May 032012

Elderly and The Use of Ice Packs: Is It Safe?

Bruises, sprains, strains, all are treated with cold therapy. Caregivers of elderly parents should know that there are precautions that should be taken when using cold therapy, especially with the elderly. The skin of the elderly is more fragile, more susceptible to damage and they often have decreased sensation that will not alert them in time if skin damage is occurring. Below, I will outline ways caregivers can help avoid injuries when applying cold therapy.

Cold Therapy

Strains and sprains are usually best treated with cold therapy. Ice is the treatment of choice for the first 48 to 72 hours after an injury. First remove any jewelry from the affected area. If it is an arm or leg that is affected, raise it to promote blood return and reduce swelling and pain.

Fill the ice bag 1/4 to 1/2 full of ice and remove all air to promote better conformity to treatment area. Applying wet towels to the skin before applying ice will facilitate skin cooling and is much more effective than dry cooling. Always apply a towel between the skin and ice to prevent frostbite. Wrap the ice pack with a towel to decrease the warming effects of the outer air however do not over insulate.

If your parent cannot stand the thought of putting something cold on an injured area, apply a warm moist towel then place the cold pack on top of it. This will allow for slower and deeper cooling and less discomfort.

Dangers From Use of Ice

I once took care of a man who hurt his knee playing baseball. He took something for the pain, put an ice pack on it, secured it with an elastic wrap and fell asleep. He was admitted to the hospital with frostbite to his knee. Living in Florida that just is not something we usually have to deal with.

There are four stages of cold progression: cold, stinging, burning and numbness. Once numbness occurs, remove ice pack immediately and allow area to warm up at least one and half to two hours before reapplying. The skin will be red when you remove the cold pack but that should clear up in an hour or so. If there are white patches in the red area, there was too much cooling. Wait at least two hours before applying any more cold therapy and the next time do not leave it on as long. Certainly remove cold packs immediately if blistering occurs and seek medical attention.

As a general rule, do not use compression such as elastic wraps (ace bandages) to hold cold packs in place. Check the skin after 5 minutes. If blisters are seen or numbness has occurred, remove the cold pack.

As with heat packs, chemical cold packs should be checked for leaks before use and should not be applied to the face.

If using gel packs remember they provide more aggressive cooling than ice bags and so deserve greater caution and monitoring. Most commercial/chemical packs are not as cold as ice. Never apply reusable cold packs directly to the skin. Most reusable cold packs usually lose their effectiveness after 15 minutes.

Never leave any cold application on for more than 30 minutes. Realize that bony areas such as elbow, knees, and ankles will require less time than fatty areas. The superficial nerves at these joint sites are especially vulnerable to cold-induced damage and nerve pain.

Ice should not be used when there is circulation impairment, impaired sensation, impaired ability to communicate discomfort, and impaired mental status, common concerns among our elders.

Alternating heat and ice can be effective treatment of muscle spasms and some sports injuries. How you alternate the heat and ice depends on who you ask but as a rule of thumb apply heat for 10 to 20 minutes, take it off and wait 20 to 30 minutes, then apply ice for another 10 to 20 minutes. There really is not much research to support of disclaim it and what most healthcare professionals will tell you is if it helps, do it.

May 022012

Should Your Elderly Parents Use a Heating Pad?

Heating pads commonly used at home to treat a variety of injuries. However,caregivers should know that there are precautions that should be taken when using heat therapy, especially with the elderly. Their skin is more fragile, more susceptible to damage and they may have decreased sensation that will not alert them in time if skin damage is occurring. Below, I will outline ways caregivers can help avoid injuries when applying heat.

Heat Application

Before applying heat, be sure to remove any jewelry from the affected area to prevent the metal from burning the skin. You should also place a cloth between the skin and the heat source to protect the skin from burns.

When using commercial heat packs inspect to make sure that no chemicals are leaking out after breaking the seal that activates the chemicals inside. Chemicals leaking onto the skin can cause severe burns. If a leak should occur flush immediately with cool water and call your healthcare provider. Never apply chemical heat packs to the face.

When using an electric heating pad start with the lowest setting and do not leave heat on for more than 30 minutes. Caution your parent not lie on a heat source such as a heating pad. For one thing they might fall asleep and that can lead to burns and for another it could damage the wires ruining their heating pad or cause a fire. Do not fold the heating pad, use pins to hold it in place, or use one with a damaged plastic cover or a frayed cord.

Wait at least one to one and a half hours after removing a heating pad before reapplying heat to allow the skin to cool down and you will have better results. When heat is left on a long time the body tries to compensate and cool the area which leads to stiffness and increase pain.

Never use an analgesic rub with a heating pad. I have seen some nasty skin damage from that. Those rubs are chemical heating agents and combined with a heating pad can lead to burns.

Moist Heat

The most effective heat is moist heat and there are several commercial moist heating pads on the market today that are a safe choice. You can also heat wet towels or cloths though they will require frequent reheating. If you do decide to use moist heat with a regular heating pad, please put the pad in a plastic bag first to prevent getting a shock.

A better choice would be to fill a sock with regular rice, tie one end, place it inside another sock and tie that, heat it in the microwave for no longer than a minute. Apply the wet cloth to the affected area, cover with your new rice bag and place a towel over it to hold in the heat.

Be careful when using the microwave to warm heat packs such as rice bags or wet cloths. Since microwaves do not always heat evenly so be sure to check for hot spots.

Avoid Use Of Heat

Heat therapy should not be used on most injuries when they first occur with the possible exceptions of neck and back strain. Using heat too soon after an injury can actually compound the problem and slow the healing. Heat is best for injuries 48 to 72 hours after they occur.

Heat should not be used if there has been recent or potential bleeding, deep blood clots, impaired circulation, impaired sensation, impaired ability to communicate and impaired mental status. Do not apply heat to swollen areas until the reason for the swelling has been determined.

As a general rule, heat should not be applied to open areas since heat increases the need for oxygen and may damage new tissue growth and delay healing. Heat applied to a bruise may increase bleeding.

Warning: Never apply heat over a medication patch. The heat may cause the medication to be absorbed more rapidly into the bloodstream and can lead to serious problems. This can also be a problem if your parent uses a medication patch and is running a high temperature.

Check the skin under a heat pack or heating pad 5 minutes after application. Though some mild redness and warmth are expected, you want to ensure the skin is not burning. If blistering should occur, remove the heat, apply a cool, wet cloth and call your doctor or seek immediate medical attention. Should the redness continue for 30 minutes or more after the application of heat remove the heat source until the redness is completely gone.

Apr 102012

That was how my aunt greeted me when I answered the phone this morning. (I used to get a lot of these calls in my home healthcare days also). My granny is 92 years old, still lives by herself, only quit driving in the last year, and her mind works pretty darn good. My aunt makes the same mistake a lot of caregivers make, trying to impose their will on their parent. It does not usually work.

Most people will tell you that they could not boss their parents around when they were kids, it did not work when they were teenagers and yet they think it will work now. As my daddy once told me after I yelled at him that he treated me like a kid, “You will always be my little girl.” You never really grow up in your parent’s eyes no matter how old you are.

Just because someone is older and needing assistance does not mean that they are not able to make decisions for themselves. It can be very frustrating when you feel they need help and they refuse. The tendency is to treat them as if they were the child and tell them what to do, especially if you are a parent. So what do you do?

You get someone else they will listen to, to talk to them. You are probably frustrated and your parent is probably at best annoyed with you. My grandma on the other side of my family would not listen to any of her children or grandchildren. But her home healthcare nurse? Anything she said was law!

Offer them choices. “Do you want me to call the doctor and see what he thinks you should do?” Let your parent make the decisions they can make. Explain what needs to be done and why. Sometimes you may just have to let it rest for a while and let it be their idea.

If it is a truly serious situation and they are still refusing help, call 911 and request an ambulance. They come in wearing their uniforms and stretcher and equipment looking all professional and it really can make a difference. You might consider asking your parent, “How about I call the paramedics? They can check you out and see what they think.” This will usually get their attention.

The best thing to do is treat your parents with respect and dignity. Allow them as much independence as possible. Do not fuss and nag them. And remember, you children are watching you. Chances are, they will treat you the same way you treat your parents.

I realize there are those people out there who are going to refuse no matter what you do. In that case, you have to remember that they have the same right to refuse care just like you do.

What became of Granny? I called the doctor’s office knowing it was Monday and he would have a packed office but they told me to bring here in, he could get to her faster. He gave her a couple of shots, sent her for tests and sent her home.

Use your resources.