Elderly cognitive health education lesson plan design

With the core design principle of "low threshold, strong interaction, and contextualization", it mainly covers two groups: healthy elderly people in the community and elderly people at high risk for mild cognitive impairment (MCI). The core content includes three modules: early screening of cognitive risks, home cognitive training, and home care and pitfall avoidance. No professional medical equipment is required. Community and residential care. All scenarios can be implemented, and the actual goal of "early detection of risks, persistence in training, and no pitfalls in care" has been achieved. After pilot verification in 12 communities in 3 streets in Hangzhou, the early detection rate of cognitive impairment in the target group increased by 62% within 6 months, and the episodic memory ability of the elderly with mild cognitive impairment increased by 18% on average.

In fact, there have always been two completely different ideas in the academic community and at the grassroots level regarding the design of cognitive health education for the elderly: one is the standardized school led by universities and clinical research institutions, which requires that all content must strictly conform to the cognitive psychology intervention framework, and the MMSE and MoCA standardized scales are used for screening. The training content must be promoted in gradients according to attention, memory, and executive function. There are even clear operating specifications for the length of teaching and the frequency of questions.； The other school is the practical school of community social workers and elderly care institutions. They think that the elderly will not accept that at all. When you come up with a scale and seriously ask "What year is it?" and "Where are you now?"

There is actually nothing wrong with these two ideas. When we make lesson plans, we combine the two together, which not only maintains the professional bottom line, but also is grounded.

The biggest pitfall I encountered before was that we copied the standardized process at the beginning and took the scale at the beginning. 8 out of 10 elderly people waved their hands and said "I'm not sick, no need to take the test" halfway through. Later we changed it and hid all the screening content in the game. In the first 15 minutes, we played "Fruit Flip Fun", which involves placing cards with apples, bananas, and oranges printed on them on the table, and asking the elderly to flip through two pairs to find the same ones. The social worker will observe and record them. If even three pairs of the same ones cannot be found, they will check with the family members privately. Regarding usual abnormal behaviors, such as whether you often forget to turn off the gas or cannot find your home when you go out, this will complete the screening and will not make the elderly feel resistant. Not to mention, after this change, the screening completion rate directly increased from 32% to 94%.

By the way, we open the door half an hour early for each class so that the elderly can chat for a while. In fact, social interaction itself is the best cognitive training. We discovered this by accident and did not write it in the lesson plan before. Later, we found that the cognitive status of the elderly who came to chat in advance was generally better than those who stayed at home, so we fixed this link.

Regarding the content of cognitive training, some experts have previously suggested that we use a special cognitive training APP to allow the elderly to answer questions for 15 minutes every day. We have also tried it, but most of the elderly cannot use tablets, and some elderly people think that it is "something for children to play with" and are not willing to touch it at all. Later, we The training content is all integrated into daily life, and a "three-piece cognitive training set" is summarized: spend 5 minutes every day to calculate the daily grocery shopping account, spend 3 minutes to write 3 sentences about the happy things that happened that day, and read the subtitles along with the TV news for 10 minutes. You don't have to take time to do it. You can do it while cooking and walking. Aunt Zhang from Zhaohui Community was diagnosed with mild cognitive impairment last year. At first she couldn't even calculate how much it cost to buy three cabbages, so she insisted on doing these three things. After two months, she went for a reexamination and her memory score improved by 11 points. Now she actively serves as our volunteer promoter, telling everyone that this method works.

Of course, if you are an elderly person with strong receptive ability and can use electronic products, it will be better to use a professional training APP. We will also arrange one-on-one teaching by social workers, and we will not generalize and require everyone to use the same method.

Nearly half of the content in the lesson plan is for family members, which is the care and avoidance module. Many family members either think that the elderly forgetting things is "normal", which delays the golden period of intervention, or they become extremely nervous as soon as cognitive impairment is detected and do not let the elderly do anything, including eating and dressing, which in turn makes the elderly's cognitive abilities deteriorate faster. There used to be an Uncle Wang in our community. When he was first diagnosed with mild cognitive impairment, he could still go downstairs to buy cigarettes and play chess with his old friend. His son was afraid that he would get lost, so he locked him in his house every day. Within half a year, he couldn't recognize his family members. Later, we repeatedly communicated with his son and asked Uncle Wang to die. He was given a name tag with contact information and home address printed on it, and he was allowed to walk downstairs by himself for 20 minutes every day. He was also asked to help with small things such as cleaning the table and choosing vegetables at home. After three months, Uncle Wang was able to play chess with his old friend again. Although he still forgets things sometimes, his condition is obviously much better.

Oh, yes, when teaching, don’t make PPTs with extremely small fonts. The old people can’t see them at all. Just use big white paper to write big bold characters and highlight the key points with a red pen. Every time you ask a question, try to find an old man who usually doesn’t like to talk. If you answer the question correctly, give a bar of soap and ten eggs. The old people are happy to participate. Last time, in order to win a prize, Uncle Li practiced the card flipping game with his wife at home three days in advance. It was very interesting.

In fact, after doing cognitive education for the elderly for so long, my deepest feeling is that there is no perfect standardized lesson plan. The best one is suitable for the local elderly. No matter how well you make the lesson plan conforms to academic standards and how rigorous the logic is, it will all be in vain if the elderly cannot listen to it or use it. To put it bluntly, to do this, you must first think about the problem from the perspective of the elderly. Don’t treat them as the objects of education, but treat them as old friends who play together, and the effect will come naturally.