Text ◆Cui Yong’en (Project Director of the Inter-Professional Team of the “Renji Love Heirloom” Nursing Fellowship Program), Wang Minshan (Deputy Project Director), Huang Peixin (Nurse), Lin Boqian (Nutritionist), Li Junhua (First-Class Occupational Therapist)
In a two-elderly family, once one of them loses the ability to take care of himself due to old age or illness, there will be a situation where the elder takes care of the elder.
Because the caregivers themselves have limited physical strength or abilities, lack of awareness of the disease, or do not know how to seek support, the caregivers feel even more strenuous.
(Hong Kong News) As society begins to pay attention to the stress of caregivers, different community resources have emerged. If caregivers know how to seek help in a timely manner, allowing professional teams to intervene early and provide advice on appropriate medicines can help solve problems and overcome difficulties together.
Two elders living together make the mistake of taking care of their health and getting worse at the same time
In the early days of their retirement, Mr. and Mrs. Li often traveled together and lived a simple and comfortable life. However, later, Mr. Li often fell down and became unsteady on his feet for no apparent reason, and was diagnosed with atypical Parkinson’s disease. Atypical Parkinson’s disease degenerates more quickly than typical Parkinson’s disease and does not respond satisfactorily to Parkinson’s medication. Therefore, Mr. Li and his wife live together and usually lack support.
Mr. Li’s appetite has been poor in recent months, resulting in a sharp weight loss, rapid deterioration of body functions, and even the difficulty of holding the handrails with both hands. After evaluation by social workers, Mr. Li was referred to the “Renji Love Heirloom” Elderly Care Fellowship Program (hereinafter referred to as: the team) to receive support.
Poor holding posture, hand pain and numbness
The team found that when Mrs. Li was taking care of her husband, she used incorrect holding and transfer postures, which worsened her existing carpal tunnel syndrome and caused continued pain and numbness in her hands. Regarding the rapid change of her husband’s condition and her own situation, Mrs. Li seemed helpless and confused, “I don’t know how to take care of her, and I am in pain all over my body.”
Mr. Li is mostly bedridden, and his daily care falls on his wife, who suffers from carpal tunnel syndrome. Due to Mrs. Li’s poor supporting posture, the load on her hands became heavier and heavier over time, making her care more difficult.
Whenever she needed to help her husband move indoors, Mrs. Li would first help him onto a movable chair that had no brakes. He might fall down in the process. In addition, due to Mr. Li’s weak lower limb muscle strength and weak sitting balance, the size and height of the original chair at home are no longer suitable, and the support is insufficient. As a result, he can only stay in bed for a long time, and even develops pressure sores.
Expensive supplements don’t improve condition
In addition, due to Mr. Li’s difficulty in eating, less food can actually reach the intestines and stomach for digestion, resulting in insufficient intake of calories and protein, resulting in muscle and weight loss. The body is unable to maintain the most basic functions, such as eating ability and immunity, and his condition changes rapidly. Difference. However, Mrs. Li believed that her husband could still eat food of normal texture, which put Mr. Li in danger of serious complications such as aspiration pneumonia.
Mrs. Li’s husband was eager to buy expensive nutritional supplements through a friend’s introduction, and also arranged for an unknown examination, hoping to restore her husband’s health and make the symptoms disappear. Unfortunately, those supplements and tests did not bring any improvement to Mr. Li’s condition, and even caused him to develop diarrhea.
Meet nutritional needs With suitable supplements
In view of the situation of Mr. and Mrs. Li, after evaluation and consultation, the team provided the following support:
1.Adjust the correct treatment direction
Adjust reasonable expectations for the condition, discontinue supplements of questionable effectiveness, establish the correct treatment direction, and delay deterioration
The nurse explained to Mr. and Mrs. Li that the main direction of treatment is to relieve symptoms through drugs to maintain the patient’s mobility. They should be guided to take drugs according to the doctor’s instructions and should not listen to Tu Tu’s instructions.
The nutritionist also analyzed with Mrs. Li that the effectiveness of the “supplement” was doubtful and failed to target the disease; Mrs. Li should give priority to meeting her husband’s basic nutritional needs, including sufficient calories and protein to ensure that the weight does not fall further and to prevent muscle loss.
Get enough nutrition from meals
2.Improve cognitive deficiencies, address dysphagia, and ensure adequate nutrients
After Mr. Li’s swallowing assessment by the hospital’s speech therapist, he was advised to eat pureed meals. The purpose of changing food texture is to target the abilities that patients lack, such as chewing ability and oral nerve response, to improve swallowing ability and safety.
Mr. Li should try his best to follow the food texture recommendations so that he can eat at least some foods safely. He can drink liquid drinks, so it is recommended to drink more milk, nutritional milk powder and protein powder to supplement calories and protein.
nurse:“Purchasing supplements from the public may not have therapeutic effects. You should first understand the ingredients and functions, and consult a doctor before taking them to avoid conflict with the original medicine.”
Nutritionist:“The appearance and taste of softer food may be different from usual, which makes it difficult for most patients to accept it. Caregivers can try to mix and place different foods separately to let patients know the rice paste and meat paste they eat, and the appearance and appearance of food.” Better.
There are “exquisite soft meals” on the market that look and taste better, such as cabbage mousse, abalone mousse, curry, etc., which can present the paste food in its original appearance and improve patient acceptance. “
Change positions regularly to prevent pressure ulcers
3.Prevent pressure ulcers through diet and aids
Mr. Li sometimes has inexplicable injuries on his body. After evaluation by a nurse, it was found to be a pressure sore, also known as a pressure injury. Due to inconvenience in movement and maintaining the same posture for a long time, long-term pressure is placed on the bony protrusions and stress-bearing parts of the body. In addition, nutrition Pressure injuries caused by insufficient intake are difficult to heal.
Nurses and occupational therapists recommended that Mr. Li change his position regularly and use high-back chairs and pressure-reducing mattresses to avoid long-term pressure on the same part of the skin. When using diapers, be sure to keep your skin dry and use skin protective ointment to prevent skin damage due to excrement irritation.
Nutritionist:“You should drink 1.5 to 2 liters of fluids every day, including water, soup, milk and other types of drinks to avoid dry and fragile skin and increase the risk of pressure injuries.” Absorbing the following nutrients can help with the recovery of pressure injuries.
◆High protein foods: fish, beans, red meat (beef, pig, sheep) and poultry
◆Iron-rich foods: red meat, dark green vegetables (broccoli, spinach), sesame seeds, sunflower seeds
◆Foods containing vitamin C: can be absorbed from different vegetables and fruits
◆Foods containing zinc: red meat, seafood, milk and cheese, lentils and beans
nurse:“The early symptoms of pressure injury are redness, blisters or broken skin under pressure. If a patient is found to have the above symptoms, they should pay more attention, such as increasing the density of turning, reducing pressure, etc., to avoid worsening of the condition.”
Teach correct holding techniques
4.Make good use of auxiliary equipment, improve your holding skills, and reduce injuries to both parties.
The occupational therapist bought Mr. Li a lightweight push-type wheelchair with a braking device as an auxiliary tool, mainly used for supporting and transferring at home. He also bought a high-back chair so that Mr. Li could sit out during the day. In the living room, it not only improves the quality of life, but also prevents the formation of pressure ulcers. In addition, the therapist also taught Mrs. Li about product safety instructions and correct holding techniques, making daily care easier and safer.
The holding method will take into account the elderly’s performance in daily life functions, muscle strength and balance to assess the degree of assistance needed. As long as you use the posture principles flexibly and abide by them, daily care can be done with less effort, effort-saving and safer. There are many auxiliary products on the market. Therapists will help you choose suitable products based on clinical assessment and home environment needs. It is recommended that caregivers seek professional advice first and avoid buying indiscriminately to avoid “getting something without using it”.
After the team’s appropriate intervention and suggestions, Mrs. Li mastered the correct knowledge of care, identified the priority goals of care, and equipped with appropriate auxiliary equipment, making care more convenient and reducing the stress of care.