Management of Peripheral Edema in Elderly Patients

Diuretic Use and Management

Diuretics reduce peripheral edema symptoms but do not address fatigue and dyspnea related to low cardiac output, according to the American College of Cardiology 1

Recent evidence suggests that diuretics prescribed for peripheral edema (without heart failure or hypertension) may be safely discontinued in many elderly patients, with no effect on mortality, as reported by the British Journal of Pharmacology 2, 3
Edema recurrence after withdrawal was inconsistent across studies and often temporary when it occurred, with only 15% of patients requiring diuretic re-initiation after withdrawal, according to the British Journal of Pharmacology 2, 3
The evidence quality is very low, but the safety profile of deprescribing attempts appears acceptable, with 3% of patients reporting feeling unwell with urinary incontinence after deprescribing, as noted by the British Journal of Pharmacology 2, 3

Limit fluid and sodium intake, especially during mobilization of extracellular water accumulated from inflammatory processes, as recommended by Clinical Nutrition 4, 5
Consider hypodermoclysis (subcutaneous fluid administration) for mild-to-moderate dehydration in chronic care settings, as it is safer, less invasive, and causes less discomfort than intravenous routes, according to Clinical Nutrition 4, 5