To most, a little weight gain or minor swelling in certain areas might not seem like a reason to seek medical help. However, for elderly or chronically ill individuals, these could be signs of edema, an often misunderstood and potentially serious condition. Once called dropsy, edema affects 4.4 million people in the United States and is frequently caused by an underlying condition, such as kidney damage, heart failure, chronic lung disease, liver disease or even arthritis. Specifically, the condition occurs when excess fluid leaks out of small blood vessels and is trapped in the surrounding tissues caused by triggers like an injury, surgery, allergic reaction or changes in the body’s chemical composition.
Types of Edema
While there are various kinds of edema, the most common is peripheral edema, which occurs in the feet, ankles, legs, hands and arms. Generalized edema refers to fluid retention that affects the entire body, but this condition may still appear to primarily affect the extremities thanks to the force of gravity. Other types are classified according to the specific organ or system that is affected. For example, pulmonary edema occurs when fluid accumulates in the lungs, lymphedema presents when the lymphatic system is not functioning properly, and corneal edema involves fluid retention in the cornea that affects vision.
A Common Problem for the Elderly
Seniors are typically at a higher risk for edema due to lower activity levels, increased incidence of multiple chronic conditions, and the amount and types of medications they take. While the above examples are a bit specific, it is important for family caregivers to understand the general symptoms and possible causes of edema to prevent the development of serious complications, some of which can be life threatening.
Symptoms of Edema
Knowing what to look for can be half the battle. General symptoms include:
- Swelling or puffiness of the skin;
- Skin that appears stretched, shiny or discolored;
- Aching body parts;
- Stiff joints;
- Weight changes; and
- Skin that maintains a dimple after being pressed for a few seconds (known as pitting edema).
Causes of Edema
This condition can result from a number of different contributing health factors. Common causes include physical inactivity, standing or sitting still for too long, hereditary predisposition, surgery, high altitudes, heat, burns, menopause, and excessive salt intake or an unhealthy diet. It often emerges as a result of leaking capillaries where fluid leaks into the surrounding tissue, producing swelling.
In rarer cases, low albumin, a protein in the blood that affects how capillaries function, and high blood pressure can both contribute to this. Any obstructions in the body that affect the circulation of fluids like lymph and blood can inhibit drainage and lead to swelling. Examples of this include blood clots and tumors. Edema is also a common symptom of heart, liver and kidney diseases.
Certain medications can cause fluid retention, which can be doubly problematic for a patient who is affected by any of the conditions mentioned above. Calcium channel blockers, NSAIDs (ibuprofen, Aspirin, Naproxen, etc.), corticosteroids, and some anti-diabetic drugs can all cause swelling. Prescriptions used to treat Parkinson’s disease and Alzheimer’s disease, such as pramipexole and memantine respectively, can also cause fluid buildup in the body.
It is important to seek medical attention in treating edema. If it is left untreated, it could result in painful swelling, difficulty walking, stiffness, stretched/itchy skin, infections, scarring, poor blood circulation, reduced elasticity in arteries, veins, and joints, or skin ulcers. Family caregivers who suspect edema should address the concern immediately with a physician. Some medication changes may be in order to get their condition under control.
Of course, treating the underlying cause of your loved one’s swelling is the primary objective. In severe cases, diuretics may be used to promote removal of excess fluid through urination. While these medications are effective, they can also deplete the body of important vitamins and minerals, so a healthy diet and physician supervision are crucial to their effective use.
What Caregivers Can Do to Help
There are a number of minor lifestyle adjustments that can have a significant beneficial effect on a patient who is prone to edema. Caregivers can help their loved ones adhere to these guidelines, which can prevent discomfort and serious complications.
Serve Healthy Meals
Some foods naturally possess diuretic properties that can help balance fluid buildup, such as asparagus, parsley, beets, grapes, green beans, leafy greens, pineapple, pumpkin, onion, leeks and garlic. Aside from their diuretic effects, these foods are also excellent sources of vitamins, minerals and antioxidants.
A low-sodium diet is important for maintaining cardiovascular health and minimizing water retention as well. Encourage your loved one to use fresh herbs, citrus, and other sodium-free condiments and seasonings on their food to add flavor instead of reaching for the salt shaker. Be sure to read nutrition labels carefully when purchasing foods as well, since sodium is hiding in everything these days. Keep in mind that the Dietary Guidelines for Americans recommends a daily maximum of 2,300 mg of sodium. While the body needs salt to function properly, a physician or dietician can help you and your loved one devise a balanced and nutritious diet that will help combat swelling.
If your loved one has a specific limb or area that is affected by edema, it could be beneficial to wear a compression stocking, sleeve or glove. Placing added pressure on the area during the day can prevent fluid from collecting there. These products come in a range of compression levels and it is important to work with a physician to make the product fits properly and provides the right amount of pressure. These garments can be difficult to put on and take time to get used to, but they should never be painful or uncomfortable. Compression products are often covered through health insurance or prescription plans, especially if a physician prescribes their use.
Targeted application of pressure through massage can help circulate excess fluid that has pooled in the extremities. A method known as manual lymphatic drainage can be helpful for individuals who suffer from lymphedema. Be sure to consult with your doctor before seeing a licensed medical massage therapist. Individuals who have high blood pressure, deep vein thrombosis (DVT) or are prone to blood clots should take extreme caution when considering massage. Pressure incurred during a session could potentially loosen plaque from the artery walls and release blood clots that could end up in the heart, lungs or brain. Those with fragile or thin skin are not ideal candidates for massage either.
Condition the Skin
Even if your loved one’s edema is under control, it can still cause a great deal of discomfort and compromise the integrity of their skin. Be sure to keep the affected areas clean, well-conditioned and protected with shoes or clothing to avoid cracking, splitting and injuries. Not only are these injuries painful, but they can also become infected very easily.
Put Their Feet Up
Resting with the affected limb(s) above the heart can help prevent pooling and improve circulation. It can be difficult to get a loved one to keep their feet or arms elevated regularly throughout the day, but this is one of the simplest options for managing swelling. Slight elevation may be helpful at night during sleep as well. Depending on the part of the body that needs to be elevated, there are a number of products, such as pillows, slings and wedges, that can help support this position and offer comfort.
Get Moving, Keep Moving
Using body parts affected by edema may help reduce swelling and eliminate excess fluid. Even the smallest movements and mildest exercise regimen can help to get blood and lymph circulating and strengthen the cardiovascular system. If your loved one has any other conditions that prevent them from being active or require special care, check with their physician before beginning a new plan. The doctor or a physical therapist may be able to suggest specific exercises to reduce symptoms as well.
Limit Fluid Intake
We all know that staying hydrated is an important piece of our overall health. However, for someone with a chronic health condition that causes edema, less is more. In serious cases, such as pulmonary edema due to severe heart failure or peripheral edema due to advanced kidney disease, your loved one’s doctor may prescribe daily liquid limits. Many healthy foods, like watermelon, soup, ice cream and gelatin contain a great deal of water and should therefore be factored into your loved one’s limit.
There are a few different techniques for carefully adhering to this restricted diet. One method involves using a container that holds the daily allowance amount for reference. With each serving of liquid that is consumed throughout the day, an equal amount of water is poured into the container. Once it is full, no more liquid should be consumed. Another technique is to determine a set serving size of fluid to consume with each meal (and possibly snacks) throughout the day that adds up to the allowance. Spacing out consumption times can help prevent meeting the limit early in the day and becoming excessively thirsty later on.
By understanding the underlying causes of edema, discussing treatment options with a health professional, and encouraging lifestyle changes, you should be able to keep your loved one safe and comfortable at home.