Bedridden

Introduction I am sick in bed and can't get up. Bedridden (or long-term bed rest, long-term bed rest) 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.

Cause

1. Cerebrovascular disease: cerebrovascular disease is the primary cause of prolonged illness in the elderly (more than 50%) 1 severe stroke: the elderly with severe cerebrovascular accidents, after the acute phase of treatment, saved lives, but The legacy of neurological deficits affects limb function, including loss of recognition, loss of function, ataxia caused by deep sensory disturbances, bilateral sputum 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 to make the disease worse, resulting in long-term bed rest, this situation is called compound Sexual 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%). In the bedridden elderly, the femoral neck fracture caused by the fall is the most, followed by the fracture of the femur and tibia, the spine and the tibia. After the fracture, the plaster is fixed, and the bed rest is easy to cause the muscle or bone atrophy to cause the joint contracture or rigidity. The patient is bedridden. 2 osteoarthrosis: rheumatoid arthritis, gouty arthritis, diabetes, osteoarthrosis, etc., to the late stage, causing joint deformation, rigidity, and restricting patient activity further leads to bedridden.

3. Old age: The elderly with longevity can not take care of themselves due to the effects of various diseases such as disability 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 can cause bed-ridden even if they have a cold, and cause a series of chain reactions to develop into bedridden in the short term.

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 may be effective in the early treatment and rehabilitation, but due to the progressive development of the disease, the disease gradually worsens, and finally lead to long-term bed rest 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 do not meet the neurophysiological hemiplegia rehabilitation training, 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

General radiography examination of bone and joint soft tissue CT examination chest CT examination

Bedridden - clinical manifestations

1. Physical manifestations: long-term bed rest can occur in a variety of complications, making the disease worse due to long-term bed rest and braking caused by a series of clinical manifestations, called the disuse syndrome or lack of exercise syndrome, once the elderly enter this state Hard to get rid of.

(1) The nervous system:

1 Sensory changes: Elderly people who are bedridden for a long time are often accompanied by paresthesia and a decrease in pain threshold. When paralyzed patients involve sensory afferent nerve fibers, they quickly show a loss of sensation or sensation below the level of injury.

2 motor function decline: long-term bedridden patients all exercise is lower 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 autonomic activity, so patients can not adapt to daily changes such as posture changes, autonomic nervous system instability and cardiovascular system Certain influence.

(2) Muscle system: The most obvious signs of prolonged bed rest occur in patients with muscle system 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, 25kg after 3 weeks and 32kg 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, often accompanied by muscle contracture, is more common in knee flexors and extensors, which pose serious obstacles to standing and walking.

(3) Skeletal system:

1 Osteoporosis and ectopic calcification: Osteoporosis is caused by decreased muscle activity and hydroxyproline and calcium excretion after bed rest, resulting in 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. Because of the reduction of joint movement in the bed, 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 and cannot perform a full range of activities, causing irreversible deformities, causing permanent rigidity of the joints. Causes deformed arthritis and inflammation around the joints.

3 low back pain: prolonged bed rest caused by back muscle contracture, lumbar lordosis increased pelvic forward tilt, easily cause back pain.

(4) Cardiovascular system:

1 Heart rate increases: In the elderly who are in bed for a long time, the sympathetic tension exceeds the vagus nerve and the basal heart rate increases.

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 shortened the end-diastolic volume, and the cardiac function storage was further reduced than before bed, so the patient can only be limited. Physical activity, because excessive exertion may cause significant tachycardia and angina, 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. The elderly who stayed in bed for a long time had obvious reduction of venous venous return in both lower limbs when standing up and sitting up, which prevented the diastolic ventricular filling ventricular stroke volume from decreasing, thus significantly lowering the standing blood pressure.

4 edema: limb movement can promote venous return, limbs that cannot be moved due to disuse can easily lead to venous stasis, which increases the hydrostatic pressure of capillaries, and edema occurs when liquid penetrates into the interstitial space. 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, coupled with the elderly often in a hypercoagulable state can easily cause 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 hypoventilation and excessive blood flow in the lower part of the lungs, causing significant arteriovenous short circuit to reduce arterial oxygen tension and lead to hypoxia. If the patient increases metabolism due to infection or exercise, hypoxia is more pronounced.

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 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. Constipation for a long time can cause obstruction of the stool or 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 venous side of the microvascular bed to increase venous return, and excitatory right atrial volume receptor reflex inhibits the secretion of vasopressin. Causes polyuria.

2 Increased urinary sodium excretion: This is a temporary phenomenon that occurs with the initial polyuria.

3 excessive urinary calcium: prolonged 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 urinary calcium significantly excessive bladder function damage and placement of the urethra, 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.

(8) Skin system:

1 skin atrophy: subcutaneous fat is reduced due to loss of appetite and malnutrition, skin aging leads to thinning of skin thickness and elastic fiber degeneration, 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 manure and urine.

2. Psychological performance: The elderly 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, and their mental activity is also significantly reduced due to long periods of inactivity and closed doors. According to the survey, 42% of the elderly who stayed in bed for a long time live alone; only 58.6% of the family members can talk frequently; 40% to 60% do not watch TV, newspapers, and radio; 79.3% have no interest in life; 39.5% have never had social interactions. Almost isolated; 18.2% nearly dementia. Therefore, the elderly have been bedridden for a long time, the quality of life is greatly affected, often pessimistic disappointment of physical illness is also increasingly aggravated, psychological and mental disorders physical disorders aggravation of mental disorders, forming a vicious circle until the elderly 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 families and society. Family members of the elderly in bed often need to invest a lot of physical, mental and financial help, which affects the normal life of the family. The elderly in bed are declining in their daily living ability, and more than 90% of them need special care, resulting in 57.1% of family members can not go out. 33.4% can't sleep, 25.6% can't work, 1.5% can't get married. The elderly in bed have increased medical care needs, high medical expenses, and high hospitalization rates. Among the elderly who have been bedridden for a long time, 31% are in the hospital, and 2/3 of the remaining 69% are at home and 1/3 are in the old-age unit. With the implementation of China's family planning policy, the traditional big family is gradually decreasing, the number of small families is increasing, the dependence of the elderly on the next generation's economy is gradually decreasing. The increase of small families and the aging of the population will lead to the number of elderly people who are unattended and the number of lonely elderly people. As a result, the care of the elderly in bed will gradually shift to social services. How to use limited social resources and medical services to study and adopt various social measures to improve the social environment to ensure that the medical care and living conditions of the elderly in bed are The challenge we face.

Complications: The most common complications are acne and pneumonia. Fracture is also one of the main reasons for the elderly to stay in bed for a long time.

Bedridden - diagnosis

Diagnostic criteria for bedgage in the 1970s Japan proposed that elderly people who have been treated for illness (including rehabilitation) do not get up again and stay in bed for more than 6 months are called chronic illnesses, but the individual differences due to aging and the cause of bed rest Different, can not be generalized, even in bed in January, according to the type and extent of the disease can be determined to be a long-term bed. Due to the ageing of the population and changes in the spectrum of diseases, improving the quality of life of the elderly has gradually received attention. In the 1990s, Japan once again proposed that the clinical phenomenon of elderly people who need some or all of their daily life loss due to long-term illness and disability is called chronic illness. According to the degree of self-care of the elderly with disabilities, they are classified as follows: 1 Self-care: Although there are disabilities, daily life can generally take care of themselves and go out on their 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 life needs people to support bed life. 4 bed-level B-class: full-day bed life.

Differential diagnosis

Back pain in bed is aggravated: low back pain is aggravated when lying in bed, but it is relieved after getting up, and lumbar fibrosis should be considered.

Bedridden - clinical manifestations

1. Physical manifestations of long-term bed rest can occur in a variety of complications, making the disease worse due to long-term bed rest and braking caused by a series of clinical manifestations, called the disuse syndrome or lack of exercise syndrome, the elderly are difficult to enter this state get rid of.

(1) The nervous system:

1 Sensory changes: Elderly people who are bedridden for a long time are often accompanied by paresthesia and a decrease in pain threshold. When paralyzed patients involve sensory afferent nerve fibers, they quickly show a loss of sensation or sensation below the level of injury.

2 motor function decline: long-term bedridden patients all exercise is lower 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 autonomic activity, so patients can not adapt to daily changes such as posture changes, autonomic nervous system instability and cardiovascular system Certain influence.

(2) Muscle system: The most obvious signs of prolonged bed rest occur in patients with muscle system 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, 25kg after 3 weeks and 32kg 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, often accompanied by muscle contracture, is more common in knee flexors and extensors, which pose serious obstacles to standing and walking.

(3) Skeletal system:

1 Osteoporosis and ectopic calcification: Osteoporosis is caused by decreased muscle activity and hydroxyproline and calcium excretion after bed rest, resulting in 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. Because of the reduction of joint movement in the bed, 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 and cannot perform a full range of activities, causing irreversible deformities, causing permanent rigidity of the joints. Causes deformed arthritis and inflammation around the joints.

3 low back pain: prolonged bed rest caused by back muscle contracture, lumbar lordosis increased pelvic forward tilt, easily cause back pain.

(4) Cardiovascular system:

1 Heart rate increases: In the elderly who are in bed for a long time, the sympathetic tension exceeds the vagus nerve and the basal heart rate increases.

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 shortened the end-diastolic volume, and the cardiac function storage was further reduced than before bed, so the patient can only be limited. Physical activity, because excessive exertion may cause significant tachycardia and angina, 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. The elderly who stayed in bed for a long time had obvious reduction of venous venous return in both lower limbs when standing up and sitting up, which prevented the diastolic ventricular filling ventricular stroke volume from decreasing, thus significantly lowering the standing blood pressure.

4 edema: limb movement can promote venous return, limbs that cannot be moved due to disuse can easily lead to venous stasis, which increases the hydrostatic pressure of capillaries, and edema occurs when liquid penetrates into the interstitial space. 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, coupled with the elderly often in a hypercoagulable state can easily cause 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 hypoventilation and excessive blood flow in the lower part of the lungs, causing significant arteriovenous short circuit to reduce arterial oxygen tension and lead to hypoxia. If the patient increases metabolism due to infection or exercise, hypoxia is more pronounced.

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 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. Constipation for a long time can cause obstruction of the stool or 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 venous side of the microvascular bed to increase venous return, and excitatory right atrial volume receptor reflex inhibits the secretion of vasopressin. Causes polyuria.

2 Increased urinary sodium excretion: This is a temporary phenomenon that occurs with the initial polyuria.

3 excessive urinary calcium: prolonged 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 urinary calcium significantly excessive bladder function damage and placement of the urethra, 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.

(8) Skin system:

1 skin atrophy: subcutaneous fat is reduced due to loss of appetite and malnutrition, skin aging leads to thinning of skin thickness and elastic fiber degeneration, 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 manure and urine.

2. Psychological performance: The elderly 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, and their mental activity is also significantly reduced due to long periods of inactivity and closed doors. According to the survey, 42% of the elderly who stayed in bed for a long time live alone; only 58.6% of the family members can talk frequently; 40% to 60% do not watch TV, newspapers, and radio; 79.3% have no interest in life; 39.5% have never had social interactions. Almost isolated; 18.2% nearly dementia. Therefore, the elderly have been bedridden for a long time, the quality of life is greatly affected, often pessimistic disappointment of physical illness is also increasingly aggravated, psychological and mental disorders physical disorders aggravation of mental disorders, forming a vicious circle until the elderly 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 families and society. Family members of the elderly in bed often need to invest a lot of physical, mental and financial help, which affects the normal life of the family. The elderly in bed are declining in their daily living ability, and more than 90% of them need special care, resulting in 57.1% of family members can not go out. 33.4% can't sleep, 25.6% can't work, 1.5% can't get married. The elderly in bed have increased medical care needs, high medical expenses, and high hospitalization rates. Among the elderly who have been bedridden for a long time, 31% are in the hospital, and 2/3 of the remaining 69% are at home and 1/3 are in the old-age unit. With the implementation of China's family planning policy, the traditional big family is gradually decreasing, the number of small families is increasing, the dependence of the elderly on the next generation's economy is gradually decreasing. The increase of small families and the aging of the population will lead to the number of elderly people who are unattended and the number of lonely elderly people. As a result, the care of the elderly in bed will gradually shift to social services. How to use limited social resources and medical services to study and adopt various social measures to improve the social environment to ensure that the medical care and living conditions of the elderly in bed are The challenge we face.

Complications: The most common complications are acne and pneumonia. Fracture is also one of the main reasons for the elderly to stay in bed for a long time.

Bedridden-diagnosis: Diagnostic criteria for bedgage in chronic illnesses 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. The difference is large and the cause of bed rest is different. It cannot be generalized. Even if you stay in bed for one month, you can decide to stay in bed for a long time depending on the type and degree of the disease. Due to the ageing of the population and changes in the spectrum of diseases, improving the quality of life of the elderly has gradually received attention. In the 1990s, Japan once again proposed that the clinical phenomenon of elderly people who need some or all of their daily life loss due to long-term illness and disability is called chronic illness. According to the degree of self-care of the elderly with disabilities, they are classified as follows: 1 Self-care: Although there are disabilities, daily life can generally take care of themselves and go out on their 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 life needs people to support bed life. 4 bed-level B-class: full-day bed life.

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