Annual health check-up for the elderly

The annual health check-up for the elderly is not an "increased package" for ordinary physical examinations, but a special health management action customized for the physiological degeneration characteristics of the elderly. If done at least once a year for people over 65 years old, it can provide early warning of more than 80% of the risks of chronic and degenerative diseases in the elderly. It is currently recognized as the most cost-effective pre-intervention method in the field of elderly health.

I have been working in the community elderly health service for almost 4 years. I have seen too many people who confuse the annual elderly examination with the physical examination of ordinary employees. I have also met many elderly people who think that "it is normal to have some problems as you get older, and it is useless to check them." Last year, Aunt Zhang in the community was a typical example. She had just had a physical examination for retired employees organized by her unit at the beginning of the year, and her blood routine, chest X-ray, and abdominal color ultrasound were all normal. She told everyone she met that she had a strong body. Later, the community came to notify her of a free annual examination for the elderly, and she was dragged over by her daughter. During the gait assessment, I found that her stride length was extremely small and her arms hardly moved when she walked. I quickly arranged for a follow-up neurology examination, and it was found that she was early-stage Parkinson's disease. Because she was discovered early, she has been under control with medication for almost a year, and her daily shopping for groceries and square dancing are not affected at all. If we wait until the symptoms of hand trembling and stiffness appear before checking, the intervention effect will be at least half.

There is indeed a lot of controversy about the annual check-up for the elderly. One group thinks it is entirely an IQ tax. All the normal physical check-ups have been checked, so there is no need to do one more.； The other group believes that the more expensive and comprehensive the project, the better, and they would like to arrange PET-CT and whole-body gene sequencing. In fact, both ideas are a bit extreme. The former does not understand the core difference between the two: the screening logic of general physical examination is to "find diseases" and focuses on universal problems such as tumors and abnormal heart, liver and kidney function. It does not cover the elderly-specific content such as fall risk assessment, preliminary cognitive function screening, sarcopenia screening, and nutritional risk assessment. It is precisely these seemingly "non-fatal" problems that are the culprits that cause the elderly to become disabled, mentally ill, and have a sudden decline in their quality of life. The problem with the latter is that the special characteristics of the elderly's constitution are ignored. Many items with large amounts of radiation and low screening efficiency do not need to be done every year. Instead, they may bring additional burdens to the body. There was an old man who was filial to his children and bought a high-end physical examination package worth more than 20,000 yuan. The tumor markers were checked for more than a dozen items and all were normal. Later, when he came to the community to prescribe antihypertensive drugs, I gave him a free one. Fei's stand-up and walk test took him a full 19 seconds, which was much higher than the 12-second qualifying line for people over 70 years old. He was at a very high risk of falling. Later, he adjusted the dosage of antihypertensive drugs and helped his family apply for free installation of bathroom handrails, avoiding a high probability of fracture. Do you think a package worth 20,000 yuan is not as practical as a test with a stopwatch?

Regarding the frequency of annual examinations, there is no completely unified view in the academic community. The American Geriatrics Society's guidelines mention that elderly people over 75 years old, with less than 3 underlying diseases, and completely normal daily activities can be relaxed to once every 18 months.； However, the recommendations of our National Geriatrics Branch are more in line with the domestic situation: people over 65 years old should do it at least once a year regardless of whether they have underlying diseases. After all, the prevalence of hypertension and diabetes among the elderly in my country is close to 60%, and the risk of fluctuations in chronic disease control is much higher than that of European and American people. Encrypted screening can adjust intervention plans in a timely manner.

In fact, many people don’t know that community health service centers in most parts of the country now provide free annual health check-ups for senior citizens over 65 years old, so they don’t have to spend their own money to get high-end packages from private institutions. When I usually do annual check-ups for the elderly, I always make a habit of asking a few questions about household matters, such as asking, "Have you forgotten to turn off the gas while cooking recently?" ”“If I go downstairs to buy rice, can I carry it up myself? ”, there are many old people who want to save face, but their memory is getting worse and worse, their legs are weak and they dare not walk, and they refuse to tell their children for fear of causing trouble. Only by asking questions according to family rules can you find the problem early.

To put it bluntly, the annual health check-up for the elderly has never been about detecting serious diseases. To put it bluntly, it is to conduct an "annual road condition check" for the elderly's bodies. Loose roads must be repaired and potholes must be filled in advance. It is much more cost-effective than waiting for the car to overturn and then calling for rescue. Do you think this is true?