Expected Outcomes of Routine Care for the Elderly

The core expected results of daily care for the elderly are essentially to maintain the quality of life, reduce the risk of disease progression, and retain the ability to live independently under the premise of individual tolerance, rather than simply pursuing life extension.

Last week, I went to a community nursing home for a quarterly assessment. I met Uncle Li, a 78-year-old patient with sequelae of cerebral infarction. His left limb muscle strength was only level 3. His children’s initial request to the caregiver was that he should be able to walk on his own within three months. The caregiver helped him practice standing and walking every day. Within two weeks, fluid accumulated in his knees. He tossed and turned in pain all night long. He got angry when meeting people and said he didn’t want to live anymore. Later, we adjusted the care goals and no longer set the target of "walking independently". Instead, we prioritized practicing his fine movements of holding a cup with his right hand and buttoning his shirt by himself. We also pushed him downstairs to play chess with his old neighbor for half an hour every week. Now Uncle Li smiles when he sees the caregivers. Last month, he made a little plasticine tiger by himself for his great-grandson who came to visit. Don't underestimate this kind of "small goal". For the elderly, being able to control one or two small things in life is more practical than the beautiful indicators on the test sheet.

In fact, not only family members, but also the elderly care industry has different tendencies in determining expected results. One group prefers "function first" and believes that as long as the elderly have room for recovery, they should promote functional recovery as much as possible, even if it is a little hard work in the process. This type of plan is more suitable for younger elderly people aged 60-70, with few underlying diseases and strong demands for independent life - such as the one we received last year. A 66-year-old aunt has just had a hip replacement surgery. Her goal is to go back to square dancing in half a year. The rehabilitation training we arranged for her is too intense, and she cooperates. In the end, she does achieve her goal. Now she often returns to the inn to give us small prizes she wins by dancing square dancing. The other group insists on "comfort first" and believes that the functional decline of elderly people with advanced age and multiple comorbidities is irreversible. The core of care is to reduce pain. There is no need to make the elderly suffer for the so-called "better function". We will basically adopt this idea for elderly people over 85 years old with serious underlying diseases such as heart failure and chronic obstructive pulmonary disease. Rather than forcing them to practice walking and climbing stairs, it is more meaningful to allow them to eat a bowl of hot rice and bask in the sun for half an hour every day.

I have been working as a front-line nurse for almost 7 years, and the most common question I encounter is that family members ask why my elderly are making slow progress based on other nursing care results. One family member who was particularly impressed was who kept asking "When will my mother be able to take a bath by herself" every day at first. We didn't answer directly. We first asked the old man what he thought. The 82-year-old Grandma Chen clutched her clothes and said that she most wanted to water the jasmine on the balcony by herself. We adjusted the training plan, first practicing her sitting position to hold a small kettle with her wrists, and then practicing the movement of slowly moving to the balcony with a walker. It only took two weeks for her to realize this wish. That day she was standing on the edge of the balcony, and the water droplets on the petals dripped onto the back of her hands, and her eyes narrowed into slits when she smiled. After more than three months, she slowly learned to wash herself. The progress was slower than the family expected, but both the elderly and her family members felt very satisfied.

Of course, this does not mean that all conservative solutions are right. The biggest fear is that one size fits all regardless of the situation. Two years ago, I met an 82-year-old man with chronic obstructive pulmonary disease. His children heard others say that climbing stairs can improve lung function, so they forced the man to climb three floors every day. As a result, he developed respiratory failure within half a month and was admitted to the ICU. After he came out, he didn't even have the energy to eat by himself. Instead, all the functions he had retained before were depleted. In the current grading standards for elderly care issued by the Ministry of Civil Affairs, "subjective satisfaction of the elderly" has long been placed in an equally important position as "functional improvement." To put it bluntly, nursing is not about performing "reverse growth" surgery on the elderly, but about paving a cushion for their downhill life to prevent them from falling too painfully.

After all, care for the elderly is inherently a matter of “thousands of people”. There is no unified KPI and no standard answer. You said, which outcome is more valuable: an old man with dementia who can recognize his wife every day, or an old man who has just suffered a stroke and can pick up chopsticks to eat by himself? There's really no comparison. As long as the elderly suffer less, feel better, and can do two more things they want to do, the care will not be in vain.