Gout in Older Adults: Home Care and Supports

What gout is

The body makes uric acid when it breaks down substances called purines, found in our own cells and in some foods. Normally the kidneys remove uric acid in urine. If levels in the blood stay high (hyperuricaemia), uric acid may form needle-shaped crystals in joints, triggering sudden intense inflammation. Not everyone with high uric acid develops gout, and gout can occur even with normal levels during an attack.

Why older adults: kidney function declines with age; many older people take medicines that raise uric acid, such as some water tablets (diuretics) and low-dose aspirin; and obesity, high blood pressure, heart disease and diabetes are more common. Women's risk rises after menopause.

Typical attack: - Sudden severe pain, often at night, in one joint, especially the big toe. - Swelling, redness, heat and shiny skin. - Peaking within 12 to 24 hours. - Settling over a week or two even without treatment, but faster with it. - Possible mild fever.

Chronic gout (repeated attacks, over years) can lead to hard lumps called tophi around joints and ears, joint damage and kidney stones.

It may not be gout: see a doctor

A hot, swollen joint can also be:

• Septic arthritis (joint infection), a medical emergency.
• Pseudogout (calcium crystals), common in older adults.
• Rheumatoid or other inflammatory arthritis; see osteoarthritis vs rheumatoid arthritis.
• Cellulitis (skin infection).
• A fracture or injury.
• A blood clot, if the calf is affected.

Diagnosis may involve examining the joint, blood tests (uric acid, kidney function, inflammation markers), X-ray, ultrasound or, ideally, examining fluid taken from the joint for crystals. Do not assume gout; get a diagnosis, especially for a first attack. A joint that is hot, swollen and painful with fever or chills, an inability to move it, or a recent injury needs urgent assessment.

What to do during a flare at home

These measures support, but do not replace, medical care. Ask a doctor about the right treatment for your parent, particularly as many gout medicines have risks in older adults.

1. See a doctor early. Treatment started within the first day or two works best. Do not delay.

2. Rest the joint. Avoid walking on a painful foot or using the affected hand more than necessary. Use a stick, crutch or frame if needed; see how to choose a walking stick. Keep a clear path and avoid slips; see falls risk assessment at home.

3. Raise the limb. Elevate the foot or leg on pillows, above heart level when resting, to reduce swelling; see leg elevation pillow guide.

4. Apply cold. A cold pack wrapped in a cloth, for 10 to 15 minutes at a time, several times a day, can ease pain and swelling. Do not apply ice directly to skin. Be careful with numb skin; see heat or cold for joint pain. Avoid heat, which can worsen inflammation.

5. Protect from touch. A bed cradle or frame over the foot can keep sheets off a sensitive toe. Loose, open footwear or a soft sandal may be tolerable; avoid tight shoes.

6. Drink fluids. Water helps the kidneys eliminate uric acid; aim for good hydration unless the doctor has limited fluids because of heart or kidney disease; see hydration for older adults.

7. Avoid alcohol, especially beer and spirits, and sugary drinks, during a flare.

8. Take medicines only as prescribed. Do not give an older person leftover tablets or someone else's pain medicines. Anti-inflammatory medicines, gout-specific tablets and steroids each carry risks in older adults, especially those with kidney, stomach, heart, blood pressure or diabetes problems, or those on blood thinners; the choice and dose must be set by a doctor. Aspirin can raise uric acid and should not be started or stopped without advice. See painkillers and older adults and polypharmacy and deprescribing.

9. Do not start or stop uric acid–lowering medicine during a flare unless the doctor says so; changes can trigger or prolong attacks.

10. Keep a record of the attack: date, joint, triggers, medicines; see keeping a pain diary and talking to the doctor.

Reducing future attacks

Long-term care often needs a combination of lifestyle and medicine decided with a doctor. Preventive medicines to lower uric acid are recommended for people with frequent attacks, tophi, joint damage, kidney stones or kidney disease. They are taken daily and started under supervision, as starting them can trigger flares unless cover is given. Blood tests monitor uric acid levels.

Lifestyle measures that help:

• Healthy weight, with gradual weight loss if overweight. Avoid crash diets and fasting, which can raise uric acid and trigger attacks; see fasting, festivals and older adults.
• Plenty of fluids, mostly water.
• Limit alcohol, especially beer and spirits.
• Limit sugary drinks and fructose-rich foods such as soft drinks and sweet juices.
• Moderate high-purine foods. The biggest purine sources are organ meats (liver, kidney, brain), some seafood (anchovies, sardines, mackerel, shellfish) and red meat. Many vegetarian foods such as lentils, peas and spinach contain purines, but evidence suggests they do not raise gout risk in the same way as meat and seafood. Most people do not need to avoid pulses, dal and vegetables; check with the doctor or dietician.
• Choose low-fat dairy, such as curd, milk, which may be protective.
• Eat a balanced diet with vegetables, whole grains and fruit; see nutrition for heart health after 60 and nutrition for diabetes after 60.
• Review medicines with the doctor, particularly water tablets and aspirin, but do not stop them yourself.
• Manage other conditions: high blood pressure, diabetes, kidney disease and cholesterol.
• Keep active within comfort; see exercise with arthritis.
• Avoid dehydration, which can trigger attacks, especially in hot weather, illness, after surgery or on fasting days; see heat stroke and dehydration in seniors.
• Do not rely on supplements or herbal remedies such as cherry products, vitamin C or turmeric without advice; evidence is limited and some interact with medicines; see supplements and medicine interactions.

Weight and monitoring: a regular scale at home helps track gradual loss; see weighing scale and weight loss in seniors.

Footwear, supports and daily life

• Roomy, soft footwear during and between flares, with a wide toe box; see choosing shoes for older feet.
• Insoles or cushioned soles can lessen impact; see insoles and orthotics for foot and heel pain.
• Knee or ankle supports are only for comfort; do not use tight supports on a hot, swollen joint; see knee support buying guide and ankle supports.
• Home aids: a stick, raised seat and bed cradle during flares.
• Skin care over tophi and swollen joints; see a doctor for ulcerated or infected lumps.
• Joint protection for hands: use built-up grips and avoid heavy gripping; see arthritis daily living gadgets.
• Plan for travel and festivals, with medication, water and rest, since feasting, alcohol and dehydration can trigger flares.
• Sleep and mood: pain affects both; see sleep problems in older adults.

Warning signs: seek urgent help

Go to a doctor or hospital urgently if:

• A joint is hot, red, swollen and very painful with fever, chills or the person is unwell, which can mean infection.
• The pain is in a joint after a recent injury, injection or surgery.
• There are signs of kidney stones: severe flank pain, blood in urine, vomiting.
• There is chest pain, breathlessness or swelling in the calf, which may be a clot.
• The person is confused, cannot drink or has passed little urine.
• Pain is severe and not controlled, or the person cannot move.
• Skin over a joint or tophus is broken, weeping or infected.
• A person taking gout medicine develops severe diarrhoea, vomiting, muscle weakness or unusual bruising; seek advice at once.

When to ask a professional

See a doctor for any suspected gout, particularly the first attack, repeated attacks, or if the usual treatment is not working. A rheumatologist can advise on long-term uric acid control. A dietician can help with diet and weight. A pharmacist can review medicines for interactions. A nurse can advise on skin care. A physiotherapist can help with movement after a flare.