Silver Age Health丨Rehabilitation Training for the Elderly (Diseases, Accidents and Precautions) - Diseases

As the global population aging process accelerates, the proportion of the elderly in the total population continues to rise, and the health of the elderly has increasingly become the focus of social attention. According to statistics from the World Health Organization (WHO), as of 2023, the global population aged 60 and above has reached 1.2 billion, and it is expected that by 2050, this number will increase to 2.1 billion. In China, according to the results of the seventh national census, the population aged 60 and above is 264.02 million, accounting for 18.70%, and the degree of population aging is higher than the world average (the population aged 60 and above accounts for about 13%). Due to the natural decline of physical functions, such as weakened muscle strength, reduced joint flexibility, decreased cardiopulmonary function, and slower nervous system reaction speed, the elderly are more vulnerable to various diseases, such as cardiovascular disease, diabetes, arthritis, cognitive impairment and other chronic diseases. These health problems not only seriously affect the quality of life of the elderly, limit their ability to carry out daily activities, and make it difficult for them to take care of themselves, but may even cause psychological problems, such as anxiety and depression, which cause them to suffer great psychological pain. At the same time, they also bring heavy burdens to families and society, including medical expenses, human and material resources for long-term care, etc. Rehabilitation training, as an important intervention method, plays an irreplaceable role in the health management of the elderly.

▏Rehabilitation training for cardiovascular diseases in the elderly

Cardiovascular diseases are common diseases among the elderly, such as hypertension and coronary heart disease, which seriously affect the physical health and quality of life of the elderly. Rehabilitation training is of great significance for the rehabilitation of patients with cardiovascular diseases, and can effectively improve cardiovascular function and reduce the risk of disease. Walking is a simple and easy aerobic exercise suitable for most elderly people with cardiovascular diseases. During walking, the muscles of the body contract and relax rhythmically, which accelerates blood circulation. This not only helps to reduce blood viscosity and reduce the risk of thrombosis, but also allows the heart to get a certain degree of exercise and enhance myocardial contractility. Studies have shown that patients with hypertension who insist on walking for a long time have significantly better blood pressure control than those who do not exercise, and their systolic blood pressure can be reduced by an average of 5-10mmHg. For patients with coronary heart disease, walking can improve the endurance of the heart, increase blood flow in the coronary arteries, improve myocardial blood supply, and reduce the frequency of angina attacks. It is generally recommended that the elderly walk for 30-60 minutes a day, and the speed should be comfortable for them. The walking time and speed can be gradually increased according to their physical condition. Tai Chi, as a traditional Chinese fitness exercise, has slow, gentle and coherent movements, emphasizing the coordination and unity of body and mind. When practicing Tai Chi, breathing and movements are closely coordinated, which can regulate the autonomic nervous system and balance the functions of the sympathetic and parasympathetic nerves, thereby lowering blood pressure. Tai Chi movements can also promote blood circulation throughout the body, enhance vascular elasticity, improve endothelial function, and protect the cardiovascular system. Studies have found that patients with coronary heart disease who practice Tai Chi for a long time have significantly improved cardiac function indicators such as left ventricular ejection fraction and cardiac output, enhanced heart pumping capacity, and significantly improved quality of life. Practicing Tai Chi 3-5 times a week for 30-60 minutes each time can bring good rehabilitation effects to patients with cardiovascular diseases.

▏Rehabilitation training for diabetes in the elderly

Diabetes is a common chronic metabolic disease with a high incidence rate among the elderly. For elderly people with diabetes, rehabilitation training combined with diet control and blood sugar monitoring is the key to controlling the disease and preventing complications. Diet control plays a fundamental role in the treatment of diabetes. Elderly people with diabetes should follow the principle of low-sugar, high-fiber diet and control the total calorie intake. Reduce the intake of high-sugar foods such as refined grains, candies, and beverages, and increase the intake of foods rich in dietary fiber such as vegetables, whole grains, and beans. Reasonably distribute the calories of three meals, generally according to the proportion of 30% for breakfast, 40% for lunch, and 30% for dinner, and avoid overeating. For patients with large fluctuations in blood sugar, eating small meals frequently can help stabilize blood sugar levels. The choice of sports should be determined according to the physical condition and interests of the elderly, mainly aerobic exercise, such as walking, jogging, swimming, cycling, etc. These exercises can increase the body's sensitivity to insulin, promote muscle uptake and utilization of glucose, and thus lower blood sugar levels. The intensity of exercise should be moderate, generally sweating slightly after exercise, feeling slightly tired, but recovering quickly after rest. The exercise time can be chosen 1-2 hours after a meal. At this time, the blood sugar level is higher, and exercise can better play a role in lowering blood sugar. Each exercise lasts 30-60 minutes. Blood sugar monitoring before and after exercise is crucial. Before exercise, blood sugar should be measured first. If the blood sugar level is lower than 5.6mmol/L, you should eat properly before exercising to prevent the occurrence of hypoglycemia; if the blood sugar level is higher than 16.7mmol/L, exercise should be avoided, because exercise at this time may cause blood sugar to rise further and induce acute complications such as ketoacidosis. After the exercise, blood sugar should also be measured in time to observe the effect of exercise on blood sugar. If blood sugar is significantly reduced after exercise, carbohydrates should be supplemented appropriately, such as eating some fruits, biscuits, etc. Regular monitoring of glycosylated hemoglobin and understanding the average control level of blood sugar over a period of time will help adjust diet and exercise plans and drug treatment doses.

▏Rehabilitation training for respiratory diseases

Chronic obstructive pulmonary disease (COPD) is a common respiratory disease in the elderly. The main symptoms include dyspnea, cough, and sputum, which seriously affect the quality of life of patients. Breathing training is an important part of the rehabilitation treatment of COPD patients, which can effectively improve respiratory function and improve the quality of life. Abdominal breathing training increases the ventilation of the lungs by enhancing the movement of the diaphragm. Patients can take a supine or semi-recumbent position with their hands on the front chest and upper abdomen respectively. When slowly inhaling through the nose, the abdomen gradually bulges outward, and the hand can feel the abdomen lifting up. At this time, the diaphragm descends and the lower part of the thorax expands outward, allowing more air to enter the lungs; when exhaling, the abdomen gradually retracts inward, and the lips are shrunk into a whistle shape, so that the gas is slowly exhaled through the mouth, and the abdominal muscles are contracted at the same time to help the diaphragm rise and expel the gas from the lungs. The ratio of inhalation to exhalation time is generally 1:2 or 1:3, and each training lasts 10-20 minutes, and 2-3 times a day. Long-term adherence to abdominal breathing training can enhance diaphragm strength, improve breathing efficiency, and alleviate dyspnea symptoms. Pursed lip breathing training mainly prolongs the exhalation time through the tiny resistance formed by pursing the lips, increases the pressure in the airway, prevents the small airway from collapsing prematurely, and is conducive to the discharge of gas in the lungs. The patient closes his mouth and inhales through the nose, then exhales slowly through pursed lips (like whistling), and tries to exhale the gas completely when exhaling. Similarly, the ratio of inhalation to exhalation time is 1:2 or 1:3, and each training lasts 10-20 minutes, 2-3 times a day. Pursed lip breathing can improve lung ventilation function, reduce carbon dioxide retention, relieve dyspnea, and improve patients' exercise capacity and quality of life. Breathing training should be performed during the stable period of the disease, and avoid performing it during the acute attack period to avoid aggravating the disease. During the training process, pay attention to the rhythm and depth of breathing, and avoid overventilation or underventilation. The training intensity can be gradually increased, but excessive fatigue and discomfort should be avoided. If the patient experiences discomfort symptoms such as palpitations, shortness of breath, dizziness, etc. during the training, the training should be stopped immediately and a doctor should be consulted.

▏Rehabilitation training for neurological diseases

Stroke, also known as stroke, is a common neurological disease in the elderly, with high morbidity and high disability rates. Rehabilitation training is crucial for the functional recovery and improvement of self-care ability of stroke elderly people. It can be divided into two stages: early bedside rehabilitation and comprehensive rehabilitation training in the recovery period. In the early bedside rehabilitation stage, it usually starts within 48 hours to 7 days after the condition of the stroke patient stabilizes. The main purpose of this stage is to prevent complications, maintain joint mobility, and lay the foundation for subsequent rehabilitation training. Joint mobility training is one of the important contents of early rehabilitation. Nurses or family members should assist patients in passive activities of the affected limbs in the order from proximal joints to distal joints, such as flexion, extension, abduction, adduction of the shoulder joint, flexion and extension of the elbow joint, flexion and extension and rotation of the wrist joint, etc. Each joint is moved 3-5 times, 2-3 groups a day, and the movements should be gentle and slow to avoid excessive pulling to cause pain and injury. Through joint mobility training, joint stiffness and contracture can be effectively prevented, blood circulation can be promoted, and the normal function of articular cartilage and ligaments can be maintained. As the patient's condition stabilizes further and his physical condition improves, he enters the comprehensive rehabilitation training stage of the recovery period, which is generally 1-6 months after the onset of stroke. The focus of rehabilitation training at this stage is to promote the recovery of limb function, improve motor ability and self-care ability in daily life. Stretching training plays an important role in reducing muscle tension and improving the range of joint motion. Rehabilitation therapists can stretch the joints and muscles of the patient's affected limbs. For example, stretching the triceps surae can improve the dorsiflexion function of the ankle joint and relieve foot drop; stretching the upper limb flexors can reduce the tension of the upper limb flexors and promote upper limb extension. When stretching, pay attention to moderate strength and gradually increase the degree of stretching. Each stretch lasts 15-30 seconds, and each action is repeated 3-5 times, 2-3 sets per day. Balance training and walking training are essential to improving patients' ability to carry out daily activities. Balance training can start with sitting balance training and gradually transition to standing balance training. During sitting balance training, let the patient sit on the edge of the bed or on a chair, with both feet flat on the ground and both hands on both sides of the body, and gradually increase the range of body movement, such as turning the head left and right, stretching the hands left and right, etc., to improve the patient's sitting balance ability. When the patient's sitting balance ability is better, standing balance training can be performed, first standing with the help of others, gradually transitioning to independent standing, and then training to move the center of gravity forward and backward, left and right to improve the standing balance ability.

▏Rehabilitation training for elderly people with Parkinson's disease

Parkinson's disease is a common degenerative disease of the elderly nervous system. Its main symptoms include resting tremor, bradykinesia, muscle rigidity and postural balance disorders, which seriously affect the patient's motor function and quality of life. Rehabilitation training, as an important part of the comprehensive treatment of Parkinson's disease, can effectively improve the patient's motor function, improve the quality of life, and reduce the burden on patients and their families. Balance training is one of the important contents of rehabilitation training for Parkinson's disease. Parkinson's patients are prone to falls due to postural balance disorders, which seriously affects their life safety and independence. Balance training can be carried out in a variety of ways, such as using balance boards, balance mats and other equipment for training. The patient stands on the balance board with his feet shoulder-width apart, and keeps the balance board stable by adjusting the center of gravity of the body. Each training lasts 10-15 minutes, and is performed 2-3 times a day. You can also perform single-leg standing training, starting with standing on one leg for 3-5 seconds, and gradually increasing the standing time, 3-5 times for each leg, and 2-3 sets a day. Through these balance training, the patient's balance ability can be enhanced, the body's stability can be improved, and the risk of falling can be reduced. Gait training plays an important role in improving the walking ability of patients with Parkinson's disease. Parkinson's disease patients often have abnormal gaits such as small steps and panic gait, which affect the speed and stability of walking. In gait training, visual prompts, auditory prompts and other methods can be used to help patients improve their gait. For example, set marking lines at a certain distance on the ground, and let the patient take steps according to the prompts of the marking lines. The distance of each step should be moderate and the steps should be as even as possible; you can also use a metronome, set a suitable rhythm, and let the patient walk according to the rhythm of the metronome. In this way, the patient's stride and frequency can be adjusted. At the same time, pay attention to correcting the patient's body posture when walking, keep the body straight, raise the head, look straight ahead, and swing the arms naturally. Each gait training lasts 20-30 minutes and is performed 2-3 times a day. Daily life activities training aims to help Parkinson's disease patients improve their ability to take care of themselves so that they can live independently better. The training content includes basic activities in daily life such as dressing, eating, washing, bathing, and going to the toilet. In dressing training, choose loose and easy-to-put-on-and-off clothing, and start with putting on and taking off tops, so that patients can learn how to put their arms into sleeves, button or zip, etc. In eating training, choose appropriate tableware, such as non-slip bowls, spoons, etc., to help patients improve the accuracy and efficiency of eating; when washing and bathing, pay attention to maintaining a safe environment, and install handrails, non-slip mats and other facilities in the bathroom to prevent patients from slipping. Through daily life activities training, patients' self-confidence can be enhanced, their quality of life can be improved, and they can better integrate into daily life. (Picture from the Internet)

Author | Han Mei is a practicing pharmacist who has worked in a well-known national tertiary hospital for more than 30 years and has rich medical care experience. She has represented the hospital on many occasions to go out for exchanges and study. She is an expert in food hygiene and nutrition, has a national nutritionist qualification, and is a science enthusiast.

Preliminary review | Chen Jiaqi, Li Shuhao

Review | Wei Xinghua

Final Review | Han Yonglin