Geriatric disease prevention and health care knowledge training content

The core logic of geriatric disease preventive care has never been to copy general health formulas and "prevent all diseases" by taking health products. Instead, it should be based on "individualized layered intervention". First, special screening for the elderly to identify risks, and then adjusting diet, exercise, and medication habits based on one's own physical constitution and basic diseases can minimize the probability of geriatric diseases and delay the progression of the disease. This is the most practical conclusion that we have drawn from eight years of community geriatric health care training and having examined the health files of thousands of elderly people.

During a training session a while ago, I met Aunt Zhang who lives in Building 3. She came to me with a post on her circle of friends about "eight glasses of water a day to lower blood pressure" and said that she had been drinking this for half a month and her feet were so swollen that she couldn't even put on shoes. After asking, I found out that she had chronic renal insufficiency, and her drainage function was weak. She couldn't drain out the water she drank, so it was strange that she wasn't swollen. You see, the same prescription may be useful for an elderly person with high blood pressure who does not have kidney disease, but for her, it has become a burden. How can there be any health tips that are universally applicable?

Speaking of which, we must first mention the special screening that is most easily overlooked. Many elderly people said that I had a physical examination at work every year and nothing was wrong. Why did I suddenly have a heart attack? The general physical examination items are for all age groups, and many screenings specifically for diseases that are highly prevalent in the elderly are not included. For example, for people over 60 years old who have a high incidence of lung cancer, low-dose spiral CT once a year is much more reliable than taking X-rays. Last year I met a 70-year-old man whose chest X-rays had been normal for three consecutive years. Early-stage lung cancer was detected as soon as CT was done. Fortunately, it was discovered early and he has undergone minimally invasive surgery and is recovering very well now. In addition, it is best to have a gastrointestinal endoscopy every 3-5 years for those over 50 years old, to have their bone density checked every year for postmenopausal women, and for those with high blood pressure to have a homocysteine ​​test. These are items that will not be automatically added to you during a general physical examination, so you need to pay attention to them.

Of course, this does not mean that if there is a problem, just take medicine and make up for it. Let’s talk about calcium supplementation. There is a lot of quarrel on the Internet right now. One group says that middle-aged and elderly women should take 1,000 mg of calcium every day to prevent osteoporosis. The other group says that excessive calcium supplementation will increase the risk of kidney stones and cardiovascular calcification. Both sides are supported by clinical data. Who is listening to? In fact, it is very simple. First, do a serum calcium test and bone density screening. If it is true that the bone mass is low and the blood calcium is not high, then it is no problem to supplement according to the dosage. If the blood calcium is high, drinking two more glasses of milk is safer than taking calcium tablets. I have seen many ladies buy a bunch of imported calcium tablets to take calcium supplements every day. In the end, kidney stones were found during physical examination. Do you think they were wronged?

There are even more sayings about exercise. Orthopedic doctors often tell the elderly, "Don't walk blindly. Walking ten thousand steps will hurt your knees the most." Especially for the elderly with degenerative osteoarthritis, walking 3,000 to 5,000 steps a day is enough. Walking too much will wear down the cartilage.； However, cardiovascular doctors will recommend at least 150 minutes of moderate-intensity exercise every week to maintain cardiopulmonary function and reduce the risk of myocardial infarction and cerebral infarction. Both sides are right, the key is to find the way that suits you. For example, if you have bad knees, don't force yourself to walk. Playing Tai Chi, swimming, or sitting on a chair and doing a few sets of body stretches can still achieve the same exercise effect. The 82-year-old Uncle Wang in our community has been suffering from knee problems for more than ten years. He does Tai Chi for 20 minutes in the small garden every morning and plays chess with his old friend for two hours in the afternoon. Now his blood pressure and blood sugar are very stable, and he rarely catches a cold.

There are even more misunderstandings about diet. Many elderly people have heard the saying that "eating vegetarian is healthy" and dare not touch any meat. As a result, they were diagnosed with sarcopenia during their last physical examination and could hardly walk. There is now a new consensus in the nutrition community. Elderly people over 70 years old do not need to strictly limit fat intake. Eating some pork belly and drinking some whole milk appropriately can supplement protein and prevent muscle loss. It is much healthier than eating boiled vegetables every day. Of course, the premise is that you do not have basic diseases such as severe hyperlipidemia or pancreatitis. If your triglycerides are particularly high, you still have to follow the doctor's advice to control your diet.

By the way, there is another pitfall that I must mention: Never stop prescription medicines indiscriminately, and don’t take health care products as medicine. Last year, there was an aunt in our community who listened to a lecture on health care products and said that their "Quantum Health Pills" could cure diabetes. She secretly stopped metformin and took health care products for three months. She was sent to the ICU for ketoacidosis and spent hundreds of thousands to save her. What do you think this is? Some elderly people think that their recent dizziness is caused by high blood pressure, so they randomly add half a tablet of antihypertensive medicine. Uncle Li in Building 4 did this before, adding half a tablet of nifedipine. As a result, he fell down due to low blood pressure and kowtowed, and required seven or eight stitches. This is really not alarmist.

The health files that our community hospital now builds for the elderly are all three-color marked "red, yellow and green". Red refers to high-risk groups, such as those with a history of stroke or myocardial infarction. We will visit them every half month to help measure blood pressure and blood sugar, and adjust medication.； Yellow is medium risk. People with high blood pressure and diabetes but are under relatively stable control will be followed up by phone once a month. ； Green means low risk, meaning there are no underlying diseases and health guidance will be provided every quarter. In fact, to put it bluntly, the prevention of geriatric diseases is really not that complicated. Don't believe in the "one trick to cure all diseases" gimmick. If you feel uncomfortable, go to a community doctor as soon as possible. Don't force yourself or mess around. It's better than anything else.

Yes, one last thing to add, if you have an elderly person with a bad memory at home, it is best to write the time and dosage of the medicine on the medicine box and stick it on the refrigerator. If you really can’t remember it, set an alarm. If you miss a dose, don’t make up for it. Just take it as normal next time. Don’t take twice the amount at one time. This is the most common medication error we see. Just have more snacks.