Daily care guidance for the elderly

There is no universal template for daily care for the elderly. The core should be based on the individual tolerance of the elderly, focusing on covering the three dimensions of basic care, chronic disease management, and emotional support, and giving priority to avoiding the three most common fatal risks of falls, pressure ulcers, and aspiration.

I have been working as a front-line caregiver in a community nursing home for four years, and I have seen too many family members imitate the unified standards on the Internet, which in turn makes the elderly miserable. I just met Aunt Wang last month. Her family saw a short video saying that the elderly must walk 8,000 steps a day to prevent degeneration. They forced Aunt Wang, who had severe knee joint degeneration, to walk for two hours a day. In the end, the pain was so severe that she could not get out of bed. She went to the hospital and received intra-articular injections to relieve the pain.

In fact, there have always been two schools of thought in the rehabilitation community regarding whether the elderly should move more or rest. One school advocates "prioritizing active exercise" and believes that long-term immobility will accelerate muscle loss and functional degradation, making it more likely to cause problems.； The other group insists on "moving less and nourishing more" to avoid unnecessary risks such as bone and joint wear and falls. Both of these statements are actually correct. It all depends on the individual situation of the elderly: if the elderly can usually go up and down the stairs by themselves, have no problem with their balance, and have no bone and joint pain, 30-60 minutes of light activity every day is absolutely fine. It is even encouraged to go downstairs more often to chat with old neighbors and bask in the sun, which is much better than being bored at home. ； However, if you are an elderly person with sequelae of cerebral infarction, visual impairment, or joint pain that makes walking two steps uncomfortable, instead of just trying to count the steps, it is better to do muscle massage and passive joint movement in bed to avoid muscle atrophy.

The most common fatal accident is actually a fall. I have seen too many elderly people who were originally in good health, but fell and fractured their femoral necks. They then developed complications such as pneumonia and deep vein thrombosis after being bedridden for a short time, and they died. I’m not being alarmist. Last year, Grandpa Li in our community got up in the middle of the night to go to the toilet because he didn’t like the glare of the light. He walked in the dark and stepped on his slippers that slipped to the ground. He broke a bone and left after lying there for three months. His family members cried with regret. By the way, there are still many family members who ask whether to buy all-inclusive anti-fall protective gear for the elderly. My personal experience is that if the balance is really bad, just wear a hip protector. That kind of all-inclusive protective gear is heavy and boring. The elderly will not wear it after wearing it twice, and they spend money in vain. It is better to make some small improvements at home: throw away the warped carpets, install handrails on the bathroom sink and toilet, and put a night light on the bedside. These things that cost tens of dollars are much more useful than protective gear that costs thousands.

When it comes to the frequency of bathing, we had an argument once when communicating with colleagues from all over the country: Most colleagues in the south recommend giving the elderly a bath every day in summer. It will be refreshing and less likely to cause prickly heat.； Most colleagues in the north recommend washing every 3-5 days or even once a week to avoid excessive cleansing that damages the oil layer of the skin, causing itching and flaking in winter. In fact, there is no standard answer. Some old men in the north who I take care of tend to sweat in the summer, so they can take a shower for 5 minutes a day. But in the winter, their skin is so dry that white flakes fall off, so they just wash it once a week, and apply body lotion on the whole body every time, which makes them feel very comfortable. If the elderly have difficulty in moving, it is perfectly fine to take a sponge bath. There is no need to hold the elderly person to the bathroom to wash themselves. If they slip and fall, the gain outweighs the gain.

If an elderly person is already bedridden or has been in a wheelchair for a long time, the most important thing to pay attention to is pressure ulcers. Many people think that pressure ulcers only occur on the buttocks. In fact, pressure ulcers can occur on heels, shoulder blades, even gums stuck by dentures, and ears pressed by long-term oxygen inhalation. As long as the pressure continues for more than 2 hours, they may burst. Last week, a grandma went to an afternoon performance in a wheelchair. She didn't change her position. When she got home, her tailbone was red. Her family thought it was an allergy. When we came to see her, she already had a stage I pressure sore. Fortunately, she came early and it disappeared within two days after applying medicine. Regarding the frequency of turning for pressure ulcers, there are different opinions in the industry: some guidelines require turning once every 2 hours, while others say that as long as the elderly skin is not red and painful, turning once every 3 hours is no problem. My own experience is that don’t get stuck on time, and don’t wake up a sleeping elderly person just to turn over at the right time. Usually, touch the area where the elderly person is under pressure. If the temperature is higher than other places and does not fade when pressed, turn over quickly. This is much more useful than a stuck watch.

Another fatal risk that is easily overlooked is aspiration. Many elderly people's swallowing function has deteriorated. If they eat too quickly or eat something that is too sticky or too thin, it will easily get stuck in the trachea. In mild cases, it can cause repeated aspiration pneumonia, and in severe cases, they can suffocate on the spot. I once met a family member who was feeding Yuanxiao to an old man. He was afraid that the food would get cold and the food would get stuck in the airway. By the time 120 came, he would have run out of air. It was really a pity. There are also different opinions about the diet of the elderly: some say that all food should be broken into paste to avoid getting stuck in the throat. ； Some people say that food that is too broken will easily choke into the trachea and will not improve swallowing function. In fact, it depends on the situation: if you have had swallowing imaging and have been diagnosed with dysphagia, just make thick paste food according to the requirements of the rehabilitation therapist. Normal old people can just eat normally. A reminder to eat slowly and stop chatting while eating is better than beating the rice into paste - think about it, eating tasteless paste every day will reduce the appetite of the elderly, which is not worth the gain. When it comes to food, many family members ask me whether to buy protein powder for the elderly to supplement nutrition. We in the industry have argued about this many times: some nutritionists say that supplementing protein powder for the elderly with low protein can improve their immunity, while some geriatricians say that supplementing protein powder for the elderly with poor kidney function will increase the burden on the kidneys. I generally recommend that family members take the elderly to have their blood checked first. If the albumin is lower than 30g/L, they can take supplements under the guidance of a doctor. Don’t listen to the salesman and buy a bunch of them. The elderly will feel bloated and uncomfortable after taking them.

Many family members think that nursing care is about taking care of food, drink, and living, and nothing else. In fact, the elderly's emotions have a much greater impact on the body than you think. Several elderly people I have met have no organic health problems, but their children are busy and no one talks to them. They sit at home in a daze every day and cannot eat. On the contrary, their blood pressure and blood sugar are unstable. In the past, Grandpa Chen in our district had children who were working in other places, and the nanny he hired was only responsible for cooking and cleaning. The old man sat by the window every day and looked downstairs. He lost ten pounds in half a year. Later, we came to play two games of chess with him every week and listened to him talk about his past days as a soldier. Within two months, his appetite increased and his blood pressure stabilized. To put it bluntly, what the old man wants is not that you buy him expensive supplements, but that you are willing to sit down and listen to him nagging a few words. If you don't just lower your head and scroll through your phone when he talks, that is more hurtful than not buying him delicious food.

To be honest, caring for the elderly is really not a test, and there is no perfect answer. You can only use the various guides on the Internet as a reference. What your elderly person can eat comfortably, do what makes him happy, and whether there is any pain. These are the things that should be put first. After all, the core of our nursing care is to make the elderly comfortable and live a quality life.