The benefits of raising awareness of lymphoedema among care home staff
Patients with lymphoedema referred to a lymphoedema service from care homes in one health board area in Wales were often complex cases, with repeated cellulitis, a history of falls and other complications. A pilot project was initiated to develop education and raise awareness of lymphoedema among care home staff.
To enable care staff to identify residents with lymphoedema, promote prompt referrals, raise the importance of skin care and exercise in the management of lymphoedema and estimate the likely costs from complications associated with lymphoedema.
An education tool was developed and 47 care homes were asked to participate. A lymphoedema therapist carried out a scoping review of the residents.
Forty-four care homes agreed to participate in the project with 1216 education packs being issued to care home staff. Initial findings suggest that of the 960 residents reviewed, 262 had lymphoedema (27%); 4% suffered with frequent falls, 1% had wounds and 3% had recurrent cellulitis. Only 13% (35/262) of residents with lymphoedema were known to the local lymphoedema service. Of the 31 residents reporting cellulitis, 81% had lymphoedema; of the 11 residents identified with a wound, 100% had lymphoedema and of the 40 residents reporting falls, 70% had lymphoedema.
This educational project has identified the value of raising awareness of lymphoedema within care homes.
Lymphoedema/chronic oedema is a chronic condition causing swelling, pain and skin problems, as well as functional and mobility issues. It is caused by a lymphatic system failure, which occurs when the transport capacity is reduced by overload, congenital abnormalities or through the removal of lymph nodes because of malignancy. Obesity, cellulitis, cardiovascular conditions, immobility and ageing are among the factors involved in developing lymphoedema. In an epidemiological study in the UK by Moffatt et al (2017), the crude prevalence of lymphoedema was 3.93 per 1000 of the population rising to 28.75 per 1000 in those aged 85 or over.
The impact of lymphoedema can affect individuals physically, psychologically, emotionally and socially (Thomas et al, 2020). Reports of increasing falls, superficial wounds, difficulty in accessing footwear, anxiety and pain are commonly encountered. People with lymphoedema also suffer from repeated cellulitis episodes, which can account for 2-3% of all hospital admissions (Posnett and Franks, 2008). Furthermore, the cost of managing lower limb wounds in patients, many of whom have lymphoedema, was estimated to be more than £5 billion per annum in 2015 (Guest et al, 2015). All told, lymphoedema is a burden to both the individual and, economically, to the NHS.
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