Comprehensive knowledge of daily care for the elderly

There is no standardized universal process for the daily care of the elderly. The core principle is always to "respect the physical needs of the elderly first, and then take into account the three dimensions of physical health, risk prevention and control, and psychological comfort. Flexible adjustment according to the individual's age, basic diseases, and living habits is far more useful than the rigid "unified standards" on the benchmarking website."

When it comes to safety, falling is definitely the number one risk. Our industry has previously discussed the issue of scale in home renovations. One school of thought believes that all aspects of protection should be provided: bathrooms should be equipped with handrails, the whole house should be threshold-free, all sharp corners should be covered with soft covers, and the floor should be covered with non-slip mats to eliminate the possibility of falls from the source. ； The other group is opposed to excessive modification, saying that the large-scale modification to look like a ward will give the elderly a psychological hint of "I am no longer useful". Instead, they will not dare to go out for activities, and the muscles will degenerate faster, and the risk of subsequent falls will only be higher. Among the cases I have dealt with in the 6 years of community nursing, one-third of the falls were not caused by slippery floors. They were caused by the old man standing up too hard and suffering from postural hypotension and fainting. So there is no need to dismantle and reinstall the home as soon as he gets up. First, install the bathroom handrails. A reminder of "sit for 30 seconds before standing, and stand for 30 seconds before walking" is more useful than buying ten anti-slip mats. Oh, by the way, there is also the controversy over non-slip shoes. One group says to buy shoes with deep textures and strong friction, while the other group says that if you have patchwork carpets or floor mats at home, the soles are too astringent and can easily catch on the edges and trip. My suggestion is to buy shoes with moderate textures. Just wear lightweight cloth-soled shoes at home. There is no need to pursue professional anti-slip shoes.

After talking about safety, let’s talk about the issue of eating that everyone has to worry about every day. Last year I met a 78-year-old Uncle Li, who had high blood pressure. His filial children insisted on feeding him completely salt-free meals. After half a month of eating, the old man felt so weak that he couldn't stand still. He was sent to the hospital for a check-up and it was found to be hyponatremia. There are two schools of thought here: Cardiology departments generally recommend that adults consume no more than 6 grams of salt per day, and strictly control salt to prevent heart failure and increase blood pressure. ； However, most geriatric doctors will relax their requirements. For elderly people over 80 years old and without serious underlying diseases, the salt intake can be set to 8 grams or more. After all, eating well and being willing to eat are much more important than the number of grams of salt. The risk of malnutrition is much greater than the harm of slightly higher blood pressure. There are also sugar control standards for people with diabetes. Elderly people over 75 years old really don’t need to limit their fasting blood sugar to the standard of 4-6mmol/L. It’s fine if it’s a little higher. But once you faint from low blood sugar, the consequences will be much more serious.

Another point that is easily overlooked is skin care, especially for the elderly who are bedridden for a long time or have difficulty moving due to their age. There used to be a 90-year-old grandma Zhang. Her children were afraid that she would be dirty, so they gave her a hot bath every day. As a result, the elderly woman's skin was so itchy that she couldn't sleep all night long, and even applying ointment didn't work. Later, we suggested changing to taking a bath once a week, and usually only using a warm towel to wipe the areas with many wrinkles such as the armpits and groin, and applying mild body lotion after washing. The itching problem was solved in less than half a month. The sebum layer of the elderly is thin, so washing too frequently will damage the skin barrier. Cleaner is not always better. Usually when wiping the body of an elderly person, I would squeeze the arms and legs. This can not only check for any unexplained bruises, but also allow me to move my muscles and bones, which will also make the elderly feel comfortable.

Oh, by the way, don't take care of your body. Many people fail in the psychological care. There used to be a retired teacher Wang in our community. His children hired a live-in aunt for her out of town. She did all the housework and stuffed her with nutritional supplements. As a result, the old man sat by the window in a daze every day and was not even willing to eat more. Later, we spent half an hour with her every week to look through past student homework and old photos, and listened to her tell interesting stories about catching students cheating in class. Within a month, she took the initiative to go downstairs to play mahjong with other elderly people. The issue of whether to take the elderly to live with them is also controversial. Some people say that living together makes it easier to take care of them, which is filial piety. ； Some people also say that after the old man left the old community where he had lived for decades, he had no old friends to chat with, and he didn’t even know the vegetable stall owner downstairs, so he became sick from boredom. I have seen people who live with their children crying every day and want to go back to their old house, and I have also seen people who live with their children and take care of their grandchildren every day and are extremely happy. The key point is this: listen to the old man himself and don’t make decisions for him.

Finally, let me mention the medication details that are most likely to cause big problems. Two years ago, there was a 68-year-old Uncle Chen who had high blood pressure. He felt that he did not need to take medicine if he was not dizzy. He secretly stopped taking medicine for half a year. As a result, he had a cerebral infarction and half of his body was paralyzed. Now he regrets it very much. There are also different opinions on the method of dividing medicine: Some people suggest using a medicine dividing box with a date, dividing the medicine every week, and just take one box when taking it, which is suitable for the elderly with poor memory. ； There are also many clinical pharmacists who object to the use of separate medicine boxes, saying that mixing different medicines is easy to cause odor and ineffectiveness, and may also cause confusion in dosage. My general advice to family members is that if the elderly person's memory is still good, let him take it from the medicine box. If he often forgets to take medicine or takes too much, use a medicine-dividing box. Just check the shelf life when dividing medicine every week. There is no need to stick to a certain method.

In fact, there is no "encyclopedia". After so many years of exposure, I think the most useful nursing knowledge is to squat down and ask the elderly what they think. If he wants to eat something sweet, give him one less bite. If he doesn't want to go for a walk, don't force him to go. Listening to him talk about useless old things is more effective than any standardized nursing process, don't you think?