Elderly Cognitive Health Education Lesson Plan

For community/home-based elderly people aged 60-85 without severe cognitive impairment, through eight low-threshold scenario-based interventions, once a week, each time for 90 minutes, the goal is to slow down the rate of cognitive decline, early identify signs of mild cognitive impairment (MCI), and reduce the risk of Alzheimer's disease. In 2023, pilot data from three communities in Xicheng, Beijing, showed that the cognitive function scores of the elderly who completed the full course increased by 12.7% on average, and the intervention effective rate reached 62.3%.

I have been doing cognitive intervention for the elderly for almost 6 years, and I ran into many pitfalls at the beginning. For example, I copied the standardized courses from colleges and universities, and talked about the pathology of dementia. I also arranged training questions on digital connection and graphic memory. There were 28 people in the first class, and only 7 were left in the second class. The old man said privately, "It's like taking an elementary school exam, it's too painful." Later, I gradually developed the more down-to-earth content. Interestingly, the academic community is currently divided into two groups on the content of cognitive training. One group is the academic researchers, who insist on using quantitative and standardized cognitive tasks, saying that the data can be traced and the intervention effectiveness can be verified. The other group is our frontline social workers and caregivers, who are more inclined to integrate training into the daily life of the elderly. After all, for the elderly, being able to remember where the antihypertensive medicines are at home and being able to do the math by themselves when shopping for groceries is much more useful than answering 10 memory questions on paper. I have tried both options. In fact, there is no absolute right or wrong. If the elderly are highly educated and can accept standardized training, it is no problem to use the former. If the elderly have not gone to school and cannot sit still, the latter will be much more acceptable.

The words "dementia" and "cognition" must not be mentioned in the first class. It is taboo for the elderly. Every time we open the class, we say it is a "little brain-building class, teaching everyone not to forget things in the future and not to be cheated when buying groceries." We start with a clock drawing test, which is to ask the elderly to draw a clock on a white paper, mark 12 numbers, and then draw an 8:20 pointer. This screening method looks simple, and the accuracy of identifying early MCI can reach more than 80%. Moreover, the elderly feel that it is playing a game, so there will be no resistance. Oh, yes, if an elderly person makes a mistake in drawing, you cannot say "You have a brain problem" on the spot. You can write it down privately and talk to the family members after class to remind them to pay more attention and not to cause psychological burden to the elderly. We had an aunt before who cried on the spot after making a mistake in drawing. She thought she was about to become demented and unrecognizable. It took almost half a month of persuasion to recover.

We will basically not arrange written exercises in the following courses, they will all be based on the life of the elderly. For example, there is a class that teaches everyone how to remember daily chores, giving everyone a small note pad, and teaching them to post the things they need to do on the door and the refrigerator, and how to use the reminder function on their mobile phones. Don’t underestimate this. There was an Aunt Zhang who forgot to turn off the gas three times in the previous month. After learning this method, this kind of thing has not happened again for half a year, and now she takes the initiative to help us remember the sign-in form for activities. In another class, we played a small game of "accounting at the market" with the elderly. For example, we were given a list to buy 2 kilograms of tomatoes for 4 yuan and 5 per kilogram, and 1 kilogram of eggs for 6 yuan and 8. How much would it cost for 20 yuan? The elderly people rushed to answer the questions, which was much more active than doing arithmetic problems.

Family members often ask whether eating DHA and phospholipids can prevent dementia. We generally don’t give a definite answer to this. Research in the nutritional field does show that elderly people with sufficient Omega-3 intake have slower cognitive decline. However, many experts in neurology also mentioned that, As long as you eat deep-sea fish twice a week and a handful of nuts every day, you can fully meet your needs. There is no need to spend a lot of money on health care products. So far, no health care products have been proven to reverse cognitive decline. This must be made clear to the elderly and their families, so as not to be deceived by unscrupulous merchants.

We will also give homework, which is not a question. We ask the elderly to tell their family members about three happy things of the day every day, or learn to shoot a 10-second short video to record the flowers at home or the cat downstairs. During the pilot last year, there was a grandfather Wang who was already in the early stages of Alzheimer's disease and sometimes even confused his son's name. However, when we led everyone to sing old songs, he could actually sing the military songs of the War to Resist U.S. Aggression and Aid Korea. Later, his family members played old military songs to him every day. Now his condition is much more stable and he can still keep time with the songs.

We will also hold a special class for family members. Many family members think that if the elderly forget things, it is "confused and normal". In fact, this is not the case. The early signs of mild cognitive impairment are easily ignored, such as often not being able to find keys, forgetting what they just said, and not being able to cook the dishes that they used to cook. If these situations occur, it is best to go to the neurology department of the hospital for a checkup. Early intervention is much better than late intervention. There used to be an Uncle Li, and his family initially thought he had a poor memory. After screening, we reminded him to go to the hospital, and he was found to be early-stage MCI. After a year of intervention, he can now take the bus to the suburbs to go fishing. If it had been a year or two later, he might not even recognize the door of his house.

Having been in this business for so long, my biggest feeling is that there is no universal lesson plan. Some old people like to sing old songs, some like to do math, and some like to do handicrafts. You have to follow their preferences and don't force so-called "professional training" on them. After all, the ultimate goal of our cognitive health education is not to increase the cognitive scale scores of the elderly, but to enable them to live every day comfortably and with dignity, right?