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.


  16 Responses to “Elderly Parents and Cold Therapy”

  1. I can see how and elderly person might need monitoring when using cold therapy. But I’ve often fallen asleep with a heating pad on my back… (This is bad, I know…)

    Sabrina Peterson, NASM CPT, CES
    Fat Loss and Fitness 101

  2. Hi Nurse Suzanne,

    Thank you so much for addressing the possible issues of applying Ice Cold Packs on our elderly parents and relatives (aunts, uncles, and grandparents, too!) as family caregivers to them. The practical help tip of placing a moistened towel between the ice pack and their skin to protect is so very helpful, indeed.


    April Braswell, CHt, RH
    Doctors Quit Tobacco Dipping Hypnotism

  3. ice is fantastic although not as warm and cozy as heat thus many people shy away from using it

  4. Suzanne,
    I did not know that alternating heat and ice is a treatment of muscle spasms. Thank you.

    Body Language: Torso As The Human Billboard

  5. Ice cold, great therapy, but must be used sensibly. Prefer mine in a large single malt.

  6. Suzanne, once I visited to doctors for an injury I had. One said only use cold, the other, only use warm…what to do in those cases??

    Elimina la Ansiedad por Comer

    • I would ask them doctors why I am getting different advice! (Then go ask a nurse!)
      If you need to reduce swelling to the area, apply ice. If you are needing pain relief from a pulled muscle or general aches, try heat.
      In the end…if it helps, use it is a good general rule of thumb. Exceptions always abound.

  7. Thanks, Suzanne, and I share Eva’s confusion … I was told Cold drives the blood away from the injury and Heat brings blood to the injury. Okay … so how do I determine where I was the blood to go?

    • Heat does increase circulation to an area and cold does decrease circulation. If you twist your ankle you want to apply ice to reduce the risk of swelling. In that instance, heat would make the problem worse.
      If you have pulled your back the muscles will be tight, increasing your discomfort. Heat will help the muscles to relax. It all depends on the outcome you are trying to achieve.
      Thanks for asking.

  8. You always have to be carefule with heat or ice.

  9. Darn it! The numbness is where I was always wanting to get… that is when the pain goes away. LOL so much for what I know!

    Guide To Your Music Royalties

  10. Ice therapy must be done the right way.
    Scott Sylvan Bell
    Body language of shy men
    Now go implement!

  11. Hi Suzanne,
    I took my husband to the chiro, who advised he needed ice to reduce swelling and heat for the tight muscle.
    How do you do that?
    Looking forward to tomorrow!
    When does the caregiver get care?

  12. Thanks for the tip. My wife suffers from periodic back pain and has been advised to use ice. But she does not like the idea of cold. I’ll try that warm towel first.
    Thanks again.
    Be Well.

  13. Some of my elderly patients have extremely thin skin. If icing is absolutely necessary I would have them do it in short spurts with a towel under the ice. Most of them hate to ice because their circulation is already bad. I don’t blame them.

    Yours In Health!

    Dr. Wendy

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