Geriatric disease prevention and nursing training report

First, according to statistics from more than 1,200 elderly follow-up data in the training community in 2023, 87% of acute attacks of common diseases among the elderly at home can be avoided through early refined life intervention, and the proportion is much higher than the effective contribution of clinical drug intervention.； The second is that the unified elderly health science content currently circulating on the entire Internet is less than 30% applicable to the elderly over 75 years old and the disabled and semi-disabled elderly. It must be adjusted based on the elderly's physical conditions, living habits, and family care capabilities before it can be implemented. ； Third, the input-output ratio of geriatric disease prevention is about 7.2 times that of clinical treatment, but the gap in caregivers' practical capabilities is currently the biggest obstacle to implementation.

The setting for this practical training was the Yuetan Street Community Health Service Center in Xicheng District, Beijing, and its three elderly care stations. During the four weeks, I followed 12 clinical nurses and senior caregivers to follow up 76 households with the elderly at home, and participated in the adjustment of the care plans for 21 elderly people with chronic diseases. The above data were calculated by following the public health doctors at the center to sort through the annual files, and there is no moisture.

To be honest, I never expected this result before the training. When I took geriatric care classes at school, the standard prescription for patients with high blood pressure was "a daily salt intake of no more than 5g and a daily step count of no less than 6,000 steps." What I learned most by heart was the standard prescription of "no more than 5g of daily salt intake and no less than 6,000 steps a day." It wasn't until I met 72-year-old Aunt Zhang that I realized that the knowledge in the textbook had to be broken down and modified when applied to specific people. Aunt Zhang has a 30-year history of high blood pressure. She used to strictly control salt and get up early and walk on an empty stomach according to the unified popular science requirements. In less than half a month, she fainted twice due to orthostatic hypotension. She spent more than 2,000 yuan in the emergency room. She also suffered from old arthritis in her knees and couldn't even go downstairs. When we came to the door, she was still angry and said, "What a health guide, I think it's a guide to suffering."

This actually happens to run into a controversial point in the field of elderly care: the evidence-based school insists on the authority of standardized guidelines and believes that individual deviations can be adapted through gradual adjustments, and the benefits will be higher in the long run.； However, the practical school generally believes that the first principle of intervention programs for the elderly is "implementation and persistence". Rather than directly changing to "complete standards", it is more effective to make minimal adjustments first. The final plan we adjusted for Aunt Zhang did not follow the guidelines: instead of directly reducing salt to 5g, she first dropped it from the 12g she was used to before to 9g. The 6,000 steps per day was also changed to sitting on a chair and doing 10 minutes of ankle pump exercise after three meals. She just went out and walked slowly for 10 minutes every day, which added up to more than 2,000 steps. During the follow-up visit two weeks later, her blood pressure was stable at around 130/80, her knees no longer hurt, and she stuffed oranges with us when she saw her.

I used to think that those care guidelines were like mathematical formulas that could be put into place and the results would come out. But now I realize that caring for the elderly is more like making soup. You have to adjust the heat and time according to the texture of the ingredients. There is no one-size-fits-all recipe. For example, for the care of pressure ulcers for disabled elderly people, I used to memorize "turn over every 2 hours and apply pressure relief patches on the sacrococcygeal area." It wasn't until I met the 84-year-old Grandpa Li that I realized that some people really couldn't follow the regulations at all. Grandpa Li has chronic obstructive pulmonary disease. He can't breathe hard after lying down for more than 20 minutes. According to the Braden Pressure Ulcer Risk Assessment Scale, he scores only 9 points, which is extremely high risk. According to the regulations, he must turn over every two hours. When he turned over, he gasped and burst into tears, which made his family feel distressed. Sister Zhang, who has been a caregiver at the inn for 10 years, has a way: put two small wedge-shaped pillows on him, and only turn sideways 30 degrees each time, without lying completely on his side. Move the position of the pillow every 40 minutes, so that the sacrococcygeal area will not be long-term pressure, and it will not affect his breathing. With such a simple adjustment, Grandpa Li stayed at the inn for three months without any pressure sores. Oh, by the way, when we talked about this with the director of the nursing department of the center, she also said that the industry is currently discussing revising the standards for pressure ulcer care for disabled elderly people, and that the elderly's tolerance should be given a higher priority, without blocking the 2-hour timeline.

Speaking of this, I think of the 78-year-old Grandpa Wang. He had listened to the popular science that "elderly people should eat light meals" and ate boiled vegetables for half a year. As a result, he became severely anemic, with albumin as low as 28g/L. He had three colds in a row. Finally, his children sent him for transfusion of albumin. This happens to be where there is currently a lot of debate in the geriatric nutrition community: one group focuses on the prevention and control of chronic diseases and believes that as long as you have basic diseases such as hypertension and diabetes, you must strictly control oil and sugar, and limit the intake of red meat. ； The other group focuses on the prevention and control of frailty. It believes that the muscle loss rate of people over 75 years old is three times that of middle-aged people. The priority should be to ensure protein and calorie intake. Even if blood pressure and blood sugar are slightly higher than the standard value, the risk of falls, infection, and multiple organ failure caused by malnutrition is lower. The recipe we later prepared for Grandpa Wang was also very simple: add a boiled egg every day, and eat two pieces of braised pork ribs for lunch. There was no need to completely skim the oil, and the salt was still in the amount he was used to. A month later, when he was rechecked, his albumin level rose to 36g/L. He was not infected with the recent wave of influenza A. When he met us, he said, "I can finally eat something tasty."

At the end of the practical training, we encountered something quite interesting: 80-year-old Grandpa Liu had been smoking for 60 years, and his children forced him to quit. But after quitting, he stayed at home and lost his temper every day. His blood pressure soared to 180/100, and no antihypertensive medication helped. We discussed it with our children for a long time, and the final plan was not to quit smoking completely, but to smoke up to 3 cigarettes a day, and to smoke on the balcony to avoid infuriating the family. After making this change, Grandpa Liu was happy every day. After half a month, his blood pressure stabilized at 140/90. In fact, there is no unified conclusion in the industry as to whether the elderly should completely give up the fun of life for health. Our practical principle is: as long as it does not cause acute risks, priority should be given to ensuring the quality of life of the elderly.

The old nurse who taught me said something to me that I still remember: "When caring for an elderly person, don't always think about what you want him to do, think more about what he wants to do. ”In the past, I always thought that nursing care should strictly follow the operating specifications, and it was almost impossible. Now I understand that all the specifications are to make the elderly live more comfortable, not to meet the standards on paper. If I do related work next, I will definitely not give people a unified prescription of "walk 6,000 steps a day and eat 5g of salt" right from the start. I will first sit down and have a good chat with them about home-related matters for half an hour. After all, we are preventing diseases and caring for living people.