Daily care precautions for the elderly

The core principle of daily care for the elderly has never been to apply a unified maintenance list, but to find a balance point that suits each individual between "safety risks" and "respecting the elderly's independent wishes" - this is the most practical conclusion I have come from after eight years of guiding home-based elderly care, encountering dozens of major and minor accidents, and dealing with hundreds of elderly people and their families.

Don't tell me, many family members come up with the mentality of "I want to give the elderly the best care" and search for a list of precautions online to apply at home. In the end, either the elderly lose their temper and fail to cooperate, or they have an accident. Let’s talk about the prevention of falls that everyone is most concerned about. The standard requirements of the Western Medicine Rehabilitation Department are that all aisles, bathrooms, and kitchens at home must be equipped with handrails, all floors should be anti-slip, and all thresholds, footstools and other things that may cause stumbling should be removed. Even the folding ponytail that the elderly love to use must be taken away. After all, hip fractures caused by falls are the number one cause of disability in the elderly. This conclusion is supported by solid clinical data. But the home of Aunt Zhang I met last year had been modified in this way. The handrails were so large that they blocked her way to play with succulents on the balcony. The aunt went on a hunger strike for a week, saying, "You are treating me like a useless person and locking me in a cage." Later, we contacted colleagues from the Geriatric Psychology Department for evaluation, dismantled the two handrails on the balcony, and installed a separate foldable handrail next to Auntie's succulent rack. She usually put it away out of the way and pulled it down when needed. Finally, Auntie was willing to cooperate with the rehabilitation training. There is now controversy over "over-protection" in the academic community: one group believes that safety is the bottom line and there is no room for luck. ； Tracking data from another group also shows that in over-modified homes, the willingness of the elderly to take active activities will decrease by more than 30%, and the muscle degeneration rate will be faster than that of the elderly who do not undergo modifications. In the final analysis, nursing is not about putting the elderly in a sterile safe, but allowing him to live his life comfortably.

Compared with the visible risk of falling, conflicts over eating are actually the biggest source of quarrels in many families. Uncle Li, whom I met at the last community free clinic, has had type 2 diabetes for more than 20 years. His children were afraid of his high blood sugar and wouldn't even let him touch the barbecued pork buns he had eaten for thirty years. As a result, Uncle Li secretly hid fruit candies in his pocket and sometimes ate three or four at a time. Last winter, he went to the emergency room directly because of ketoacidosis. Nowadays, the nutritional community is divided into two groups regarding the dietary requirements of the elderly: one group is to strictly follow the doctor's instructions to control sugar, salt, and oil. The most important thing is to keep the basic disease indicators within the standard line. ； The research results of the other group in the past two years are also very convincing: for people over 75 years old, as long as their indicators do not fluctuate drastically, they do not need to eat too harshly, and the emotional value brought by appropriately satisfying their appetites will have a much greater positive impact on life span than lowering blood sugar by 0.5mmol/L. The compromise method commonly used in our industry is also simple. Cut the high-sugar and high-oil foods that the elderly love to eat into small pieces, put them in a sealed box, and give them 1-2 pieces every day. For example, give 1/4 of the barbecued pork buns. This will not make the indicator drift too much, nor will it make the elderly feel like they are being treated like a child who cannot control themselves. Oh, by the way, don’t always force the elderly to drink protein powder and take health products. Many elderly people have constipation and poor appetite due to supplements. If you really want to check your nutrition, go to the community hospital to do an MNA nutrition screening. If you are missing something, supplement it will be useful.

There is no standard answer to taking medicine. Once upon a time, there was a grandma Wang who mixed antihypertensive medicine and sleeping aids and fainted at home. Fortunately, her children came home early that day. After that, her children watched her take the medicine every day and watched her swallow it every meal before she felt relieved. As a result, within two months, she discovered that the old lady secretly hid the medicine under her tongue and spit it out after her children left. She saved up half a bottle. Nowadays, there are actually two completely different ideas for medication management: one is full supervision, where family members or caregivers divide the medication in the morning, noon and evening, and watch them finish. This is suitable for the elderly with cognitive impairment and obvious memory decline. ； The other is to buy a pill-dividing box with a reminder function for the elderly, so that he can take it according to the prompts and check the remaining dosage once a week. This is suitable for elderly people who are conscious and want to be strong throughout their lives, but are less prone to resistance. The tip we usually give to family members is not to set a fixed time for taking medicine, but to tie the medicine to the elderly’s fixed habits, such as taking it after breakfast while reading the People’s Daily, or going downstairs after dinner and returning from square dancing. It is more effective than setting ten alarm clocks.

Oh, there is another point that many people tend to overlook, which is the satisfaction of psychological needs. A while ago, a family member came to me to complain, saying that the old man in the family picked up scraps every day and brought them home, leaving them so piled up in the living room that there was no room to even put his feet down. He would cause trouble every time he threw them away. In fact, it is not because the old man is greedy for the few dollars. Most of them are because they have lost their social role after retirement and always feel that they are "useless". Collecting scraps and selling them for money is the most direct proof that he can find that "I can still create value." There is no right or wrong way to deal with this matter: some people think that waste products carry bacteria and are fire hazards, and this must be stopped resolutely. ； Some people also think that a special area can be designated for the elderly, such as a corner of the balcony, allowing him to put the things he has picked up and help clean them up once a week. You can even tell him, "The money you saved from selling the cardboard boxes is just enough to buy our family's weekly milk." Positive feedback is much more effective than throwing away his things. There is also the issue of whether to install a location device for the elderly. Many family members are afraid that the elderly will get lost and buy a smart watch to check the location every day. As a result, the elderly feel that they are being watched and deliberately throw the watch at home. We generally recommend that if there is no cognitive impairment, you should first ask the elderly person if they are willing to wear one. If they are willing, buy one that looks like an ordinary mechanical watch. Don’t buy one that looks like a monitoring device. ； If he doesn't want to, just sew a small positioning button on the inside of the jacket he usually wears without telling him. This will keep him safe and won't hurt the old man's self-esteem.

In fact, after working in this industry for so long, my biggest feeling is that there is really no universal formula for elderly care. It is like winding up an old clock. If it is too tight, it will break, and if it is too loose, it will not move. Don't always make all the decisions for the elderly with the mentality of "I am doing it for your own good". Squat down and ask more often, "Do you want to go for a walk today?" "Do you want to eat a small cake?" It is much more useful than checking each item on the list. After all, the ultimate goal of our nursing care is never to let the elderly live according to the standard template, but to enable them to live happily and live the life they want.