Altzheimer's patients with elderly care: How can I grow old dignified?

"China Economic Weekly" reporter Wu Suwen | Report in Guangdong

In Aliang's impression, grandma has always been a "decent person". Every morning, she will use a card to keep her pale hair, pick up her favorite clothes, and greeted by the acquaintance after being cleaned up neatly. "Neighbors say she is a hearty and kind person."

But this image was subverted at the age of 85. A Liang's grandmother became irritable, her hair became more and more chaotic, and her shirt buttons were difficult to buckle. The doctor in the town diagnosed her with dementia and did not prescribe the medicine. She returned home after the examination. In the following years, the symptoms of the elderly became more and more serious.

Alzheimer Disease (AD), commonly known as "Alzheimer's disease". Strictly speaking, "dementia" is a collective name that involves degenerative diseases of gradual cognitive function, and AD is a common one in dementia and belongs to neurological degeneration disease. In addition to dementia, memory loss, great changes in temperament, illusion, and unable to take care of themselves, these symptoms may appear on AD patients.

September 21, 2022 is the 29th World Alzheimer's Day. This year's theme is "Knowing Knowing and Preventing early Wisdom to the Future." Data show that the number of Alzheimer's patients in my country has exceeded 10 million, ranking first in the world, and it is expected to exceed 40 million by 2050. Some doctors said that with the aging population, the number of patients is increasing, but the number of patients who go to the hospital is much less than the real number.

This is an increasingly large group, and it is also a social issue that has not been discussed enough. In a popular Weibo, about 15,000 netizens forwarded and shared the experience of the elderly at home suffering from Alzheimer's disease. Many patients and their families are trapped in the shame brought by this condition.

In a nursing home specializing in patients with Alzheimer's disease in Chaoyang District, Beijing, an old man with Alzheimer's disease is playing intellectual toys.

The old man trapped in the chaos cognition

When the doctor wrote "Alzheimer's Disease" in the diagnosis, Xiao Qing's grandmother's response was extremely fierce: "You say I am dementia? Meaning, you say I am a fool?"

In this sentence, Xiao Qing's grandmother repeated more than 10 years. At the age of 87, the old man is accompanied by Alzheimer's disease. He also accompanies Alzheimer's extremely high -risk level 3 high blood pressure and type 2 diabetes, Parkinson disease, and non -organic sleep disorders. These diseases have caused Grandma Xiaoqing's life to be difficult to take care of themselves, and they need to take a wheelchair when they go out.

"My grandmother lives in an old house for more than 30 years. Due to the special house building, she can't install an elevator. This makes her live on the third floor. , Gradually lost social exchanges. "Xiao Qing told the reporter of" China Economic Weekly ".

"At the end of August last year, the grandfather who accompanied her grandmother died unexpectedly with her grandmother. For her grandmother, the stress response brought by the widow was far more severe than the pain caused by her own disease." Xiao Qing recalled that her grandmother often had no appetite, and her grandmother often had no appetite. After waking up, he was excited to blame the people around him and asked many questions that make people feel strange and could not answer.

Three years ago, A Liang's grandmother died. In the last days, the old man who was already confusing was still trying to identify the children of her big hands. But in addition to her eldest son in his hometown, other children went to work when they grew up, and they rarely went home.

Aliang also remembers every time I go home: "I was at home in the evening, grandma always watched TV in the living room. Later, when I was watching TV, my grandmother suddenly said to himself. Think of this is the dementia of the old man '. When he developed to the later stage, the grandma would shout her brother and sisters in the dark in the early morning, thinking that it might be her childhood. "

The loneliness of the old man was at a glance in Aliang's eyes. He said with a blame: "I suspected that my family rarely accompanied her to deepen her symptoms step by step. She should still go home to accompany her."

On the Internet, there are also many netizens who have similar experiences with Aliang. In the aforementioned Weibo, a Guizhou netizen said: "The year or two of my grandfather came here, and he couldn't sleep every night when he couldn't sleep. Back to my hometown (where he stayed at a young age) ... "

Another Beijing netizen stated: "My grandma was in her 90s, she got Alzheimer's disease. At that time, I controlled my grandfather's name 'brother' every day. I had to go home and said that she was afraid. 'Brother'. My grandfather did business in Shanghai when she was young. She pulled 6 children in the northeast alone. I really don’t know how she took so many children in that era. Dare to show in front of the child, only to support it. "

Will the experience once "burst" when they lost their memory and reason?

Fang Yingying, deputy chief physician of the Department of Neurology, the First Affiliated Hospital of Sun Yat -sen University, said in an interview with a reporter from the China Economic Weekly that patients with Alzheimer's disease would forget about the newly happened. Memory will be affected.

He Yongli, Chief Physician of the Department of Neurology and Chief Physician of the Department of Medicine, Affiliated to Chongqing Medical Higher College (Chongqing Sixth People's Hospital), introduced to the reporter of "China Economic Weekly" that many clinical symptoms of many Alzheimer's elderly are mild Dementia and moderate dementia. The patient has no impression of what has happened recently. Forgot some personal experience and repeat the previous incidents. Therefore, the patient's previous experience and memory explosion is common. When further developing to severe dementia, the patient's speaking and actions will be difficult, losing environmental awareness power Maybe you can read some meaningless words fragments, incontinence in urine, eating, walking, sitting, etc. need to rely on others. A career in Zhejiang Lide Hospital, a caregiver supporting a patient with Alzheimer's disease back to the ward to rest.

Guardian pressure

Since other children are working foreign workers, the heavy responsibility of taking care of her grandmother fell on the parents who had been over the years.

Aliang told the reporter of "China Economic Weekly" that at the beginning, his father was confident in treating the elderly, thinking that he would just wait for food and drink Lazar. But later I found that this was a job that made people feel tired and mentally. Faced with an old mother who did not understand and mind, and the child was like a child, A Liang's father gradually became impatient. Sometimes he said loudly and felt guilty afterwards.

When they go out, they will lock the elderly at home, and the dangerous things will be put away. Nevertheless, the situation cannot be avoided. Sometimes, the elderly will lie on the window sill and talk nonsense, which also attracts the gossip of the neighborhood, but only the family knows the helplessness.

"My grandma is too, scolding her in a very vicious language, because she always has some wrong memories and feels that others are not good to her, and they have run countless caregivers. Her child can't hold her long -term service, Whenever a person (take care) for a month, otherwise it will collapse. "

"After I got this disease, I left home and left home many times. My family called the police overnight. We lock the door and prevent him from getting out. He smashed the door with a kitchen knife. Every day, he scolded me at home and scolded me Mom. Later, he was paralyzed on the bed, and everyone felt relieved. "

From the perspective of netizens, the care of the elderly of dementia has become the pressure of many families.

Xiao Qing said: "After the death of my grandfather, the six adults, including me and my parents, needed 24 hours to take turns to take care of my grandmother's daily life. Since my parents and I had to work, we soon realized that It is a long -term plan to hire a aunt who can live to take care of my grandmother. "

Soon, they hired an aunt from Guangxi to take care of Grandma Xiao Qing. Although they speak Cantonese, and their dietary habits are relatively similar, when Aunt Guangxi lived in the home of Guangdong's grandmother, "Originally 70 years of orderly life was forced to disintegrate, and then re -adapting to the new changes. thing."

But in Xiaoqing's opinion, the grandmother who loves to be quiet, and the cheerful and carefree aunt, the two people with different personalities live together, and there can be too many places in life. They have lived together for nearly a year, and the names on the disease on the diagnostic book seem to no longer constitute psychological and emotional pressure on grandmother. "Obviously I feel that my grandmother's physical condition is much better, and there are more words than before."

"Patients' intelligence decreases, but the need for emotional exchanges still exists." Fang Yingying said that the diagnosis of Alzheimer's disease was a great blow to patients and family members, fear and resistance. One of the biggest difficulties faced by the caregiver is to deal with the behavior of the patient's behavior. In addition, daily basic living activities such as dressing, bathing, and eating are very difficult for patients and caregivers. However, the symptoms and inappropriate behaviors of dementia are not intentional, and the caregiver should not have a shyness.

She reminded that patients' families can contact institutions such as the hospital's dementia specialties, Alzheimer's Association and other institutions to understand the knowledge, treatment plan and nursing resources of dementia. "Find a support organization that can share your feelings and anxiety, and provide useful experience and help. For example, if China dementia prevention and control network, you can also consider using the elderly Nikko Center, the elderly home or short -term care stations to reduce the nursing work."

Going to the nursing home for care is also the choice of some people. The reporter's consultation learned that in the nursing home, the elderly with Alzheimer's disease were usually managed in division, and the charges were higher than that of the elderly who were paralyzed by ordinary people and even disabled. The operator of a nursing home in Shenzhen said: "We are relatively high for the elderly who are cognitive disorders, because the difficulty of care is relatively large, and there are some activities of non -drug intervention. It reaches more than 10,000 yuan a month, and the double room. In fact, for us, it is easier to take care of those who are completely disabled and lying in bed. "

He Yongli reminded that first of all, dementia patients and caregivers need to educate and train, master the basic knowledge and development laws of Alzheimer's disease, and regularly go to the hospital to follow up to evaluate the patient's cognitive status, daily life ability, mental condition, and various types The effectiveness and side effects of the treatment formulate an individualized plan for nursing care. Secondly, the implementation plans should be different for different degrees of dementia.

In a nursing home specializing in patients with Alzheimer's disease in Chaoyang District, Beijing, the sunset is under the sunset. It is on the faces of the puppet dolls often played by the old people. wheelchair.

Will Alzheimer's disease be inherited and how to prevent it?

Data from Alzheimer's disease in 2020 shows that the comprehensive incidence of Alzheimer's disease in China is 4%. As the age increases, the prevalence of women is almost twice as much as men. From the perspective of education level, the prevalence of primary schools or below is 6%, and the prevalence of junior high school or above is 3%. From a regional point of view, East China is 5%, higher than 4%in North China, 3%of Central China, 4%in cities, and slightly lower than the rural areas. People don't have to worry about whether they are sick. Liang Xinyi, a doctoral student of Fudan University, has also started related research on the opportunity of his family's illness. She found that many research objects will over -control the disease characteristics on the Internet to determine whether they are sick and worry that they will dementia when they are old. Most of them also think that they are sick. But after we communicating with them, including observing their daily life, I found that "where is like a disease, it is normal."

In addition, the US NIA-AA (National Institute of Aging and Alzheimer's Association) emphasizes the continuity of Alzheimer's disease, and proposes that its pathological changes may begin 15 to 20 years before clinical symptoms.

So, will Alzheimer's disease be inherited? He Yongli introduced that Alzheimer's disease is a complicated multi -factor disease, and some of them have genetic functions. The pathogenic genes currently found are app, PSEN1, PSEN2, or 21 trilateral. The risk genes are APOEϵ4 pure pixels. The genetic people mostly occur in Alzheimer's disease patients under 65. Fang Yingying said that 90 % of the patients with Alzheimer's disease were ex -genetic inheritance, only 10 % were family inheritance, and people carrying APOEϵ4 genes had a high risk of onset.

It is understood that the treatment of Alzheimer's disease includes drug therapy and non -drug intervention, and drug therapy includes cognitive enhanced agents and alleviating the mental symptoms of Alzheimer's patients with mental symptoms. However, the development of special effects of Alzheimer's disease has always been a difficult challenge, and drugs can only alleviate symptoms and cannot prevent the progress of the disease.

In terms of non -drug intervention, Dr. He Yongli suggested that he can pay attention to the diet. According to the internationally recommended intervention of neurotoly delay (Mind) diet, you can eat more beans, fish, nuts, as well as whole grains, poultry meat, green leafy vegetables, tomatoes, eggplant Choose strawberries, blueberries and other berries. And fried foods such as fries, fried chicken, red meat such as pork, mutton, beef, dessert, butter and processing snacks, and cheese foods, and eat less. It is best to quit smoking and alcohol. Women drink no more than 15 grams of alcohol per day, and men do not exceed 30 grams of alcohol per day.

Fang Yingying also suggested that in addition to diet, ensure sleep quality, learn more, do more physical exercise, and more social networking can help avoid dementia or slow down the process of dementia. At the same time, the management of vascular risk factors and controlling the onset of cardiovascular and cerebrovascular diseases is also an important part of dementia.

(Liang Xinyi, a doctoral student of the Institute of Anthropology Group of the Institute of Anthropology and Ethnicology, Fudan University, also contributed to this article.

Responsible editor | Yang Lin

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