The largest challenge for anybody putting on or taking off compression garments is that those garments nothing like regular socks or hosiery that they have worn in the past. They are much more difficult to put on.
But for geriatric patients, the issue is even more difficult, as those patients suffer a sort of “double whammy” in that not only do they typically require higher compression garments, but they also often have flexibility limitations and conditions such as arthritis that make putting on and taking off compression garments that much harder. The resulting frustration can negatively impact compliance.
The most common mistake patients will make is they’ll put on compression hosiery like a typical sock, by bunching the compression sock up on their hands at the point above its heel and then they’ll try to pull it up over their toe area and then their heel, which is very hard to do.
“With compression, that is kind of like taking 30 rubber bands and trying to stretch them out and pull them over the foot and over the heel, which is a challenge area,” says Christine Marks, senior marketing manager for BSN Medical, which manufacturers compression garments under the Jobst brand. “So that’s where the frustration for geriatric patients comes in, and where people start not being compliant with their therapy, because they find taking them on and off is so challenging.”
So the most effective way for any HME provider to help those patient remain compliant is training. And the best way a provider can help in that regard, Marks says, is to show patients the three ways they can put on and take off compression stockings: the “heel pocket out” method, using gloves, and using a donning device.
The first method, the “heel pocket out” method, is more complex. In it, the patient puts his or her hand into a compression sock, grabs hold of the heel and turn it inside out, in order to more easily get move the sock over the more challenging portions of the patient’s foot.
“It’s almost like making a sock puppet,” Marks says. “But if you almost make a ‘cap’ and slowly put it over the foot, then you remove that obstacle of bunching up the compression all in one area.”
Then the patient slowly smoothes the sock up around the leg.
Another option is to use gloves. Whether a geriatric patient is putting on compression garments themselves, or doings so with the aid of a loved one or caregiver, rubber gloves can make the process go much more smoothly, by providing traction to help grab hold of the sock.
“They [patients and caregivers] can use something as simple as rubber dishwashing gloves, or a special donning glove that Jobst offers,” Marks explains. “You’re trying to create that traction for them to maneuver and place the fabric smoothly across the patient’s leg so that it’s not all bunched up in one area. It helps patients who don’t have that ability to grab and clench with their hands.”
Lastly, patients can use devices to help them don and doff their compression hosiery. This last method depends on if they patient wears closed toe stockings or open toe stockings.
If it is an open toe stocking, patients can use a plastic grocery bag or slick parachute-type fabric to put over their foot and then slip the sock over it. Because the toe is open the patient can then easily pull out the bag or slick fabric.
However if the toe is not open, they can use a donning device, which can be particularly helpful if patients have mobility of flexibility limitations that make it difficult to even bend over, reach their feet and pull up the stocking. The device provides a frame that holds the sock open, as well as two handles to let patients slip their foot into the sock and then use the handles to let them leverage their body weight to step into the stocking and then use the handles to pull it up over their leg.
“Instead of having to grasp fabric, which is very thin, they can grab a left and right handle,” Marks says. “They don’t have to worry about balance or their ability to bend over, and they can do this either sitting down or standing. This can give them a greater range of movement.”