Elderly patient amputations are performed to remove infected, ischemic, and necrotic tissue from an elderly patient’s body. Peripheral artery disease (PAD) and diabetes mellitus are also lead contributing factors for elderly patient amputations. Elderly patient amputations are often performed as a lifesaving procedure.
Common Elderly Patient Amputations
There are several different types of elderly patient amputations. A major category of elderly patient amputations is lower extremity amputation (LEA). These elderly patient amputations occur anywhere along one or both legs of the patient.
Partial foot amputation
Partial foot amputations also include transmetatarsel amputations (amputation of toes), though usually these are related to distal foot amputations from functional problems. Mid foot amputations are not universally accepted since there is risk of equinus deformity and residual ulceration.
Transtibial amputations are usually performed at the upper and middle third of the shin. If the amputation is performed higher up, the knee joint is usually preserved to help the patient regain a normal walking stride. Knee joint preservation is particularly important in elderly patients since comorbidities often limit their ability for rehabilitation.
Transfemoral amputation has declined in frequency since the 1980s. They are performed with adequate distance from the hip bones to allow for prostheses to fit afterward. Transfemoral amputation is now especially rare for elderly patients since bipedal ambulation requires more than twice as much energy as normal to function.
Partial Hand Amputation
Partial hand amputations can apply to fingertips or part of the fingertips. Thumbs are the most common site of elderly patient amputations. Losing a thumb causes difficulty with grasping and manipulating objects. Other finger amputations leave the patient still capable of grasping but with less precision.
Metacarpal amputation is the removal of an entire hand while leaving the wrist intact. Rehabilitation from this type of surgery can be very difficult since many tasks require fluid use of both hands. Prosthetics available for this type of surgery offer many different features to help compensate.
This type of amputation is similar to a metacarpal amputation except the hand is removed along with the wrist joint. Similar problems apply to wrist disarticulation since this also involves the loss of a hand. Prosthetics can compensate and the fitting is slightly different which can be more of less of an advantage.
Transradial amputations are a partial removal of the arm from the middle of the forearm. Rehabilitation after this type of surgery is also difficult because it includes the loss of a hand. Prosthetics for this type of amputation will be larger and might not offer as much functional ability for the patient.
Stages of Elderly Patient Amputations
There are several stages for the process of elderly patient amputations. Understanding these steps is helpful throughout the process. Elderly patient amputations are an arduous ordeal so it is best to prepare before beginning consultation on the matter.
Steps for elderly patient amputations:
- Deciding level of amputation
- Assessing preoperatative baseline health status of elderly patient
- Controlling limb pain from dysfunction
- Providing preventive care for the extremity and its contralateral
- Deciding appropriate surgical technique for accommodating prosthesis
- Controlling pain
- Treating wounds of the limb
- Address immobility problems
- Shaping of the limb after surgery
- Restoring the patient’s locus of control
- Maximizing treatment for any comorbid conditions and nutrition
- Selecting prosthesis design type
- Rehabilitation with prosthesis
- Discharge planning
- Determining familial roles, vocational, and housing plans
Recovery from Elderly Patient Amputations
Before undergoing elderly patient amputations, it is important to outline the goals of the procedure, as well as, functional prognosis and site of rehabilitation. Depending on the rehabilitation potential, the goals can vary from patient relief from health conditions to re-establishing an independent lifestyle.
Physicians will assess the elderly patient’s overall health condition, including cardiopulmonary reserve, functional status, muscle strength and cognitive abilities. Patients older than 80 years old are usually less likely to recover successfully because of the likelihood of comorbid illness and general health status. Impaired cognitive function also plays a key factor in decreased elderly patient amputations recovery but they are still able to achieve major improvements in functioning.
Coletta, Elise. “Care of the Elderly Patient with Lower Extremity Amputation.” Journal of the American Board of Family Medicine. 13 (2000): 23-24. Web. 10 Sep. 2013. <“Care of the Elderly Patient with Lower Extremity Amputation.” Journal of the American Board of Family Medicine. n. page. Web. 10 Sep. 2013. .>.
Van den Brande, P. “Amputation in Elderly and High-Risk Vascular Patients.” Annals of Vascular Surgery. 4 (1990): 288-290. Web. 10 Sep. 2013. <http://link.springer.com/article/10.1007/BF02009459>.