Received: 12 June 2020 Revised: 18 August 2020 Accepted: 29 August 2020 DOI: 10.1111/jjns.12383 ORIGINAL ARTICLE Influences of lower limb edema on daily lives of elderly individuals in an elderly day care center Sayumi Tsuchiya1 | Takuto Sawazaki2 | Shuji Osawa3,4 | Makoto Fujiu3 | Mayumi Okuwa5 | Junko Sugama5,6 1Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa Abstract University, Kanazawa, Japan Aim: The purpose of this study is to describe the influences of lower limb 2Department of Nursing, Nagoya City edema on the daily lives of elderly individuals in elderly day care to describe University Hospital, Nagoya, Japan the necessity of care for lower limb edema. 3Faculty of Geosciences and Civil Methods: Semi-structured interviews based on a quality of life questionnaire Engineering, Institute of Science and Engineering, Kanazawa University, for limb lymphedema were conducted. Two types of text mining analysis Kanazawa, Japan methods were used: a frequent word analysis and a content analysis. The 4 Research Fellow of Japan Society for the edema severity was graded on a scale of 0 to 3, and the sum of the numerical Promotion of Science, Tokyo, Japan values of the grades for each person was defined as the pitting score. 5Department of Clinical Nursing, Institute of Medical, Pharmaceutical and Health Results: The seven participants had a mean age of 83.4 ± 4.6 years (mean Sciences, Kanazawa University, ± SD). The pitting scores ranged from 1 to 25 in the participants. The words Kanazawa, Japan “think” (389 times), “walk” (136 times), and “put on” (135 times) were 6 Innovative Integrated Bio-Research Core, “ ” Institute for Frontier Science Initiative, extracted frequently. The content analysis focused on the words walk and Kanazawa University, Kanazawa, Japan “put on.” The participants complained of difficulty walking, pain, and numb- ness when walking, weakness of their lower limbs, difficulty putting on shoes, Correspondence Junko Sugama, Department of Clinical restrictions on shoe types, and difficulty finding shoes. Nursing, Institute of Medical, Conclusions: These results demonstrate that elderly individuals experienced Pharmaceutical and Health Sciences troubles during their daily lives caused by lower limb edema, which highlights Innovative Integrated Bio-Research Core, Institute for Frontier Science Initiative, the necessity of symptom management. Active interventions for edema by Kanazawa University 5-11-80 Kodatsuno, nurses are necessary to improve quality of life in elderly individuals. Kanazawa, Ishikawa 920-0942, Japan. Email: [email protected]. KEYWORDS ac.jp edema, elderly, lower extremity, quality of life 1 | INTRODUCTION and tissue pressures are weaker, and they have increased capillary pressure (Pomero et al., 2017). In addition to Elderly individuals can easily develop lower limb edema these characteristics, edema typically occurs in their due to their physical characteristics. The prevalence of lower limbs because of the influences of gravity and the diseases that cause edema such as heart diseases, kidney decline of muscle pump activity as a result of decreased diseases, liver diseases, thyroid diseases, and lymphatic mobility and activity. disorders increase with age. Most elderly individuals also Elderly persons are more likely to develop lower limb have malnutrition, low skin tension, low cardiovascular edema because of their reduced walking ability. Previous function, and low muscle strength because of aging studies reported a high prevalence of lower limb edema (Smith, 1996). Moreover, their plasma oncotic pressures in elderly individuals, including 24.1% in ambulant Jpn J Nurs Sci. 2020;e12383. wileyonlinelibrary.com/journal/jjns © 2020 Japan Academy of Nursing Science 1of10 https://doi.org/10.1111/jjns.12383 2of10 TSUCHIYA ET AL. outpatients and 62% in persons who walk with walking walking aid in an elderly day care center. We chose an aids (Oya, 2001). Additionally, some studies have elderly day care setting because although day care users reported that 75% of chair-bound persons in nursing have reduced activity and edema, most of these persons homes have lower limb edema (Kitamura & spend their daily lives at their own home and are likely Shirai, 2014). These results indicate that the prevalence affected by edema in their daily lives. This study suggests of lower limb edema is related to walking ability. that it is necessary to provide care for lower limb edema Elderly individuals with lower limb edema in Japan in ambulatory elderly individuals. have not received any specific treatments because many medical and nursing professions do not place much emphasis on this condition; they believe that lower limb 2 | METHODS edema is a normal aging phenomenon (Iijima & Kusunoki, 2004). However, various symptoms and risks 2.1 | Study design have been reported for lower limb edema in elderly indi- viduals. The typical symptoms include skin color change, This study was a quantitative content analysis study. decrease in skin temperature, dry skin, decrease in urine Each participant was interviewed three times about the output, weight gain, and difficulty flexing limbs influences of edema on their daily lives, and their edema (Smith, 1996). Furthermore, chair-bound elderly persons status was observed. The second interview was conducted with lower limb edema report that their lower limbs feel 3 months after the first interview, and the third interview heavy and they have difficulty moving these limbs was conducted 6 months after the first interview. The (Blazek et al., 2013; Mercier, Pastor, Moffatt, Franks, & interval between interviews was set as mentioned Quéré, 2019). Skin with edema also becomes weak, easily because a previous study reported worsening of edema damaged, and prone to pressure ulcers and skin tears severity in elderly persons 3 months after the first obser- (Greene & Meskell, 2017; Lewin et al., 2016). Therefore, vation by the researcher (Sato et al., 2015). Therefore, we studies must provide evidence demonstrating the neces- surmised that at least 3 months were needed to observe sity of care for lower limb edema in elderly persons by correlation of changes in the edema status with changes describing the influences of lower limb edema on the in participants' complaints. The investigations were con- daily lives of elderly individuals in specific ways. ducted between January 2017 and October 2017. Some previous studies have described the influences of lymphedema and lipedema on patients' daily lives. In these previous studies, edema affected walking, standing, 2.2 | Participants sitting in the seiza position, putting on clothes and shoes, and leisure activities, for example, walking, swimming, This study was conducted with elderly persons over the dancing, and skiing. Additionally, edema affected appear- age of 65 years who had lower limb edema and attended ance by influencing the patients' body image, self-esteem, an elderly day care center for outpatient long-term care. and choosing the appropriate size of clothes and shoes The capacity of the day care center was 35 persons for (Klernäs, Johnsson, Horstmann, & Johansson, 2018). each day. The inclusion criteria were as follows: those Furthermore, patients were psychologically affected by who could walk independently or walk with walking aids, edema, for example, they became annoyed, anxious, and those who could participate in an interview according to nervous (Greene & Meskell, 2017; Person et al., 2008). the nurses' judgment, and those who provided consent to However, the influences of lower limb edema on the participate in the study. The exclusion criteria were as fol- daily lives of elderly individuals have not been described. lows: those who had difficulty participating in the inter- Lymphedema is a common condition, and nearly 80% of views due to cognitive decline, those who did not provide lymphedema patients receive treatment for edema consent to participate in the study, and those who were (Moffatt et al., 2003). However, unlike lymphedema and judged by the nurse to be inappropriate for the study. lipedema patients, elderly individuals who experience lower limb edema due to aging have not received appro- priate treatment. Therefore, there is a possibility that 2.3 | Investigation method lower limb edema may have a greater influence on the daily lives of elderly individuals compared with lymph- 2.3.1 | Interview about influences on edema or lipedema patients. daily life The purpose of this study was to describe the influ- ences of lower limb edema on the daily lives of elderly The semi-structured interviews were conducted based on individuals who can walk independently or with a the contents of a quality of life (QOL) measure for limb TSUCHIYA ET AL. 3of10 lymphedema (LYMQOL) questionnaire. The original numerically using LYMQOL to achieve the aim of this English version of the LYMQOL has been verified for study. Thus, we adopted the interview method because reliability and validity (Keeley et al., 2010), and the Japa- there were no previous studies on the influences of lower nese version has demonstrated reliability and validity for limb edema on the daily lives of the elderly. The inter- lower limbs (Yoshizawa, Aoyama, Takeishi, Nakamura, & view guide is shown in Table 1 and the interviews lasted Atogami, 2017). We considered that LYMQOL could be for 20 to 30 min. At the time of the interviews, the sub- used for this study because this tool can specifically eval- jects were asked to confirm their