Elderly health care and management

The core answer to elderly health care and management is never to apply a unified care template, but to build a full-cycle support system that dynamically adjusts medical support, life care, and psychological support based on the physical condition and wishes and preferences of the individual elderly person. There is no universal optimal solution, only an exclusive solution suitable for the individual.

Last year, I stayed at a nursing home in Yuetan Street, Xicheng District for three months. The most common problem I encountered was that my children came over with the "Universal Guide to Elderly Care" that I found online and asked, "Why don't you cooperate with me even though you act like an elderly person?" The one who impressed me the most was the 72-year-old aunt Zhang Guilan, who has diabetes and mild cognitive impairment. The caregiver her children hired strictly followed the guidelines and measured blood sugar at 7 a.m. every morning and gave her hypoglycemic medicine. As a result, she got into trouble every time and dropped the blood glucose meter twice. Her blood sugar fluctuated up and down unsteadily. Later, we tried to adjust the time for measuring blood sugar to after she listened to two episodes of Mei Lanfang's "The Drunken Concubine" every morning, and gave her an exclusive pill box with a plum blossom pattern on it, teasing her that it was "a reward for finishing the show." After that, she didn't have any trouble, and even her blood sugar level was much more stable than before.

To be honest, when I first entered the industry, I thought it was absolutely right to follow the clinical guidelines. It wasn’t until I hit a wall several times that I discovered that the industry had actually been arguing about nursing priorities for many years. One group is the "medical priority group" who mainly have medical background and believe that all nursing actions must serve the control of chronic diseases and prolong life cycle. For example, diabetic patients cannot touch even one bite of sweets no matter how much they love to eat them, and disabled elderly people must turn over regularly to pat their backs to avoid bedsores even if they resist. After all, life safety is the bottom line. ； The other group is the "humanities-first group", which is dominated by caregivers who have been on the front line for a long time. They believe that the subjective wishes and quality of life of the elderly are the first priority. If a bite of sweet-scented osmanthus cake can make the elderly happy all day long, even if the blood sugar rises by 0.5, it is not unnecessarily negotiable. After all, the impact of emotions on immunity is not small.

We met Grandpa Li, an 81-year-old terminally ill lung cancer patient, before. The family first listened to the clinician’s advice to insert a gastric tube to maintain nutrition. Later, they chatted with our care team leader several times and asked the old man what he wanted, and finally decided to give up. After intubation, I chose palliative care. I fed the old man two mouthfuls of jasmine tea every day, which he had been drinking all his life, and ate two pieces of his favorite Daoxiangcun jujube cake. The old man was asleep when he finally left, holding half of the uneaten jujube cake in his hand. He walked peacefully. Which choice do you think is right? In fact, there is no absolute right or wrong. It just depends on what the family and the elderly value more. There is no need to use the standards of one party to criticize the choices of another party.

Many people think that elderly care is just about eating, drinking, and taking care of themselves. In fact, there are many hidden needs that no one pays attention to. I have seen many families follow the trend and make home aging-friendly renovations. The Internet said that the height of bathroom handrails should be 85cm, so the height should be 85cm. As a result, Grandma Wang, who is only 1.48 meters tall, had to hold her arms every time she supported her, which made her more likely to slip and fall. Later, we adjusted it down by 10cm, and she used it just fine. She said that it is much more comfortable to get up and go to the toilet now. There are also elderly people with weak waists. Don’t always think about buying expensive waist protectors. Lower the kitchen cutting table 15cm so that the elderly can pick and chop vegetables while sitting and bend less. This waist protector will be more effective than any other.

Statistics from the National Health Commission in 2023 show that there are currently more than 40 million disabled and semi-disabled elderly people in our country, and more than 65% of them suffer from three or more chronic diseases at the same time. This also means that the care needs of the vast majority of the elderly are complex, and it is impossible to rely on a single caregiver or family member to cover them all. If an elderly person at home has a chronic disease or is disabled, don’t just carry it on. Ask the elderly care service station in the community. Nowadays, most of them have free family doctors who come to check physical signs, affordable caregivers who come to help with bathing and haircuts, and social workers organize regular activities. Many elderly people are bored at home every day and have no energy. They go to the community chess club to play two games of chess, and their faces are much rosy.

In fact, after working in this industry for almost five years, my biggest feeling is that elderly care is really not a high-tech job. To put it bluntly, it means treating the elderly as ordinary people with preferences and tempers like you and me. Don't treat them as a "machine" that needs to be maintained according to procedures. If he wants to eat something sweet, give him a bite. If he wants to go downstairs and bask in the sun, he can stay with him for a while. As long as he doesn't touch the medical red line, he can be as comfortable as he wants. It's more effective than any standard guideline. Oh, by the way, if you really can't make up your mind, asking the old man for his own thoughts is more useful than asking ten experts.