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.
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.