Does the height of a bed affect swelling in the elderly?

1 answer | Last updated: Sep 14, 2017
A fellow caregiver asked...

I care for a 98 year old person with late stage dementia. She has a hole in her heart, rods in her right leg from a broken hip and her ankles swell all the time. Does the height of a bed affect swelling in the elderly?

Expert Answers

Jennifer Serafin, N.P. is a registered nurse and geriatric nurse practitioner at the Jewish Homes for the Aged in San Francisco.

Bilateral ankle swelling, also known as pedal edema, is a common problem in elders. The most common cause of edema is venous insufficiency, followed by heart failure, kidney problems, sleep apnea, and liver disease. Venous insufficiency is a chronic problem where the leg veins become weak over time, causing blood to pool in the legs. This will cause edema, as well as skin changes on the legs. First, the skin will become dry and easily irritated. Eventually, stasis dermatitis will develop, which is when the skin becomes scaly, red, dry, and itchy. Sometimes, it will even weep/ooze fluid if the edema is not controlled.

Since the lady you care for has 'a hole in her heart', I would guess that her edema is caused by heart failure. But, she may also have some venous insufficiency as well. I would check with her health care provider to see what her exact cause is, as this may help with her treatment.

To improve edema, I would recommend: 1. Exercise: using leg muscles helps pump excess fluid back to heart.
2. Elevation: put legs above level of heart at least 30 minutes three to four times/day.
3. Massage: gently applying petroleum jelly to the legs for skin care, hydration. Stroke towards heart, not towards feet!
4. Temperature: Always avoid extreme temperatures, Heat makes edema worse, while cold may slow healing. 5. Compression: circular wraps, support hose keeps fluid out of the legs (as ordered by her health care provider).

To help reduce the skin problems that come with edema, always give good hygiene. Wash her feet with mild soap and warm water, washing the toes & in between all inner spaces. Dry in between each toe. If the skin is dry, use a protective emollient like petrolatum daily, applying it from her ankle to the knee. Always make sure that the shoes are the correct size. They should be sturdy and comfortable, with a safe sole. Also, she should wear soft, non-constricting socks. Good luck!