Daily care education content for the elderly

The core goal of daily care for the elderly is not "no disease, no disaster, absolutely safe", but on the premise of fully respecting the elderly's independent wishes, taking into account physical comfort, psychological satisfaction and preservation of social functions. The core goal covers five core scenarios of dietary care, medication safety, activity support, skin care, and psychological care. Elderly people with different physical conditions can be adjusted according to their needs. There is no universal unified standard.

Last week I went to the community to do missionary work, and I met Aunt Zhang, who lives in Building 3, who was worried: her husband, Uncle Li, had just been discharged from the hospital after hip replacement surgery. She was afraid that she would choke when chewing, so she cooked white porridge with pickles every day. As a result, after only half a month of follow-up, she was found to have hypoalbuminemia, and her sacrococcygeal area was red, and she was about to develop into a pressure injury. When it comes to the diet of the elderly, there are actually two voices in the industry. Nursing guidelines in the early years generally advocated "soft food first", especially the elderly with underlying diseases and weak chewing ability. Try to make the food as finely chopped and soft as possible to reduce the risk of choking, coughing and suffocation. However, in the past two years, more and more rehabilitation experts have expressed different opinions: As long as they undergo standardized swallowing function assessment, elderly people without swallowing disorders should try to maintain a normal diet. It does not matter even if they eat slower and occasionally drop some residue. Otherwise, the masticatory muscles will not be used for a long time and will degenerate very quickly, and swallowing problems will actually occur. Elderly people like Uncle Li after surgery can eat normally as long as they stew the ribs and cut the vegetables into smaller sizes. However, drinking porridge every meal will not keep up with the nutrition.

The issue of eating has been smoothed out, but the most common problem is the safety of medication. Grandma Wang, who just received an emergency call a while ago, took apart her antihypertensive medicines, antihyperglycemic medicines, and sleeping aids and put them all in a transparent medicine box. She has a poor memory as she gets older. She just took the antihypertensive medicines in the morning and then took them again. Her blood pressure dropped to 80/50. She felt dizzy, fell and broke her head. Regarding the management of medication for the elderly, there has been a fierce quarrel among family members. One group believes that the elderly have poor memory and are unreliable, so all medicines must be put away and fed by family members or caregivers when the time comes. The elderly must not be allowed to touch them by themselves. The other group advocates "moderate decentralization". If the elderly have normal cognitive function but only occasionally forgets things, they can help him buy a packaged weekly medicine box, divide the week's medicines into morning, noon and evening in advance, and let the elderly take them by themselves and check them every night. After all, the feeling of being in control of the medication is also a psychological hint for the elderly that "I can still make the decision", which is much more comfortable than being treated like a child and being fed medicine every day.

In fact, the most important thing for many family members is "don't fall". They would like to keep the elderly at home and not allowed to participate in any activities. On the contrary, it is easy for them to do bad things with good intentions. Last year we met 82-year-old Grandpa Chen. He used to walk around the community three times every morning and do Tai Chi with his old friend. Last winter, he fell on ice and broke his arm. His son was so frightened that he hired a live-in caregiver and refused to let him go downstairs. As a result, in just three months, Grandpa Chen lost almost 4 kilograms of muscle mass, and his legs wobbled when he stood up. He could eat and dress himself, but later he couldn't even sit still, and he fell more easily. Regarding the activity management of the elderly, there are also two ideas. Conservatives believe that "safety comes first" and try to minimize going out and walking to minimize the risk of falls. ； But what is more mainstream now is the idea of ​​"risk adaptation", which means not forcibly banning activities, but helping the elderly reduce risks to a controllable range: for example, wearing non-slip shoes, wearing anti-fall belts, removing the door thresholds at home, laying anti-slip mats, and walking downstairs with them when the weather is good. Even if you walk slowly, it is better than lying in bed every day with muscle atrophy.

Don’t think that everything will be fine just because you can eat and walk. Skin problems often come to you quietly. Grandma Liu who had cared for her before was paralyzed due to a cerebral infarction and had been in a wheelchair for a long time. Her children were very filial and they wiped her body twice a day and changed into clean clothes, but she still did not avoid pressure injuries. When I asked later, I found out that they always forgot to ask the old man to move his buttocks every half hour, and there was no pressure-reducing pad on the wheelchair. The sacrococcyx was pressed for a long time, and no matter how good his skin was, he couldn't bear it. When it comes to pressure ulcer care, the standard in the early years was to "turn over every two hours." Even if the elderly are sleeping soundly, they must turn over. Now the guidelines have actually been adjusted: if the elderly are using a pressure-reducing mattress that meets the standard and their sleep quality is poor, there is no need to forcefully wake up and turn over in the middle of the night. Prioritizing sleep quality will be better for the overall condition. As long as the elderly turn over regularly during the day and check the skin condition more often.

Oh, by the way, there is another point that is most easily overlooked, which is the psychological level of care. Many family members think that "eating well, drinking well, and not getting sick or hurting means they are good." In fact, this is not the case at all. There used to be an old man whose children were very successful in their careers. They hired two caregivers to take care of them 24 hours a day. They were fed, helped when walking, and they didn't have to do any work. However, the old man lost his temper every day and even secretly tore the caregiver's clothes. After chatting with him for a long time, we found out that his children were afraid that he would be tired and would not let him go to the previous calligraphy and painting class for the elderly or call his old colleagues for fear that he would become emotional. He felt that he was just a "breathing burden" and that life was meaningless. The traditional concept of nursing only looks at physiological indicators. The "whole-person care" now advocated pays more attention to the emotional and social needs of the elderly: even if his hand shakes when writing and the paintings he draws are not good-looking, even if he talks about unhappy things when chatting with old colleagues, as long as he is willing to do it, try to support him as much as possible. The feeling of being needed is more nourishing than ten pounds of supplements.

To be honest, I have been doing elderly care for almost ten years. My biggest feeling is that there is no "standard answer". Some elderly people like to eat soft porridge, and they will be unhappy if you insist on letting them chew ribs.； Some old people have to be strong all their lives, but if you insist on feeding them, they will become anxious with you. The core of all nursing measures must be based on the wishes and status of the elderly person. There is never any hard and fast rule that "must do this".