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Explaining Oedema for the Elderly: Symptoms & DiagnosisArticle by Daniel Westhead
Have you been suffering from swollen lower extremities? If so, you might have something called oedema – a build-up of fluid in the body's tissues that causes puffiness and pain.
Incidences of oedema and lymphoedema (a more serious form of swelling that occurs when the lymphatic system doesn't work properly) rise with age. This means it's common in senior citizens. The conditions affect around four people per 1,000 in the general population, compared with around 29 people per 1,000 aged 85 and over.
The first step towards preventing and treating oedema (which can also be spelled edema) is understanding the symptoms, causes and diagnostic tools. Keep reading as we explain everything you need to know about swollen feet and legs in the elderly.
What is oedema?
Quite simply, oedema is the medical term for swelling. Fluid gets trapped in your body's tissues – sometimes the face, hands and tummy, but more often the lower extremities. Thankfully, this build-up usually drains by itself. However, you may need to speak to a GP if the condition doesn't improve within a few days.
Why are swollen legs in the elderly so prevalent? In most cases, an underperforming circulatory system is to blame. It's harder to pump blood upwards against gravity, especially if you have a sedentary lifestyle and poor diet.
What is the difference between swelling and oedema?
To the untrained eye, swelling and oedema look identical. Both cause puffiness, reduced mobility and discomfort. However, while they technically mean the same thing, there are subtle differences.
General swelling usually goes away within a few days, and it's typically the body's response to an injury. Think about the last time you sprained your ankle or stubbed your toe – the initial pain quickly disappears with ibuprofen, ice and rest. Ultimately, it's a predictable inflammatory response to an outside stimulus.
In contrast, oedema is chronic swelling that doesn't always respond to at-home interventions. Fluid gathers in the tissues surrounding vulnerable joints, leading to swollen ankles and feet in the elderly. Although it's sometimes triggered by inflammation, medication, infection and lifestyle diseases, such as heart disease and obesity, play significant roles.
Is oedema very serious?
Luckily, most cases of oedema are completely reversible and non-life threatening. It's a relatively common condition that doctors are well-equipped to diagnose and treat.
However, that doesn't make it any easier to live with – even first-stage oedema can be physically uncomfortable and mentally distressing. There's no need to suffer in silence. Speak to your healthcare provider if you're worried or experiencing pain.
What causes swollen ankles and feet in the elderly?
We've already touched on a few points about what causes swollen feet and legs in the elderly, but let's dive into a bit more detail. You'll be pleased to know most contributing factors are easy to resolve with a few simple tweaks!
Above all else, lifestyle is the leading cause of oedema. Let's go back to something we mentioned earlier – the circulatory system. Being sedentary and sitting too long triggers swelling, whereas regular movement encourages fluid to break down. Pumping and squeezing your muscles literally moves fluid back to the heart.
Plus, what you eat impacts your feet! Salty food is the main culprit because excess sodium causes fluid retention. Consuming 400mg of sodium – the equivalent of one gram of table salt – forces the body to hold onto an extra four cups of water. Counterintuitively, the only way to flush out this excess fluid is by drinking more.
Lastly, lack of movement and poor diet are precursors for obesity. The heavier you are, the harder it is for the body's drainage system to function properly. This is partly because excess fat puts too much pressure on the lymphatic vessels.
Another cause of swollen feet in the elderly is medication – oedema is actually a side effect of certain pills. We suggest reading labels carefully and speaking to your doctor, so you know what to expect. They can always recommend alternative treatments if the swelling becomes too uncomfortable.
Medications that induce swelling include:
- Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, aspirin and naproxen
- High blood pressure medications
- Diabetes drugs, notably thiazolidinediones
- Steroids, including prednisone and methylprednisolone
- Pramipexole – used to treat restless legs syndrome and the symptoms of Parkinson's disease
Although injury typically produces short-term swelling, it can lead to chronic oedema if left untreated. However, you're unlikely to suffer from a minor bump or scrape. Instead, we're talking about serious car accidents, burns and infections.
After major trauma, fluid from the wounds might leak into surrounding areas, including the brains, lungs and other organs. The condition may be permanent if you've suffered from severe vein or tissue damage, but most people fully recover.
While the causes of oedema are normally uncomplicated, there are a few exceptions. Persistently swollen legs and feet in the elderly can be a sign of more serious illnesses, including:
- Pulmonary oedema – fluid build-up in the lungs
- Cirrhosis – the severe scarring or fibrosis of the liver
- Kidney, liver and ovarian cancers
- Kidney disease
- Thyroid disorders
- Blood clots
- Deep vein thrombosis
- Allergic reactions
Oedema isn't always a bad thing – sometimes, it's trying to help. When you have an infection, you'll probably notice swelling. That's because the body pumps more healthy white blood cells into the compromised area.
However, serious infections require immediate medical attention. For example, people with diabetes are more sensitive to oedema and regular bruising, cuts and scrapes. If left untreated, broken skin could become gangrenous and have devastating consequences.
Common oedema symptoms
Now we've explained what causes swollen legs and feet in the elderly, it's time to move on to the symptoms. The good news is that most of the signs are pretty obvious, meaning you can establish preventative measures early on!
When should you be worried about oedema? Contact your GP or local A&E department if you experience:
- Shortness of breath
- Irregular heartbeat
- Chest pain
Swelling or puffiness
Swelling and puffiness are the first signs of oedema. Fluid pools in the legs, ankles and feet, making it uncomfortable to complete everyday tasks. Sometimes, body parts can double in size and lose definition, which can be physically painful and emotionally upsetting.
Stretched or shiny skin
As fluid builds, your skin has to stretch to accommodate the extra size. Consequently, you might notice tightness, redness and shininess. On top of this, stretched skin is often itchy. Moisturise daily and do your best to avoid scratching – otherwise, you could hurt yourself and risk infection.
Pitted skin is essentially dimpling. When you have oedema and press into the swollen area for a few seconds, an indentation (or pit) will remain. This is usually a sign of later stages oedema, where the fluid has accumulated to an unmanageable level.
Leg heaviness and reduced mobility go hand in hand with oedema. As tissue expands around joints, it restricts everyday movements. In the worst cases, you find yourself in an impossible situation – you need to exercise to improve circulation, but you can't because it's too painful.
While swollen ankles in the elderly are uncomfortable, they're nothing compared to bloated, distended tummies. Eventually, oedema can affect other areas of the body, especially if you don't make positive lifestyle changes. If you experience abdominal pain paired with excess fluid in your lower body, it's time to seek professional help.
How do doctors diagnose oedema?
Diagnosing swollen legs in the elderly is mostly straightforward and pain-free. Firstly, your doctor will run through your medical background, including lifestyle diseases and family history. Next, you'll receive a thorough physical examination.
Your healthcare provider will look for the above oedema symptoms and use a grading scale to identify the severity of your condition. They'll do this through a pitting test – pressing gently into the affected area for five to 15 seconds and then timing how long it takes for the indentation to rebound. Results include:
- Grade one – immediate rebound with a 2mm pit
- Grade two – less than 15 second rebound with a 3 to 4mm pit
- Grade three – rebound between 15 and 60 seconds with a 5 to 6mm pit
- Grade four – rebound between two to three minutes with an 8mm pit
The more severe the oedema, the more invasive the treatment. Generally, your doctor will advise lifestyle changes and simple home remedies like elevation and compression socks. However, grade three and four oedema may require diuretics – medicines that encourage the kidneys to excrete more water and sodium.
You’re in good hands with a SureSafe alarm
Knowing when to seek treatment and understanding more about swollen legs in the elderly can give you extra peace of mind. Nevertheless, living with oedema is still challenging, but SureSafe can provide some much-needed reassurance.