Daily care tips for the elderly

The core of daily care for the elderly has never been to copy the standardized operation manual, but to grasp the three cores of "prioritizing individual needs adaptation, pre-risk prevention and control, and simultaneous supply of emotional value" in order to maximize the quality of life of the elderly while reducing the care pressure.

A while ago, I accompanied Aunt Zhang, who has been a home care worker for 12 years, to do a home evaluation for Uncle Li, who had just had a hip replacement. As soon as I entered the door, I saw that his living room and bathroom were equipped with handrails according to the standard guidelines on the Internet, and the anti-slip mats were so thick that even the door could not be opened. Even so, Uncle Li still fell down when he got up last night. It took me a long time to figure out that all the armrests are installed according to the generally applicable right-hand position. However, Uncle Li has been left-handed all his life. He used to stretch out his left hand to support the bed when he got up at night. If he couldn't reach the armrest, he subconsciously leaned forward, but he was in trouble.

There are two schools of thought in the field of elderly care that have been arguing for several years: one is the "standardization school", which believes that all operations and devices must be based on common physiological parameters for the elderly, making it less likely to make mistakes.； The other school is the "individualization school", which advocates spending three days observing the elderly's daily habits before providing care, and then adjusting the plan. Aunt Zhang and her group, who have been working as caregivers for more than ten years, are basically on the latter side - you talk about controlling sugar for the elderly with diabetes, and the guideline says to strictly abstain from refined sugar. However, some elderly people have eaten sweet-scented osmanthus cakes all their lives. If you don't let them touch it, they will secretly eat it under the pillow. If they eat a big piece at a time, their blood sugar will spike even higher. It is better to give them half a piece every day and watch them finish eating, which will keep their blood sugar stable. Don’t think this is unprofessional. Last year, Shanghai’s community elderly care pilot released data. According to the care plan adjusted according to individual habits, the elderly’s compliance was 62% higher than that according to the standardized process.

Many people don’t realize that, rather than panicking to fix things when something goes wrong, nipping the risk at its inception can save at least 80% of the energy. Take pressure ulcers, which everyone is most afraid of, as an example. Previous clinical guidelines stipulated that bedridden elderly people should be turned every two hours, but caregivers who actually followed this instruction suffered a lot - the elderly people were already light sleepers, and would forcefully turn over in the middle of the night. They could not sleep all night long, and their immunity dropped quickly, which made them more likely to cause other problems. In the past two years, more and more geriatricians have also adjusted their recommendations: If the elderly use a qualified pressure-reducing mattress and their skin is in good condition, the interval between turning over at night can be relaxed to 3 to 4 hours. It is more cost-effective to prioritize sleep. There are also oral care that many people ignore. Don’t think that just gargling with mouthwash is enough. For the elderly who wear removable dentures, it is best to take them out and rinse them after each meal. Don’t be too troublesome - I once met an old man who had repeated stomach upsets. After half a month of gastrointestinal endoscopy, no problem was found. Finally, it was discovered that the residue stuck in the gaps between the dentures was moldy, and he swallowed it with the food every time he ate.

To be honest, I have seen too many caregivers collapse because of exhaustion, not because of the work, but because the elderly people did not cooperate. There used to be an 82-year-old Grandma Wang. The first carer hired by her children was very quick at work. She didn't let the old man touch anything, just for fear of being held responsible if she fell or bumped her. As a result, Grandma Wang lost her temper every day, didn't take any medicine or drink, and the carer left in tears after working for half a month. Later, the nurse who was replaced was not so "diligent" and spent half an hour every day with Grandma Wang to take apart the old sweater, even if it was done and then knit it back again. On the contrary, Grandma Wang was very good, taking the medicine when she was told, and taking her blood pressure when she was asked.

This matter actually corresponds to a controversial point in the current psychological care of the elderly: should the priority be given to ensuring the personal safety of the elderly, or should the priority be given to ensuring his sense of autonomy? I've seen many family members always say "I'm doing this for your own good" and ban all the elderly's hobbies. They think this is responsible. But think about it, if you were made to sit at home every day and not be allowed to do anything, you would feel panicked, right? It really doesn’t have to be black and white. For example, if an old man wants to cook, don’t just lock the kitchen, replace it with a gas valve that automatically shuts off the gas, and replace the kitchen knife with a rounded one. You can stand by and watch. This will satisfy his wish and there won’t be any big problems. After all, the object of care is a person, not an object that needs to be rectified to meet standards. Don't always regard him as a "patient who needs to be cared for". Treat him more as a family member living together, and many conflicts will naturally disappear.

The good caregivers I have come across never memorize the guidelines by heart, but instead memorize a bunch of "useless" little things: Aunt Zhang had to drink orange juice before she could swallow the medicine, Uncle Li's foot soaking water was two degrees hotter than others, and Grandma Wang had to lift her socks above her ankles to feel comfortable. There are no nursing techniques that are universally applicable. It’s just a matter of spending more time and understanding the temper and habits of the old man in front of you.