Limitations to self-management of adjustable compression wraps in the elderly: results of a prospective cohort study

Abstract

BACKGROUND : Adjustable compression wraps are used for treating lymphedema and chronic venous insufficiency. These diseases often affect elderly patients with associated pathologies or other limiting factors. These can prevent the self-application of the device by patients on themselves. A better understanding of these factors or the associated pathologies in the elderly is important before prescribing or not prescribing a wrap. METHODS : The objective of this prospective cohort study was to determine the main factors that prevent the self-application of the device (Circaid Juxtalite R ) to the lower limb in the elderly. A private nurse selected the first 30 retired subjects over 65 years of age seen at home for routine nursing care. After a demonstration, she asked them to put on the wrap in order to reach a pressure of 40 mmHg in the calf (point B1). She recorded the pressures as the subjects applied the wrap twice in a row. The next day, the subject repeated the application of the wrap twice. We considered that an average pressure of more than 30 mmHg is recommended to treat venous edema or ulceration. RESULTS : 30% of the subjects put on the wrap by themselves with an average pressure of at least 30 mmHg. Age is not a limiting factor. Obesity, gripping difficulties, cognitive impairment and low social status seem to be factors limiting the daily self-management of an adjustable compression wrap in the elderly.

Compression for Lower Extremity Venous Disease and Lymphedema (CLEVDAL)

“…Obesity (BMI > 30 kg/m 2 ), gripping difficulties, cognitive impairment, and low social status were the factors limiting the self-management of an ACW in subjects older than 65 years. The role of age (<75 years vs >75 years) was not significant 20…”

“…There are currently multiple brands of compression devices available on the market. Balet and colleagues in 2021 20 conducted a prospective cohort study to determine factors that may prevent self-application of the adjustable compression device (Circaid Juxtalite) to the lower limb by comparing the interface pressures recorded below the wrap. The study included 30 subjects older than 65 years with a Clinical (C), Etiological (E), Anatomical (A), and Pathophysiological (P) (CEAP) classification of C0-C3.…”

“…The role of age (<75 years vs >75 years) was not significant. 20 Compression is an important component of CDT. Borman and others 21 in 2021 conducted a prospective, randomized, single-blind study to evaluate the comparative efficacy of conventional multilayer short-stretch bandaging, and a Velcro ACW assessing volume reduction, ultrasonographic measurements, functional status, and QOL in the active CDT period of individuals with lower-limb lymphedema.…”

“…Limited evidence suggests that obesity, gripping difficulties, and cognitive impairment are barriers to self-management. 20 B Compression garments that do not cover the foot and heel are not inferior to standard compression stockings that include the foot and heel in patients with venous disease CEAP 3-6. 22 B Compression garments that do not cover the foot and heel are easier to don and doff unaided than garments that cover the foot and heel and may improve adherence in patients with venous disease CEAP 3-6.…”

Physiotherapy in Chronic Venous Disease

“…Several donning aids such as handy gloves or more sophisticated devices (slippery sleeves, stocking donning butlers, or the Doff N´ Donner, a soft silicone sleeve) can easily CT use. To overcome the donning problems for elderly patients, compression wrapping systems can be an alternative [38]. It was stated that achieving a good adherence to CT is "more important than choosing the highest possible compression class" [39].…”