Lecture content on prevention and treatment of geriatric diseases

There is no "one-size-fits-all" prevention and treatment formula for geriatric diseases. The core is to intervene in layers according to age, basic diseases, and lifestyle habits. When you are not sick, keep an eye on the four core indicators of blood pressure, blood sugar, blood lipids, and muscle mass. When you are sick, don't try random remedies and prioritize maintaining your quality of life. This is more effective than taking any health supplements.

I have been practicing geriatric medicine for almost 12 years, and I have dealt with at least thousands of patients. The most common pitfall is always trying to find a "universal" health regimen, regardless of one's own physical condition. Last week, I met a 62-year-old Aunt Zhang at the community free clinic next door. She has been suffering from high blood pressure for 3 years. She heard from a health care website that a vegan diet can lower her blood pressure. She hasn’t touched a bite of meat in half a year. The last time she went shopping for groceries, she fell into a wet market. She was diagnosed with severe anemia and moderate sarcopenia. Her blood pressure fluctuated and became even more dangerous than before. Do you think it’s not good to be vegetarian? It is certainly good for overweight patients with hyperlipidemia, but for elderly people who are thin and have poor absorption, eating like this is purely asking for trouble.

Oh, by the way, the most frequently asked question about calcium supplementation, I just want to give you a solid answer today. There are two schools of thought on this matter, and there is no absolute right or wrong: Orthopedic surgeons generally recommend that elderly people over 60 years old, especially postmenopausal women, take a daily supplement of 1000mg of calcium and 800IU of vitamin D3. This is based on the fact that the average calcium intake of the elderly in my country is only half of the recommended amount, bone loss is rapid, and adequate supplementation can reduce the risk of fractures.； However, nephrologists often remind you not to overdose on calcium supplements for fear of causing hypercalciuria and kidney stones. This concern is completely reasonable - if you have a history of hypercalciuria or have had urinary tract stones, the regular amount of calcium supplements must be cut in half. Check your urinary calcium every three months. If the indicators are normal, then continue to supplement. Who listens? It depends on your own physical foundation.

There is also aspirin, which was very popular in the past two years. Now everyone is confused. Some people say that you need to take it to prevent cerebral infarction as you get older, and some people say that taking it will cause stomach bleeding. Who do you listen to? Let me give you two public guideline conclusions: The cardiovascular disease guidelines before 2018 do recommend that people with a 10-year cardiovascular risk exceeding 10% can take low-dose aspirin for primary prevention. ； However, the updated guidelines in 2021 have clearly revised this statement. If you have not had clear indications such as myocardial infarction, cerebral infarction, or carotid artery stenosis exceeding 70%, but you only have high blood pressure or diabetes, the bleeding risks of taking aspirin far outweigh the benefits. Should you eat it or not? Don't go to the drugstore to buy something blindly. Take your physical examination report and see a cardiologist to calculate the risk. It takes 5 minutes and is more reliable than asking ten old buddies.

Last month, I adopted a 78-year-old Mr. Li, who has been diabetic for 10 years. He heard from his old friend that walking 10,000 steps a day can lower blood sugar. After walking for 3 months, his feet were so blistered that he lost consciousness (the touch sensation is reduced due to diabetic neuropathy). In the end, the bones were so rotten that he almost had his legs amputated. In fact, for the elderly over 75 years old, it is much more effective to prioritize muscle training than walking 10,000 steps a day. If you usually sit at home and hold a mineral water bottle, stand and hold on to the table and tiptoe, if you practice for two months, your muscle mass will increase a little, and the risk of falling can be reduced by 30%. You may not know that falling is the number one cause of accidental death for elderly people over 75 years old. It is much more dangerous than your blood sugar to be two points higher and your blood pressure to be 10 mmHg higher.

Many elderly people always want to "cure" chronic diseases and look for folk remedies everywhere, such as bitter melon water to lower blood sugar and Panax notoginseng powder to open blood vessels. In the end, they spent a lot of money, but their indicators soared even higher and they were hospitalized. Let me tell you the truth, chronic diseases in the elderly are mostly degenerative problems caused by organ aging. There is no "radical cure" at all. The core of treatment is never to lower the indicators to the standards of young people, but to control them within a safe range. The best result is that it does not affect your eating, sleeping, going out for a walk, or dancing square dances with your old sisters. For example, for people over 80 years old, blood pressure does not have to be lowered to 120/80. It is fine to control it at 140/90 or even 150. If it is lowered too low, it will easily lead to insufficient blood supply to the brain, and a fall will outweigh the gain. My grandma is 86 years old and has high blood pressure and diabetes. The goals I set for her are fasting blood sugar of 7-9 and blood pressure of 130-150. After dinner every day, she goes downstairs for a 20-minute walk. She can occasionally take a bite of peach cake and honey sandwich if she wants. Now she is more energetic than those old people who dare not eat this or touch that. Last year, I went to climb Xiangshan Mountain with my old sisters.

I didn’t list any 1, 2 or 3 precautions for you today, just because I’m afraid you might go back and try hard. If Uncle Wang next door takes a useful prescription, you might have problems after taking it. The first thing you should do when you go back is to find out your physical examination report for the past year. If you don’t understand anything, go to the family doctor in the community and go over it. Don’t believe the nonsense on the Internet about “preventing and curing all geriatric diseases with one trick”. If you have no other questions, you can raise your hand to ask. If you have a pill box or physical examination report in your hand, you can hand it over and I will take a look at it for you.