Long illness loss

Introduction Long-term illness loss refers to the decline in daily living ability due to long-term illness and disability. When the body is sick for a long time, the various functions of the body are in a process of rapid decline. At this time, it will cause physical weakness and other diseases. 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 families and society. Family members of elderly people in bed often need to invest a lot of physical, mental and financial help, which affects the normal life of their families.

Cause

(1) Causes of the disease

1. Cerebrovascular disease: Cerebrovascular disease is the leading cause of prolonged illness in the elderly (more than 50%). 1 Severe stroke: After the acute phase treatment, the elderly who suffered from severe cerebrovascular accidents saved their lives, but left behind the symptoms of nerve defects, affecting the function of limb activities, including loss of recognition, loss of function, and deep sensory disturbance. Arrhythmia, bilateral spasms or severe flaccid paralysis. This situation often has no hope of improvement or almost no improvement, thus allowing the patient to stay in bed for a long time. 2 stroke combined with other diseases: some patients with cerebral thrombosis, especially elderly patients, although left behind, but on the basis of acute myocardial infarction, or lower extremity amputation, so that the disease worsened and prolonged bed rest, this situation is called Compound disability.

2. Bone and joint diseases: The following diseases can cause long-term illness in bed. 1 Fracture: Fracture is also one of the main reasons for the elderly to stay in bed for a long time (20%). Among the elderly in bed, the femoral neck fracture caused by falls is the most, followed by fractures of the femur, tibia, ribs, spine and tibia. After the fracture, the plaster is fixed and the bed rest is easy to cause muscle or bone atrophy, causing joint contracture or rigidity. The state makes the patient bedridden. 2 osteoarthrosis: rheumatoid arthritis, gouty arthritis, diabetic osteoarthrosis and other developments to the late stage caused joint deformation, rigidity, and restricted patient mobility further led to bedridden.

3. Senior age: Nearly half of the elderly with longevity can not take care of themselves due to the effects of various diseases, disabilities and aging. Therefore, prolonged life expectancy and increased proportion of sickness are one of the common causes of prolonged bed rest. Due to aging, older people, even if they have a cold, can cause bed rest and cause a series of chain reactions in the short term, which can become bedridden.

4. Others: Other diseases include: 1 Alzheimer's disease and severe mental illness: 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 may be effective in early treatment and rehabilitation, but due to the progressive development of the disease, the condition gradually worsens, and finally lead to chronic illness, such as spinal side sclerosis and 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, hemiplegia rehabilitation training that does not meet neurophysiology, rough massage techniques, etc., can lead to long illness in bed. 5 advanced tumor and organ failure: elderly patients are bedridden due to pain, dysfunction and systemic failure caused by advanced tumors and advanced organ failure caused by chronic diseases.

an examination

Related inspection

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(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 condition is more pronounced in people with limited exercise caused by flaccid paralysis.

3 autonomic nervous system instability: the elderly in bed long-term autonomic nervous system hyperactivity 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 also has a certain impact on the cardiovascular system.

(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, Only 40kg after 1 week of braking, 32kg after 2 weeks, 25kg after 3 weeks, and so on. The rate of muscle strength recovery is much slower. It is calculated by the person who participates in the exercise program with maximum muscle strength every day, and only increases the original muscle strength by 10% per week. Loss of endurance is the result of decreased muscle strength, and its rate of occurrence is consistent with decreased muscle strength.

2 Disuse muscle atrophy: muscle volume reduction is one of the most obvious signs of long-term bed rest, and it is also the cause of muscle strength loss. In patients with flaccid paralysis, the action potential of the lower motor unit disappears, and the muscle fiber that it occupies loses its contractile ability, and muscle atrophy gradually occurs. A patient with spastic paralysis caused by impaired upper motor neurons or a patient with 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 caused by poor coordination of movement, manifested in the upper and lower limbs seriously affect the ability of patients to complete activities of daily living. The main cause of disharmony in patients with central nervous system damage is affecting the movement of the motor unit or higher-level center, but the bed itself also plays a role. Muscle atrophy is often accompanied by muscle contractures, which are more common in the knee flexors and extensors, 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. In bed-ridden elderly people, due to the reduction of joint movement, the muscles around the joints are gradually replaced by connective tissue, and the ectopic calcification of the soft tissues around the joints, the joints become stiff, unable to carry out a full range of activities, causing irreversible deformities, causing permanent rigidity of the joints. 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 decreased, the cardiac output decreased, and the heart rate increased after long-term bed rest, the diastolic filling time was shortened, the end-diastolic volume was reduced, and the cardiac function storage was further reduced before bed rest, so the patient could 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 limbs are obviously congested, the venous return is reduced, the diastolic ventricular filling is hindered, and 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 blood stasis, so that the hydrostatic pressure of capillaries increases, and the liquid penetrates into the interstitial space to cause edema. If the edema lasts for a long time, fibrinogen in the plasma penetrates into the blood vessels to form fibrin, which is easy to cause contracture. The contraction can increase 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 vital 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 are weakened, 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 was significantly reduced. For example, elderly people in bed can have insufficient ventilation in the lower part of the lungs and excessive blood flow, causing significant arteriovenous short circuit, reducing arterial oxygen tension and causing hypoxia. 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. . Old people with chronic malnutrition, reduced resistance or improper feeding cause food to enter the airway, and it is more likely to induce lung infection.

Differential diagnosis

(1) 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. Constipation for a long time can cause obstruction of the feces and even intestinal obstruction.

(2) 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 urinary catheter, prone to urinary tract infection. Excessive urinary calcium, urinary retention, and urinary tract infections can cause stones in the renal pelvis or lower urinary tract. Repeated urinary tract infections and stones can gradually damage kidney function.

(3) 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 long-term bed rest, more common in the humerus, ischial tuberosity and external hemorrhoids. This is not only a circulatory disorder caused by simple mechanical compression, but also related to local moisturization and pollution caused by malnutrition, feces and urine.

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