From the Guidelines
Pedal edema in elderly females is most commonly caused by heart failure, kidney disease, and venous insufficiency, which can lead to fluid retention and decreased circulation, ultimately affecting morbidity, mortality, and quality of life. The causes of pedal edema can be multifactorial, including medical conditions, medications, and lifestyle factors. According to the study by Hunt et al. 1, heart failure associated with relatively preserved left ventricular ejection fraction is most prevalent among elderly women, who often have hypertension, diabetes mellitus, or both, and may also have coronary artery disease or atrial fibrillation.
Medical Causes
- Heart failure: a major medical cause of pedal edema, as it affects the body's ability to properly circulate blood and remove excess fluid 1
- Kidney disease: can lead to fluid retention and decreased circulation, contributing to pedal edema
- Venous insufficiency: can cause fluid to pool in the lower extremities, leading to swelling
Medications and Lifestyle Factors
- Medications like calcium channel blockers, NSAIDs, and some diabetes medications can contribute to swelling
- Prolonged sitting or standing can limit circulation and allow fluid to pool in the lower extremities
- Hormonal changes during menopause can cause fluid retention
- Decreased physical activity and muscle tone in older age can reduce the pumping action that helps return blood to the heart
- Salt consumption can increase fluid retention
- Arthritis or other joint conditions may lead to inflammation and swelling
Management
- Elevating the feet to reduce swelling
- Wearing compression stockings to improve circulation
- Limiting salt intake to reduce fluid retention
- Staying physically active to improve circulation and reduce swelling
- Taking prescribed diuretics if recommended by a doctor to remove excess fluid Any persistent or severe swelling should be evaluated by a healthcare provider to identify and address the underlying cause, as the study by 1 suggests that diuretic deprescribing may have varying effects on mortality, adverse drug withdrawal effects, and tolerability of deprescribing attempt, highlighting the need for careful consideration of treatment options.
From the Research
Causes of Pedal Edema in Elderly Females
The causes of pedal edema in elderly females can be attributed to various factors, including:
- Systemic illnesses such as heart failure, liver disease, malnutrition, and thyroid disorder 2
- Local conditions such as pelvic tumors, infection, trauma, and venous thrombosis 2
- Medications known to increase the risk of edema of the lower extremities 2
- Chronic heart failure (CHF), which results in a significant risk of leg edema 3
- Chronic venous insufficiency, which can lead to leg swelling and ulcers 4
- Diastolic heart failure, characterized by symptoms including reduced ventricular relaxation and compliance, resulting in congestion of pulmonary and systemic circulation 5
- Congestive heart failure, which is one of the most important causes of peripheral edema seen in clinical practice 6
Systemic Illnesses
Systemic illnesses such as heart failure, liver disease, malnutrition, and thyroid disorder can cause pedal edema in elderly females 2. For example, congestive heart failure is one of the most important causes of peripheral edema seen in clinical practice, resulting from the activation of a series of humoral and neurohumoral mechanisms that promote sodium and water reabsorption by the kidneys and expansion of the extracellular fluid 6.
Local Conditions
Local conditions such as pelvic tumors, infection, trauma, and venous thrombosis can also cause pedal edema in elderly females 2. Chronic venous insufficiency, for instance, can lead to leg swelling and ulcers, and the use of compression stockings can help reduce the risk of leg ulcer recurrence 4.
Medications and Other Factors
Medications known to increase the risk of edema of the lower extremities can also contribute to pedal edema in elderly females 2. Additionally, chronic heart failure (CHF) and diastolic heart failure can increase the risk of leg edema, and the use of optimal doses of furosemide and spironolactone can help improve clinical symptoms and long-term prognosis in elderly patients with diastolic heart failure 3, 5.