Venous Disease in Older Adults: A Guide for Patients and Caregivers
The likelihood of developing varicose veins increases with age as vein walls lose elasticity and the valves gradually become less effective. Chronic venous disease often progresses slowly over many years, and many older adults have lived with varicose veins for decades before complications develop. Varicose veins are not exclusively a condition of older adults — they can also affect younger people, particularly those with a strong family history.
Why Does Age Increase the Risk?
The cumulative effect of years of venous reflux means that more advanced stages of chronic venous disease — including skin changes, venous eczema, and venous leg ulcers — are more commonly seen in older patients. Vein walls lose elasticity over time and the one-way valves gradually become less effective, allowing blood to pool in the lower limbs.
Signs of Progressed Venous Disease
Signs that should prompt specialist assessment include persistent ankle swelling that does not fully resolve overnight, brown skin pigmentation (haemosiderin staining) particularly around the inner ankle, dry itchy or inflamed skin around the ankles (venous eczema), thickened or hardened skin (lipodermatosclerosis), white scar-like patches (atrophie blanche), and slow-healing wounds or venous leg ulcers.
Venous Leg Ulcers
Venous leg ulcers — typically occurring around the inside of the ankle — represent the most advanced stage of chronic venous disease. They develop when years of persistent venous hypertension damages the skin and underlying tissues, impairing the body's ability to heal even minor injuries. Venous ulcers can be painful, slow to heal and can significantly affect mobility and quality of life.
Early recognition and treatment of the underlying venous reflux can help promote healing and reduce the risk of ulcer recurrence. Clinical studies have shown that treating superficial venous reflux, in addition to compression therapy, accelerates ulcer healing and significantly reduces recurrence rates.
A Note for Caregivers
For caregivers: if your parent or family member has a wound on their lower leg that isn't healing, or progressive skin changes around their ankles, a vascular assessment is reasonable and recommended. Many older patients accept these changes as 'just part of getting older' when in fact effective treatment exists. A duplex ultrasound scan can determine whether treatable venous reflux is contributing to the problem.
Is Age a Barrier to Treatment?
Age alone is not a barrier to treatment. Modern minimally invasive procedures are performed under local anaesthesia and are well-tolerated by older patients. The decision depends on the individual's overall health, the severity of their venous disease, their symptoms, and their goals. Many older patients experience significant improvement in comfort, mobility and quality of life after treatment.
Conservative Measures That Help
Conservative measures that can help manage symptoms include regular walking (even short walks are beneficial), leg elevation when resting, properly fitted graduated compression stockings, skin care to prevent dryness and cracking, and prompt attention to any minor injuries or skin breaks on the lower legs.
If you or a family member has persistent leg swelling, progressive skin changes, or a wound that is not healing, the first step is a consultation with a vascular specialist. A duplex ultrasound scan provides an accurate diagnosis and allows an individualised treatment plan to be developed — even for patients who have lived with varicose veins for many years.