Compression Therapy For Seniors
Compression therapy is the use of garments or bandages to help manage blood flow in the limbs. It is said to be the most important component in the treatment of venous disorders and lymphedema.
Compression garments are found in several different forms such as stockings, sleeves, and socks that come in varying degrees of compression and style.
The advantages of compression therapy for seniors are enormous, and understanding the entirety of the process is beneficial in making sure you understand how it may help you, a loved one, or a patient, age in place.
To understand how compression therapy works in venous disorders, it is first important to have a basic understanding of the anatomy of the anatomical systems in the areas where the therapy is used. As you might have guessed, there are several factors that regulate the return of blood to the heart from the limbs.
Muscles as Pumps
When lying down, it is significantly easier for the blood to flow back to the heart. However, when in a standing or sitting position, gravity must be overcome in order to complete the cycle.
In a healthy individual, the muscles surrounding the veins act as pumps in order to fulfill this role. For instance, in the leg, muscles in the foot, calf, and thigh contract with movement to force blood upwards through the veins. Therefore, good circulation from the limbs is heavily dependent on the ability to cause the necessary contractions in the muscles acting as pumps. Deteriorating muscles, limited mobility, or an abnormal gait may all contribute to the decreased functionality of circulation.
Veins and Valves
In addition to muscles, the veins transporting the blood play a vital role in circulating blood around the body.
In particular, valves located in the veins prevent reflux or the backflow of blood into the limbs. When the muscle contracts, the blood flow forces the valves open to pass. When the muscle relaxes, gravity pulls the blood back towards the valve which causes it to close and prevents blood from moving down any further.
However, when the valves do not close properly, the dynamic is compromised and the blood is allowed to pool in lower sections of the vein.
This pooling of blood in the limbs is called Chronic Venous Insufficiency and is popularly prevented as well as treated with compression garments.
How Blood Flow is Affected
Compression therapy works using gradient compression, or compression that is greatest at the ankle and decreases as it moves up the limb.
By using gradient compression, the direction of blood flow is respected and encouraged to move towards the heart. The pressure provided by compression garments gives the muscles less room to expand as they contract.
The internal pressure that is created by this is distributed throughout the area. In turn, the major veins are reduced in diameter, driving the blood flow towards the heart.
By using compression garments, blood circulation is improved from home, reducing complications that would normally make aging in place more problematic.
Compression therapy also helps to reduce swelling by forcing excess fluid that has collected in the tissue to return to the capillaries and helping to prevent future leakage.
Unlike some treatments that require close observation and care, the intimate relationship between the compression garments and muscles means that the most important factors in treatment, exercise and movement, are controlled by the patient.
Another common use of compression garments is for the treatment of swelling in the limbs. One of the most common causes of this is lymphedema, a condition in which fluid is retained in the soft body tissue of one or more of the limbs.
The retention is caused by damage to the lymphatic system, which normally aids in the return of lymph fluid to the blood stream.
Symptoms of lymphedema include swelling, a feeling of heaviness or tightness in the area, discomfort, hardening of the skin, and restricted motion. While there is currently no cure for lymphedema, it can be managed with proper compression therapy.
Compression garments for seniors can be used as a preventative measure in at-risk individuals or as early onset management. In these cases, the garments discourage future obstacles in health, an important strategy in home healthcare. However, the most common use of compression garments is in long-term management of the condition.
The process of draining excess lymph fluid from swollen limbs is much the same as the effect of compression in venous disorders. The pressure provided from the garment leads to the opening of initial lymphatics, vessels that conduct lymph throughout the body.
The valves in these vessels provide a one-directional flow, directing the excess lymph fluid out of the targeted area. With the excess fluid moving out of the swollen area, the lymphatic system is then able to properly transport it to the heart.
Finding the Right Compression Garments
In order to experience the advantages of compression therapy, it is important to find the right product and use it appropriately.
Ideal compression therapy will not constrict movement, but instead be comfortable enough to encourage it.
Products like the Bauerfeind Mirco series promote this by providing soft seamless material that is almost unnoticeable when worn.
Comfort is also important as it is crucial to wear the compression garment throughout the day, only removing it when lying down.
In addition to this, it is imperative to find a compression garment that fits the user correctly. A garment that is too loose will not have the appropriate effect, while a garment that is too tight could cause further damage.
Fortunately, unlike compression bandages that require expert dressing, compression garments are built for easy self-application, providing the proper support in all the right places.
Benefits of Compression Therapy
Compression therapy is a popular treatment in a number of disorders to improve blood flow and reduce swelling, including varicose veins, deep vein thrombosis, diabetes, lymphedema, and even pregnancy.
Compression therapy makes living at home, not only more simple, but more comfortable as other it is also proven to have a variety of benefits, such as:
- Improved appearance of the limb
- Decreased symptoms of depression
- Better sleep habits
- Increased activity levels
The many benefits of compression therapy make it an ideal option for a good portion of the population. Armed with the knowledge of how it works and how to correctly profit from it is guaranteed to give the best possible advantage in its usage.
Compression Therapy Questions and Answers
What is gradient compression?
Gradient compression delivers a squeezing to the leg that is tightest at the ankle. The amount of squeezing or compression gradually decreases up the leg. For arm sleeves, the greatest compression begins at the wrist and decreases up the arm. Compression is expressed in mmHg (millimeters of mercury). The higher the mmHg, the stronger the gradient compression.
Is uniform compression effective?
Yes, uniform compression is effective clinically in managing edema. However, research has indicated that gradient compression in the legs is more effective than uniform compression in improving venous return.
What is compression therapy?
Compression therapy refers to the benefits gained from using specialized stocking or bandages to manage chronic venous insufficiency and lymphedema. Fatigue, heaviness and aching legs are common complaints.
Gradient compression stockings are the standard of care in the management of chronic venous insufficiency and lymphedema. Compression provides two primary benefits.
Perhaps the most important effect is that compression increases the pressure in the tissue under the skin (subcutaneous) helping to reduce and prevent swelling. The compression of subcutaneous tissue helps move excess fluid (swelling) back into the capillaries (tiniest of the blood vessels) and helps prevent too much fluid from leading out of these little vessels.
Secondly, compression reduces the ability of the superficial veins in the leg to expand and overfill with blood. This in turn helps prevent blood in these veins from flowing backward and causing congestion. Congestion in the leg accounts for the leg complaints, swelling, and skin changes common with venous insufficiency.
Why are stockings so hard to put on?
Your doctor may tell you that, “if they are not hard to put on, then they cannot be providing the compression needed.” That is probably not the answer you want to hear, but unfortunately it is true.
Gradient compression stockings provide the greatest compression at the ankle.
This requires the largest part of the foot- the circumference from the top of the foot around the heel – to pass through the smallest and tightest part of the stocking – the ankle. Newer knitting technologies, yarns and finishes produce stockings that are easier to put on than the stockings of old. However, for those who have diminished arm or hand strength, or impaired mobility there are items that can make the task easier. These items include:
Is there a reason why I should not wear compression stockings?
Contraindications (medical conditions in which compression is not recommended):
Ischemia (advanced arterial disease) of the legs
Uncontrolled congestive heart failure
Untreated septic phlebitis of the leg
Compression stockings should be worn with caution with:
Allergic to garment fabric
Impaired sensitivity of the limb
Immobility (confinement to bed)
Please consult with your doctor before wearing compression 20 mmHg or higher.
What is the best time of day to measure for compression stockings?
It is best to measure earlier in the day before swelling builds in the legs. Measurements taken later in the day after swelling is present may result in choosing a stocking size that is too large. Many clinics that are unable to see patients earlier in the day will elevate, bandage, or pumps the legs for a period of time before measuring in order to reduce any swelling that is present.
I have latex allergies. Can I still use compression stockings?
Latex is a natural substance that comes from the rubber tree. Latex can be used in textiles in two forms: Dry natural rubber and natural rubber latex.
All Juzo products are latex-free using high-quality synthetic elastomers such as Elastin-Lycra and Polymid-FiberSoft.
Most Jobst garments are latex-free. Please discuss with our fitters if you have specific concerns with this.
How do I know what length stocking I need?
A knee-length gradient compression stocking is generally recommended to prevent or manage signs and symptoms of chronic venous insufficiency or other causes of lower leg swelling and skin changes. If swelling or varicosities are present above the knee, then a thigh or pantyhose style may be a better choice.
Can I wear one compression stocking on top of the other instead of wearing a higher compression stocking?
Yes, there is an additive effect with compression stockings. For example, some doctors instruct their patients to wear on level of compression in a pantyhose style and then wear a knee-length compression stocking over the compression pantyhose.
Why are compression stockings prescribed after a blood clot (DVT) in the leg?
Knee length gradient compression stockings are often prescribed for a patient who has sustained a deep vein thrombosis (DVT) or blood clot in the leg. The stockings are helpful in 1. controlling the swelling in the leg that occurs with DVT or blood clot in the leg, and 2. helping prevent the development of post-thrombotic syndrome that may occur several months after the DVT.
Should I wear stockings on the unaffected leg?
Only the leg with the symptoms or disease needs to wear the compression stocking. Some people prefer to wear compression on only the affected leg. Others may opt to wear the same brand of stocking but in a lower compression level on the unaffected or healthy leg.
When should I put my stockings on?
Your legs are least swollen when you wake up. The stockings will be easier to don if you put them on as soon as you get out of bed.
How many hours daily should I wear my stockings?
The wearing time for gradient compression stockings is dependent on both the reason for wearing the compression and the amount of compression. A doctor is the best guide for this.
Bed-bound patients may be advised by their doctors to wear anti-embolism stockings (16-18 mmHg) to prevent blood clots from forming in the deep veins of the leg.
Immediately following sclerotherapy doctors may instruct you to wear a specific level of compression continuously for a specified number of hours or days depending on the size of the veins injected.
Individuals with lymphedema are advised to follow the wearing schedule recommended by their doctor or therapist.
Individuals with chronic venous problems such as venous related leg swelling, skin changes, or varicose veins, generally wear the compression stockings while out of bed (approximately 16 hours per day) and remove them when retiring.
I am short and my stockings seem to bunch up around my ankles creating a tourniquet. Would a shorter length help?
Excess fabric around the ankle generally indicates a need to redistribute the stocking fabric upward on the leg. In the case of open toe stockings, it may indicate a need to redistribute the stockings downward on the foot if the toe band has slipped upwards. If redistributing the fabric does not solve the problem, you may need a petite or short size.
My knee length stockings cut into the back of my knee. Would a shorter length help?
The band of a correct fitting knee high should stop about two finger widths below the crease of the knee. Most times if a stocking is uncomfortable at the knee, it is due to overstretching the fabric while pulling on the stockings. If this occurs, evenly redistribute the fabric downward on the leg using rubber gloves. There should be no wrinkles in the stockings. If redistributing the fabric does not solve the problem, you may need a petite or short size.
With the warmer weather, I have experienced a rash on my skin that is exposed to the silicone band on my thigh high stockings. What causes this and what can you suggest to prevent and help heal the rash?
The rash most often results from the entrapment of moisture between the silicone and the skin. During warmer weather or physical exertion, the skin sweats. The moisture on your leg cannot evaporate due to the presence of the silicone, thus becoming trapped.
Treatment is symptomatic – cooling and drying the area – avoiding conditions that induce seating are the best approach. Over-the-counter corticosteroid lotions can be used. However, changes in the environment (cool/dry air) and lighter clothing are often more effective.
To help prevent the rash from occurring, make sure the skin is clean and dry before donning the stockings. It is also important to wash the stockings after each wearing to remove any skin oils and cells that collect on the stocking and band.
If the rash continues, discontinue wearing stockings with a silicone band until the warm humid weather changes. You should consult with your doctor if you have drainage from the rash or the rash persists.
Does a run in the stocking affect the compression?
It is possible for runs to affect the compression of the garment. This depends on factors such as the severity and location of the run. For example, a single small run confined to the upper thigh or panty area will not affect the compression of the lower leg where the stated ankle pressure is determined. A localized decrease of compression may occur in the area directly under the run. If the run is moderate to severe, compression may be affected.
Some stockings are extremely sheer. As with any hosiery, the sheerer the garment the more susceptible it is to runs. There are several things you can do to help ensure a long life for the product.
Check your footwear, hands, nails and feel for any rough spots that may damage the garment during donning or wearing. Be careful when donning the garment that you do not snag or pick the fabric. Remove jewelry and wear rubber gloves if needed. Avoid walking around without footwear to protect the stockings.
Can I use lotions and creams with my compression stockings?
If the stocking is latex free, it is perfectly safe to use lotions or creams. In fact, it is especially important for people with lymphedema or venous insufficiency since daily skin care and moisturizer is so important.
Applying lotion at night will make donning the stockings easier. If the stocking contains latex do not use lotions or creams. Heat, ultraviolet light, copper containing products, hydrocarbons and all petrolatum containing creams and ointments affect garments that contain natural rubber latex yarns.
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