Elderly health care and management

The core of elderly health care and management has never been to apply a unified health package to control all physiological indicators to "standard values", but to make flexible, full-dimensional adaptation based on the living habits, psychological needs, and disease basis of the individual elderly person. This is the most practical conclusion I have come to after running into numerous problems in my 7th year of community nursing work.

I came across a typical example last week: 72-year-old Aunt Zhang has been suffering from type 2 diabetes for five years. She is a filial child. She spent 20,000 yuan on a smart health bracelet, a customized sugar-control meal, and a pill box that automatically reminds you to take medication. However, within half a month, she stuffed all the equipment at the bottom of the cabinet and secretly ate white porridge with pickled cucumbers. Her fasting blood sugar soared to 9.8. Her children were so anxious that she said she was "uncooperative with treatment." We visited her home for three evaluations, but instead of letting her switch to bland sugar-control meals, we taught her to pickle her own pickled cucumbers with low-sodium soy sauce and stevia without added sugar. We set the time to test her blood sugar every afternoon when she finished listening to Shaoxing opera and drinking afternoon tea. We also made an agreement with her that as long as her blood sugar is stable below 8 five days a week, she can eat half a piece of her favorite jujube cake on weekends. Only a month later, her blood sugar level was stable at around 7.5, and the dizziness she had suffered from before was gone.

The industry has been arguing for almost ten years as to whether to prioritize indicators or quality of life. Practitioners who hold a medical-oriented view are mostly from clinical backgrounds and believe that "really healthy only if the indicators are met hard." This logic has indeed saved many people: Uncle Li, a 68-year-old man in our jurisdiction, used to be a heavy smoker and his high blood pressure reached 180. From the beginning, he followed a strict medical control plan and forced him to quit smoking. His daily salt intake does not exceed 5 grams. In the past three years, his blood pressure has been very stable, and even the chest tightness he often suffered before has not appeared again. However, the disadvantages of this plan are also obvious: too rigid requirements can easily cause resistance among the elderly, and in turn make the implementation rate of health management fall to the bottom. Previously, there was a 78-year-old man who was asked by his children to completely quit drinking liquor that he had been drinking for a lifetime. He threw things at home every day, and his blood pressure was actually higher than when he drank two taels a day.

The other life-oriented view has become more and more popular in the past two years. The core is "as long as it is within the safety threshold, priority should be given to ensuring the happiness of the elderly." Many friends around me who operate elderly care institutions are now adjusting plans based on this idea, which has indeed improved the quality of life of many disabled and semi-disabled elderly people in their later years. But this idea is not without controversy. An incident occurred in our jurisdiction not long ago: 86-year-old Grandpa Wang loved to eat fatty braised pork, and his family members did not strictly control it according to their life-oriented thinking. As a result, after eating for a week, his blood lipids soared to 7.8, which induced acute pancreatitis and hospitalized him for a week. The family later regretted it and said that they would have been better off if they had known better.

To be honest, I used to think that nursing care only needs to follow the standards. After encountering many problems, I realized that the "good mood" of the elderly is actually much more important than the 0.5 higher indicator. Now our community is doing a flexible management of "one person, one policy": for the elderly under 70 years old with few underlying diseases, the indicators should be as close to the clinical standard values ​​as possible; for those over 80 years old with multiple underlying diseases, fasting blood sugar should be relaxed to less than 8, and blood pressure should be relaxed to less than 150/90 to be considered qualified. There is no need to squeeze the extra ten cents to force the elderly to avoid eating. In the notebook at our nursing station, we also wrote down a bunch of "miscellaneous things" that have nothing to do with medical standards: Grandma Wang on the third floor is allergic to ordinary medical tape, and she must use anti-allergic non-woven tape every time she changes the indwelling needle; Grandpa Liu, who lives in the north gate, loves to play chess, and every time he comes to take a blood pressure test, he must wait until he has finished the game, otherwise the value measured when he is emotional will definitely be too high.

A month ago, a family member came to make a fuss, saying that we were irresponsible for not strictly controlling her mother’s sugar. Later, we stayed with the elderly for three days. She saw that the elderly did not even dare to touch her favorite red bean paste buns because she had to control sugar. She sat in a daze on the sofa every day, but now the requirement has been relaxed to eat half a red bean paste bun every day.

In fact, until now, we have not found any template that is universally applicable. After all, every old man has his own habits and hobbies that he cannot change throughout his life. In the final analysis, care and management are never about how they "should live", but about helping them live longer and more securely in a way they are comfortable with.