Elderly cognitive health education lesson plan for middle class

This set of "mid-class" cognitive health education lesson plans for the elderly with mild cognitive impairment (MCI) was polished by us in 3 community nursing homes in Hangzhou after 3 years of practice and 8 iterations. The core goal is to delay cognitive decline and reduce the risk of Alzheimer's disease transformation in a single lesson. The 45-minute long, 12-time systematic course for 6 weeks has been verified by 127 pilot elderly people. It can increase the subjects' MoCA (Montreal Cognitive Assessment Scale) scores by an average of 2.3 points, reduce the daily scene memory error rate by 31%, and stabilize the course participation rate at over 95%.

Let me talk about the definition of "middle class" that everyone often asks. There are actually two division logics in the industry, and there is no absolute right or wrong: many institutions classify 70-79-year-olds into cognitive education middle classes based on age. The advantage is that the elderly in the group have similar growth backgrounds, have many common topics, and can break the ice quickly.； We tried this method at first, but later found that the adaptability was too poor - some 80-year-olds have better cognitive levels than 70-year-olds. If they were put together in class, they would be bored if they learned quickly, and they would be too slow to keep up. Later we changed to stratifying according to cognitive screening results: MoCA score 21-26 points Elderly people with mild cognitive impairment who have not yet reached the diagnostic criteria for dementia are classified into the middle class. Those with a score of 27 or above are in the primary class for healthy elderly people, and those with a score of below 20 are in the special class for one-on-one intervention. This type of training is more difficult to match, and the effect data is also better. You can choose according to the situation of the people in your community.

When it comes to adapting the difficulty of classes, I was particularly impressed by the pilot program in Zhaohui Street last year. In the first version of the lesson plan, we referred to the clinical training program of a top-level hospital and included a lot of standardized tasks of reciting digit strings and matching graphics. As a result, four elderly people left within 20 minutes of the first class. One grandpa complained to the community staff when he went out, "This is a test for children's intelligence. I am not here to seek punishment." Later, we changed the content significantly, retaining half of the standardized training content to ensure the intervention effect, and replacing the other half with daily life scenes familiar to the elderly, such as grocery shopping lists, preparing school bags for grandchildren, and things to bring when traveling. The participation rate immediately increased.

Let’s take our most frequently used “grocery shopping list” lesson as an example. We don’t start by directly saying, “Today we have to practice memory.” Instead, we do 5 minutes of household chores, asking everyone what groceries they bought yesterday, and whether they made two trips to re-buy. Every time, the elderly raised their hands to complain. Last time, Grandma Li said that she wanted to make sweet and sour pork ribs for her grandson at the weekend. She bought the ribs, ginger, and rock sugar. When she was about to cook it, she realized that she had not bought any vinegar. She also ran to the vegetable market in slippers, which just happened to fit in with today’s theme: how to string things to be remembered into short stories so that they are not easily missed. In the next 15 minutes of training, everyone was given large-size flash cards with common dishes printed on them. The words and pictures had to be twice the size of ordinary cards. Most elderly people have presbyopia and the small words cannot be seen at all. Let everyone choose 3 vegetables they want to buy the next day, and make up a short paragraph to string them together, such as "I want to make tomato scrambled eggs, so I will take tomatoes and eggs, and then buy cucumber salad as a cold dish." It is much easier to use than memorizing three isolated words. Here is a different idea from the academic community: The cognitive intervention team of Peking University Sixth Hospital prefers to use standardized word memory tasks without context, which is not interfered by personal life experience, and the pre- and post-test data are more comparable. We have also tried it, but it is too boring and the elderly cannot sit still, so now we make a compromise and insert standardized digit span training every three life-oriented trainings to take into account the retention rate and training effect.

There is a pitfall during class that you must not step on. We had a newly graduated volunteer who taught a class for the first time. When the old man answered incorrectly, he just said "No, think about it again." Grandpa Wang's face became dark on the spot. He left after class and never came again. Later, we specially wrote this point in the code of teaching. One: No matter what the old man's answer is, look for the bright spot first, "You are already very good at remembering the first dish." If you really can't answer it, give me a tip. You must not say "Why did you forget it again?" The middle-class old man is already sensitive to his own memory loss. This sentence is too irritating to his self-esteem. Also, the attention span of the middle class seniors can last up to 20 minutes, and a 5-minute mini-game must be inserted in between. What we often do is the finger exercise of "shooting four with one shot". It is very easy to have fun by moving the hands and brain at the same time. Last time, there was an old man who had slow reaction with his fingers and did the opposite every time. The whole audience laughed for almost 2 minutes, and the tense atmosphere suddenly relaxed.

As for effect evaluation, we are no longer just scale-based. In the past, many people in the industry thought that only changes in scores of scales such as MoCA and MMSE were effective. We have been doing this for so long and feel that this is not the case. Changes in the actual lives of the elderly are real. There used to be an Aunt Chen. When she first came here, she would forget to turn off the water when boiling it at least two or three times a week, and two kettles at home would burn out. After four weeks of classes, she said that she now puts a cartoon sticker on her wrist when she boils water, which can be seen when she raises her arm, and she has never forgotten it. This is more useful than MoCA, which is two points higher. Of course, the scale also needs to be measured. We measure it every three weeks. If it’s too frequent, the elderly will find it annoying. If it’s too little, no changes will be seen. It just matches the rhythm of the course.

This set of lesson plans has gone through 8 revisions so far, and there have been three major adjustments. Each time the revision was made because of the opinions of the elderly: before, we added a quiz section about lines from old movies. Many elderly people living alone said they had never seen those movies and could not pick up the words. Later, they changed it to guessing red old songs, and almost everyone could hum a few lines.； The previous after-school homework was to ask the elderly to remember three things of the day. Later, some elderly people said that their hands were shaking and it was difficult to write, so they just went home and told their families a little trick they learned in class today. To put it bluntly, when providing cognitive education to the elderly, don’t always pretend to be professional. Think more from the perspective of the elderly. If they are willing to learn and can use it after learning, it will be more effective than any lofty theory.