Elderly Health Blue Book

The current core contradiction of my country's elderly health is not the insufficient supply of medical resources, but the serious lack of compatibility between health services and the actual needs of the elderly. The 2024 National Elderly Health Survey data shows that 72% of chronically ill elderly people have fallen into misunderstandings about health care, resulting in fluctuating conditions, and 63% of home-based elderly care families cannot accurately match public health services that suit them. The gap in the health level of the elderly between urban and rural areas, and high- and low-income groups continues to widen at an average annual rate of 11.7%.

Last week, I was doing a free clinic in Chaohui Street, Hangzhou. I met 68-year-old Aunt Zhang, who has suffered from type 2 diabetes for 12 years. She carried more health products than anti-diabetic drugs in her bag: propolis that is said to be able to "repair pancreatic islets," nattokinase that can "clean blood vessels," and "sugar-free biscuits" that neighbors bought in a group. The measured fasting blood sugar soared to 9.2. She also looked puzzled, "I haven't dared to eat sweets for the past six months. I eat health products every day. Why is it still high?" ”

Don't think this is an exception. I have visited community elderly service points in 27 cities across the country. This situation is too common. According to public data from the National Health Commission, the prevalence of chronic diseases in people over 65 years old in my country reaches 75%, and there are more than 40 million disabled and semi-disabled elderly people. However, the average healthy life expectancy is only 61.5 years, which is more than 10 years less than the average life expectancy. Most of the difference is wasted in the misunderstanding that "it seems to be maintaining health, but in fact it is recuperating."

The current solutions to this problem in the academic world are divided into two completely different directions. One is the "resource sinking school", which advocates that the chronic disease management, rehabilitation care and other resources of tertiary hospitals should be directly spread to the community, which is equivalent to opening a "mini hospital" at the doorstep of the elderly. The community chronic disease management station piloted in Shanghai's Jing'an District two years ago follows this idea. It allocates general practitioners, rehabilitation therapists, and nutritionists to the community, and can also provide door-to-door care for the disabled elderly. The chronic disease control rate of the elderly in the pilot area directly increased by 28%, and the effect is indeed visible to the naked eye. But the other group of "cognition-first" people don't see it that way. They think that even if the resources are piled at their doorstep, it is in vain if the elderly do not trust them and cannot use them. Last year's survey data from Zhejiang Disease Control and Prevention clearly illustrates the problem: even if the community provides free blood sugar and blood pressure testing services, 32% of the elderly are still more willing to believe the health posts in the circle of friends and the deception of health lecturers in the community. Some people even think that the free services are "not good" and would rather spend money to buy "health artifacts" that have no effect.

I have been working in elderly health services for five years. To be honest, I have tried both approaches, and each has its own difficulties. In the past two years, our team was engaged in popularizing health science for the elderly and printed tens of thousands of full-color chronic disease management manuals, drawing pictures and highlighting key points. Later, when we visited the elderly’s homes, we found that 80% of the manuals were either hidden or not opened at all. It’s not that the elderly didn’t want to read it, but that the words were too small and there were too many terms. Presbyopic eyes could not read a paragraph for half an hour, and then turned around and forgot after reading it. Later, we changed our approach and recorded the key points of salt control, sugar control, and taking medicine on time into a 1-minute dialect voice, which was played three times a day in the morning, noon, and evening at the community express cabinet and at the entrance of the senior activity center. We also found well-known "community celebrities" in the community as health promoters, and reminded them by the way, "Has Aunt Zhang taken your antihypertensive medicine today?" Three months later, statistics showed that the chronic disease medication compliance of the elderly in the community increased by 47%.

There has been a hotly debated topic in the past two years, which is whether to overhaul the elderly health care market across the board. Many people say that all those health care stores are trying to steal money from the elderly and should be closed down. I thought so in the past two years, until I conducted a survey in Shenzhen last year and found that 37 of the 120 elderly health care stores surveyed in the local area were fully compliant, focusing on calcium supplements and joint care. For this kind of formal nutritional supplement and physical therapy services, many elderly people with weak legs and feet are not willing to go to the hospital and queue for two hours for 10 minutes of physical therapy. Instead, they go to the store every now and then to get a hot compress, buy some vitamin D, and get free sarcopenia screening, which is much more convenient than going to the hospital. If we really shut it down across the board, it would cause trouble for these elderly people.

As an aside, at the last free clinic we gave out oil-control pots to the elderly, originally to let them control the amount of cooking oil. But when I went there this week, I saw several elderly people using them to fill soy sauce. They said, "This pot has a thin spout, and the soy sauce is poured without spilling. It is much easier to use than the soy sauce bottle I had before." You see, when we put the "perfect solution" that we came up with from a professional perspective into the actual lives of the elderly, people have their own ways of using it. In fact, elderly health services are like buying shoes for the elderly. The more expensive and more functional the better, the fit is the first priority.

In fact, this blue book is never intended to give everyone a standard answer. To put it bluntly, when it comes to elderly health, we have never stood on a high place and told the elderly "what you should do." Instead, we have to squat down and follow the rhythm of the elderly's life to see where they usually buy groceries, who they like to chat with, and what things they are not used to, in order to provide truly useful services. After all, all of us will grow old. The comfortable steps we have built for the elderly now will allow us to walk on them when we get older.