Comprehensive knowledge on geriatric disease prevention

The prevention of geriatric diseases can never be achieved by taking sky-high-priced health products, extreme taboos, and high-intensity exercise. The optimal underlying logic is Layered prevention and control, adapting to individuals, prioritizing early screening, and daily fine-tuning There is no one-size-fits-all solution for the four core principles. All adjustments must be customized based on the elderly’s basic diseases, living habits, and tolerance. It is easy to cause problems if rigidly applied standard answers are applied.

You may not believe it, but I have been doing health education for the elderly in the community for almost 6 years, and I have encountered a lot of negative cases. For example, Uncle Zhang, who lived in Building 3 last month, had no problems with his physical examination last year except for a little high blood fat. After watching a short video and listening to a so-called health expert saying, "Old diseases are all caused by food, and walking 10 kilometers a day on a vegetarian diet can clear blood vessels." So he gave up the braised pork he had been eating all his life and went to bed every day before dawn. I went to the park for a two-hour walk, but after three months, I had lost a lot of weight. My knees hurt so much that I couldn't go downstairs. I went to the hospital to find out that my meniscus was worn to the second degree. A blood test revealed that my albumin was extremely low. And because I had secretly taken some off-brand health products that "cleaned my blood vessels" for half a year, my liver enzymes were three times higher than the normal value. It was not worth the gain.

Speaking of this, someone must ask, if the doctor orders blood lipids to be controlled, can the old man be allowed to eat braised pork indiscriminately? In fact, the advice given by doctors in different departments is inherently different: cardiologists will clearly require the elderly with a history of coronary heart disease and hyperlipidemia to control the intake of red meat, high-fat and high-sugar foods, and to limit the intake of salt to no more than 5g per day. ； However, every time colleagues in the nutrition department meet elderly people over 70 years old, they will repeatedly urge them to eat more high-quality proteins such as eggs, milk, lean red meat, fish and shrimp. Otherwise, sarcopenia will come to their doorstep, and a fall will cause a fracture of the femoral neck. The complications of long-term bed rest are more than 10 times more dangerous than hyperlipidemia. We did a community follow-up last year. 82-year-old Grandma Li has high blood pressure, but she likes to eat sweet and sour pork ribs twice a week. Her children can't resist her, so they just let her go. She usually goes downstairs to dance for half an hour every day, and she also likes to eat fresh vegetables. The indicators in her physical examination last year were more stable than those of many elderly people who have strict dietary restrictions. To put it bluntly, the positive psychological benefits of happiness are sometimes much greater than the impact of eating an extra bite of meat.

Oh, by the way, there is another point that many people overlook: the time points for early screening are actually different in different countries and different institutions. For example, the American Cancer Society recommends that ordinary people over the age of 50 undergo a colonoscopy every 10 years. However, in light of the high incidence of digestive tract cancer in my country, the National Health Commission has already advanced the age for first gastrointestinal endoscopy screening to 40 years old. I forced my 72-year-old aunt to have a gastroscopy last year. She always said that her acid reflux and belching was an old stomach disease, and she could just take some stomach medicine and not suffer the consequences. It turned out that she had Helicobacter pylori infection and mild atrophic gastritis. After timely sterilization and dietary adjustments, the symptoms have completely disappeared after half a year. If it takes another two or three years, it may develop into gastric cancer. This does not mean that all screenings must be completed. For example, elderly people over 75 years old who do not have high-risk lung factors (such as smoking less than 20 years ago and no family history of lung cancer) do not need to undergo low-dose spiral CT every year. The cumulative risk of radiation is actually higher than the benefits of early screening. These must be judged based on individual circumstances. Don’t just do all the screenings once you hear that they are important.

There is another controversial point: should an old man who has smoked all his life quit smoking? We had quarreled several times before when we were preaching. Some doctors believe that no matter how old you are, there are benefits to quitting smoking, and you must quit smoking completely. ； However, some colleagues in the respiratory department mentioned that if you have smoked for more than 40 years, are over 75 years old, and do not have a history of severe COPD or lung cancer, you do not need to force the elderly to quit completely. The stress-induced increase in blood pressure, anxiety and insomnia caused by sudden withdrawal will be more harmful to the body than smoking 3 or 4 cigarettes a day. It is better to slowly reduce it to less than 5 cigarettes a day, and at the same time do annual lung screening, which is safer. Grandpa Wang, who lives next door to me, is 81 years old and has been smoking for 60 years. His children forced him to quit smoking. After quitting for half a month, he would throw things at home every day. His blood pressure soared to 180. Later, he slowly reduced his smoking to 2 cigarettes a day. Now he eats well and sleeps well, and there are no major problems in his lung examination.

Oh, yes, don’t just take care of your body. The impact of mental state on geriatric diseases is really underestimated by many people. Previously, there was a 76-year-old Grandpa Liu in our community. His children were out of town. He lived alone. Every time he had a physical examination, he had no major problems. He just complained about headaches and chest pains every day. He went to several hospitals and couldn't find any problems. Later, our community organized a senior chess team and invited him to participate. We also found him a volunteer job teaching children to play chess. After working for less than three months, he said that all his problems were gone and he could eat an extra bowl of food. There are currently two major directions in the field of preventive medicine, one is the prevention and control of chronic diseases at the physiological level, and the other is emotional intervention at the psychological level. Studies have proven that elderly people who have been lonely and anxious for a long time are more than 30% more likely to develop high blood pressure and Alzheimer's disease than elderly people with a cheerful attitude. This is not alarmist.

After all, there is really no "all-in-one" standard answer to geriatric disease prevention, and there is no need to pursue perfection in everything. If your old man likes to drink a few sips of wine and doesn’t have liver disease or gout, it’s okay to drink one or two liters of white wine every day. ； If he doesn't like to move, there is no need to force him to walk 10,000 steps a day. He can clean the table and water the flowers at home. Moving is better than lying down. Don't ruin the joy of life for the elderly for the sake of so-called "health standards". After all, being able to live comfortably and happily until the age of eighty or ninety is better than anything else.