China has now entered an aging society, and the various problems of an aging society have gradually emerged. We often encounter elderly people who are sick, and children are overwhelmed by the need to balance work and care for the elderly, especially for families with only one child. Many elderly people are partially or completely in need of care because of their advanced age, cardiovascular and cerebrovascular diseases, bone and joint diseases or injuries, etc. They are often required by their families and some medical professionals to stay in bed for a long time in order to recover from their illness. But often the patient’s disease or injury has not yet improved, but a series of complications, seriously affecting the patient’s health, and even endanger the patient’s life safety. We remind the majority of patients’ families that the consequences of prolonged bed rest are serious, and once they occur, there is less hope for recovery to rise again, so emphasis should be placed on prevention, and different rehabilitation care measures should be taken for elderly bed-ridden patients with different diseases to prevent the occurrence of complications or reduce the adverse effects caused by complications. Long-term bed rest can lead to various complications and worsen the condition. Prolonged bed rest and braking cause a series of clinical manifestations called disuse syndrome or hypermobility syndrome. Once an elderly person enters this state, it is difficult to get rid of it. Let’s have a general understanding of: Skin system 1, skin atrophy: due to loss of appetite and malnutrition resulting in a decrease in subcutaneous fat, skin aging resulting in thinning of skin thickness and degeneration of elastic fibers, resulting in loss of skin fullness. 2. Decubitus ulcers: This is a common clinical manifestation of prolonged bed rest, mostly seen in parts of the sacral sciatic tuberosity and external ankle. This is not only a circulatory disorder caused by simple mechanical compression, but also related to factors such as malnutrition, local wetness and pollution formed by feces and urine. Respiratory system 1.Decrease in lung volume and ventilation volume: When the bedridden elderly inhale or exhale forcefully, the intercostal muscles, diaphragm and abdominal muscles rarely contract, together with the respiratory muscle strength decreases, and the cribriform joints and cribriform cartilage joints cannot withstand the full range of activities, resulting in a significant decrease in lung volume effective breathing volume and maximum ventilation volume. 2, hypoxia: the above restrictive damage and the effect of horizontal posture (bed rest) on pulmonary circulation make ventilation/blood flow ratio significantly lower, such as bed-ridden elderly can occur in the lower part of the lung hypoventilation and excessive blood flow cause significant arteriovenous short-circuit phenomenon, reducing the arterial oxygen tension, leading to hypoxia. If the patient has raised metabolism due to infection or exercise, the need for hypoxia is more pronounced. 3. Accumulating pneumonia: Bed rest makes the cilia clearance function of the respiratory tract significantly reduced, and respiratory mucus secretion easily accumulates in the lower bronchi, which, together with restricted respiratory movement and weakened cough reflex, easily causes bacteria and viruses to multiply in the lungs and accrue accumulating pneumonia. The elderly are malnourished for a long time, and their resistance is reduced or improper feeding causes food to enter the airway by mistake, which is more likely to induce lung infection. Neurological system 1, sensory changes: long-term bedridden elderly are often accompanied by abnormal sensation and reduced pain threshold. 2.Decreased motor function: All movements of long-term bedridden patients are lower than those of sedentary people who perform daily activities, and this condition is more obvious in people with motor limitation caused by flaccid paralysis. 3. Autonomic nervous system instability: The autonomic nervous system of the elderly who are bedridden for a long time is overactive or underactive, and as a result, it is difficult to maintain a balanced state of autonomic activity, and therefore the patient cannot adapt to daily activities such as postural changes, and the autonomic nervous system is unstable, which also has certain effects on the cardiovascular system. Muscular system The most obvious signs of prolonged bed rest occur in the muscular system, especially in paralyzed patients. 1. Decreased muscle endurance: muscle strength can be lost by 20% after 1 week of bed rest, and every subsequent week of bed rest will result in a 20% decrease in remaining muscle strength. In the absence of any motor nerve damage, a person’s dominant side grip strength of 50kg is 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, with only 10% of the original muscle strength increasing each week for those who participate in the exercise program at maximum muscle strength each day. The loss of endurance is the result of muscle strength loss, and the speed of its occurrence is consistent with muscle strength loss. 2, disuse muscular atrophy: muscle volume reduction is one of the most obvious signs of long-term bed rest, and is also the cause of muscle strength endurance loss. In patients with flaccid paralysis, the muscle fibers innervated by the lower motor unit lose their ability to contract due to the loss of action potentials, gradually producing muscle atrophy. In patients with spastic paralysis caused by damage to upper motor neurons or in patients with splinting, muscle atrophy can be as little as 30% to 35% of normal volume. 3, poor coordination and muscle contracture: muscle atrophy, muscle strength loss and endurance limitation cause poor coordination of movement, which is manifested in the upper and lower limbs and severely affects the patient’s ability to complete activities of daily living. The main cause of uncoordination in patients with central nervous system damage is a lesion affecting the motor unit or higher centers, but bed rest itself also plays a role. Muscle atrophy is often accompanied by muscle contractures, mostly in the knee flexors and extensors, which present a serious obstacle to standing and walking. Skeletal system 1, osteoporosis and heterotopic calcification: Due to reduced muscle activity and increased excretion of hydroxyproline and calcium after bed rest, the depletion of organic and inorganic compounds of bone leads to osteoporosis, thus bed-ridden elderly are more prone to fractures than their peers, and the transfer of bone calcium causes transient or persistent hypercalcemia, often accompanied by calcium deposition in damaged soft tissues, which is called heterotopic calcification. 2, joint fibrous degeneration and joint ankylosis: these two types of damage are also the main manifestations of prolonged bedridden illness. Bedridden elderly people due to reduced joint movement, the muscles around the joints are gradually replaced by connective tissue, coupled with ectopic calcification of soft tissues around the joints, the joints become stiff, unable to carry out the full range of activities, resulting in irreversible deformity, causing permanent joint ankylosis, and can cause deformational arthritis and periarthritis. 3, low back pain: prolonged bed rest causes contracture of the low back muscles, increased lumbar lordosis, and anterior pelvic tilt easily cause low back pain. Cardiovascular system 1.Increased heart rate: In elderly people who are in prolonged bed rest, the sympathetic nerve tension exceeds that of the vagus nerve, resulting in an increase in the basal heart rate. 2, reduced cardiac reserve: elderly people with reduced myocardial contractility, reduced cardiac output and increased heart rate after prolonged bed rest, shortened diastolic filling time, reduced end-diastolic volume, further reduction in cardiac function reserve than before bed rest, so the patient can only perform limited physical activity, because excessive exertion may cause significant tachycardia and angina, which can also be said to be a manifestation of potential cardiac insufficiency. 3, upright hypotension: This is one of the most common symptoms of cardiovascular system maladjustment after prolonged bed rest. When the elderly who are bedridden for a long time get up and sit up, both lower extremities are obviously stagnant, the venous return is reduced, which prevents the diastolic ventricular filling and reduces the ventricular beat volume, thus making the standing blood pressure significantly lower. 4, edema: the movement of the extremities can promote venous return. The limbs that cannot move because of disuse can easily lead to venous blood stagnation, so that the fluid hydrostatic pressure of capillaries increases, and fluid infiltration into the tissue interstitial edema occurs, such as edema lasts for a long time, the fibrinogen in the plasma infiltrates outside the blood vessels, forming fibrin, which can easily cause contracture, and contracture can increase the degree of disuse, resulting in a vicious circle. 5, venous thrombosis: long-term bedridden bone iliac muscle pump role significantly reduced or disappeared, lower limb venous blood stagnation coupled with the elderly are often in a state of hypercoagulation, easily cause venous thrombosis. Digestive system The bedridden elderly have a general decrease in gastrointestinal activity, which not only affects peristalsis, but also affects the secretory function of digestive glands. 1, loss of appetite: inactive elderly caloric needs reduced, bedridden caused by anxiety, depression can cause significant loss of appetite, and ultimately lead to malnutrition. 2, constipation: long-term bedridden elderly due to increased sympathetic nerve tone, gastrointestinal peristaltic function is reduced, intestinal absorption of water increased, fluid and fiber intake is too low, easy to cause constipation. Prolonged constipation can cause fecal obstruction or even intestinal obstruction. Endocrine and urinary system 1.Polyuria: It mainly occurs in the early stage of bed rest, because the body is in horizontal position, some extracellular fluid is transferred to the venous side of the microvascular bed, which increases venous return, and the right atrial volume receptor reflexively inhibits the secretion of antidiuretic hormone, leading to polyuria. 2.Increased urinary sodium excretion: This is a temporary phenomenon that occurs along with initial polyuria. 3, excessive urinary calcium: prolonged bed rest causes osteoporosis, bone calcium continuously enters the blood, and finally increases urinary calcium excretion. 4.Kidney stone and urinary tract infection: Due to significant excess urinary calcium, impaired bladder function and placement of urinary catheters, urinary tract infection is likely to occur. Excessive urinary calcium, urinary retention and urinary tract infections can lead to stones in the renal pelvis or lower urinary tract. Repeated episodes of urinary tract infections and stones can gradually impair kidney function. In addition, the bedridden elderly almost all have certain psycho-psychiatric disorders, because they cannot move, social activities are reduced, anxiety, depression, intellectual activity is also significantly reduced due to long-term inactivity and closed doors, the quality of life is greatly affected, often pessimistic and disappointed, physical disorders are often increasingly aggravated psycho-psychiatric disorders → physical disorders → aggravated psycho-psychiatric disorders, forming a vicious circle, until The vicious circle is formed, until the elderly gradually towards the end of life. Prolonged bed rest not only causes physical and mental impairment and quality of life to the elderly, but also brings heavy burden to the family and society. Family members of the bedridden elderly often need to devote a lot of physical, mental and financial help, which affects the normal life of the family. In the 1970s, Japan proposed that an elderly person who has no hope of getting up again after treatment (including rehabilitation) due to illness or disability and has been bedridden for more than 6 months is called bedridden. However, due to the large individual differences in aging and different causes of bedridden illnesses, it is not possible to generalize, and even being bedridden for 1 month can be determined as bedridden according to the type and degree of illness. Due to the aging of the population and the change of the disease spectrum, the improvement of the quality of life of the elderly has been gradually paid attention to. 90’s Japan again proposed that the clinical phenomenon that the elderly people need help in part or all of their daily life due to long-term illness and disability is called bed-ridden with prolonged illness and graded according to the degree of self-care of daily life of the disabled elderly as follows: 1.Self-care of daily life: Although they have disabilities, they can generally take care of themselves in daily life and can go out on their own; 2.Pre-bed-ridden 2.Pre-bedridden period: the elderly can generally take care of themselves in indoor life, but cannot go out without support; 3.Bedridden period A grade: indoor life needs support, bed life is the main; 4.Bedridden period B grade: all-day bed life. The importance of rehabilitation Medical rehabilitation In addition to treating the primary disease, emphasis is placed on early diagnosis, early treatment and early rehabilitation in order to get out of bed early. 1.Prevent and control infections, mainly pneumonia and urinary tract infection, pay attention to nutrition and metabolism, and do a good job of supportive treatment. 2, prevention and control of decubitus ulcers, strengthen the management of urinary and fecal infiltration sites, regular turning, timely change of mat sheets, and keep local cleanliness. 3, timely treatment of neurogenic bladder urinary tract stones or urinary closure. 4.Mental disorders should be managed and treated when they appear, so as not to become a state of desolation, and properly deal with senile dementia. 5.Strengthen exercise, we should do everything possible to make the bedridden elderly to carry out activities and exercise, such as gradually start exercise training, assembling orthopedic devices to improve mobility, and educate family members and companions, in order to make the disease to recover, to encourage the elderly to do daily life activities by themselves, do not work on their behalf. Psychological rehabilitation The bedridden elderly often have different degrees of tension, pain, fear, depression, anxiety and even anger, at this time, in addition to physical treatment, it is necessary to pay attention to psychological rehabilitation, that is, through language and feelings, mannerisms and speech, the patient to understand the causes of morbidity and related factors, influence and change the patient’s feelings, understanding, emotions, behavior, establish a correct understanding of disability and attitude, improve and eliminate the patient’s The patient’s pathological psychological state and the resulting physical symptoms and dysfunctions, so that the form and spirit are in harmony, the spirit and body are unified, and the positive influence and role of the spirit on the body is given full play, so as to finally achieve the purpose of reducing disability or promoting the cure of disability, the means of which include methods such as emotional and moral harmony, psychological guidance, psychological suggestion and behavioral therapy. Care and prognosis Elderly people who are bedridden for a long time should be strengthened to prevent bedsores and pneumonia and fractures. Older people who are bedridden for a long time should be based on prevention. Some illnesses that are otherwise mild result in bedridden elderly people due to the lack of proper guidance for them. The elderly are generally physically weaker, their resilience, will and other aspects are worse than young people, the risk is also more, so a little bit of minor illness, there is a tendency to engage in too much caution, resulting in unnecessary long-term bed rest → disuse syndrome → systemic symptoms worsen, comorbidities → make the vicious circle of bed rest time more extended. Therefore, the more elderly people should leave bed early to prevent prolonged bed rest. Specific programs are: 1. Prevent causes and triggers, mainly stroke and fracture; 2. Prevent artificially created prolonged bed rest and prevent complications after bed rest for the elderly, the most common complications are bedsores and pneumonia. Fracture is also one of the main causes of prolonged bed rest in the elderly. 3, proper massage can be prevented. But the massage needs to choose the right location, otherwise it will not play a rehabilitation effect, but may aggravate the condition. Method/Step Massage back to prevent pneumonia: the elderly take a semi-recumbent position, waist with pillows against, family members standing behind the elderly, a hand holding the elderly shoulders, the other hand of the palm root back and forth to rub the muscles on both sides of the spine 3 – 5 minutes, and then lightly clenched fist (note the palm hollow), rhythmically from the bottom up, from the outside to the inside gently buckle back, while buckling to encourage the elderly cough. If the elderly cannot sit up, they can also use the same technique to pat and massage on their side. In addition, keeping the room ventilated, usually for 30 minutes each time, two to three times a day, strengthening oral hygiene and practicing balloon blowing can help prevent pneumonia. Prevention of decubitus ulcers: Allowing the elderly to change positions, wiping and drying exposed parts with warm water, keeping beds flat, soft and clean, turning over frequently (once every 2 hours) and using an anti-decubitus mattress all help prevent decubitus ulcers. Press the soles of the feet to prevent urinary infections: Frequent foot massage helps prevent urinary infections. The soles of the feet are densely distributed with reflex zones of the urinary system, such as the kidneys, ureter, bladder, urethra, and lymph glands, which all have corresponding reflex zones on the soles. The operator can use the knuckle of the index finger, or other blunt round tools (such as pen caps, etc.), to each toe as the beginning, the sequence to the heel point press, continuous press after 5 toes as a group, 3 groups per day massage. In addition, the elderly should also try to drink more water (more than 1500 ml per day), and then wash the perineum, if necessary, to give acupuncture, hot compresses, etc. can also help prevent urinary tract infections. Press the lower waist to prevent constipation: In addition to improving food, frequent massage of the location under the belt (about one thumb width outward under the spinous process of the fourth lumbar vertebra) can help prevent the occurrence of constipation. Here there are the third, fourth and fifth lumbar nerve branches and lumbar arteries and veins through, regular massage can promote intestinal motility. Elderly people lying prone or on their sides, with the thumb finger surface pressure, and a little force to rub 1 – 2 minutes (massage in a circle when rubbing), massage 3 – 5 times a day. If you need to solve specific problems, we recommend that you go to the hospital to interview the relevant health care professionals.