Older People with Amputations

Original Editor - 

Top Contributors - Sheik Abdul Khadir, Admin, 127.0.0.1, Kim Jackson and Lauren Lopez  

Introduction

The Geriatric Amputee can describe two types of people - someone who undergoes a lower extremity amputation (LEA) after the age of 65, and someone who had a LEA at a younger age, but is now over 65. Because 75% of all LEA occur in patients over 65, this article will refer to this population of geriatric amputees.(Fletcher) The most significant distinguishing factor of the Geriatric Amputee is their overall health and function prior to having an amputation. As one ages, there is an increased frequency of having a single chronic diseases; and subsequently, an increase in co-morbidities effecting the health and function after an amputation. (Fried 2004)

Amputation at any age is a significantly disabling event. However, when a geriatric patient undergoes a LEA, it can have devastating - even fatal - consequences. In a study by Fletcher, et al (2001), the median survival was 1.5 years after an amputation, which is significantly less than the expected survival rate of 7.5 years for age-matched controls. There is a significant increase in 30 day mortality rate related to age and number of co-morbidities. (Kristensen). It is estimated that approximately 13% of geriatric patients will die within 30 days of undergoing a LEA. If a geriatric patient has 4-5 co-morbidities, they are 7 times more likely to die within 30 days of amputation compared to patients with only one comorbidity.

The leading cause of LEA in patients over 65 is severe peripheral artery disease (PAD) - with or without diabetes. (Carmona, 2005)This statistic is highlighted by the finding that amputations due to diabetic complication occur at a younger age, and these patients tend to die at a younger age.(Dillingham) Although PAD is a local problem causing the ischemic event, vascular disease is a systemic disease affecting arterial function in the heart, brain, and kidneys. Up to 75% of dysvascular amputees have cardiac disease and the leading cause of death after a LEA due to PAD is a cardiovascular disease.(Fleury)

Immediate Post-Operative Considerations

Surgical intervention for a patient over 65 with co-morbidities for any reason is dangerous. When one disease process has advanced to the point of requiring an amputation, the other existing systemic diseases increase the overall risk of complication and death of the geriatric patient after surgery. Risk factors must be taken into account when treating a geriatric patient immediately post-operatively. It is important that the Physical Therapist monitor their patient’s progress and treatment tolerance by making decisions on clinical, physiologic factors rather than assuming their patient can’t do an activity or exercise solely because of their age or disease process. It is still imperative to provide the same level of post-operative care for the geriatric amputee - albeit with potential modifications to the treatment interventions. The treatment goals, guidelines, and interventions are the same for the Geriatric Amputee as the are for a younger amputee;however, there are some salient difference that should be considered for this patient population.

Special Considerations for the Geriatric Amputee:

Prosthetic Considerations and Issues

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