Daily care education content for the elderly

The first priority is the prevention of three types of fatal accidents, including falls, pressure ulcers, and aspiration. The second priority is the standardized management of chronic diseases and emotional support. The third priority is the maintenance training of self-care ability. The core goal of all nursing actions is to "maximize the preservation of the dignity of the elderly's life and reduce unnecessary medical injuries." There is no universal perfect standard, and all plans must be adjusted individually.

I have been working in a community nursing station for more than half a year, and I have seen too many elderly people who were originally in good health collapse because of an inconspicuous accident. Aunt Zhang, who was treated last week, could usually go to the square to dance the fan dance, but because she woke up in the early hours of the night to look for slippers in the dark, she stepped on a plastic bag that fell on the ground and broke her hip. After lying down for three months, she couldn't even stand upright. There are actually two different practical ideas about fall prevention: one is the "whole environment protection flow", which advocates wrapping all tables and corners in the home with anti-collision strips, covering the floor with non-slip mats, and giving the elderly full-foot-covering slippers with anti-skid patterns. High-risk elderly people may even be accompanied 24 hours a day to minimize the time they spend alone and walking around. ； The other is "ability maintenance flow". It is believed that over-protection will cause the elderly's balance ability and muscle strength to deteriorate quickly, making them more likely to fall. It is also recommended to do simple balance training such as standing on one leg and sitting with one leg raised 2-3 times a week. Only core modifications should be made to the environment, such as installing handrails in the bathroom and placing a night light in the place where you get up at night. There is no need to change the home to look like a hospital. The current consensus in domestic and foreign guidelines is to combine the two. First, conduct a fall risk assessment for the elderly. If you have fallen before, have high-risk factors such as Parkinson's disease or lower limb weakness, you should be more protective. If you are strong, encourage more activities and avoid excessive restrictions. I also met a 78-year-old man who went out to practice Tai Chi every day. His children insisted on buying him a walker and forcing him to use it. As a result, he couldn't get used to it and fell off. It was really unnecessary.

A more hidden risk than falling is aspiration. Don’t underestimate the risk of choking. Aspiration pneumonia caused by aspiration in the elderly has a higher mortality rate than falling and fractures. Many family members like to use straws to drink water for the bedridden elderly because they find it convenient. In fact, there have been many clinical cases where the elderly were lying down and using straws, and the water flow rate was difficult to control, making them more likely to choke. Different schools of nursing now have differences on this: Doctors in the rehabilitation department recommend sitting up to eat. Never lie down when drinking water. Even if you use pillows to support your upper body and lift it to above 30 degrees, it is better than lying down. If you can drink from a cup, don't use a straw. If you really need to feed, use a small spoon, only half a spoonful. Wait for him to finish swallowing, cough twice to confirm that he is not choking, and then feed him the next mouthful. Don't talk to him while feeding and amusing him. Some people think that elderly people with bad teeth should eat porridge and soup. In fact, thin food is more likely to choke. On the contrary, thicker rice cereal, steamed eggs, and soft noodles are safer. If you really want to drink soup, you can also use a thin gravy, which can reduce a lot of the risk of aspiration.

Elderly people who are bedridden for a long time should also pay attention to pressure ulcers. In the past, everyone was stuck with the standard of turning every two hours, and they had to drag the elderly up and turn them even at two or three in the morning. Now the new clinical guidelines have actually been adjusted: if you use a medical decompression mattress, and the elderly's skin is in good condition and there is no edema or malnutrition, it is completely fine to turn once every three to four hours. There is no need to torment the elderly to sleep all night just to meet the standard. I would also like to mention here a misunderstanding that many family members have: they think that everything will be fine if they use an air mattress for the elderly. In fact, the protruding areas such as the sacrococcyx and heels still need to be touched every day. If there are red areas, rub them more and use a soft pillow to lift them up. Don't wait until they are broken before dealing with them, which will be troublesome.

After preventing these fatal risks, the most important thing next is the standardized management of chronic diseases. To be honest, I have seen more than half of the elderly hospitalized in emergency departments because they secretly reduced or stopped taking their medicines. There used to be a 72-year-old Uncle Li who had been taking medicine for high blood pressure for five or six years. Last year, he felt that he was no longer dizzy, so he secretly cut the medicine into half a tablet, and then stopped taking it altogether. At the end of the year, he suddenly suffered a cerebral hemorrhage and was sent here. He was rescued and could not move half of his body. His children regretted it. There is also a point that everyone often debates here: Should we take medicine strictly according to the doctor's instructions without any compromise, or can we adjust it according to the elderly's feelings? Our practical experience is that you must not adjust the medicine yourself. However, if you feel uncomfortable after taking medicine, such as swollen feet after taking antihypertensive medicine, or stomach discomfort after taking antihyperglycemic medicine, don’t take it hard, and don’t stop on your own. Write down the blood pressure and blood sugar values ​​you usually measure, and go to the doctor to adjust the plan. There are many choices for chronic disease medicine now, and you can always find a suitable one.

Another point that many family members overlook is emotional support. Many elderly people have nothing to do after retirement, and coupled with their poor health, it is easy to feel that they are a burden on the family, and some may even lose their temper and refuse to cooperate with care. Don't always tell the elderly, "You don't have to worry about anything, just take good care of your health." It sounds like you care, but in fact, the elderly feel useless after hearing this. There used to be a grandma Wang who was very filial to her children. She would take food to her hands and help her put on clothes and even socks. But after half a year, grandma Wang couldn't even tie her own buttons. She sat on the bed and cried every day, saying that she was a useless person. Later, we suggested to the family members that even if it was a little slower, they should let the old man dress and eat by himself. After dinner, let her help clean the table. Even if it was not clean, it didn't matter. Within two months, Grandma Wang was in much better spirits and could go downstairs for a walk by herself. There are actually different opinions on this point. Some family members think that I don’t let the elderly work because I feel sorry for her and are filial. However, research on geriatric psychology shows that doing even the smallest things within your ability can bring a sense of value to the elderly that is stronger than how many supplements you buy.

In fact, there is no standard perfect answer for caring for the elderly. Don’t copy the so-called care lists on the Internet. Observe the elderly’s reaction. It is more important that he feels comfortable and happy than anything else. After all, the essence of our care is not to treat the elderly as a machine that needs repairing, but to enable him to live a solid and dignified life every day.