Daily care knowledge for the elderly

The core of all daily care for the elderly is never about expensive care products or strict care procedures. Instead, priority is given to avoiding the three high risks of falls, pressure sores, and aspiration. All other details must be flexibly adjusted based on the elderly's independent wishes and physical condition. There is no standardized care template suitable for all elderly people.

I have been working as a care guide in a community nursing home for almost 7 years. I have seen too many examples of family members following the "care list" on the Internet one by one, which in turn made the elderly miserable. I met a 76-year-old Aunt Zhang a while ago. Her son was so scared after she fell once before that she wrapped all the table corners in the house with thick anti-collision strips and covered the whole house with anti-slip mats. But last month, when the aunt wanted to move a stool to the balcony to get clothes, her foot hooked on the curled edge of the anti-slip mat. She sat on the ground and fell and fractured her femoral neck. It was even more serious than last time.

In fact, there have always been two different care ideas in the anti-fall industry: The mainstream recommendation of the Western Medicine Rehabilitation Department is to try to achieve "three yeses and three nos" in home environment renovation: handrails, anti-slip mats, night sensor lights, no debris on the road, no excessively high thresholds, and no long-term slippery floors. This logic is aimed at the elderly who already have obvious gait disorders and poor balance ability, and can indeed minimize the risk of falling. However, many senior caregivers in the field of dementia care have different experiences: If an elderly person can still go out for a walk or buy groceries independently on a daily basis, there is no need to make the home too "barrier-free". Otherwise, the elderly's balance ability will not be exercised for a long time, and in an unfamiliar external environment, they will be more likely to fall more heavily because they cannot adapt to it. There is nothing wrong with both ideas, but the key point is to look at the specific situation of the elderly person. My general advice to the family members is that if the elderly person is usually active, it is okay to leave a small threshold of no more than 3cm at the door. The anti-slip mat can be completely attached to the floor without curling. It is enough to spread it in commonly used places such as bathrooms and kitchens. It is not necessary to spread it all over the house because it will easily snag.

In addition to falls, the most important thing that bedridden elderly people need to pay attention to is pressure ulcers. In the past, traditional nursing guidelines required turning over every 2 hours. Many family members set alarm clocks and had to wake up and turn over even if the elderly were sleeping soundly. As a result, the elderly did not have a good rest, and their immunity declined, which made them lose weight faster. The latest research on evidence-based nursing in recent years has actually updated this conclusion: If the elderly use a pressure-reducing mattress that meets medical standards and there is no redness or hardness on the local skin, the interval between turning over can be extended to 3 to 4 hours, and even longer at night. After all, for bedridden elderly people, sleep quality is much more important than turning over at stuck points. Our 92-year-old Grandpa Li has been bedridden for almost 5 years and has never developed a pressure sore. At first, his children were turned strictly every two hours. Later, they changed to pressure-reducing pads, turning them every 3 hours during the day and only once every 4 hours at night. Even though he sleeps well and has a good appetite, his weight has increased by three kilograms in the past two years.

Another risk that many people tend to overlook is aspiration, especially for the elderly with sequelae of cerebral infarction and poor swallowing function. Many family members always think that they are given porridge and rice cereal for easier digestion, but they end up choking as soon as they are fed. Last time, an uncle choked on rice cereal and was hospitalized for half a month. The recommendations from different departments here are a bit different: the Department of Gastroenterology believes that soft liquid food is easy to digest and is convenient for the elderly with bad teeth. However, swallowing trainers from the Department of Stomatology and Rehabilitation Department believe that too thin liquid food has poor adhesion and is more likely to slide along the epiglottis into the trachea. On the contrary, foods with a certain consistency such as rice soup with edible thickeners, soft steamed cakes, and steamed eggs are less likely to choke. There is also a feeding position. You don’t have to sit upright at 90 degrees. Some elderly people have deformed spines and cannot sit still. A semi-recumbent position of 45 degrees or above is enough. Feed slowly and wait two or three seconds for each mouthful before feeding the next mouthful. This is more important than what you eat.

In addition to these three major risks, there are also some small details that are not paid attention to in daily life, which can easily make the elderly uncomfortable. For example, when brushing your teeth, many people think that the elderly have to use ultra-soft toothbrushes if their teeth are not good. In fact, if the elderly have periodontitis, a toothbrush that is too soft cannot remove the food residue between the teeth, and can easily aggravate periodontal problems. Just choose one with soft bristles, and brush for 3 minutes each time. If you wear dentures, take them off every night and soak them in denture cleaning solution. Do not sleep with them on, otherwise you will easily get denture stomatitis. There is also bathing. Elderly people’s skin secretes less oil, so they only need to wash once or twice a week in winter. In summer, there is no need to shower every day. You must apply body lotion after washing, otherwise the skin will become dry and itchy, and scratches will easily lead to infection. Many elderly people have itchy skin in winter and think it is allergies, but in fact it is just too dry.

In fact, there is really no standard answer when it comes to nursing care. No matter how much is said on the Internet, it is better to observe the reaction of the elderly person. If he feels comfortable and is willing to cooperate, that is better than anything else. After all, the purpose of our nursing is to make the elderly live a safe and comfortable life, not to complete any tasks, right?