Expected Outcomes of Routine Care for the Elderly

The core expected outcome of daily care for the elderly has never been to "reverse aging and return to the state before illness", but to maintain the ability to live independently as much as possible on the basis of the individual's existing health, reduce the risk of acute and chronic complications, take into account the satisfaction of emotional and social needs, and ultimately maximize the quality of life that matches the health status.

I have been working in a community nursing home for nearly 6 years, and I have met too many family members who initially expected to go astray - Aunt Zhang, a 72-year-old cerebral infarction patient who was admitted last spring. When she was first admitted to the hospital, my daughter held my hand and said, "Please help my mother to practice going downstairs to buy groceries by herself. She used to love going to the vegetable market." It can be assessed that the muscle strength of the aunt's left limb is only level 3, combined with severe degenerative knee joint disease. It is difficult to stand still, let alone going downstairs. We communicated with the family for almost two weeks before we came up with the expectations: instead of pursuing walking, we should first practice sitting balance and hand grasping ability. Now, more than half a year later, my aunt can use her walker to move to the balcony to water the longevity flowers she planted. She can drink from her own cup and eat with a spoon. She can video chat with her sisters who are far away from home for half an hour twice a week. Her family members now say to everyone when they meet, "This effect is ten times better than I thought at the beginning."

In fact, in the field of geriatric care, there has never been an absolute unified standard for the judgment of expected results. There are even two different directions in the industry. It is not clear who is right and who is wrong, but it only applies to different groups of people. One is the "function-first" orientation that has become popular after the popularization of rehabilitation medicine in recent years. The core is to help the elderly restore their lost body functions as much as possible, even if it requires a certain intensity of rehabilitation training and a certain amount of pain. This orientation is very cost-effective for 60-75-year-old elderly people with sudden illnesses (such as cerebral infarction, post-fracture surgery) and few underlying diseases. I have seen many elderly people who have just suffered half paralysis after a stroke and can go out for a walk by themselves after half a year of recovery. The other is the "comfort first" orientation that is more respected in geriatric care. The core is to put the subjective feelings of the elderly first, without forcing high-intensity rehabilitation and not excessively restricting dietary preferences. This type is more suitable for elderly people over 80 years old, with multiple comorbidities, or even in the late stages of disability and dementia. After all, for this group, "living comfortably" is more meaningful than "living long and functional".

The easiest pitfall for many family members is to regard "normal indicators" as the only criterion for evaluating results. There used to be an 81-year-old man with chronic obstructive pulmonary disease. His family kept an eye on his blood oxygen saturation every day and forced him to walk 5,000 steps a day to practice lung capacity. As a result, he had an acute asthma attack after walking for three days and went to the emergency room. In fact, for him, if his daily blood oxygen level is stable at over 90%, he can sit down and eat a bowl of hot noodle soup every day, he does not need to be hospitalized for pneumonia in winter, and he does not have any adverse nursing events such as falls or pressure ulcers throughout the year, he has already exceeded the goal of nursing care. The ADL daily living ability scale that is commonly used in our industry to evaluate is, to put it bluntly, counting six things: eating, dressing, bathing, going to the toilet, moving, and controlling bowel and bladder. The more you can complete by yourself, the better the nursing results will be. It is more practical than any blood drawing or X-ray index.

There are also many people who ignore the psychological results and always think that "if there is nothing wrong with their body, they are fine." This is actually a big loss. I used to take care of a grandmother Li who was in the middle of Alzheimer's disease. When she was first brought here, she made a fuss every day to "go back to her home" and refused to eat or sleep. Her family members said that as long as she didn't make any fuss, it would be fine. Later, our caregivers went through the old boxes she brought and found a bunch of medals she had received as a model worker in a textile factory, as well as fabric tigers she had made before. She used these things to talk to her about her past as a master and an apprentice every day. We also found rags for her to sew and play with. Now grandma can sit quietly for two hours a day sewing tiger tigers. Occasionally, her granddaughter can still recognize her when she comes to see her, and she pulls her to feed her. Do you think this is a good result? Her memory is actually still slowly declining, which according to medical indicators is "progressive", but her quality of life is much higher than when she first arrived.

Our site just held a discussion last month, and it was quite noisy. The topic was: Should we strictly limit the diet of the elderly in order to control chronic diseases? For example, should diabetic elderly people absolutely not be able to eat sweets? Is it true that high blood pressure cannot be touched with any salt? In the end, we did not draw an absolute conclusion, but only came up with a measure that everyone recognized: those under the age of 70 who have just been diagnosed should still be under control. After all, complications develop quickly. ； Those over 80 years old should not be stuck like that. I met an 86-year-old grandma who loved sweets all her life. After she got diabetes, her family wouldn’t let her touch any sweets, and she was depressed every day. Later, we discussed with her family and gave her half a piece of peach cake every afternoon, just one bite, and her blood sugar didn’t fluctuate much. Grandma looked forward to the afternoon snack time every day, and she felt much better.

After working in this industry for a long time, I feel that there is never a unified standard answer to the expectations of elderly care. They are all tailored to each elderly person's situation. We often say in private that good nursing results are actually seven words: no falling, no pain, and no boredom. It looks simple, but it can be maintained steadily for a year and a half, which is better than any beautiful inspection report. After all, we are caring for real people, not cold cases, right?