Hot Packs and Older Skin: Using Heat Safely

Why older skin burns more easily

• Thinner skin. With age the outer layers thin, so heat reaches deeper tissue at a lower temperature.
• Reduced sensation. Diabetes, peripheral neuropathy, stroke and some medicines dull the sense of heat and pain. A person may not feel a burn until the skin blisters.
• Poor circulation. Reduced blood flow means heat is not carried away, so the skin gets hotter.
• Slower healing. Burns in older adults take longer to heal and are more likely to become infected.
• Memory and attention. People with dementia may fall asleep or forget a pack is in place.
• Fragile skin from medicines, such as steroids or blood thinners, which cause bruising and tearing.

A burn that would be minor in a young adult can become a serious wound in an older one. Safe use of heat is therefore a matter of rules, not guesswork.

What heat can help

Heat is used for:

• Muscle stiffness and spasm, such as in the neck, shoulders and back;
• Joint stiffness in osteoarthritis, particularly before exercise;
• Chronic aches, in a stable joint without swelling;
• Menstrual-type or abdominal cramps, with a doctor's agreement; and
• Warming cold hands and feet, carefully.

It is not usually the right choice for a new injury or a hot, swollen joint, where cold is usually better; see heat or cold for joint pain.

Types of heat product

Microwaveable or hot gel packs. Heated in a microwave or hot water, they stay warm for 20 to 30 minutes. Check the temperature carefully, because they can be much hotter than expected, and microwaves heat unevenly.

Hot water bottles. A traditional source of heat. Rubber bottles can leak or burst, so check for wear and fill with hot, not boiling, water. A cover is essential.

Electric heating pads. Convenient, with adjustable settings, but they carry a risk of burns and fire, particularly if folded, used with a blanket or left on while sleeping. Choose models with automatic shut-off and low-voltage safety features.

Heated wraps for the neck, back or knee. Shaped for the body part, some with straps.

Herbal or grain-filled bags. Heated in a microwave, they give moist heat. Check for hot spots and keep them dry, since mould can grow.

Chemical heat patches. Single-use adhesive patches that warm for several hours. Do not use them on fragile skin or while sleeping. Never stick directly on the skin for long periods.

Warm baths and showers. Gentle general heat, with attention to slipping; see bathroom safety checklist for seniors.

Infrared lamps and saunas. Not recommended for older people at home without a doctor's advice.

The golden rules

1. Never apply heat directly to the skin. Always put a barrier layer, such as a thick towel or a cover, between the pack and the body. 2. Keep it warm, not hot. The skin should feel pleasantly warm, not hot. A temperature of around 40 to 45 degrees Celsius is generally the upper limit for safe, longer use; much hotter can cause burns in minutes. 3. Limit the time. Use for 15 to 20 minutes at a time, then take a break of at least an hour. Check the skin every 5 minutes. 4. Check the skin before and after. Look for redness. A mild pink that fades is acceptable; bright red, blotchy, mottled or blistered skin means stop. 5. Never sleep with a heat pack. A person may sleep through a burn. Do not use electric pads or hot bottles in bed overnight. 6. Do not lie or sit on a heat source. The pressure traps heat. 7. Never use with other heat or creams. Do not use a heat pack over rubs, menthol or capsaicin creams, or medicated patches, which can increase burning. 8. Stay with a person who has dementia, or who cannot tell you if it is too hot. 9. Do not use on broken, inflamed or numb skin. 10. Check the equipment. Throw away leaking bottles, frayed cords and cracked packs.

Hot water bottles: extra care

• Use water from a kettle that has been off the boil for a minute, not freshly boiling.
• Fill to about two-thirds, expel air and screw the stopper in firmly.
• Always use a cover or wrap in a towel.
• Replace a bottle every one to two years, or sooner if the rubber is cracked or stiff. Check the date stamp on the neck.
• Do not use on the bare skin of someone who cannot feel heat.

Who should avoid heat or ask first

Ask a doctor or nurse before using heat if your parent has:

• diabetes or neuropathy, with reduced sensation;
• poor circulation or peripheral arterial disease;
• a stroke, with numb areas;
• dementia or confusion;
• fragile, bruised or broken skin, or skin conditions;
• swelling, redness or heat in the area, which can mean infection, gout or a clot;
• recent injury, within the first 48 hours;
• a pacemaker or implanted device near the area, for electric pads;
• heart disease or high blood pressure, if applying heat to large areas;
• pregnancy (not relevant to most seniors); or
• numbness or tingling.

Do not use heat on the abdomen of someone with unexplained pain; seek advice.

Using heat for common problems

Stiff knees and hips in the morning. A warm pack on the joint for 15 minutes before getting up, then gentle exercise; see knee osteoarthritis at home.

Neck and shoulder tension. A warm wrap for 15 minutes, with a pillow supporting the neck; see neck pillows for travel and sleep.

Lower back ache. A warm pack over the lower back while lying on the side or sitting upright, with a towel barrier; see lower back pain after 60 and lumbar cushions.

Cold hands and feet in winter. A warm, not hot, bottle wrapped in a towel at the feet while sitting, and warm socks; never touching the skin; check frequently.

Winter in cold cities. Layer clothes, use a room heater with care and good ventilation; see cold-weather warmth for older adults.

If a burn happens

1. Remove the heat source at once. 2. Cool the area under cool running water for about 20 minutes. Do not use ice, butter, toothpaste or ointments. 3. Remove tight clothing or jewellery near the area, before swelling. 4. Cover loosely with a clean, non-fluffy dressing or cling film. 5. Do not burst blisters. 6. Seek medical help for anything beyond a small, superficial redness: for blisters, broken skin, burns larger than a hand's palm, burns on the face, hands, feet or joints, or in a person with diabetes or fragile skin. Older adults should be seen even for small burns.

Alternatives to heat

• Gentle movement and stretching, which ease stiffness.
• Warm clothing and layered knits for general warmth.
• Warm baths or showers, with care.
• A warm drink and a warm room.
• Massage by a trained person.
• Pain relief as advised by a doctor.

When to ask a professional

Ask a doctor, nurse or physiotherapist before using heat if your parent has any of the conditions above, or if pain is severe, new or not improving. A nurse can check skin and teach safe use. Our care advisors can arrange a nurse visit.