Understanding Oedema in Senior Citizens: Causes, Symptoms and Early Signs

Oedema causes swelling in certain parts of the body, which may interfere with daily activities. Making a few simple lifestyle changes, like propping up the swollen area or moving around if you have been sitting or standing for a while, can help ease the swelling and make you feel more comfortable. Since oedema can sometimes point to an underlying health concern, it is a good idea to check in with your healthcare provider if you notice any swelling or related symptoms. They can help you figure out what is going on and guide you toward the best care.

Oedema in senior citizens

Oedema is more common in senior citizens, although it can impact anyone. Still, it is most common in pregnant women.  

Oedema symptoms

Symptoms of oedema include:

• A visible increase in the size of a body part from the previous day.
• The skin over the swollen area looks stretched and glossy.
• Trouble walking if swelling affects the legs, ankles or feet.
• Coughing or trouble breathing.
• There may be a sensation of pressure or tightness in the affected area.
• Mild discomfort or tenderness in the affected area.

Causes of Oedema

Once your healthcare provider diagnoses oedema, the next step is to determine what is causing the fluid build-up in your tissues. There are several potential causes for oedema, including:

• Gravity: Spending long periods sitting or standing in one place can cause fluid to naturally collect in your legs, feet and arms (dependent oedema).
• Weak vein valves (venous insufficiency): When the valves in your veins are weak, it becomes difficult for blood to return to your heart, leading to fluid build-up in the legs and the development of varicose veins.

Underlying health conditions:  

• Heart failure: When the heart is not pumping efficiently, the body compensates by retaining fluid and increasing blood volume. This leads to congestion in the veins, enlargement of the liver and fluid build-up in body cavities, such as the abdomen (ascites) and subcutaneous tissues, causing swelling (oedema) in the legs.
• Chronic lung diseases: Like severe emphysema, oedema can place excessive strain on the heart’s right ventricle, ultimately leading to its failure.
• Liver disease: Like severe cirrhosis, oedema triggers liver failure.
• Malignant lymphedema: It occurs when cancerous tumours obstruct parts of the lymphatic system, such as the lymph nodes.
• Thyroid diseases: Diseases like hypothyroidism can cause oedema.
• Allergic reactions: An allergic reaction occurs when the body swells up in response to specific allergens, like an insect bite, in individuals who are sensitive to them. In some cases, the reaction can be severe (anaphylaxis) and demands immediate medical attention. This type of swelling is typically temporary rather than persistent.
• Medication side-effects: Certain medications, such as those used for blood pressure or pain management, can cause swelling as a side effect.
• Poor nutrition: A diet lacking in balance or high in salt (sodium) can lead to fluid retention in various parts of your body.
• Pregnancy: Swelling in the legs is common during pregnancy due to pressure from the uterus on blood vessels in the lower body.
• Weakened immune system: Oedema can result from allergic reactions, infections, burns, trauma or blood clots.

Diagnosis of Oedema

In diagnosis of oedema, your healthcare provider will conduct a physical examination and may order additional tests to determine the cause. They will check for swelling, particularly in areas where the skin appears shiny or stretched.

Oedema grading

Oedema grading is a system used to assess the severity of oedema and estimate the amount of fluid accumulated in your tissues.

To test for oedema, your healthcare provider will gently press their finger on a swollen area for 5 to 15 seconds (a pitting test). When the pressure is released, a dimple or ‘pit’ will form in your skin, indicating the presence of fluid build-up.

The grading scale measures how quickly the dimple disappears (rebound) after the pitting test, with the following grades:

• Grade 1: Immediate rebound with a 2 mm pit.
• Grade 2: Rebound within 15 seconds, with a 3 to 4 mm pit.
• Grade 3: Rebound takes more than 15 seconds but less than 60 seconds, with a 5 to 6 mm pit.
• Grade 4: Rebound takes 2 to 3 minutes with an 8 mm pit.

How to treat Oedema?

Oedema treatment can depend on its underlying cause, particularly if it is related to a health condition. For example:

• If lung disease, like emphysema or chronic bronchitis, is causing oedema, your healthcare provider will advise quitting smoking if you are a smoker.
• In cases of oedema linked to chronic heart failure, your provider will recommend lifestyle changes, such as monitoring your weight, fluid intake and salt consumption. They may also suggest reducing alcohol intake.
• If oedema is a side effect of medication, your provider might adjust your dosage or switch medications to alleviate the swelling. Always consult your healthcare provider before stopping any medication.

Treatment to reduce swelling

• To help reduce swelling, in addition to treating the underlying cause of oedema, you can take several measures to prevent fluid build-up in your body:
• Avoid staying in one position for too long. If you are sitting or standing for an extended period, take short walks to keep your circulation moving.
• Consider using compression socks, stockings or sleeves as they apply pressure gently to some areas of the body, helping to stop fluid from building up. If you have chronic oedema, oedema shoes that can be adjustable are also a great choice because they are designed to fit comfortably and accommodate swelling.
• Cutting salt in the diet also reduces fluid accumulation, as too much can cause your body to retain extra fluid.
• Please follow instructions from your healthcare provider regarding any medications you are taking. They might recommend a diuretic, commonly known as a ‘water pill’, to help your body eliminate the excess fluid.

Oedema relief for seniors

• In some cases, oedema can be linked to underlying health conditions like heart failure or liver or kidney disease, which may not always be preventable. However, managing symptoms with the right care and lifestyle adjustments can still help improve comfort and quality of life.
• If excess salt intake is the cause of your oedema, reducing the amount of salt in your diet can help prevent it.
• Staying active can also prevent oedema. Prolonged sitting or standing without moving can cause fluid to accumulate in your tissues. If you have been sitting for a long time, try to get up and move around when possible, to reduce the risk of swelling.

Complications of oedema

If left untreated, oedema can lead to:

• Swelling that becomes increasingly painful
• Difficulty walking
• Stiffness in the affected area
• Skin stretching, which may cause itching
• A higher risk of infection in the swollen area
• Scarring between tissue layers
• Reduced blood flow
• Decreased flexibility in arteries, veins, joints and muscles
• An increased risk of developing skin ulcers

When to seek medical emergency?

Certain symptoms associated with oedema, such as shortness of breath, difficulty breathing, chest pain or swelling in just one limb, require immediate medical attention. Anyone experiencing these more severe symptoms, especially those with underlying health conditions like congestive heart failure (CHF) or kidney disease, should seek urgent care right away.

Conclusion

Oedema is a common condition that varies in severity depending on its cause. In mild cases, it often resolves on its own, while more severe cases may require medication and treatment. If you experience unexpected swelling in any part of your body, it is important to consult your healthcare provider for an evaluation. Oedema can sometimes indicate an underlying health issue, and early diagnosis and treatment can lead to the best outcomes.