What are the characteristics of cognitive health in the elderly?

I have been doing cognitive screening work for the elderly in the community for 5 years and have interacted with nearly a thousand elderly people over the age of 60. To be honest, the core characteristic of cognitive health in the elderly has never been "not forgetful at all", but slight memory loss, slowed down reactions, etc., which do not affect normal life and social interactions at all.

There was debate in the industry over this judgment standard in the past two years. Some clinical experts believe that early intervention is needed as long as there is forgetfulness or difficulty remembering recent events. Others who are biased towards geriatric sociology believe that "old fog" is a normal manifestation of aging and there is no need to make a fuss. In the past two years, we have been on the front line a lot. In fact, we have a more pragmatic judgment logic, and we will never label the elderly as "cognitive decline" just because of a small problem.

Aunt Zhang, who came for a free screening last week, said that she is 78 years old. Sometimes she just stuffs her reading glasses into the cracks of the sofa and turns around to look for them. But she can turn around and tell the embarrassing incident as a joke to the old sisters who danced square dances together. She is very clear about pension calculation at the end of the month and daily groceries. She can also take the lead in organizing the Tai Chi team in the community to arrange new performances. She can even clearly remember the sequence of movements of more than 20 people and who is standing in which position. Do you think she is cognitively unhealthy? It certainly doesn’t make sense. In fact, the old man's perception is like an old enamel jar that has been used for decades. It is normal to have some paint peeling and bumps. As long as it does not leak and can hold water normally, there is no need to regard it as a defective product.

There is another characteristic that many family members overlook. Cognitively healthy elderly people usually have good emotional stability and will not change their temperament without warning. There used to be an old man in our jurisdiction who used to have a very gentle personality. After retirement, he and his wife spent many years raising flowers and grass together. Suddenly, during that time, he always suspected that his wife had stolen his pension and would get angry at the cat at home. We came to do follow-up screening and found out that this was an early manifestation of cognitive impairment. On the other hand, those elderly people with good cognitive status, even if they occasionally have a little quarrel with their children or get upset after losing a game of chess with an old friend, they can quickly turn around and will not get into trouble, let alone have abnormal situations such as persecutory delusions and hallucinations.

Don’t even think about old people who are hard-coded as to whether they can use a smartphone. After all, many old people have never been exposed to digital products in their lives. When we make judgments, we will refer to their original living abilities. For example, Uncle Wang, who has been farming in the suburbs all his life, is 76 this year and can’t even use the old man’s mobile phone. But when to plant cabbage, how to mix pesticides, and go to the market to sell vegetables, he can calculate everything accurately. He can also ride a tricycle to pull vegetables to the market 20 miles away. This is definitely a state of cognitive health.

Nowadays, we are becoming more and more flexible in screening. We will not make a judgment based on just a few points on the scale. After all, every elderly person has a different growth background and living habits. As long as they can live their own lives clearly, participate in social activities and take care of their lives according to their own wishes, they have proper cognitive health.