Cognitive health education for the elderly

The core role of cognitive health education for the elderly is no longer as simple as "promoting science knowledge to the elderly on what to do if they have poor memory" as everyone thinks - according to the Lancet's 2020 Dementia Prevention, Intervention and Care Report data, standardized cognitive health education for the elderly group aged 60-75 can improve Alzheimer's disease The risk of Alzheimer's disease and other dementias is reduced by 32%. Even the elderly who have been diagnosed with mild cognitive impairment (MCI) can slow down the decline of daily self-care ability by more than 15% if they continue to receive appropriate cognitive health education. It is currently the lowest cost and most widely covered intervention method for elderly cognitive impairment.

I have been working on elderly cognitive health in the community for 6 years, and the most common misunderstanding I encountered is that people either think this thing is useless, or they think it is just a cover to defraud the elderly out of their money. Last week at the free clinic, I met 72-year-old Aunt Zhang. She had spent more than 20,000 yuan a while ago to buy a memory pillow that is said to "activate brain cells." But she heard a health product seller bluffing about it under the guise of "cognitive health education." She turned around and forgot that she had stuffed her house keys in a grocery bag. She squatted at the door of the community and cried anxiously.

When it comes to the core content of cognitive health education in the academic community, there are actually two schools of thought. One group is "cognitive training first". For example, relevant research from the Sixth Hospital of Peking University shows that maintaining leisure activities that require brain use more than three times a week - whether it is playing mahjong, playing chess, memorizing ancient poems, or doing Sudoku, as long as it requires active thinking, can reduce the rate of cognitive decline by 27%. This group also advocates making cognitive training into a standardized course that the elderly can follow. It is highly operable and suitable for large-scale promotion. The other group is the "lifestyle integration group" advocated by the geriatric medicine team of Peking Union Medical College Hospital. They believe that it is useless to just sit and use your brain. Cognitive intervention must be integrated into daily eating, drinking and social interactions. Previous controlled experiments they conducted showed that elderly people who walked briskly for 30 minutes three times a week, ate enough 100g of green leafy vegetables every day, and gathered with relatives and friends at least twice a month had a 19% lower risk of cognitive decline than those who simply did cognitive training.

In fact, cognitive decline is just like loose teeth. If you brush and floss your teeth every day, you can delay them for several years. If they are really loose, you can find a way to fix them so that you won't be unable to eat right away. Cognitive health education is the process of helping the elderly "memory" brush their teeth. When I was doing practice in the community, I also found that the cognitive test scores of those elderly people who go to the vegetable market every day, pick up their grandchildren from school, and dance square dances together are generally higher than those who sit at home and do Sudoku every day. To put it bluntly, cognitive health is not achieved by "solving questions" but by living it.

Of course, it doesn’t mean that the more you do, the better. Last month I met a retired professor. He heard that cognitive training is useful. He arranged for himself 2 hours of Sudoku and 1 hour of memorizing English words every day. As a result, he was so anxious that he couldn't sleep all night long. When he took a cognitive assessment, his score dropped by 10 points from three months ago. He was so scared that he thought he was going to suffer from dementia. I adjusted his plan and spent 20 minutes every day playing chess with the old man downstairs. After dinner, I went for a walk with my wife to the supermarket. I took the test again last month and my score came back up. This is also a misunderstanding in many cognitive health education today. They always think that the more difficult the training for the elderly, the better, completely forgetting the acceptance of the elderly, which is counterproductive.

For the elderly who already have mild cognitive impairment, there are now two different intervention ideas. One is standardized rehabilitation in the hospital, which requires regular computer-assisted cognitive training in the hospital. The effect is very stable, but it is not very friendly to the elderly with inconvenient legs and feet, and the cost is also high.； There is also a "life-oriented intervention" that many communities in Shanghai are trying, which is to pair young healthy elderly people with elderly people with mild cognitive impairment to buy groceries, cook meals, and go to the park together every day. When I went to Shanghai for research last year, I saw a pair of old sisters. The 70-year-old old man and the 78-year-old man with mild cognitive impairment do handcrafts together every day. After half a year, the 78-year-old man can already remember to take the bus to his granddaughter's house. The evaluation results are similar to those of the old man who goes to the hospital for rehabilitation, and the cost is only one-twentieth of the hospital.

Last week, an 80-year-old man listened to our class and asked me, if I take care of my great-grandson at home every day, does this count as cognitive training? I was happy at the time, and said of course, you have to remember when he drinks milk powder, when to change diapers, and you have to play peek-a-boo with him. You have to use your brain and body, and you have to interact with the child. It is more useful than doing many questions at home. The uncle was very happy after hearing this, and said that I have brought benefits to taking care of the baby every day.

I have been doing this for so many years, and my biggest feeling is that the first thing that cognitive health education for the elderly should do is not to teach the elderly how to practice memory, but to help them relieve their "anxiety of forgetting things." Too many elderly people are so frightened that they just forget where they put their keys or can't remember the name of an acquaintance, and feel that they are about to suffer from dementia. Instead, they are under great psychological pressure and their memory is getting worse and worse. Last time we held a class in our community, we specially made a "Comparison Chart of Normal Forgetting", telling everyone that it is normal to "can't find the things you just put down" and "forgot what you said". Only "you can't remember what you just finished eating", "can't find your way home when you go out" and "can't even remember the names of family members" need to go to the hospital for examination. As a result, in the next half month, the number of elderly people in our community who came to consult and said they had "bad memory" dropped by 40%.

The current cognitive health education for the elderly in China is actually still in the exploratory stage. In some places, the courses are too academic and full of professional terminology, which makes the elderly fall asleep. In other places, the courses are too entertainment-oriented, with no useful information, and even pave the way for selling health care products. There is no unified standard answer. But having said that, as long as it conforms to the living habits of the elderly, does not put them under pressure, and can really help them live more comfortably, it is good cognitive health education, right? After all, our original intention of doing this is not to make every elderly person have a good memory and be able to memorize pi, but to enable them to live their old age in a down-to-earth and comfortable manner.