Compression

Ensuing Patients Get a Good Fit

Older people may increasingly suffer from tired, achy legs, varicose veins and foot swelling as part of the many aging-related ailments. Treatment for these types of ailments is known as compression therapy, and it addresses the underlying circulation problems that most geriatric patients experience including edema, venous insufficiency, lymphedema and venous stasis.

“These conditions are so common that they are often overlooked or their seriousness underestimated, but left untreated they can quickly deteriorate and result in infections, weeping or blistering skin and stasis ulcers,” says Claudia Boyle, compression wear specialist and owner of Van Driel’s Medical Support Wear.

Compression garments are designed to provide support and increased circulation to the affected area. Compression is measured in millimeters of mercury and can range from 15-50 mmHg.

  • Products between 15-20 mmHg typically treat tired, achy legs, mild edema, varicose veins and foot swelling. This level of pressure can also help to prevent vein thrombosis.
  • Higher levels of pressure, such as 20-30 mmHg are for severe varicosities, for open face ulcers, moderate edema and post surgery. This level of compression also helps to prevent the recurrence of venous ulcers, moderate to severe varicosities during pregnancy and thrombosis.
  • For people who have ulcers, mild lymphatic edema and varicosities, they typically need 30-40 mmHg.
  • Levels beyond 40mmHg treat severe varicosities, edema, venous ulcers and moderate to severe lymphedema.

Compression stockings are the most commonly used compression garments for older patients. The idea that compressions stockings are ugly and unstylish is changing with some of the newer garments on the market.

Over the counter stockings are now available in almost every size, shape, color and fabric imaginable—from men’s dress to women’s sheers to athletic socks. With the amount of colors available beyond the standard black or white, these are often stockings are almost indistinguishable from normal hose or men’s dress socks.

Measuring Up

Boyle says that patients are able to get a better fit, greater comfort and therefore a better result with a measured stocking rather than a stocking measured by shoe size.

Mid-weight and athletic compression socks often work well for geriatric patients since the soft and thick fabric is easier to get on and is gentler on their fragile skin. These types of stockings will also do a far better job of addressing edema than the hospital TEDs.

If symptoms are addressed early on they can often be treated with a fairly low compression stocking (like a 15-20 mmHg) that is both easy to get on and comfortable to wear.

Velcro garments are now often prescribed for patients who have difficulty applying and removing compression stockings or have a need for a less elastic type of compression.

While they are not for every patient, cost and bulk can be issues, they do provide a comfortable and manageable alternative to stockings.

Dollars and Sense

Boyle says there are two big issues that providers can address to help increase patient compliance: cost and application issues.

  • Cost: Medicare doesn’t cover the stockings (exceptions for open stasis ulcers only), so most geriatric patients have to pay out of pocket for them.
  • Application issues: Compression stockings are harder to put on than regular socks. Some patients may resist because their stockings are uncomfortable or actually hurt them. That issue is usually a symptom of too high a compression or a poor fitting stocking since a stocking that provides appropriate support and that doesn’t bind is generally quite comfortable.

Education on application methods is important to patient compliance for all patients, Boyle says. Once the appropriate stocking is established, a provider needs to determine if the patient has assistance or will have to apply and remove the stockings themselves. Then a provider can determine what type of application aids will be most useful to them.

Applications aids are designed to help patients use compression stockings independently. Aids such as grippy rubber gloves, floor mats and a variety of special slides like Easy Slide, can be used to apply the stockings. Metal frame ‘butlers’ and newer plastic frames like the Australian Ezy-As aids also work well for some patients.

Without education on application, wear and care the likelihood of patient compliance is greatly reduced and the likelihood of frustration greatly increased.

“If a patient has been able to try their stockings on to assure fit and comfort and has been instructed on how to apply and remove and care for them, they are far more likely to wear them, and even come back for more,” says Boyle.

Points to take away:

  • Untreated circulation problems can quickly deteriorate and result in infections, weeping or blistering skin and stasis ulcers.
  • Mid-weight and athletic compression socks work well for geriatric patients since the soft and thick fabric is easier to get on and is gentler on their fragile skin.
  • Uncomfortable or painful garments are usually a symptom of too high a compression or a poor fitting stocking.
  • Properly educating the patient on application, wear and care increases the likelihood of compliance and reduces the likelihood of frustration.

Learn More:

Visit HMEB’s compendium of compression articles and products at hme-business.com/portals/compression.

This article originally appeared in the June 2012 issue of HME Business.

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