Summary of actions to improve nutrition for the elderly

The effective coverage rate of the target population is 82%, and the detection rate of malnutrition such as underweight and hypoalbuminemia in people over 65 years old has dropped from 24.2% before the operation to 12.5%. However, the three core problems of insufficient personalized adaptation, access gaps in remote villages, and cognitive misalignment among family members have not been solved, and are far from a mature stage for replication and promotion.

Don't tell me, at the beginning we all thought that the most difficult part of this project was applying for funding and getting enough nutrition packages. Only when we got started did we realize that changing the lifelong eating habits of the elderly was really difficult. For example, Aunt Zhang Guiying from Chengxi Community said that she is 72 years old and has a 20-year history of diabetes. She used to eat plain porridge with pickles or sugar-free biscuits sent by her children for meals. Her fasting blood sugar spiked to 13, and her legs felt weak even after walking for two steps. We checked her home and measured her serum albumin, which was only 32g/L. She was moderately malnourished. We prescribed a low-GI meal menu for her, and asked the community canteen to leave her a soft meal with less oil and salt every week. We also gave her calcium and vitamin D supplements according to the standard. It has only been three months, and her fasting blood sugar has stabilized at around 6. Last week, she went to the park to perform with the community's elderly yangko team. This change visible to the naked eye is more reassuring than any data.

Interestingly, in the third month of the operation, there was an argument between the public health department and the clinical nutrition department. Colleagues from public health think that with limited funds now, basic nutritional supplements should be distributed to all the elderly on a universal basis, with wide coverage and low cost. Even if it can only solve the problem of insufficient calcium intake for most people, it is still worthwhile. ； However, doctors from the clinical nutrition department firmly objected, saying that supplementing without individual testing would increase the metabolic burden if the elderly had kidney function problems. Over-supplementing with protein would increase the metabolic burden. In the past, an elderly person had blindly supplemented with vitamin A and was sent to the emergency room for dizziness and nausea. Individual nutrition screening must be done first and then a targeted plan can be given. In the end, we made a compromise and came up with a transitional method: ordinary elderly people will be given basic calcium and VD at the same time. Elderly people with basic diseases such as hypertension, diabetes, and renal insufficiency will be arranged for a free serum nutritional index test, and then a nutritionist will come up with a one-on-one plan. So far, it seems to have balanced coverage and safety. Of course, this is only a stop-gap measure. Which of the two paths has higher long-term benefits, we have to track the data for two more years before we can say.

Last month, I visited Dongxi Village at the foot of the mountain. I walked for forty minutes on a winding mountain road carrying a nutrition bag. The 81-year-old uncle Li Shouyi, who was deaf, shouted to him three times, "Don't eat more than a beer cap of salt a day." He rubbed his head and laughed: "I have eaten salty food all my life, and it is bland. How do you pay attention to this after living so old? ”His son works in other provinces, and every time he sends back honey, bird's nests, and brain supplement for the elderly. However, the uncle has diabetes, so these things cannot be touched and can only be piled in a dusty cupboard. We still have seven remote villages like this. Either the young people have left and only the elderly are left behind, or the village doctors are too old to teach them how to conduct nutritional screenings for the elderly. Nutritional packages have been distributed, but no one is paying attention to how to eat and how much to eat. The distribution rate is 100%, and the conversion rate is not even 30%.

In the past, we also followed the textbooks and printed out nutritional information into color manuals and distributed them. After a return visit every half month, eight out of ten households had the manuals covered with soy sauce bottles - the characters were too small for the elderly to see clearly. Later, it was changed to a wall sticker the size of A3 paper, with the characters bigger than walnuts. It was posted on the wall of the old man's kitchen. When you look up from cooking, you can see "put less salt, eat more eggs, and stew the vegetables until tender." The effect is much better. I once asked the director of the nutrition department of a tertiary hospital to give a lecture. Most of the old people sitting at the table were asleep. Later, I asked Uncle Li from the community who had diabetes before and controlled his blood sugar very well with diet to talk about his experience. The seats were full, and some people asked, "Is the steamed pumpkin you mentioned really can be eaten?" ”, it turns out that what an acquaintance says is 10 times more effective than an expert.

To be honest, there is no perfect solution now. In the next six months, we plan to pilot precise nutrition testing in three communities in the city center and create exclusive nutrition files for each elderly person. A few remote villages will first recruit a group of local young volunteers to help the elderly every week. They will also pay attention to taking supplements and changing their eating habits. The family members also plan to open a "children's class". After all, the elderly listen to their family members most. Just saying "stop eating leftovers" is not as useful as saying "don't eat leftovers" when the children call.

There is no need to rush things for the elderly, nor can we do it one-size-fits-all. If we can solve the feeding problem of one more elderly person, even if the six months of work are not in vain.