Experience on cognitive health education for the elderly

The core of cognitive health education for the elderly has never been to instill medical knowledge in one direction, nor to force the elderly to undergo various standardized trainings. Instead, it is to "preserve the elderly's ability to live independently and reduce the burden of care" as the core goal, and to provide personalized intervention in a way that the elderly can understand and are willing to accept. All cognitive education that is divorced from the real life scenarios of the elderly is ineffective. This is a practical conclusion that I came to after working in cognitive intervention services at a community elderly health service station for four years, after encountering many difficulties.

When I first started doing this job, all I could think about was the standardized process I learned from training: I should first do a popular science presentation, then do a cognitive screening, then give a training plan based on mild and moderate cognitive impairment, and do an effect evaluation every quarter. Following this logic in the first cognitive class, we went door-to-door to notify 20 elderly people over 65 years old who lived alone a week in advance. In the end, only three came, and two of them left after sitting for 10 minutes. The remaining uncle Li came here to cool down because he thought the air conditioner at home was broken. Afterwards, he said to me, "Little girl, don't talk about these scary things about cognitive degeneration and Alzheimer's disease. I'm very fine."

Later, I went to the Provincial Jingwei Center to participate in advanced training, and I happened to encounter two schools of thought that were very quarrelsome in the academic world: one was a group of young scholars who advocated "pre-emptive strong intervention". They believed that systematic cognitive training should be started as soon as they retire at the age of 60. Sudoku, memory problems, and brain reaction games must be arranged, preferably no less than 5 hours a week, and quantitative assessments are also required, so as to minimize the risk of Alzheimer's disease.； The other group is an old professor who has been engaged in geriatric psychiatry all his life. He slammed the table on the spot and said that the current cognitive education is simply burdening the elderly. They should be retired and have to clock in and answer questions every day. If they do not do it correctly, they will be told "Why do you have such a bad memory". Instead, it makes the elderly anxious and insomnia, and accelerates cognitive degradation. It is better to let the elderly dance square dances and take care of their grandchildren. Whenever there are signs of forgetting things or being unable to find their home, they can intervene as needed.

At that time, I sat down and listened, and what both sides said seemed to make sense. When I returned to the community and tried both methods, I found that it really couldn’t be generalized. For example, Uncle Zhang in the community was a middle school mathematics teacher before retiring. He loved to do logic problems. We found Sudoku problems and graphical reasoning problems for him, and he would do two pages of them every day after dinner. After three months, his cognitive scale score increased by 8 points. He felt quite a sense of accomplishment. He said, "The more I use my brain, the better it becomes. Now I have no trouble tutoring my grandson in junior high school mathematics." But that wouldn't work for 72-year-old Aunt Zhang. Before she retired, she worked as a train operator in a textile factory. She got a headache when she looked at the numbers. She was forced to do training by her daughter. After sitting for two minutes, she wiped her tears and said, "I'm uneducated. You just think I'm old and useless." Later, we changed our approach and every time we met, we would talk to her about the past in the factory, which worker was the best at making chili sauce, and how many wires she connected in one minute during the last skills competition. After two months of chatting, she can now not only accurately name more than 30 old workers, but also went to the vegetable market last week to buy vegetables.

To be honest, after working in this industry for a long time, I realized that many times what we think of as "professional" is simply unnecessary trouble in the eyes of the elderly. Previously, the cognitive health manual we printed was color printed on coated paper with small text and flowers. The elderly took it and turned it over twice before throwing it away. Later, it was changed to beige Dowling paper with size 4 characters. The pictures were all photos we took of elderly activities in the community. A photo of Aunt Zhang dancing in the square was also on the cover. Now many elderly people put the manual next to their pillows, flip through it when they have nothing to do, and show off to their neighbors, "Look, I'm in the manual." Also, when we mentioned "mild cognitive impairment (MCI)" to the elderly, they didn't understand it and found it scary. Later, we changed the explanation: "Let's practice our memory so that we won't be cheated when shopping for groceries, we won't forget to bring our keys when we go out, and we can remember the phone numbers of a few more old friends." The number of people who were willing to come suddenly tripled.

Of course there are times when I am quite powerless. Last month, we found out that Grandma Liu, who lives alone, has mild cognitive impairment and often forgets to turn off the gas. We went to her home and told her and her children from other places that we wanted to intervene. Grandma Liu said, "How can people not be confused when they are old? What's the point of messing around?" Her children also said, "We are busy with work and have no time to take care of the elderly. Just be happy." As a result, Grandma Liu went out to buy breakfast last week and forgot her way home, so she was sent back by the police station. Her children rushed to see us, but in the past three months, her cognitive score has dropped by 6 points, and the effect of further intervention is not as good as before.

Last week we held a "nostalgic tea party" and asked the elderly to bring old photos of themselves when they were young to talk about the past. The 83-year-old Grandpa Wang took photos of his time as a soldier and talked for 40 minutes about his time at the border guard post. He even made it clear in which year and month he received third-class merit and the name of the squad leader at that time. His son told us before that Grandpa Wang was in the early stages of Alzheimer's disease and could not even remember what grade his granddaughter was in. When the meeting ended, Grandpa Wang secretly gave me two oranges and said, "Last time you said you liked sour food, I grew them on the balcony of my house, specially reserved for you." I held the oranges and stood in the sun, and suddenly I felt that those scales, ratings, and controversies were not as real as this moment.

Now our station no longer has a fixed cognitive class schedule. Sometimes when the weather is nice, we take the old man to chat in the yard in the sun. As we chatter, we ask, "Do you remember what you cooked for the wild vegetables we picked last time?" If the answer is right, we give him a piece of soap and a paper towel. Everyone rushes to answer, which is much more active than sitting in a classroom. If you really want to say something about your experience, it’s actually nothing fancy. Don’t treat the elderly as someone who needs to be corrected or educated. Treat them as the elders in the family. They are willing to listen to what you say and come to the activities you organize. This is more effective than any professional theory.