old age bedridden
Introduction
Introduction to old-aged bedridden A long-term bed rest (or long-term bed rest, bedridden) refers to a clinical phenomenon in which the elderly suffer from diminished daily life due to long-term illness and disability, and some or all of them need help, including long-term bed rest, sitting chairs and Old people who can only live indoors can not go out. The consequences of staying in bed for a long time are serious. Once it happens, the hope of rehabilitation is small, and it should be focused on prevention. basic knowledge The proportion of illness: usually seen in the elderly, the incidence rate is about 0.02% - 0.04% Susceptible people: the elderly Mode of infection: non-infectious Complications: hemorrhoids pneumonia fracture
Cause
Elderly long-term bedridden cause
(1) Causes of the disease
Cerebrovascular disease
Cerebrovascular disease is the leading cause of chronic illness in the elderly (more than 50%), 1 severe stroke: the elderly with severe cerebrovascular accidents, after the acute phase of treatment, saved the life, but left the symptoms of nerve defects , affecting the function of physical activity, including loss of recognition, loss of function, ataxia caused by deep sensory disturbance, bilateral hernia or severe flaccid paralysis, which often has no hope of improvement or almost no improvement, thus allowing patients to stay in bed for a long time. 2 stroke combined with other diseases: some patients with cerebral thrombosis, especially elderly patients, left with sputum, but combined with acute myocardial infarction, or lower extremity amputation, resulting in aggravation of the disease and long-term bed rest, this situation Called a compound disability.
2. Bone and joint diseases
The following diseases can cause long illness in bed.
1 Fracture: Fracture is also one of the main reasons for long-term bed rest in the elderly (20%). Among the elderly in bed, the femoral neck fracture caused by falls is the most, followed by femur, humerus, rib, spine and tibia fracture, fracture After the plaster is fixed, bed rest is easy to cause muscle or bone atrophy, resulting in joint contracture or rigidity, making the patient bedridden.
2 osteoarthrosis: rheumatoid arthritis, gouty arthritis, diabetic osteoarthrosis and other developments to the late stage caused joint deformation, rigidity, limited patient mobility and further bedridden.
3. Senior age
Due to the influence of various diseases, disability and aging, nearly half of the elderly have no life to take care of themselves. Therefore, prolonging the life expectancy and increasing the proportion of sickness is one of the common causes of prolonged illness. Because of the aging, the elderly even have a cold. Can cause bed rest, and in a short period of time caused a series of chain reactions, developed into bedridden.
4. Other
Other diseases are:
1 Alzheimer's disease and severe psychosis: Alzheimer's disease and severe mental illness patients often suffer from long-term bed rest due to decreased self-care ability or unattended care.
2 progressive disease: some diseases can be treated early, rehabilitation may be effective, but due to the progressive development of the disease, the condition gradually worsens, and finally lead to long-term bed rest, such as spinal side sclerosis, cerebellar atrophy.
3 Post-fall syndrome: As a result of decreased activity after falls, joint stiffness and physical weakness, further reducing the range of activities, and ultimately bedridden.
4 misuse syndrome: due to improper treatment or rehabilitation, such as medication or surgical errors, non-conformity to neurophysiological hemiplegia rehabilitation training, massage techniques, etc., can lead to long-term bed rest, 5 advanced tumor and organ failure: due to advanced tumor The resulting pain, dysfunction and systemic failure, as well as advanced organ failure caused by chronic diseases, make the elderly bedridden.
(two) pathogenesis
The cause of chronic illness in the elderly is multifaceted, and the current pathogenesis has not yet been elucidated.
Prevention
Elderly long-term bed rest prevention
Old people staying in bed for a long time should be based on prevention. Some of them are mild diseases. Because they are not properly guided, the elderly are bedridden. The elderly are generally weak in physical strength, and their resilience and will are all aspects. It is worse than young people, and there are many risks. Therefore, there is a tendency to be too cautious when there is a slight illness. As a result, unnecessary long-term bed rest disuse syndrome systemic symptoms worsen, comorbidity malignancy that makes bed time longer Cycling, therefore, the older the elderly should leave the bed early, to prevent prolonged illness in bed, the specific plan is:
1 prevention causes and incentives, mainly to prevent stroke and fracture.
2 to prevent artificially created long-term bed rest, the elderly should emphasize early activities after bed rest, get out of bed early, excessive silence has adverse consequences.
3 Rehabilitation training should be carried out as soon as possible, and at the latest, it should start 1 week after the onset of illness.
4 Rehabilitation should aim at improving the ability of daily living activities and improving the quality of life, and should not be limited to general rehabilitation training.
5 get up early, change clothes, eat and other daily life should not be in bed.
6 Improve the living environment, use a variety of machines, such as the backrest, sit at the bed, wheelchairs, etc., to avoid complex disability.
7 Actively use community health and welfare facilities, do rehabilitation training, and/or participate in day hospitals to maintain daily living ability, so as to prevent prolonged illness and bed rest.
Complication
Elderly long-term bedridden complications Complications, acne pneumonia
The most common complications are hemorrhoids and pneumonia, and fractures are one of the main causes of long-term bed rest in the elderly.
Symptom
Elderly long-term bedridden symptoms Common symptoms Back pain Depression Loss of appetite Skin aging Anxiety Arteriovenous short circuit Pain threshold Reduce muscle atrophy Muscle contracture Hypotension
Physical performance
Long-term bed rest can cause various complications, which can make the disease worse. Due to a series of clinical manifestations caused by prolonged bed rest and braking, it is called disuse syndrome or lack of exercise syndrome. Once the elderly enter this state, it is difficult to get rid of .
(1) The nervous system:
1 Sensory changes: elderly people who are bedridden for a long time are often accompanied by a decrease in paresthesia and a pain threshold. When a patient with a feeling of afferent nerve fibers is involved, it is quickly expressed below the level of injury.
2 motor function decline: all patients with long-term bed rest are less than those who perform sedentary activities every day. This situation is more obvious in people with restricted exercise caused by flaccid paralysis.
3 autonomic nervous system instability: elderly patients with long-term bed rest, excessive autonomic activity or insufficient activity, it is difficult to maintain the balance of autonomous activities, so patients can not adapt to daily activities such as posture changes, autonomic nervous system instability and cardiovascular system Have a certain impact.
(2) Muscle system: The most obvious signs of prolonged bed rest occur in the muscular system, especially in patients with paralysis.
1 muscle strength, endurance loss: after 1 week in bed, muscle strength can be lost 20%, after each bed for 1 week will reduce the remaining muscle strength by 20%; in the absence of any motor nerve damage, if the dominant side grip force is 50kg, Brake is only 40kg after 1 week, 32kg after 2 weeks, 25kg after 3 weeks, and so on, and the speed of muscle strength recovery is much slower. According to the person who participates in the exercise program with maximum muscle strength every day, Only 10% of the original muscle strength is increased every week, and the loss of endurance is the result of muscle weakness, which is consistent with the decrease in muscle strength.
2 Disuse muscle atrophy: muscle volume reduction is one of the most obvious signs of long-term bed rest, and is also the cause of muscle strength decline. In patients with flaccid paralysis, the action potential of the lower motor unit disappears, and the muscle fiber that it occupies is lost. The contraction ability gradually produces muscle atrophy. In patients with spastic paralysis caused by upper motor neuron damage or splint fixation, muscle atrophy can be only 30% to 35% of normal volume.
3 poor coordination and muscle contracture: muscle atrophy, muscle weakness and limited endurance and other factors cause poor coordination of movement, which is manifested in the upper and lower limbs seriously affect the ability of patients to complete activities of daily living, the main reason for the imbalance of patients with central nervous system damage is It affects the lesions of the motor unit or higher-level center, but the bed itself also plays a role. Muscle atrophy is often accompanied by muscle contracture, which is more common in the knee flexor and extensor muscles, causing serious obstacles to standing and walking.
(3) Skeletal system:
1 Osteoporosis and ectopic calcification: due to decreased muscle activity and increased hydroxyproline and calcium excretion after bed rest, depletion of organic and inorganic compounds in bone leads to osteoporosis, so elderly people in bed are more prone to fracture than their peers The transfer of bone calcium causes transient or persistent hypercalcemia, often accompanied by calcium deposits in damaged soft tissue, which is called ectopic calcification.
2 joint fibrosis and joint rigidity: these two kinds of damage are also the main manifestations of prolonged bed rest. The elderly in bed are reduced due to joint movement, the muscles around the joint are gradually replaced by connective tissue, plus the ectopic calcification of the soft tissue around the joint, the joint changes Stiff, unable to carry out a full range of activities, causing irreversible deformities, causing permanent rigidity of the joints, and can cause deformed arthritis and inflammation around the joints.
3 low back pain: prolonged bed rest caused by back muscle contracture, increased lumbar lordosis, pelvic forward leaning, easily cause back pain.
(4) Cardiovascular system:
1 heart rate increases: elderly people who are in bed for a long time, the sympathetic tension exceeds the vagus nerve, leading to an increase in the basal heart rate.
2 reduction of cardiac reserve: the myocardial contractility of the elderly is reduced, the cardiac output is decreased, and the heart rate is increased after long-term bed rest, the diastolic filling time is shortened, the end-diastolic volume is decreased, and the cardiac function reserve is further reduced before bed rest, so the patient can only perform Limited physical activity, because excessive exertion may cause significant tachycardia and angina, it can also be said to be a manifestation of potential cardiac insufficiency.
3 Orthostatic hypotension: This is one of the most common symptoms of cardiovascular system discomfort after prolonged bed rest. When the elderly in bed for a long time stand up and sit up, both lower extremities are obviously congested, venous return is reduced, and diastolic ventricular filling is hindered. The ventricular stroke volume is reduced, so that the standing blood pressure is significantly reduced.
4 edema: limb movement can promote venous return, limbs that can not move due to disuse can easily lead to venous stasis, increase the hydrostatic pressure of capillaries, edema of fluid penetration into the interstitial space, such as long duration of edema, plasma Fibrinogen infiltrates into the extravascular form to form fibrin, which tends to cause contracture, and contracture increases the degree of disuse, resulting in a vicious circle.
5 venous thrombosis: long-term bed rest, the pump function of the epiphyseal muscle is significantly reduced or disappeared, the venous blood stasis of the lower extremities, plus the elderly are often in a hypercoagulable state, easily lead to venous thrombosis.
(5) Respiratory system:
1 Reduced lung capacity and large volume of ventilation: When the elderly in bed are maximally inhaling or exhaling vigorously, the intercostal muscles, diaphragm and abdominal muscles rarely contract, and the muscles of the respiratory muscles decrease, and the costal joints and costal cartilage joints cannot withstand. The full range of activities resulted in a significant reduction in lung capacity, effective breathing and maximum ventilation.
2 hypoxia: the above-mentioned restrictive damage and horizontal posture (bed) on the pulmonary circulation, the ventilation / blood flow ratio is significantly reduced, such as bedridden elderly can occur under-pulmonary ventilation and excessive blood flow, causing significant arteriovenous short-circuit phenomenon, Reduced arterial oxygen tension leads to hypoxia, and hypoxia is more pronounced if the patient increases metabolic requirements due to infection or exercise.
3 septic pneumonia: bed rest makes the cilia clearance function of the respiratory tract clear, the secretion of mucus in the respiratory tract is easy to accumulate in the lower bronchus, and the respiratory movement is limited and the cough reflex is weakened. It is easy to cause bacteria and viruses to multiply in the lung and cause pneumonia. The elderly suffer from chronic malnutrition, reduced resistance or improper feeding, which causes food to enter the airway and is more likely to induce lung infection.
(6) Digestive system: The gastrointestinal activity of the elderly in bed is completely reduced, which not only affects the peristaltic performance, but also affects the secretion function of the digestive gland.
1 loss of appetite: inactive elderly need to reduce calorie, bed-induced anxiety - depression, can cause significant loss of appetite, and ultimately lead to malnutrition.
2 constipation: long-term bedridden elderly due to increased sympathetic tone, decreased gastrointestinal motility, increased intestinal absorption of water, liquid and fiber intake is too small, prone to constipation, prolonged constipation can cause fecal obstruction, and even intestinal obstruction.
(7) Endocrine and urinary systems:
1 polyuria: mainly occurs in the early stage of bed rest, because the body is in the horizontal position, part of the extracellular fluid is transferred to the vein side of the microvascular bed, which increases the venous return, excites the right atrial volume receptor, and reflects the antidiuretic hormone reflexively. Secretion, leading to polyuria.
2 Increased urinary sodium excretion: This is a temporary phenomenon that occurs with the initial polyuria.
3 excessive urinary calcium: long-term bed rest caused by osteoporosis, bone calcium continuously into the blood, and finally increased urinary calcium excretion.
4 kidney stones and urinary tract infections: due to significant urinary calcium, bladder function damage and placement of the urethra, prone to urinary tract infections, excessive urinary calcium, urinary retention and urinary tract infections can lead to stones in the renal pelvis or lower urinary tract Recurrent urinary tract infections and stones can gradually damage kidney function.
(8) Skin system:
1 Skin atrophy: Subcutaneous fat is reduced due to loss of appetite and malnutrition, skin aging leads to thinning of the skin and degeneration of elastic fibers, resulting in loss of skin fullness.
2 acne: This is a common clinical manifestation of prolonged bed rest, more common in the humerus, ischial tuberosity and external hemorrhoids, etc. This is not only a circulatory disorder caused by simple mechanical compression, but also formed with malnutrition, feces, urine, etc. The local wetting is related to factors such as pollution.
2. Psychological performance
Old people who have been bedridden for a long time have almost certain psychological and mental disorders. Because they can't move, social activities are less prone to anxiety-depression. The ability of intellectual activity is also significantly reduced due to long periods of inactivity and closed doors. According to the survey, at home for a long time. 42% of the elderly in bed are living alone; 58.6% of the family members can talk often; 40% to 60% do not watch TV, newspapers, listen to the radio; 79.3% have no life interest; 39.5% have never been out, social interaction is almost isolated; 18.2% is almost dementia. Therefore, the elderly have been bedridden for a long time, and the quality of life is greatly affected. They are often pessimistic and disappointing. Physical illnesses are also increasingly aggravated. Psychological, mental disorders physical disorders aggravating psychology, mental disorders, forming a vicious circle until Let the old man gradually move towards the end of life.
3. Social performance
Long-term bed rest not only causes physical and mental disabilities and declining quality of life for the elderly, but also imposes a heavy burden on the family and society. Family members of the elderly in bed often need to invest a lot of physical, mental and economic help, thus affecting the family. Normal life, the elderly in bed due to the decline in daily living ability, need more than 90% of the caregivers, resulting in 57.1% of family members can not go out, 33.4% can not sleep, 25.6% can not work, 1.5% can not get married, bedridden elderly for health care Need to increase, high medical expenses, high hospitalization rate, in the elderly with bedridden, 31% in hospitals, the remaining 69%, 2 / 3 at home, 1/3 in the old-age units, with China's family planning policy The implementation of the traditional big family is gradually decreasing, the number of small families is increasing, the dependence of the elderly on the next generation is gradually decreasing, and the increase in the number of small families and the aging of the population will lead to an increase in the number of unaccompanied elderly and widowed elderly. Care will gradually shift to social services, how to use limited social resources and medical services, research to adopt each Social measures to improve the social environment to ensure the health care and living conditions of the elderly in bed are the challenges we face.
In the 1970s, Japan proposed that elderly people who have been treated for illness (including rehabilitation) do not have to get up again and stay in bed for more than 6 months, which is called chronic illness. However, due to the large differences in aging individuals And the causes of bedridden are different, can not be generalized, even in bed in January, according to the type and degree of disease, can be determined to be a long-term bedridden, due to population aging and disease spectrum changes, improve the quality of life of the elderly is gradually valued, in the 1990s Japan Once again, the clinical phenomenon that the elderly suffer from daily life loss due to long-term illness and disability, and some or all of the clinical symptoms that need help, is called bed-long illness, and is classified according to the degree of self-care of the elderly with disabilities as follows:
1 Self-care: Although you have a disability, you can take care of yourself in your daily life and go out on your own.
2 in bed before the period: indoor life can generally take care of themselves, but no one can not go out.
3 bed-level A grade: indoor living needs support, bed life-based, 4 bed-level B-class: all-day bed life.
Examine
Elderly long-term bed rest check
The blood is generally normal.
In patients with pulmonary infection, abnormalities can be found on the X-ray.
Diagnosis
Diagnostic diagnosis of elderly patients with chronic illness
Clinical needs are differentiated from sputum, muscle weakness and hereditary diseases.
