Economic Observer Reporter Jiang Xin
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"Who do you think this is?"
The old man ate the food delivered to his mouth, squinted at the screen of his mobile phone, looking confused, "I don't know".
"Who am I?"
The wrinkles on the old man's face slowly unraveled a little, "You run a store."
"I still remember me, I just can't tell my name anymore. My daughter is on my phone, your granddaughter."
Zhang Jin's heart tightened through the screen of the phone, and tears almost flowed out, but he was squeezed back again.
The other end of the phone is her mother, who no longer knows her old man, and is a grandmother over 70 years old.
htmlOn September 21, World Alzheimer's Day, Zhang Jin, who works far away in Beijing, bought supplements online in advance and entrusted his mother to take her to visit his grandmother.Mom didn't know the existence of Alzheimer's disease day, and didn't want to "live" this day, but she still bought a lot of food for her grandma at the request of Zhang Jin.
Mom was glad to find that after a few days, her mother knew her again. Although she did not say her name, she still remembered what she did when she was young.
Two months ago, Zhang Jin went back to his hometown to visit his grandma. At that time, grandma also didn't know herself or mother.
Change clothes, cut nails, wash hair, and cut hair. Zhang Jin and his mother did a series of cleaning work for grandma. Grandma is very well-behaved, and her expression is invisible deep in the wrinkles, and she feels like a child who needs care. During the hours, grandma only said one thing, when feeding the melon she liked into her mouth, she said, "This melon is good."
Alzheimer's disease is called the most dignified terminal illness. Although it cannot be cured, grandma's occasional "cognitive awakening" still gives Zhang Jin and her mother a little more comfort.
Around the Mid-Autumn Festival, the film "Mom" was released. The film tells the story of an elderly 85-year-old mother taking care of her 65-year-old daughter suffering from Alzheimer's disease alone. Because her daughter suddenly suffered from Alzheimer's disease, the mother-daughter relationship returned to her "original appearance" - the daughter seemed to be a child, unable to travel, live alone, and even lost control of her emotions. The 80-year-old mother once again "became a mother" to take care of her daughter whose memory is gradually declining. When she saw her daughter, who was nearly 60 years old in the middle of the film, repeating repeatedly "You are a good person, you are really like my mother" in the face of her mother's care, Zhang Jin burst into tears. She remembered her grandmother, and was also afraid that one day her mother would not know her.
2022 "World Alzheimer's Disease HTML August" theme is "Know your enemy, beware of yourself, be early and early wisdom - work together to the future". Zhang Jin, who paid attention to the above information and already knows about it, bought a bunch of educational handmade materials and books and sent it to his mother, and joked to his mother, "Aren't you always afraid of yourself, Alzheimer's Disease ? Come, prevent it."
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Alzheimer's Disease , also known as "dementia", has been clinically called "dementia". However, in the field of care, in order to show friendship with this group and reduce their sense of stigma, people are more inclined to call it cognitive disease.
According to the definition of World Health Organization , cognitive disorders are a chronic or progressive syndrome caused by a variety of diseases that affect the brain. It is usually the cognitive function (i.e. the ability to process thoughts) that experiences a more severe decline than the normal aging process. It affects memory, thinking, orientation, understanding, calculation, learning, language and judgment skills. Cognitive impairment is often accompanied by emotional control, social behavior, and motivational decline.
According to statistics from the World Health Organization (WHO), one person in the world is diagnosed with cognitive disorder every 3 seconds. According to the "Current Situation and Development Report on Cognitive Elderly Care Services" released by the of the Chinese Association for Aging in in 2021, there are about 15.07 million cognitive impairment among the elderly aged 60 and above in my country, and it is expected to reach 22.2 million in 2030, with the incidence rate far higher than the global average, and cognitive care has also become the focus and difficulty in the field of elderly care.
In terms of prevalence, the prevalence of cognitive symptoms among people over 60 years old is 6.04%.After the age of 55, the risk of cognitive disease doubles for every 5 years. Of course, the risk of disease is different for different genders. Overall, the prevalence of cognitive disease in women is 1.65 times that of men.
There are also some risk factors that may increase the risk of cognitive disease, such as genetic factors, low education level, hearing loss, hypertension, , obesity, smoking, lack of exercise, lack of social interaction, diabetes , depression, etc.
Cognitive symptoms can be divided into hundreds of types according to the cause of the disease. Among them, Alzheimer's disease-type cognition is the most common form, and may account for 60-70% of all cases of cognition. Therefore, people often misequate cognition and Alzheimer's disease, but in fact there are other types of cognition, such as the other three common types, vascular cognition (caused by damage to the blood vessels in the brain), Lewy body cognition (caused by abnormal protein aggregation in nerve cells) and frontotemporal lobe cognition (caused by damage to the frontotemporal lobe of the brain). The boundaries between different types of cognition are not clear, and mixed types of cognition often exist at the same time.
Different types of cognitive symptoms also have some differences in symptoms, but as the disease progresses, a comprehensive decline in cognitive function and life ability will occur.
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Because she is in a small fourth- and fifth-tier cities, Zhang Jin’s hometown does not have rich medical resources in this regard. Although she has consulted the information many times, her relatives in her hometown are not very active in treating treatment suggestions.
Worried about grandma's condition, Zhang Jin once consulted a medical classmate. She was told that the course of cognitive disease varies from person to person and usually lasts from 8 to 12 years. Since the development of cognitive disorders is gradual, people with cognitive disorders will gradually go through early, mid- and late stages, and each stage will have different performance and care priorities.
This is clearly reflected in grandma.
According to Zhang Jin's mother's recollection, as early as a few years ago, grandma had some cognitive impairment , becoming forgetful, especially what just happened; gradually communication became difficult, and while being irritated, she could not express her meaning in appropriate sentences; she would also get lost in familiar places, be confused about time and date, and housework was becoming more and more difficult for grandma. But at this time, the family did not take grandma to treat. Zhang Jin learned that if he received medication in the early stage, his condition may slow down.
At present, grandma not only can’t remember what happened, but daily behaviors such as dressing and bathing have also become difficult. Zhang Jin’s mother would buy a large bag of underwear for grandma every time. If her uncle and aunt are not at home, grandma will often have incontinence.
Zhang Jin didn't know whether her grandmother could still sense the time and place, or understand what was happening around her, but it can be clear that sometimes she no longer knew her children. What Zhang Jin and his younger generation can do is buy some food and objects for grandma that she likes to eat, and help grandma do some personal hygiene cleaning when she has time. Although it is like a piece of white paper wrinkled by time, Zhang Jin hopes grandma can spend this special time happily.
In some medical journals and papers, Zhang Jin understands that emotional remission and interactive communication are also important in the face of patients with cognitive symptoms, but neither Zhang Jin nor his relatives know how to proceed scientifically.
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1 movie "Mom", the protagonist's mother finally moved into the elderly care community with her daughter. Many scenes in the
movie are filmed in Taikang Home Elderly Care Community . It is understood that in response to the world problem of caring for patients with severe cognitive disorders who cannot take care of themselves, Taikang Home has set up a memory care area in the community and has introduced a new "Heshi Nursing" service model for patients with severe cognitive disorders.
Namaste Care is a service model founded by Ms. Joyce Simard, an internationally renowned Alzheimer's disease expert. It provides services for people with advanced cognitive symptoms to reduce or relieve patients or elders' emotions such as hopelessness, helplessness and loneliness, and heal the soul through the touch of love and meaningful activities.In addition, the community also has a "people-centered" care concept, creating a friendly environment, entertainment healing, special catering, employee support and family support for five major sections, as well as three special non-drug therapies for multisensory stimulation therapy, music therapy, and nostalgic therapy, which has given the elderly the feeling of staying in.
Gong Zengliang, the head of cognitive care at the Health Care Department of Taikang Home Medical Care Center, said in an interview with reporters, "Each stage of care should be different for people with cognitive symptoms. For the early stage, the focus of care is to retain ability and solve emotional problems; for the middle stage, it is mainly to solve the problem of mental behavioral symptoms; for the late stage, it is how to enter their world and let their souls interact with the outside world. For the early and middle stages, we have many ways; but for the late stages, how to serve their souls is a blank.
"Mom's condition is getting worse and worse. She has closed herself in her own world. We are completely unable to communicate and can no longer find the feeling of intimacy that we used to be..."
"My mother's condition is getting worse and worse. She has closed herself in her own world. We two can't communicate at all, and we can no longer find the feeling of intimacy that we used to be..."
In the memory care area of Taikang Home Shuyuan, there is an elder called "Grandma You". Grandma You is 83 years old this year and has been troubled by cognitive symptoms for 10 years. According to Ms. Chen, the daughter of Grandma You, before moving to Taikang Home, Grandma You could no longer communicate with others normally, completely forgot about their relatives, and could not remember their appearance and names; she could not walk independently; most of the time she closed her eyes, clasped her hands into fists, and immersed in her imaginary world...
After contacting Taikang Home Memory Care Service, Grandma You came to the nursing room every day to receive holster care. Through head cleaning, combing massage, hand cleaning, essential oil touching, nail care, tasting delicious meals and drinks, touching simulated dolls, feeling comfortable rocking chairs, listening to soothing music and other healing methods, The mother-in-law's body gradually relaxed. After receiving several round-trip care, Ms. Chen was surprised to find that Grandma You's hands were clenched from tight to stretch, her eyes were slightly closed to open, and she also gave different feedback on the environment she was in. She said, "This way of care allowed us not only to have physical contact but also to communicate emotionally, which made mothers start to let go of their guards, start to feel the outside world, and be willing to vent their feelings."
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But not all cognitive patients are as lucky as the protagonist and Grandma You in "Mom".
Like Grandma Zhang Jin, in China, 90% of cognitive patients are actually cared for by relatives at home. The dilemma of "one person is disabled, the whole family is imbalanced" is emerging in countless families.
htm The symptoms of l1 cognitive symptoms can be roughly divided into two categories. One is the core symptoms. The cognitive ability decline caused by pathological changes in the central nervous system , such as memory disorders, dysdirectional disorders, dyscalculus, aphasia , etc. The second is peripheral symptoms, which are caused by the superposition of core symptoms and social environmental factors, mainly refer to various types of mental behavior abnormalities, such as hallucinations, delusions, depression, wandering, collection, agitation, and violence.Therefore, the treatment of cognitive symptoms includes drug treatment and non-drug treatment.
drug treatment is mainly carried out in the memory clinics, neurology, etc. of professional medical institutions. Related drugs mainly intervene in pathogenic mechanisms such as Alzheimer's disease and Lewy body lesions, trying to completely solve its core symptoms. The treatment of
non-pharmacological therapy is effective in relieving both core symptoms of cognitive symptoms and peripheral symptoms, especially peripheral symptoms.
For example, through non-pharmacological therapy treatment and activities, good communication and environmental support, psychological and emotional companionship and support for cognitive people, enhance their sense of security, self-esteem and self-confidence, and reduce mental behavioral symptoms.
But in the family, it is difficult for caregivers to provide professional care in the face of family trivial matters. Therefore, outside the high-end elderly care community, it is crucial to allow more people to enjoy care guidance or services.
, the "Notice of the State Council on Issuing the National Aging Development and Elderly Care Service System Plan" released at the beginning of this year, mentioned many measures to pay attention to disabled and dementia elderly people.
For example, the notification requires improving the service level of public nursing homes. Increase efforts to transform existing public nursing homes, improve the care capacity of disabled elderly people, add special care areas for dementia elderly people, and give priority to the accommodation of disabled elderly people on the basis of meeting the accommodation needs of policy-protected recipients.
, for example, promotes the extension of medical services to the home community. Support qualified medical and health institutions to provide home medical services such as home beds and home visits to elderly people with disabilities, chronic diseases, elderly people with disabilities, etc. who are unable to move or have real difficulties. Public medical institutions provide door-to-door medical services to the elderly, and charge "medical service price + door-to-door service fee".
At the same time, the notice proposes to support areas with conditions to implement home-friendly transformation of elderly, disabled, and disabled elderly families among the scattered support for extremely poor people, and equip auxiliary devices and anti-lost devices and other facilities and equipment. Explore the establishment of a nursing leave system for parents of only children. Explore the "respite services" for family caregivers of disabled elderly people. Places with conditions are encouraged to implement barrier-free and age-friendly transformation for families of disabled, disabled, and older people in financial difficulties.
In addition, the notice also encourages the establishment of a long-term care insurance system, focusing on solving the basic nursing security needs of severely disabled people. However, in the current pilot projects, few projects include dementia.
With the acceleration of population aging and the decline in birth rate, the care problems and supply and demand contradictions of cognitive disorders will become more and more obvious. Fortunately, from the national level or the social level, this problem is being paid more and more attention and solved.
Shortly after Zhang Jin visited his grandmother and left, because his aunt and uncle were not at home when they were out to farm, his grandmother accidentally fell and injured while thinking about going out for ventilation. Zhang Jin's cousin saw this on the camera and told her family to be sent to the hospital quickly. Fortunately, it was not bad.
Despite this, Zhang Jin hopes that such a story will not be played out in other cognitive elderly people.
(at the request of the interviewee, Zhang Jin is a pseudonym)
Tips
1. What early signals are there that I may have cognitive symptoms?
Common symptoms of cognitive disease are deteriorating in memory, computing ability, learning ability, understanding ability, judgment ability, language ability, behavior ability, etc. The top ten early warnings released by the Alzheimer Association in the United States can help us identify the occurrence of cognitive disorders.
1) Memory loss affects daily life. Forget what just happened is one of the most common symptoms of Alzheimer's disease, especially in the early stages. Other symptoms are also manifested as forgetting important dates or events; repeatedly asking for the same information, etc.
2) There is difficulty in planning things or solving problems. For example, it is difficult to cook according to a familiar recipe, or to have difficulties handling monthly bills. It's hard to concentrate and spend longer than before doing familiar things.
3) It is difficult to complete familiar work at home, at work and during leisure time. Sometimes it can be difficult to drive to familiar places, manage work plans, or remember the rules of your favorite games.
4) Confused about time and place. Time, date, and season may be confused. Sometimes you may forget where you are or how you got to this place.
5) It is difficult to understand the relationship between visual images and spatial. Difficulties are found in reading, judging distances, and distinguishing colors. You may even be unable to recognize yourself in the mirror.
6) There are new difficulties in speaking and writing words. You may not know how to continue the conversation or repeat what you say. You cannot find the right word or name the wrong thing (for example: call the watch "the clock in the hand").
7) The object is placed in the wrong place and loses the ability to retrieve it. Sometimes it may be accused of stealing. This phenomenon may occur more frequently as time progresses.
8) The judgment is weakened or worsened, for example: it may be difficult when paying. It may also have problems with personal image and neatness, becoming unkempt.
9) Exit work and social activities and begin to give up your interests and hobbies.
10) Changes in emotions and personality will become very confused, suspicious, depressed, fearful, or anxious.Feel uneasy at work, with friends, or in unfamiliar environments outside of your “comfort zone.”
2. Can cognitive symptoms be prevented? How can I prevent cognitive disorders?
According to a review article published by Professor Yu Jintai and others in the 2020 in the sub-blog of the New England magazine, the incidence of cognitive diseases can be reduced by up to 35% by adjusting scientific lifestyles and controlling key comorbidities. Therefore, cognitive disorders are preventable to a certain extent.
In terms of scientific lifestyle: BMI (body mass index) can be reached and maintained within the range of 18.5-24.9kg/㎡ through reasonable diet and appropriate physical exercise. It is not advisable to be too fat or too thin; it is necessary to insist on physical exercise; engage in more brain exercises, such as reading and playing chess; do not smoke; and ensure adequate and good sleep.
In terms of controlling comorbidities: try to avoid and manage diseases that are high-risk for cognitive diseases, such as diabetes, cerebrovascular diseases, head trauma, weakness, hypertension, depression, atrial fibrillation, anxiety, etc.
Other aspects: In the early years, you should receive as much education as possible to increase the brain's cognitive reserve. In fact, learning and education at any stage of life is helpful; in addition, you can supplement more vitamin C; vitamin B and/or folate for patients with hyperhomocysteinemia.
However, estrogen replacement therapy is not recommended for postmenopausal women, and for patients with mild cognitive impairment who have not been diagnosed with cognitive disorders, it is not recommended to use acetylcholinesterase inhibitors to prevent Alzheimer's disease.
