Lymphedema in the elderly: A special needs population

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Lymphedema in the elderly is often complicated by comorbidities, diagnostic uncertainties, and intervention complications. Damage to the lymph system results in fluid overload, causing edema. In developed countries, damage to the lymphatic system typically results from surgery and radiation therapy for cancer treatment. In the elderly, differentiating true lymphedema from other types of edema becomes more difficult because of the many conditions which may cause edema, such as cardiac disease or chronic venous insufficiency. Inactivity and muscle weakness in the elderly add to the difficulty in managing treatment. Current treatment for lymphedema includes specialized massage, bandaging, exercises, compression garments, and compression pumps. Acute or chronic causes of edema, such as a deep venous thrombosis, may be a contraindication for lymphatic therapy intervention. However, some nonlymphatic edemas may respond well to the intervention. Chronic venous insufficiency may complicate existing lymphedema or may cause lymphedema if the lymphatic system becomes stressed attempting to compensate for the venous system. The elderly may also require modification to lymphedema intervention, such as reduced treatment times, simplified exercises, and reduced bandaging layers. They may require adaptative exercise equipment. Alternate treatment settings, such as in home health or nursing home, require adaptive approaches. Social and safety issues impact the choices for intervention. The demands on the therapist working with the elderly with lymphedema require ingenuity and patience. Functional improvement with lymphedema intervention may allow the patient to remain at home rather than at an alternate setting.

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