Compression Stockings for Elderly Parents: Complete Guide

Why Compression Stockings Matter

Compression stockings (also called compression socks or support hose) apply graduated pressure to the legs, with the tightest pressure at the ankle and decreasing pressure moving up the leg. This helps blood flow upward toward the heart, counteracting the effects of gravity and weakened vein valves.

How They Work

When veins become less efficient at returning blood to the heart, blood pools in the lower legs. This causes swelling, discomfort, and can lead to serious problems like blood clots. Compression stockings squeeze the veins, helping them work more efficiently and reducing swelling.

When Are Compression Stockings Prescribed?

Common reasons elderly patients may need compression stockings:

Chronic venous insufficiency: Weak vein valves causing leg swelling, aching, and skin changes
Leg swelling (edema): From various causes including heart failure or prolonged sitting
Varicose veins: Bulging, twisted veins that can cause discomfort
After DVT (deep vein thrombosis): To prevent post-thrombotic syndrome
DVT prevention: During hospitalization, after surgery, or for high-risk patients
Lymphedema: Fluid buildup often after cancer treatment
Long travel: To prevent blood clots on flights or long car rides

Types and Compression Levels

Compression Levels (Measured in mmHg)

Level	Pressure	Common Uses	Prescription?
Light	8-15 mmHg	Minor swelling, tired legs, travel	Over-the-counter
Moderate	15-20 mmHg	Minor to moderate swelling, varicose veins, travel	Over-the-counter
Firm	20-30 mmHg	Moderate to severe swelling, varicose veins, DVT prevention, post-surgery	May require prescription
Extra Firm	30-40 mmHg	Severe swelling, post-DVT, severe venous insufficiency, lymphedema	Usually prescribed
RX Strength	40-50+ mmHg	Severe lymphedema, severe venous disease	Prescription only

More Is Not Always Better

Higher compression isn't automatically better. Too much compression can cut off circulation, especially in patients with peripheral artery disease (PAD). The doctor will prescribe the appropriate level based on your parent's condition. Never increase compression without medical guidance.

Stocking Lengths

Knee-high: Most common; easier to put on; adequate for many conditions
Thigh-high: Needed when swelling extends above the knee; more difficult to keep up
Pantyhose/Waist-high: For swelling or venous issues involving both legs; can be challenging for toileting

Contraindications: When NOT to Use

Compression Can Be Dangerous If:

Peripheral artery disease (PAD): Poor arterial circulation; compression can worsen blood flow
Severe peripheral neuropathy: May not feel if stocking is too tight
Skin conditions: Open wounds, weeping dermatitis, severe skin fragility
Acute DVT: Until treated and stabilized (doctor will advise)
Congestive heart failure: May need medical clearance first

The doctor should assess whether compression is appropriate before starting, especially checking for adequate arterial blood flow (often using ankle-brachial index testing).

Getting the Right Size

Proper sizing is critical. Stockings that are too small won't go on; those too large won't provide adequate compression.

How to Measure

Measure in the morning: Before swelling accumulates
Ankle circumference: At the narrowest point above the ankle bone
Calf circumference: At the widest point of the calf
Leg length: From floor to knee crease (for knee-high) or to top of thigh (for thigh-high)

Professional Fitting Recommended

For prescription compression (20 mmHg and above), professional fitting is ideal. Medical supply stores, specialized pharmacies, and wound care clinics can measure and fit correctly. Some offer custom stockings for unusual leg shapes.

How to Put On Compression Stockings

This is often the biggest challenge. Compression stockings are deliberately tight and can be difficult to get on, especially for elderly patients with limited hand strength or mobility.

Step-by-Step Technique

1 Apply in the morning before legs swell. Have your parent sit in a chair with feet flat on the floor.

2 Turn the stocking inside out to the heel. Put your hand inside and grab the heel pocket.

3 Position the heel pocket over the foot, with the heel in the correct position. This is crucial—if the heel is misaligned, the stocking won't fit properly.

4 Roll or slide the stocking up gradually, smoothing as you go. Don't yank or pull from the top band.

5 Check for wrinkles and bunching. Smooth out any folds, which can create pressure points and cut off circulation.

6 Ensure proper positioning. The heel should be in the heel pocket. The top band should be at the appropriate level (below knee crease for knee-high).

Donning Aids

Many devices can make application easier:

Stocking donners: Frame devices that hold the stocking open while you slide your foot in
Rubber gloves: Improve grip for pulling up the stocking
Silk liners: Worn under compression stockings to reduce friction
Application powder: Helps stockings slide on more easily
Heel guides: Help position the stocking correctly on the foot

Invest in a Donning Aid

For elderly patients who struggle to put on compression stockings, a good donning aid is worth the investment. Devices like the Jobst Stocking Donner or similar products can make independent application possible. Home health aides can also help with daily application.

Removal Tips

Remove at bedtime unless otherwise directed
Roll down from the top rather than pulling off
Rubber gloves help grip the material
Some donning aids also help with removal

Daily Care and Maintenance

Wearing Schedule

Put on in the morning before getting out of bed or shortly after
Wear all day unless doctor advises otherwise
Remove at bedtime (compression usually not needed when lying flat)
Check skin daily for irritation, redness, or marks

Washing

Have at least 2 pairs so one can be worn while the other is washed
Hand wash or machine wash on gentle cycle
Use mild soap; avoid fabric softeners (they break down elastic)
Air dry or tumble dry on low; don't use high heat
Don't wring out
Replace every 3-6 months or when compression noticeably decreases

Common Problems and Solutions

Problem	Possible Cause	Solution
Can't get them on	Wrong size, swelling, technique	Remeasure, apply earlier in day, use donning aid, try open-toe style
Roll down or slip	Wrong size, weight of fabric	Try thigh-high with silicone band, garter belt, or different brand
Uncomfortable/tight band	Wrong size, folding at top	Ensure proper positioning, check for rolling, may need different size
Skin irritation	Fabric sensitivity, pressure	Try cotton-lined version, check for proper fit, apply lotion at night (dry before wearing)
Toe numbness	Too tight at ankle	Wrong size, needs remeasurement, possible PAD (consult doctor)
Bunching behind knee	Stocking too long	Try petite length, fold top down slightly (if doctor approves)

Compression Stockings After DVT

Patients who have had a deep vein thrombosis (blood clot) are often prescribed compression stockings to prevent post-thrombotic syndrome (PTS)—chronic swelling, pain, and skin changes in the affected leg.

Usually 30-40 mmHg compression prescribed
May need to wear for 2 years or indefinitely
Significantly reduces risk of PTS
Should be fitted once acute swelling has resolved

When to Call the Doctor

Increased pain, swelling, or skin changes despite compression
Numbness or tingling in toes
Color changes in feet (blue, white, or mottled)
New wounds or skin breakdown
Signs of infection (redness, warmth, fever)
Stocking consistently leaves deep marks or causes pain

Insurance Coverage

Coverage varies:

Medicare: Generally does not cover compression stockings
Some Medicare Advantage plans: May offer coverage
Private insurance: May cover with prescription and documentation of medical necessity
FSA/HSA: Usually eligible expenses

Cost Considerations

Quality compression stockings typically cost $30-80 per pair. Given the need for at least 2 pairs and replacement every 3-6 months, this adds up. However, the benefits often outweigh costs for patients who truly need them. Some medical supply companies offer discounts for multiple pairs.

Caregiver Tips

Making It Routine

Build into the morning routine—right after dressing
Keep stockings by the bedside
Have donning aids readily accessible
Consider home health aide assistance if struggling

Encouraging Compliance

Explain why compression helps (reduces swelling, prevents complications)
Acknowledge the difficulty—validate their frustration
Celebrate when swelling improves
Try different styles (open-toe may be easier)

Track Daily Care Tasks

Our caregiving resources help you establish routines and track compliance with compression therapy.

Explore Our Resources

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Persistence Pays Off

Compression stockings can be challenging, especially at first. But with proper technique, the right aids, and persistence, most elderly patients can successfully use them. The reduction in swelling, improved comfort, and prevention of serious complications make the effort worthwhile.