Lymphoedema: causes, prevention and management in older people

Abstract

The lymphatic system must have variation in tissue pressure to load it and to help flow. Being a low pressure system, external pressure must not be constantly high on any segment and there must be a pressure gradient along it. When the flow rate of lymph fails there can be compromised immunity, a tendency to deposit fat, fibrotic induration, and a vicious cycle of worsening of cellular and organ health often associated with recurrent infection. As we age we become less active, lose muscle tone, and increase our weight, develop a higher percentage of body fat, and may have poor skin care and be prescribed medications which impact on lymphatic load. Combined with this, the tendency to immobility, limb dependency and periods of time when high external pressures exist in small superficial areas increase the risk of or contribute to lymphoedema through reducing lymphatic flow. Older people are more likely to have had more radical surgery and radiotherapy for cancer with more significant damage to their lymphatic systems, again adding to lymphoedema risk. Immobility, hypertension, venous disease, kidney and liver failure can lead to oedema, while thyroid dysfunction can cause myxedema, and genetic or metabolic issues can cause lipoedema, compounding the clinical problems. A key point in good management is early identification and accurate diagnosis. Ideally, other issues that especially impact on lymphatic load should be managed prior to targeted and sequenced treatment for the swelling, with the aim being to improve patient comfort. Management can involve the patient, partner, family or carer as well as a range of health professionals to help reduce or maintain limb size, appearance and function as well as reduce symptoms of heaviness, tension and discomfort and a range of other issues that impact on quality of life and activities of living.