without taking it seriously. On the contrary, those children who are willing to sit down and discuss with the old man have much better results in implementing the plan: for example, if the old man really likes pickles, they agree with him that he can only eat half a piece of pickles every day, and eat them with multi-grain porridge. ； If you really don’t want to walk 10,000 steps a day, then walk downstairs twice a day and chat with your old neighbor for half an hour. The effect will be much better than walking 10,000 steps and injuring your knees.

Now in the national basic public health service, people over the age of 65 can get a free comprehensive geriatric assessment every year. It not only involves drawing blood and doing a B-ultrasound, but also checks whether you can buy and cook by yourself, whether you forget things, whether you wobble when walking, whether your food tastes good, and whether you have been in a bad mood for a long time. This is much more useful than spending thousands of yuan for a high-end physical examination. After all, the indicators of high-end physical examinations are set according to the standards of young people, and many of them are of little reference significance to the elderly.

I have been working in community health management for the elderly for almost six years. I have seen too many families who make a mess at home for the sake of "health". I have also seen 82-year-old Grandma Chen who drinks half a cup of rice wine and smokes two puffs of cigarettes every day, but is still in good health and goes to the park to play chess every day. Of course, I am not encouraging smoking and drinking, but if changing a lifelong habit will cause a huge psychological burden on the elderly, then there is really no need to force it. After all, elderly health management is never about "diseases" but "people". It is more important for your elderly to live happily and comfortably than any perfect indicator.