Source: Health Times (ID: jksb2013)
“Our goal is not to cure a disease, but to maintain the functional status of the elderly, able to support Its home-based care, improve the quality of life of the elderly and their families. “
Liu Xiaohong, director of the Department of Geriatrics of Peking Union Medical College Hospital, said in the live broadcast of “People’s Famous Doctor” co-hosted by People’s Daily Health Client and Health Times that geriatric syndrome is unique to the elderly and caused by multiple factors Aging, diseases and environmental factors can lead to functional decline of the elderly. From disease prevention, acute disease management, chronic disease management, to functional maintenance, all are the work content of geriatrics.
Liu Xiaohong (first from left), director of the Department of Geriatrics, Peking Union Medical College Hospital
Received span>Photo provided by visitors
1. Why do old people always choke?Associated with decreased muscle function
Coughing is a manifestation of dysphagia, most It is related to aging, frailty, and poor coordination of oropharyngeal muscles. Disease factors such as stroke can also cause dysphagia.
Cough and aspiration can cause aspiration pneumonia , Some elderly people have atypical symptoms. If they often have low-grade fever for unknown reasons, or have confusion, they need to seek medical attention in time.
Prevent sarcopenia and maintain pharyngeal muscle function is an effective preventive method. Decreased swallowing function It is recommended to carry out rehabilitation exercises as soon as possible under the guidance of a rehabilitation doctor.
You can use thickeners (such as adjusting the water to the texture of rice soup) every day, and do not choose a diet with uneven food texture ( There are both liquid and solid in the bowl, such as glutinous rice dumplings), food with residue (such as mung bean cake), broken or ground medicines, etc.
If the elderly have abnormal gait such as wider stride, wobbly walking, lateral deviation, etc., or cannot stand in “tandem” (one toe pressing against the other) Balance abnormalities such as heels), easy to lean back after light touch, or a fall within 1 year, should seek medical attention as soon as possible.
Liu Xiaohong emphasized that in addition to internal factors, environmental factors are involved in about 70% of falls in the elderly. It is recommended to retrofit the residential environment for aging, such as preparing night lights, installing handrails in slippery environments, not using small carpets, removing scattered wires on the ground, etc. The elderly have a high risk of falling within one week of changing to a new environment, such as hospitalization, travel, etc., pay more attention.
Factors such as pet running, orthostatic hypotension, poor eyesight, and taking sleeping pills are also prone to fall. It is recommended to do a comprehensive assessment of the elderly, regular drug reconstitution, and remove unnecessary or possibly falling drugs under the guidance of a doctor.
3. Is it normal to have constipation when you are old? Don’t be nervous when you don’t have a bowel movement< /span>
Constipation in the elderly is related to aging, slowed gastrointestinal motility, insufficient dietary fiber, and insufficient drinking water. Liu Xiaohong said that the elderly have decreased thirst and insufficient drinking water in hot and dry environments, which can increase the absorption of water in the colon and cause dry and hard stools.
Older adults should avoid laxative abuse. Taking stimulant laxatives can damage the intestinal bacterial barrier, resulting in loose stools and a feeling of incomplete bowel movements. The elderly may not have bowel movements for 2 to 3 days after stopping the laxatives, and the elderly are worried about taking the laxatives again, forming a vicious circle.
“You don’t have to worry about not having a bowel movement for two days, just stop the bowel movement.” Liu Xiaohong suggested that compared with the reduction in the number of bowel movements, the main complaint of the elderly is that defecation is laborious and time-consuming, which is related to the pelvic floor muscles. If the function declines, or the rectal-anal function is not coordinated, the defecation method can be adjusted, such as placing a footrest on the toilet, so that the body is in a semi-squatting position, which is more conducive to defecation.
4. Which seniors can choose geriatrics? Old age, coexistence of multiple diseases, and reduced function strong>
Liu Xiaohong said that the current hospital specialties are too detailed. There is no suitable department for admission. The Department of Geriatrics takes into account the treatment of multi-specialty diseases, the diagnosis and treatment of geriatric syndromes and functional maintenance, which greatly reduces repeated examinations and multiple medications.
For advanced age, coexistence of multiple diseases,For the elderly who are frail and whose activities of daily living begin to decline, multiple reversible problems can be identified and resolved through comprehensive geriatric assessment, which can help the elderly go home and live as soon as possible.
5. Is the longer the treatment time better for the elderly? No long-term hospitalization necessary
Elderly people keep a variety of chronic diseases stable and avoid acute exacerbations. The key is to maintain their inner ability (including physical and mental strength), and have the physical strength to go out of the community and do what they want to do Good cognitive function, no depression, vision and hearing can cooperate with activities of daily living.
The long-term hospitalization of the elderly will lead to functional decline, muscle loss, and even falls due to restricted diet during hospitalization examinations, poor sleep after changing to a new environment, and infusion tubes, urinary catheters and other pipelines restricting getting out of bed. . Among elderly patients hospitalized with acute illness, about half of them cannot return to their pre-morbid state at discharge. It is recommended that elderly patients be discharged as soon as possible after their condition is stable, and regular follow-up after discharge.
6. How can the elderly prevent dementia? It’s good to go to the supermarket span>
Liu Xiaohong said that the incidence of dementia in the elderly over 65 years old in my country is 4%~6%, and the incidence of dementia in the elderly over 90 years old is nearly 50%.
“An elderly woman will be very good if she has 6 friends.” Liu Xiaohong suggested that advanced age, female, low education level, and living alone are risk factors for dementia. Do educational activities. For example, going to the supermarket is a good choice. Not only can you get started, but you can also see multi-sensory stimuli such as items of various colors, shapes, memorize prices, smell scents, taste tastes, etc., and increase brain activity areas.
In addition, vascular dementia is related to diabetes, hypertension, hyperlipidemia, etc., and these chronic diseases need to be managed well.
7. Does poor hearing and vision affect the elderly? Important to maintain inner strength< /strong>
Many elderly people have blurred vision and hearing loss, and feel depressed. Liu Xiaohong emphasized that hearing and vision are very important for maintaining the inner capabilities of the elderly.
The poor hearing in the elderly can lead to social alienation, depression, and dementia due to lack of information stimulation; poor eyesight can affect independent living and outdoor activities.
Presbyopia (presbyopia) can occur around the age of 50, requiring 2 to 3 years of optometry and glasses to protect vision; it is recommended to test vision every year. If cataract occurs, eye surgery can be treated. About 75% of the elderly have hearing loss and often cannot hear clearly.
High-frequency voice, it is recommended that the speaker keep his voice low when communicating, and the bytes are clear, so that the elderly can see the mouth shape. It is recommended that the elderly go to the ENT department for a hearing test and wear bilateral hearing aids.
8. Who should the elderly listen to when they are sick? Choose a plan that meets seniors’ wishes< /span>
“Good medical care is medical care for the elderly with serious medical conditions, limited life expectancy, advanced age, frailty or disability. “Liu Xiaohong said that there is a difference between the expectations of the patient and what the doctor can do. For example, the doctor will pay attention to the disease, the family members are worried that the elderly are hungry and require a nasogastric feeding tube, and the elderly want to take a bath and go home without pain.
In this regard, the doctor needs to objectively and detailedly inform the condition, diagnosis and treatment plan, benefits and risks, burden, etc., the doctor and patient make joint decisions, and make a medical plan in advance when the cognitive function of the elderly with dementia is still good For medical measures that are wanted or not desired, appoint a medical agent to choose a plan that meets the wishes of the elderly.
Families often express that they are unwilling to tell the elderly about the condition, and they are worried that the elderly will not accept it. In fact, it is not difficult for the elderly to find abnormalities from some details. Instead, they are in a state of anxiety due to uncertainty about the condition, unable to communicate with their family members, and feel lonely and helpless. actuallyThe old man is stronger than he imagined, and only when he knows the truth can he make the right decision.
This article was first published on 2022-07-01 Health Times “Doctor Union Reminder: The elderly should learn to live with the disease” ( Reporter Li Yimeng)
Chinese Journal of Practical Internal Medicine
Real Deserving of Name
If you like it, click “