Lecture on geriatric disease prevention and health care

There is no magic medicine or panacea that can prevent all geriatric diseases. The most reliable method of prevention is always a combination of "lifestyle adjustments that fit your own constitution + accurate screening once or twice a year + a non-distressed emotional state". Don't believe those gimmicks on the Internet that "one trick can prevent all diseases".

I have been working in the elderly health service in the community for almost 7 years. Last week, I met 62-year-old Aunt Zhang, who came to me with half a bottle of imported deep-sea fish oil. She said that her neighbor said that taking this can clear blood vessels and prevent high blood pressure. After taking it for half a year, the last blood test showed that the low-density lipoprotein had increased by 0.3mmol/L, and she had acid reflux every day. Are you saying this thing is useless? No, but it is only useful for people who are deficient in Omega-3 and have mildly elevated blood lipids. If you eat cured bacon and drink bone soup every day, no matter how much fish oil you eat, you will not be able to prevent excess fat.

I have to be fair to everyone here. There are two mainstream ideas for geriatric disease prevention. No one is right or wrong. It depends on which one suits you. One is the evidence-based school of Western medicine, which focuses on the indicators. The thresholds for blood pressure, blood sugar, and blood lipids should be intervened, and which screenings must be done at age. These are all conclusions based on decades of clinical data; the other is the adjustment school of traditional Chinese medicine, which is not obsessed with a certain method. The level of an indicator depends more on your overall condition - whether you can eat well, sleep soundly, walk without fluttering, and feel cheerful. Even if your blood pressure is 10mmHg higher than the standard value, as long as it is stable and not uncomfortable, you don't have to take medicine to bring it down to the standard line.

Oh, by the way, many people think it is troublesome to go to the hospital and think that a routine physical examination every year is enough. Here is an important point: for friends over 50 years old, it is best to add 3 screenings in addition to the routine physical examination. This can really help you avoid big problems. The first is a low-dose chest CT, which is much more accurate than a chest X-ray and can screen out early-stage lung cancer. People who have smoked for a long time and have a family history of lung cancer are best to do it once a year. The second is a painless gastrointestinal endoscopy. I have seen too many uncles and aunts refuse to do it for fear of discomfort. They wait until they have blood in the stool to check it. They are already in the middle and late stages of digestion. In fact, painless gastrointestinal endoscopy can be done in one sleep, and it can be done once every 3-5 years, which can screen out more than 90% of the risk of early cancer of the digestive tract; the third is bone density testing, especially for postmenopausal aunts. Osteoporosis is not felt in the early stage, and it will be too late to replenish it after a fall and fracture.

As for lifestyle adjustment, it really doesn’t need to be so complicated. Eating boiled vegetables every meal and walking 10,000 steps a day is just looking for trouble for yourself. There used to be a 71-year-old elder brother who used to eat pickled radish with porridge every day. His blood pressure kept hovering around 150/90. When I asked him to take antihypertensive medicine, he said he didn't feel dizzy and didn't want to take it. I gave him a lazy idea: cut the pickled radish and take it first. Soak it in water for 20 minutes before frying it. After dinner every day, I walk around the community for 20 minutes. You don’t have to walk fast, just chat with the old man. I will test again three months later. The blood pressure is stable at 135/85mmHg, and I have not taken any medicine. Someone also asked me if walking 10,000 steps a day is necessary? It's not necessarily true. Last time, an aunt had a degenerative knee disease. She walked 10,000 steps for half a month and ended up in so much pain that she couldn't go downstairs for physical therapy. If your joints are not good, you can do Tai Chi or sit on a chair and stretch your upper limbs, which can still achieve the same exercise effect.

Let’s just talk about the issue of supplements that everyone is most concerned about. This is really controversial now, so I will make it clear to everyone without bias. From the perspective of evidence-based medicine, unless your blood test shows vitamin D deficiency, calcium deficiency, or B vitamin deficiency, there is really no need to buy hundreds of extra yuan of imported supplements. Taking too much will increase the burden on the liver and kidneys, and even induce stones; but according to traditional Chinese medicine, The idea is, if you always feel weak and short of breath, drink some astragalus water. If you always feel dry, drink some Ophiopogon japonicus and Dendrobium. There is no harm in eating these foods and medicines with the same origin. It can make you feel comfortable. You can choose according to your own constitution. There is also the issue of drinking. The current mainstream view is that alcohol is a first-level carcinogen and should not be touched even if it is a sip. However, there are also many elderly people who have been drinking for a lifetime. Drinking one or two warm rice wine every day makes them feel better, and their liver function tests show no problems. I will not force you to quit. If you feel comfortable, just drink a few sips less. If you have gout or hepatitis, it is definitely best to abstain from alcohol.

After all, what is most easily overlooked by everyone is emotion. Two months ago, a 68-year-old Aunt Li came to me and said that her blood pressure was still high and low after taking three antihypertensive drugs. When I asked, I found out that her son worked out of town. She stared at her mobile phone at home every day waiting for her son to report that he was safe. Sometimes she was afraid that he would be tired from working overtime, and sometimes she was afraid that he would not be able to eat well or sleep well. I persuaded her to sign up for the community square dance team, and also signed up for a Chinese painting class at the University for the Elderly. Last week she came to prescribe antihypertensive medication, saying that now she dances and draws with her old sisters every day, her blood pressure is very stable, and she has already lost one medication. You see, living a miserable life every day, no matter how many medicines you take, it is not as effective as a bright mood.

What I’m talking about today is not a golden rule. After all, everyone’s physical condition and living habits are different. No matter how good someone else’s health regimen is, it’s not as practical as dressing warmly, eating well, and sleeping soundly. If you feel uncomfortable, don't bear it, and don't search Baidu to scare yourself. It's better to go to a community hospital and ask a doctor.